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Education is key to quality dementia care

Ahead of next month's international dementia conference in Birmingham, executive director at the Hartford Institute for Geriatric Nursing Tara Cortes says health professionals and carers need better training and education to provide quality care for people living with dementia. 

As science and medicine help push the average age in industrialised countries to 75 or 80, ageing is having a profound global effect.

The number of over-85s continues to increase and we will soon see the number of over-100s growing at a regular pace. But with age comes an increasing vulnerability to chronic diseases, functional decline, and decreasing quality of life.

A major factor contributing to the problem is the lack of a prepared workforce to care for the unique needs of older adults, and promote or maintain wellness and cognitive and physical function in our ageing population through age-sensitive care.  

Dementia is one of the most common chronic diseases affecting around half of those over age 85. Dementia adds a burden to the healthcare workforce because so few understand the complexity of the disease or the changing behaviours that result.

Many primary care providers don’t recognise the early signs of dementia and don’t ask the questions of patients or their families that could help detect the condition. Nurses often do not anticipate the increased confusion and agitation in patients with dementia when admitted to hospital, or when they have developed infections of the urinary tract or upper respiratory tract. 

Healthcare organisations must value the care of older adults and provide specialist, quality care for this patient group.  Health professionals need educating in geriatrics and gerontology, and educational institutions must provide more skills training to ensure the workforce of the future is prepared to care for this rapidly growing, complex and vulnerable population. Unless this is systematically provided, the financial and emotional burden on society will continue to grow. 

Systematic training and education for the workforce would help them to understand how to avoid prolonged hospital stays, reduce iatrogenic complications, and avoid unnecessary loss of function. Professionals must also understand the resources needed by older adults and their families to keep them safe at home with optimal function.  

In 2007, the Institute of Medicine in Washington DC called for increased content in geriatrics and gerontology in all professional programmes. Despite some improvements, geriatrics content is still insufficient, and clinical experiences focused on gerontology are not robust. Curricular changes do not sufficiently impact the vast majority of the current workforce and continuing education must focus on meeting the unique healthcare needs of our ageing population.

Many family members characterise the experience of watching a loved one with dementia as ‘losing the person they knew’. As the number of older people rises, the burden of caring will increasingly fall on families, with family carers often facing physical and emotional challenges. There is also a financial burden to bear if a family member has to give up their job to care for a parent. 

Many people prefer to grow older in their own homes, and many cultural norms expect ageing loved ones to be cared for at home. But this requires a workforce of both paid and unpaid workers, and the challenge of training this diverse care workforce – including nursing assistants, companions and even neighbours - is enormous. 

Training is not standardised or consistent, and varies from no formal education at all to courses lasting a few weeks. This leads to a workforce that does not understand the unique needs of the ageing people in its care, a lack of confidence and low job satisfaction. 

Family carers need educational resources to help them manage medications, transfer people safely, change dressings and understand behaviour in people with dementia. They also need community resources to provide support and tailor resources to particular needs. This is when a partnership of patient, family and community is so important. 

Better education and training for formal and informal carers would help them value and understand the uniqueness of caring for older adults, and increase the likelihood of more older adults being able to live safely at home with optimal physical and mental function.

Paid carers in the home should have skill levels ranging from simple skills for companions to more robust skills for those certified as home care nurse assistants, or home care assistants. Family and other unpaid carers need resources and support to provide the right care at the right time with minimal stress and carer burden. 

On the wall of the Health and Human Services Administration Building in Washington DC is a quote from former US vice president Hubert Humphrey:

‘It was once said that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.’

Our governments need to recognise the need for resources to prepare the workforce to provide knowledgeable, evidence-based quality care to those in the twilight of life. 

Author

Tara Cortes is executive director at the Hartford Institute for Geriatric Nursing and professor at New York University College of Nursing. Ms Cortes is one of the headline speakers at the International Dementia Conference at The Vox, in Birmingham, on November 3 and 4. The conference will bring together experts from around the world to share innovative ideas in dementia care. www.internationaldementiaconference.co.uk 

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