Dementia and rising obesity pose major challenge to NHS.

In the second part of our NHS series, efforts to tackle a growing crisis of dementia are spotlighted

The rising proportion of elderly people living with dementia in Tayside means that 1970s-built Ninewells Hospital is increasingly unsuitable for many patients, due to its design and signage, it’s been claimed.

The warning has been sounded by Dr Cesar Rodriguez, dementia consultant and associate medical director for older people with NHS Tayside, and dementia nurse consultant Andy Shewan, who says there has to be increased investment in care homes and community hospitals – not only to meet the needs of patients but also to improve NHS efficiencies.

There are currently around 90,000 people with dementia in Scotland – 10% of whom live in Tayside.

However, due to longer life expectancies, that number is predicted to increase by 50% over the next 15 years.

Tayside also has a clinic for youngeronset dementia, and with a sizeable drink/drug addicted population in Dundee at risk of early-onset brain damage, there is also concern about future impact as this cohort of cases moves through the NHS system.

“The reality is that the biggest factor for dementia is age,” said Mr Shewan.

“But the difficulty now is that dementia patients are beginning to filter into everybody’s care areas. In cardiology, for example, it makes operations very complicated.

“Scotland is leading the world to an extent on dementia care. But one of the difficulties as you lose your memory is the ability to consent to any kind of treatment you get.”

Dr Rodriguez said one of the biggest societal challenges was the “stigma” that still surrounds dementia.

A key strategy in Scotland is for people to stay in their own homes or a homely setting for as long as possible to keep them healthier, and ultimately reduce demand on NHS services.

Evidence suggests that elderly patients are much more vulnerable if they are admitted to hospital.

This means that early intervention is key to keep them out of hospital and, if that is not possible, shorten their stay.

However, when people are admitted to acute hospital as a “last resort”, they are increasingly at a much more declined stage.

In Fife, where 70% of patients entering the Victoria Hospital, Kirkcaldy, are now aged over 65 with conditions such as dementia, delirium and cognitive impairment increasingly likely, a pioneering “front door” acute frailty team has been established to reduce the risk of “bed blocking”.

Dunfermline-born Joy Reid, 43, nurse consultant for older people at NHS Fife, says that without a doubt an “absolute success” of the NHS is that people are living longer. However, a consequence is that innovative ways are having to be found to cope with rising demand.

The former clinical academic fellow at Dundee University said: “There’s compelling evidence that if frail, elderly people stay in hospital for shorter lengths of time, they are less likely to need long term care.

“If we identify them at the front door and by that, we mean accident and emergency and our admissions unit, they are less likely to deteriorate and can get back home earlier.

“If someone comes into A&E because they have fallen, for example, we’d want to investigate why and address it early.

“This reduces pressure on the hospital but, most importantly, it is also good for the patient if they are followed up in the community rather than being kept in.”

West Fife farmer Bob Shedden, 81, who has Parkinson’s Disease, has spent two days in the Fife frailty unit and won’t fault the care he’s received.

The Cairneyhill native, who has progressive mobility issues, was admitted after being unable to get out of his chair at home, which led to an infection.

After a fully comprehensive assessment by the frailty team, and after successful efforts to get his temperature down, he’s looking forward to getting home after just a couple of days – far earlier than if he had been admitted longer term to a main ward.

“Everyone here has been fantastic – I can’t fault it,” he said. “They even let my wife bring me in a fish supper!”