Don’t wait for the next generation of hospitals, a few changes can make current environments better for dementia patients.
Admission to hospital can be a confusing and frightening experience for people with dementia. Their problems with memory, orientation and confusion and difficulties with communication often lead to extended stays.
This is evident in the increased risk of complications and co-morbidities associated with hospitalisation for people with dementia. Recent estimates from New South Wales show that people with dementia stay in hospital almost twice as long as those without it, averaging 16.4 days of care, compared with 8.9 days for other patients. The average cost of hospital care for people with dementia is also higher than for people without ($7720 per episode, compared with $5010).
The fact that people with dementia are spending, on average, more than two weeks in hospital must give us pause. Whilst they may tolerate the busy, complex environment of a hospital ward without serious negative effects for a day or two, placing a confused and anxious person in such an environment for two weeks is unlikely to help them to a full recovery.
Perhaps part of the problem lies in the nature of most hospitals. They are places where sickness is treated and illness is the focus of attention.
The presence of someone with an illness, such as dementia, that does not respond to treatment and that makes addressing other conditions (for example a fractured hip) difficult, must be extremely frustrating for busy nursing and medical staff.
Perhaps we have to face the fact that until a cure for dementia is found – one that can be delivered via pills or injections – the design of today’s hospitals is unsuitable for people with this ailment. Perhaps we need to step back and ask: is there another way?
Rather than designing hospitals to maximise the efficiency of the delivery of treatments, why not design them to reduce confusion, agitation, depression, apathy and powerlessness? Even better, rather than focusing on symptom reduction, why not focus on the promotion of health and well-being? It is well established that people heal more quickly in less clinical environments, with views, lots of natural light, plants and artworks.
This focus on health and well-being rather than illness has been conceptualised as a salutogenic, as opposed to pathologic, approach. Quite specific ideas on how to build environments that promote well-being have already been well described. In fact, such facilities are already in use in other fields of medicine. For example, when you enter the new Royal Children’s Hospital in Melbourne, you are greeted by the sight of a four-storey, multi-coloured monkey. Just downstairs in the waiting area is a huge aquarium full of beautiful tropical fish and around the corner is – surprise, surprise – a meerkat enclosure. What have these things got to do with treating illnesses? Nothing at all. They are about encouraging wellness and lifting the spirits.
What would be the equivalent features in a hospital catering for older people, particularly those with dementia? It may be hard to think about it now, but there will be an answer.
Whilst we are working on finding the inspirational features of the next generation of hospitals, we must get on with re-designing existing hospitals so they reduce confusion, agitation, depression, apathy and powerlessness by applying the knowledge that we have gained in designing residential aged-care facilities for people with dementia.
To help accomplish this, the Australian Government, through the Department of Health and Ageing, has funded the NSW/ACT Dementia Training Study Centre to run two-day workshops in every Australian state and territory this year on design – not just in acute care, but also in rehabilitation and multipurpose services, where people with dementia spend a much longer time. The lead designer of The Royal Children’s Hospital, Kristen Whittle, will be discussing the application of his approach to the care of people with dementia at several of these workshops.
The events will be followed by consultancy services for individual wards or units within healthcare settings. This will ensure that the ideas generated in the workshops are applied to existing facilities.
We cannot let the present situation continue while we wait for new hospitals to be built. There is so much that we can do now in order to improve the hospital experience for people living with dementia.
Professor Richard Fleming is a psychologist who has specialised in the development of services for people with dementia for 30 years. He is director of the NSW/ACT Dementia Training Study Centre at the University of Wollongong and a consultant on designing dementia-friendly healthcare and residential care environments.
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