The project was aiming to find out information about the sleep quality of patients with dementia and their carers. There was interest in this area because previous research has found that sleep disturbances in this group have been linked to poorer physical health outcomes; carer physical and emotional role limitations; mental health health-related quality of life. Sleep disturbance associated with caring for someone with dementia has also been reported to be a major reason for institutionalisation.
It was recognised that an increasing number of older people with dementia and/or mental health problems are admitted to acute hospital inpatient settings. These patients often require additional supports and hospital staff are less able to manage these patients within a busy ward environment. In addition to increasing staff skills through staff training, often individual patients will highlight specific issues which require a more specialist understanding or assessment. The project sought to provide this additional support and assessment.
Information Services Division (ISD) was keen to further develop the Scottish Patients at Risk of Readmission and Admission (SPARRA) tool to identify patients who may benefit from a more anticipatory approach to their care; planning for events or exacerbations to reduce the risk of emergency hospital admission.
SPARRA is a tool which predicts a patient’s risk of emergency admission; a patient with a SPARRA score of 50% has a one in two chance of being admitted to hospital in the following year.
The number of people in the UK aged over 65 is growing and is forecast to reach 16.1 million by 2035. The burden of disease associated with aging will increase as will the demands on health services including end-of-life and palliative care. The National Confidential Enquiry into Patient Outcome and Death in 2008 found that rather than advanced care planning and palliation taking place, some patients were subjected to excessively active interventions in their last months of life.
The pilot study aimed to ascertain whether using primary and secondary care data to identify patients at risk of hospital admission and agreeing and implementing an Anticipatory Care Plan in this population could help to reduce hospital admission rates. Anticipatory care planning allows patients to express their wishes for care prior to a sudden deterioration in their health.
One example was a lady with Dementia who was referred in order to consolidate support available and identify any areas that might require assistance. However, during preparation it transpired that this elderly lady was also a victim of financial abuse. The family knew this was going on and wanted it stopped but did not know what to do about it. The Family Group Meeting brought these concerns into the open. Social work was informed of these allegations but they agreed to wait for the outcome of the Family Group Meeting before pursuing their own enquiries.