3. Hospital Setting
Role of hospital staff in dementia diagnosis
Patients with dementia have frequent hospitalizations. [83] Thus, it would be reasonable to view hospitals as a prospective place to screen for dementia.
Dementia patients have increased rates of adverse outcomes including mortality, delirium, longer hospital length of stay, new institutionalization and increased cost of hospital care. [83-86] Early detection of dementia during hospitalization is crucial not only to utilize inpatient imaging resources, prompt dementia specific care and aid in discharge planning but it also represents an important opportunity to initiate treatment and referral to relevant community services. [83, 87] Furthermore, accurate recording of dementia
…show more content…
[83] Table 6 demonstrates approximately half of hospital inpatients with dementia were undiagnosed resulting in inaccurate documentation in medical records and hospital registries. [87-89] This was similarly reflected in the Hospital Dementia Services Project by the Australian Institute of Health and Welfare , which demonstrated poor identification and recording of dementia, with 47% of dementia patients not having dementia recorded as a principal or additional diagnosis. [84]
Paper Study Type Study Objective Results Limitations
Bowler et al
1994
UK
[87]
Cross Sectional Study Determine rates of psychiatric disorders (delirium, dementia, functional psychiatric disorders) among elderly medical inpatients and accuracy of medical and nursing staff in detecting these disorders
Psychiatric diagnosis determined by panel of 6 psychiatrists using a 2 stage census (validated screening instrument followed by patient interview) compared against opinion by medical and nursing staff via questionnaire Approximately 50% of cases were correctly identified by medical and nursing staff separately but taken together 75% of cases were correctly identified
Tendency to misdiagnose dementia as depression and delirium as dementia Small sample size (n=201) taken from elderly medical wards from a single hospital in 1994 limiting generalization to other
…show more content…
Comparison between GPs and specialists Positive association between self estimated competence and general attitude and approach to dementia patients.
Statistically significant difference in self reported competence between specialists and GPs with specialist reporting higher level of competence. Survey may not reflect actual behaviour
Borson et al 2006
US
[96]
Retrospective Case Note study Evaluating predictors of spontaneous physician identification of cognitive impairment compared against standardized clinical dementia assessment and use of the Mini-Cog. Use of Mini-Cog improved detection of cognitive impairment
Confounding factors affecting rate of physician recognition include dementia subtype, non-English speaking status and low income.
Secondary analysis of physician specialty: geriatricians had better rates of dementia recognition compared to general internists and family practitioners. (no significant effect with multivariate analysis) Low statistical power of study
Comparison of dementia detection abilities between different specialists not primary aim of
A physician has an unenviable position; he is closest to man approaching a god-like stature. And despite the demise of 'doctor knows best', we still need to trust his diagnosis-something that is increasingly difficult in a world where information is widely available, and Google substitutes for a doctor. In the case of psychiatry the issue of trust is amplified since diagnosis is based on a patient's expressed thoughts and overt behaviours rather than solely on biological phenomena. And these thoughts and behaviours are influenced by the patient's environment-a mix of his social, cultural and technological experiences.
Butler, R. (2008). The Carers of People with Dementia. BMJ: British Medical Journal , 336, 1260-1261.
Dementia is a disease which causes mental debility and affects one’s way of intelligent, attentiveness, recollection and problem-solving (NHS, 2013). As a result of dysfunction of brain cells in some parts of the brain it affects the thinking process then dementia occurs and it usually comes with age (Ibid). It is estimated that 560 000 people suffer from dementia in England and as a result the NHS and Social Care spend about 3.3billion (National Audit Offices)
The New England Journal of Medecine. A Controlled Trial of Inpatient and Outpatient Geriatric Evaluation and Management, 346, 905-912. Retrieved on November 8th, 2006 from http://content.nejm.org/cgi/content/full/346/12/905
Staff should be able to identify the most common signs and symptoms of dementia that can
Doctors need a sure way to diagnose the disease before treatment or studies can be done. The diagnosis is an autopsy of brain tissue examined under a microscope. In addition, medical history, a physical exam, and mental status tests are used for diagnosis (Posen, 1995). Often, tests are done to rule out other potential causes of the dementia. This allows the identification of other causes of thinking and behavioral changes to be made before concluding that the patient has Alzheimer’s or another form of dementia. The tests that are requested to be done include CT and MRI scans to rule out strokes or brain tumors which could account for change in memory and behavior; thyroid and psychological tests which can also detect thinking and behavior problems (Posen, 1995).
