Transcript Medical Ward - Dementia Partnerships

Nigel North
Clinical Psychologist/Neuropsychologist
Almost 66% of beds are occupied by
people over the age of 65
 Increasing interest in improving acute
hospital care for older people
 Loss of autonomy, independence, mood
disorder are issues for older people in
acute medical wards
 (DOH 2001, 2003, 2004)
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A number of studies have identified
psychosocial issues as influencing length of
stay, engagement in rehabilitation and
morbidity
 These issues include depression, anxiety and
cognitive problems
 Other issues identified include, loss of
control over environment, a reduction in
meaningful and valued activity, loss of
mobility and independence
 (Siebens et al 2000, Eyres and Unsworth
2005, DOH 2008, Callum et al 2008)
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A variety of physical health conditions associated
with depression: Stroke, CHD, Diabetes, Cancer
(NICE 2009)
Depression common in people with dementia
(Baylor et al 2000) (62%)
Depression associated with a 50% increase in
financial costs of medical care (Katon 2003)
Mood disorder may lead to deterioration in some
conditions (Stroke, CHD, Diabetes) (NICE 2009).
Cause vs consequence
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Significant numbers of older people in hospital
have depressive symptoms that may hinder their
recovery (Cullum et al 2008)
Detection of Psychosocial Problems is poor
(Jenkins et al 2010)
Adverse outcomes resulting from this may include:
› Delayed Discharge (Holmes & House 2000)
› Greater risk of readmission (Koenig 1999)
› Higher mortality (Cullum et al 2008)
› Functional status and cognitive decline
predictive of LOS, Mortality, discharge
destination (Campbell et al 2004)
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Medication
› Costs
› Side effects
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Psychological therapy
› 1:1
› Group
› IAPT
› Numbers of people to ‘treat’
› Numbers of ‘Therapists’ required
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Aim:
› To increase social engagement
› Provide cognitive and intellectual stimulation
› Improve well being and mood
Delivered by voluntary assistant
psychologists
 Rota for each week day (3 people for
half a day)
 One to one
 Group
 Designed to meet individuals needs and
level of functioning
 Medical Ward and Stroke Ward
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Communication skills
 Psychological therapy skills (basic)
 Education (dementia, neuroscience,
values)
 Problem solving skills
 Detection/Recognition of psychological
disorder
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‘Social Games’ (Bingo, Scrabble, Cards,
Word and Number ‘Games’
 Newspaper discussion groups
 Conversation groups
 Reminiscence (group/individual)
 Cognitive Retraining Approaches (Quiz,
Crosswords, ‘Brain Training’)
 Voluntary participation but all
approached unless ward indicated
otherwise
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Assessment of Mood (Brief Assessment
Schedule Depression Cards , BASDEC)
 Satisfaction Questionnaires, 5 point scale
(Activities, Ward Environment, Care)
 Length of Stay (LOS)
 June 2010 – April 2011
 LOS assessed two months before and
two months after intervention
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1. No of participants 110 (82 males, 28 females)
2.
Average Age: 80.4 years (SD = 9.7)
3.
Significant reduction in depression between pre
and post assessment (67 vs 13)
4.
Significant increase in satisfaction with activities
available on the ward
5.
Significant increase in patient satisfaction with
ward environment
6.
Significant increase in satisfaction with care
provided on the ward
42 ‘Mild’ Cognitive Impairment
 18 Moderate Cognitive Impairment
 ?Dementia?
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“The activities were so very useful and
helpful”
 “The chats and cards were really good”
 “I enjoyed the hand massage and
chatting, it makes the day go quicker”
 “This has been really good, I wish I could
see them after I leave here”
 “I enjoyed the activities, particularly a
good chat”
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“I am usually so lonely with no-one to talk
to, everyone is so busy doing their work, I
really appreciate having these people
coming in”
 “I have made new friends here through the
conversation groups”
 “It made me feel more alive, more alert,
more me”
 “It’s great, it really adds something to the
day, you feel more useful, more involved”
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Collected by the hospital in hours
 Data for two months prior to the start of
the project and for a follow up period of
two months after it
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Medical Ward
LOS pre-intervention
LOS post-intervention
Reduction
273.55 hours
207.85 hours
24% (65.7hrs)
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Stroke Ward
LOS pre-intervention
LOS post-intervention
Reduction
384.72 hours
241.01 hours
37.4% (143.71 hours)
Medical Ward (pre)
 Stroke Ward (pre)
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The LOS for the 110 people involved
Medical
 Stroke
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273.55 hrs
384.72 hrs
199.50 hrs (74.05Hrs)
220.35 hrs (164.37 hrs)
The project improves mood
The project improves satisfaction
?? Length of Stay
Costs are negligible. The project was run by
volunteers of which we have hundreds.
Three hours of training was given to the
volunteers at the beginning of the project
and five hours of supervision given during
the project (Total of 8 hours of an assistant
psychologist’s time = £96
 To be continued………
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