Letters Dementia debate

Asking older patients about their memory is simply practising evidence based medicine properly

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2746 (Published 03 May 2013) Cite this as: BMJ 2013;346:f2746
  1. David Oliver, consultant geriatrician1
  1. 1Royal Berkshire NHS Foundation Trust, Reading, UK
  1. davidoliver372{at}googlemail.com

For two reasons I disagree with McCartney’s view that older patients admitted to hospital should not routinely be asked about their memory.1

Firstly, one in four hospital beds is occupied by a patient with dementia, yet around half have never been diagnosed before presenting, often in acute crisis and already fairly dependent; the dementia is therefore clinically relevant.2 Delirium is almost as common in hospital patients over 65 years, often with cognitive impairment as the main risk factor.3 Acute admission offers an opportunity to identify and sometimes prevent or treat these or other problems, such as depression. Dementia and delirium are associated with longer stay and higher rates of morbidity. Identifying the problem in hospital offers an opportunity to ensure adequate follow-up, information, and support after discharge. By analogy, when patients present with fractures, we can use the contact with hospital opportunistically to find cases and assess falls risk and bone fragility, then start interventions to prevent further events, in line with good practice guidance.

Secondly, evidence for the benefits of comprehensive geriatric assessment on older patients’ long term health and wellbeing is strong.4 Part of the assessment is to identify psychological comorbidity, including cognition and mood. Hospital doctors should assess cognition and mood in all acutely admitted older patients. This isn’t screening or even “case finding”—it is just practising evidence based medicine properly. It’s a shame to have to pay people extra for doing this, and the Commissioning for Quality and Innovation payment system has technical teething troubles. But it’s no more of a national screening programme than identifying risk of pressure damage or malnutrition in admitted patients.

Notes

Cite this as: BMJ 2013;346:f2746

Footnotes

  • Competing interests: None declared.

References