The realisation that hospital staff had little training or confidence in dementia/delirium care was one of the driving forces behind ground-breaking research at the Centre for Gerontology and Rehabilitation in the School of Medicine at University College Cork (UCC).
The ambitious research programme began in 2011 by collecting the first ever multi-hospital longitudinal dementia data in Europe, showing that nearly 30 per cent of older people admitted to hospital had dementia, and that many were receiving multiple medications that act on the brain. The School of Medicine at UCC then co-led a national audit of 35 acute hospitals in Ireland (INAD), co-funded by Atlantic Philanthropies, which demonstrated several deficits in dementia care.
The research team also co-led a series of studies showing that delirium, a life-threatening, acute confusion, was very common but under-recognised in older people in hospital in Ireland.
The initial results of this research programme were quoted directly in the Irish National Dementia Strategy (INDA) of 2014 and informed several key priority actions, including funding for three hospitals to develop integrated care pathways for dementia, which were later adapted for national use.
Overall, the combined dementia-delirium research has now contributed to two national delirium algorithms and four national dementia pathways. In 2017, the research team validated the 4AT delirium screening tool (the first ever ED validation study of this tool), which is now recommended for use nationally in emergency departments.
The INAD audit was approved in 2021 as a bi-annual HSE audit, and the National Dementia Office has sought funding for six dementia quality improvement leads and 16 acute hospital dementia clinical nurse specialist posts nationally.
The medication prescribing data, coupled with a linked UCC PhD project, was instrumental in the prioritisation of a national clinical guideline on psychotropic prescribing for people living with dementia (2019), co-led by Prof Suzanne Timmons and Prof Stephen Byrne.
Acute hospital dementia and delirium care are starting to improve nationally, as the full impact of the national guideline, pathways, training, enhanced staffing and more widespread hospital-based dementia teams and quality improvement projects begins to bear fruit.
Prof Timmons, Professor of Geriatric Medicine, Centre for Gerontology and Rehabilitation, said: “Acute hospitals are frightening and potentially dangerous places for people living with dementia or cognitive impairment. The right data, shared with the right people, have helped to make hospital dementia and delirium care a national healthcare priority.”
Prof Helen Whelton, Head of the College of Medicine and Health, added: “This research is a great example of how researchers in the College of Medicine and Health are working in partnership with the Health Service Executive to improve healthcare locally and nationally.”