Would doctors routinely asking older patients about their memory improve dementia outcomes? NoBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1745 (Published 26 March 2013) Cite this as: BMJ 2013;346:f1745
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I am a great fan of Dr McCartney's writing and usually agree wholeheartedly with her opinions and hope she keeps up her thought-provoking opus. However, with specific regard to the Dementia CQUIN for patients admitted to hospital, I must reluctantly take issue with her for the following reasons.
1. 1 in 4 hospital beds is occupied by someone with dementia, yet around half of these have never been diagnosed before presenting often in acute crisis and already quite dependent. Delirium is equally common in hospital patients over 65 (often with cognitive impairment as a main risk factor). The hospitalisation does offer an opportunity to identify these problems and do something about them. And both are associated with longer stay and high rates of morbidity. Clearly a contact with a service such as an acute hospital offers an opportunity to do something to help older patients and their families. By analogy, when patients are admitted with fractures, it affords us an opportunity to look at falls risk, bone health and consider interventions to prevent further falls and fractures. I doubt that anyone would say that this was some kind of introduction of screening by stealth. It is merely formalising good clinical practice and attempting to optimise treatment and prevention of further adverse events. Finding people with dementia or delirium gives us an opportunity to get their inpatient care right, the diagnose reversible problems such as depression or delirium which may masquerade as dementia and sign post patients to appropriate services.
2. There is a very strong evidence for the benefits of comprehensive geriatric assessment (see meta-analysis by Ellis and Langhorne BMJ 2011) for older patients' long term health and wellbeing. Part of CGA 's holistic biopsychosocial approach is to look at psychological co-morbidity including cognition and mood. Ensuring that frontline clinicians do this is no more than formalising good basic medical practice for older patients. It is quite misleading to call it a screening programme. It isnt even "case finding" its just practicing medicine properly. Its a shame that anyone should have to be paid an uplift for it. But please lets not pretend it is screening, any more than performing the confusion assessment method or looking for falls risk factors or pressure area risk would be for patients on admission.
Competing interests: No competing interests