The Fife Dementia Strategy: 2010 – 2020 - The Knowledge Network

4.11.2 All people over the age of 65 receive a comprehensive geriatric
assessment during admission to hospital.
In 2008 in Fife 55% of acute medical admissions were patients over the age of
65 years. An estimated 33% of these admissions had a significant cognitive
impairment. A number of these patients may not have had an acute medical
condition but were being admitted due to a lack of an alternative service to
meet there needs. Despite this, it remains the case that in the acute
environment the focus of assessment and care is on the patients’ physical
condition, and their dementia or other mental health conditions are often
overlooked 70 . When hospital staff fail to identify or deal with the whole person,
including their dementia, it can lead to longer stays and poorer outcomes than
for people who are psychiatrically well 71 .
A recent review of the use of the admission assessments used in Fife
highlighted a lack of coordination in elderly patients admitted to acute
medicine which resulted in problems further along the patient’s journey as
their needs were insufficiently documented and addressed. Since recognising
and assessing an individual with a potential cognitive impairment is the first
step to providing person centred care in any environment, a more holistic
approach better suited to the older person is necessary. In some cases it may
be the first step towards receiving a diagnosis and getting the appropriate
treatment and intervention.
The comprehensive geriatric assessment assesses an elderly person’s
physical, cognitive and mental health, as well as the functional ability and
socio-environmental situation of the individual. The introduction of such a
holistic assessment is thought to have a significant benefit to people with
mental health conditions such as dementia in the hospital setting and is
currently being piloted in Fife. The assessment framework will be evaluated,
and if positive will be rolled out to all appropriate settings in Fife.
Medical Admissions Unit Comprehensive Geriatric Assessment and Triage
The Medical Admissions Unit in the Victoria Hospital Kirkcaldy is involved
in a pilot project to develop the use of a comprehensive geriatric
assessment and triage programme. All patients over 65 and admitted to
the unit will receive an assessment within 24 hours of admission. The
main domains of the assessment surround physical health, functional
ability, cognitive and mental health and factors that affect the persons
socioeconomic situation. Using this tool will allow for a more reliable and
efficient evaluation, and improved communication between health care
providers. All of these aspects can positively impact the care of someone
with dementia in the hospital.
70 Borbasi S, Jones J, Lockwood C & Emden C. (2006). Health professionals’ perspectives of
providing care to people with dementia in the acute setting: toward better practice. Geriatric
Nursing. 27(5): 300-308.
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