Dementia is a pertinent public health issue in Australia. Whilst there are various types of Dementia, they all significantly impact an individual’s quality of life. The consequences of Dementia extend to carers and family and this, together with increasing prevalence, inconclusive and probable preventive measures and absence of a cure, indicates the need for further research, to enable Australia to combat the significant public health issue that is Dementia.
Glass, J. (2012, March 13). Diagnosing Alzheimer's disease: Patient History, Exams, and More. WebMD. Retrieved May 3, 2014, from http://www.webmd.com/alzheimers/guide/making-diagnosis
As humans when we are faced with any psychological or emotional problems, our initial thought is to turn to a therapist, doctor or any other health practitioners. Our initial thought when we are faced with problems regarding our health is to turn to a health professional because for ages that’s how it has been. When it comes to our health, health professionals nowadays do more harm than help. Many might disagree, but often patients are misdiagnosed with mental illnesses they do not have. Misdiagnosis occurs when a therapist or other health practitioners decide that a patient is suffering from a condition that he or she may not be suffering with. When misdiagnosed, patients are given unnecessary treatment, which could potentially
The expected hierarchy among health care providers is led by physicians. The doctor has long been the “expert” on anything to do with the human body, whether it is disease or injury. The evolution of technology brought the World Wide Web readily to every consumer’s doorstep resulting in a slight shift of this everlasting faith. Older adults continue to retain some of this confidence in their physicians due to their tendency not to use the internet and search for their own ...
Delirium is a cognitive disorder that alters the patients’ level of consciousness, generally as an acute onset, impairs memory, fluctuations in behavior, produces disorganized thinking, and perceptual disturbances such as hallucinations (Downing, Caprio & Lyness, 2013). In order to diagnose and monitor Delirium a confusion assessment method (CAM) is used to measure the symptoms of ...
The elderly represents a large amount of the population in our society and continues to grow each day. As the population grows, it is important to meet the demands and resolve the challenges that we encounter in regards to the overall quality of health and well-being of the elderly. Mental health of the elderly is a major issue but majority of the time goes unnoticed and untreated by caregivers and loved ones. About 20 percent of adults 55 and older are suffering from some type of mental health disorder, and one in three elderly adults do not receive any type of treatment (The State of Mental Health, 2008). Those suffering from mental illness are hesitant to seek out help or any type of treatment because of the stigma, services and cost for care that then comes with mental health disorders. Mental health issues that affect elderly include dementia, delirium, and psychosis. Some of the most common conditions include anxiety, mood disorders such as depression and bipolar disorder and cognitive impairment such as Alzheimer’s disease. Mental health is essential to the
...th dementia is complex and it needs careful assessments of risk for falls by qualified nursing staff. Ongoing comprehensive assessment, documentation and reporting can prevent fall in older people with dementia. The study shows that the people with dementia are at higher risk for fall and the challenges are increased for the nursing staffs that care for them. Nurses need to assess and understand the patient’s physical needs and provide the appropriate care by helping them with their ADL’s (Struksness et al., 2011).
The Psychiatric Mental Health Nurse Practitioner (PMHNP), role and job description is providing primary mental health care services, to those with mental health problems, or psychiatric disorders. The PMHNP is required to assess, diagnose, provide treatment plans, prescribe medication therapy, and offer counsel across the lifespan. The PMHNP provides care in a wide range of settings to children, adolescents, adults, the elderly, and their families. This mental healthcare takes place in the primary care settings, emergency rooms, hospitals, outpatient mental health clinics, senior living communities and in private practices. Being culturally competent to care for the ever changing demographics of the United States is necessary. The PMHNP assess and treats in a holistic manor and utilizes evidenced based practice. Regardless of race, gender, age, religion, sexual orientation, political persuasion, or socio economic standing the PMHNP is there to treat. The PMHNP role also includes establishing a therapeutic relationship, being sensitive to many abnormal behaviors, and caring for those frequently distressed emotionally. Collaboration and the ability to make referrals are essential for the PMHNP. Patients present with undiagnosed problems and establishing the proper diagnosis by a qualified PMHNP begins with the initial assessment interview (Gilfedder, Barron, & Docherty, 2010).
Introduction This assignment critically discusses dementia, a widespread disability among older adults today. It provides an introduction to dementia and analyses its prevalence in society. The various forms of dementia are elaborated with descriptions of dysfunctions and symptoms. Nursing Assessment and Interventions are provided in the further sections which discuss actions nurses should take while evaluating patients and treating them.