It is nice to hear some good health news for a change, particularly in these despairing times of the Covid-19 pandemic, which is causing immense pain and suffering, writes Lloyd Mudiwa
My editorial this week is inspired by a poster my young son spotted in a local shop window over the weekend. ‘A little GOOD NEWS on a yellow poster! WE ARE BACK OPEN,’ read the poster. Beside this poster, was the Health Service Executive (HSE)/and Government of Ireland Coronavirus Covid-19 Public Health Advice poster on how to, ‘Help prevent coronavirus’.
Given the general sense of despair at this time my son was excited to share this good news, as ‘little’ as it may have been, so much that he asked me for my phone to take a picture and send to his mother.
A day later, I was just as excited as my son when I heard the good news on Monday (August 31) that the Co Kildare coronavirus lockdown was to be lifted with immediate effect after Covid-19 case numbers in the county stabilised sufficiently.
Speaking at that evening’s Department of Health briefing, Acting Chief Medical Officer Dr Ronan Glynn’s empathy struck me.
He realised that although it had taken a relatively lower level of intervention than was introduced countrywide earlier at the start of the pandemic in Ireland, to bring the Kildare situation under control pretty quickly, the positive result was as a result of people’s willingness to stick with the interventions despite their frustration, fatigue and even anger in many instances.
“It’s nice to be able to give some good news,” Dr Glynn said.
“This was the first time that we had to recommend measures on a regional basis like this,” Glynn said. “I know it was difficult, I can only begin to imagine the impact that it had on some communities and on businesses in particular – and in Kildare in particular – given the protracted nature of the measures.”
With fears that dementia sufferers and their carers would be forgotten in the midst of the Covid-19 crisis realised, hopefully people living with this set of symptoms and behaviours that occur when the brain stops working properly — despite their frustration at the failure by successive governments to prioritise modernising dementia care — can also feel excited at “a little good news”, the HSE National Dementia Office’s publication on Tuesday (September 1), of the results of the second Irish National Audit of Dementia Care in Acute Hospitals).
In recognition of the growing number of people with dementia in Ireland and the consequent need for guidelines and standards around dementia, the first Irish audit of dementia care in acute hospitals was undertaken from April to September 2013.
At this time, the design and delivery of care in our acute hospitals predated the evolving understanding that older people, and in particular those with dementia and delirium, are proportionately the key groups that acute hospitals serve, which was reflected by a focus on acute illness with relatively little adaptation for cognitive impairment, multiple illness and frailty.
That first audit found a large number of areas where changes were necessary to improve the quality of dementia care, but some inspiration was drawn from the finding that the quality of dementia care in Irish hospitals was generally on par with that found in the baseline audit of dementia care in the UK, performed in 2010.
The second round UK audit in 2012 had found significant improvements as a result of the findings and recommendations of the baseline audit.
It is was the vision of the Irish National Audit of Dementia Steering Committee and the Irish National Audit of Dementia Advisory Group that the findings and recommendations of our own first audit would have a similar impact on the quality of dementia care in acute hospitals in Ireland.
The results of the second Irish audit, which involved 33 acute hospitals including two large orthopaedic hospitals (recognising the overlap between hip fracture and dementia), show that indeed there has been good progress in making hospitals more “dementia-friendly” and in many areas of general care, such as the management of pressure ulcers and nutrition and mobility assessment.
There were also improvements in training staff in dementia care. Approximately one-third of hospitals now have dementia-specific staff employed, and the same proportion have a dementia quality improvement team or working group, reflecting a desire to work together within the hospital to improve dementia care.
The audit, however, also identified that improvements are needed in the gathering and recording of information to support person-centred care and in screening for delirium on admission to hospital, its assessment and treatment.
Delirium increases the risk of death and discharge to residential care, so its prompt diagnosis and treatment is vital.
The report also recommends implementing the National Clinical Guideline on Psychotropic Medications in all settings, including acute hospitals, and the HSE to facilitate dementia awareness training for acute hospital staff so that they can keep a person living with dementia as independent and safe as possible during their hospital stay.
Staff training and the implementation of national dementia pathways are the foundation of improved dementia care. Recognising the role of the carer and their natural concern for the person living with dementia in a new environment is also important.
The National Dementia Office has already produced a range of online resources to support acute hospital staff and will meet with each Hospital Group to discuss their group’s findings and their action plans for improved acute hospital dementia care in 2021/2022. And it is not inconceivable to expect that there might again be a little more good news for dementia patients come the third audit.