Adapting EDs to make them more dementia friendly
As more people with dementia are treated in EDs, how can departments ensure that needs are met?
For people with dementia, the emergency department (ED) can be disorientating, distressing and sometimes unsafe.
As a researcher and relative of someone living with dementia, I have seen first-hand how poor care in an ED can threaten the dignity, well-being and safety of a patient who has dementia.
With the population of the UK ageing, and an increasing number of people living with dementia accessing care in the ED, it is imperative we find ways to ensure these spaces are dementia friendly. But what does that mean?
A dementia-friendly ED is one where practices and the organisation of care are appropriate for people with cognitive impairments. In this environment, the needs of patients with dementia and the carers who support them are recognised and understood in a holistic way.
Promoting a different culture
Creating a dementia-friendly ED is an undertaking that has many components, including cultural change as well as structural and procedural adaptations to ED systems.
It is essential to promote a culture where holistic care is encouraged, potential safety risks are escalated early and senior staff model person-centred care.
Structural changes include alterations to the physical environment to make the ED more suitable for older people, facilitated access to appropriate equipment and supplies, and ensuring that ED staff have access to training in dementia care.
Process changes include adopting evidence-based protocols to improve screening for cognitive impairments, and reducing risk from secondary harms including falls, deconditioning and infection.
Why should we invest in creating dementia-friendly EDs? People living with dementia are frequent users of EDs, but dementia is rarely the primary reason for admission. In many cases, co-morbid dementia has a direct impact on the patient’s experience of care. In particular, patients with dementia are more likely to have an extended stay in ED and have an increased risk of preventable hospital-acquired harms such as deconditioning, delirium, functional loss and other conditions associated with old age.
The physical environment of a typical ED can be disorientating and distressing for people with dementia and care processes that focus on rapid triage, assessment and intervention are often inappropriate for older people with complex needs.
ED staff are balancing multiple patient needs and have reported that it is difficult to provide care for patients with dementia who are distressed or agitated while they are in the department. Adapting the physical environment to be more dementia friendly – for example, increasing the number of bays that are visible to staff and reducing excess noise – and investing in skills-based training could help decrease the incidence of agitation and distress, which in turn may make it easier for nursing staff to provide care.
To summarise, as the population ages and the prevalence of dementia increases, more people with the condition will be treated in EDs. Investing in adaptations that make the ED more dementia friendly will improve the patient experience, and make it easier for staff to provide good care.
Other countries have invested in creating comprehensive, evidence-based best-practice guidelines for the care of older people with dementia in EDs. The UK could learn from these examples and I believe we should create similar guidelines for the NHS.
About the author
Courtney Shaw is a PhD student, Doctoral Training Centre at the University of Bradford