Fit for purpose? Dementia and the healthcare professions

The massive impact of the dementia lobby is evident worldwide and most certainly in the UK. Dementia is seen to be everywhere. It contributes to the difficulties of people living in the community, in care homes and in hospitals. Its characteristics of variability, 24 h presence, and combinations of dependency and hazardous behaviour, make it the number one threat to the peace of mind of patients, their families, clinicians and managers; people experience adversity and money can be misspent. A huge amount is being done to improve dementia care across the spectrum of lay and professional education and action [1]. Dementia is not the only mental disorder encountered in late life: the three most common mental disorders affecting older people when they are in hospital are dementia, depression and delirium. These may occur separately or concurrently and each of them is associated with poorer outcome in terms of survival, continuing disability and return to the community. Among older people admitted to a general hospital, out of 330 people, 220 will have a mental disorder: 102 will have dementia, 96 depression and 66 delirium [2]. This means that appropriate care of at least two-thirds of older patients requires that general hospital professionals of all disciplines are competent in the recognition and management of these conditions. Geriatricians should feel equipped to play their part in this by their educational, clinical and training experiences. In this issue of the journal Mayne et al. [3] report findings from a survey of geriatricians who are identified as ‘Dementia Champions’. They are a mixed bunch. Their range of clinical activity varies and their experiences of dementia, which have prepared them for their role, span reading, self-study, involvement in research, clinical attachments and structured training. They ask that trainees in future have more and better dementia training, with more structure and less variability between centres. Their comments indicate that there is experience, education and encouragement to be found, but that trainees have to make an effort to make up the best programme to suit their ambitions. Some may feel there is nothing wrong in that, others may prefer a more coordinated approach.