Dementia Care

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46 Australian Journal of Dementia Care October/November 2016 Vol 5 No 5
information about risk factors associated
with dementia which can be managed
through lifestyle changes or appropriate
medical treatments.
Acknowledgments
We gratefully acknowledge funding provided by
the Dementia Collaborative Research Centre
(DCRC): Early Diagnosis and Prevention (for the
GP project), and DCRC: Assessment and Better
Care (for the RN project).
* Project investigators
Dr Melinda Martin-Khan , Centre for Research in
Geriatric Medicine and Centre for Online Health,
School of Medicine, Faculty of Medicine, The
University of Queensland; Professor Elizabeth
Beattie, School of Nursing, Faculty of Health and
DCRC: Carers and Consumers, Queensland
University of Technology; Dr Maree Farrow,
Wicking Dementia Research & Education Centre,
The University of Tasmania; Dr David Lie, Metro
South Addiction & Mental Health Service,
Brisbane; Professor Geoff Mitchell, General
Practice and Palliative Care, Faculty of Medicine,
The University of Queensland; Professor Dimity
Pond, General Practice, School of Medicine and
Public Health, The University of Newcastle; Frank
Schaper, Visiting Fellow, Queensland University
of Technology, and Alzheimer’s Disease
International consultant; Dr Allan Shell, GP and
Visiting Fellow, School of Psychiatry, UNSW
Australia.
References
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Barber B, Ames D, Ellis K, Martins R, Masters C,
Masters CS (2012) Lifestyle and late life cognitive
health: sufficient evidence to act now? .
International Psychogeriatrics 24 683-688.
Farrow M (2008) Dementia risk reduction: what do
Australians know? Canberra: Alzheimer’s
Australia.
Farrow M (2010) Dementia risk reduction: a
practical guide for general practitioners. Canberra:
Alzheimer’s Australia.
Fitch K, Bernstein SJ, Aguilar MS et al (2001) The
RAND/UCLA Appropriateness Method User’s
Manual. Santa Monica, CA: RAND Corporation.
Loef M, Walach H (2012) Fruit, vegetables and
prevention of cognitive decline or dementia: a
systematic review of cohort studies. The Journal
Of Nutrition, Health & Aging 16 626-630.
Travers C, Martin-Khan M, Lie D (2009) Barriers
and enablers of health promotion, prevention and
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Australasian Journal on Ageing 28(2) 51-57.
Dr Melinda Martin-Khan is a Research Fellow at
the Centre for Research in Geriatric Medicine, and
Centre for Online Health, The University of
Queensland and an Associate Investigator with
the Dementia Collaborative Research Centre
(DCRC): Early Diagnosis and Prevention, and
DCRC: Carers and Consumers. Contact her at
.
We know that hospital services
account for most of Australia’s
public health expenditure, with a
large proportion of the costs going
towards the treatment and care of older
patients with complex medical conditions
and care needs, including dementia. What
we tend not to notice is that most of the
costs of caring for older people in hospital
are for nurses. Nurses account for about a
third of hospital expenses – more even
than for operating theatres – but we don’t
actually know very much about what
society receives for this money.
Sensibly, there is an increasing focus on
‘efficiency’ and ‘productivity’ in the public
health system to make the most of
taxpayers’ money. But how can we aim for
‘cost efficiency and effectiveness’ if we
don’t knowwhat we are getting for our
money – what quality, as well as quantity,
of nursing care is being received?
Nursing care for older people
In order to better understand and analyse
quality, the context of nursing care for
older people, including those with
dementia, needs to be understood.
People over the age of 65 account for
30% of hospital admissions and 48% of
bed days (AIHW 2015) and the problems
of older patients in hospital are
increasingly complex. For example: half
of people aged 65-74, and 70% of those
over 85 have five or more comorbidities
(ABS 2010); 10.4% of people in hospital
have dementia (Bail et al 2013) and 30%
have cognitive impairment (ACSQH
2010); almost all people in hospital need
assistance for daily living (Barnes et al
2013); and the enormous functional
variability between older people even of
similar ages can make predicting needs,
workloads and costs more difficult.
Patients with dementia provide a
classic example of the complexity of the
care needs of older people in hospital.
Their care is complicated by the fact that
dementia is usually an accompanying
comorbidity, rather than the reason for
hospital admission; it’s often poorly
diagnosed and poorly documented
(Laurila et al 2004; Rodwell et al 2010);
and people with dementia have longer
lengths of stay (AIHW 2013).
The problems in hospitals are also
increasingly complex, with the number of
available beds decreasing in relation to
the population, bed occupancy usually
over 90% when 85% is considered safe
(Kuntz et al 2015); simple surgery goes
elsewhere, leaving only the most complex
cases (Sammut 2009); a lack of senior staff
(Garling 2008); an increasingly casualised
workforce (Alameddine et al 2012) and
less experienced nurses caring for
patients, as more senior nurses take on
administrative and academic roles
(Garling 2008).
Nurse sensitive outcomes
My research interest is in improving
sustainable acute care health delivery for
an ageing population. In particular, my
DCRC-funded PhD examined a range of
patient outcomes demonstrated to be
sensitive to nursing (‘nurse sensitive
outcomes’): that is, “changes in health
status upon which nursing care has had a
direct influence, acknowledging other
variables also influencing those outcomes”
(International Council of Nurses 2010).
Key outcomes examined in this nursing
research field are complications that could
have been prevented.
However, there’s been limited analysis
of nurse sensitive outcomes for people
with dementia in hospital, despite the
DCRC SPEC I AL I SSUE : THE B I G P I CTURE I N DEMENT I A RESEARCH
Four warning signs of
nursing care issues
Kasia Bail explains how four common, but potentially preventable,
complications experienced by older patients with dementia in
hospital can be useful indicators of quality of care
Positive nursing work environments are
associated with lower rates of
complications