Sunday, 7 December 2014

@Ayrshirehealth #Delirium: screening without consent; 4AT not "systematic approach" in "holistic" assessment of person

Another comment by me, posted this morning, on Ayrshire Health Blog post 'Flying without wings' by @mclaughlynn:
"Derek here is a response to some of the points you make in your comment, December 6, 2014, at 11:29:

You mention “struggling to understand what is alleged to be so drastically wrong”

(1) The risks of misdiagnosis and over-diagnosis of both delirium and dementia are very real by taking the screening approach which is mandated. Doctors tell me this is the case

(2) They are screening without consent.

I understand that NICE do not recommend screening for all, just those “at risk”. I am hearing that the NICE Guidelines, when searching the word “delirium”, never once use the word “screening” presumably because there is no evidence behind such an approach. It seems that HIS have decided (by themselves) that all our “elderly (those 65 and over) are ‘at risk.’

You say that [this approach] is “not that new and not that controversial”. I am hearing that this is not the case. It is a new “screening tool”. Screening is a most controversial subject generally e.g. prostate screening, breast screening to name but a few.

You say “Might it lead to timely recognition and diagnosis of dementia for some people, yes, it might. Surely this is a good thing – unless of course the writers think that our Dementia Strategy and Alzheimer Scotland have got that wrong as well.” Let’s remember that the “timely diagnosis” campaign was led by Dr Peter Gordon. Prior to this Scottish Government was promoting “early diagnosis”.

I have heard experienced doctors say that you cannot diagnose somebody with dementia when they are experiencing delirium. Awareness of increased risk of dementia is appropriate.
Finally you say that “4AT isn’t a checklist, it’s a systematic approach to assist clinicians to intervene timeously when required.”

I would say, after consulting with clinical expert practitioners: 

(1) it is a “screening tool”. This is how 4AT has been registered and is being used

(2) it may be a “systematic approach” to the whole population but it is NOT a “systematic approach” in the holistic assessment of the individual. I have heard doctors say they would use the 4AT, as for other rating scales, to support diagnosis of delirium following time-honoured nursing and medical assessment.

I hope this is helpful to the discussion. Chrys"


Here is my comment on the Ayrshire Health Blog post 'Flying without wings' by @mclaughlynn, 3 December 2014, about her trip to the European Delirium Association (EDA) conference in Cremona, Italy this November:

I really don't like this image
"As a 62 year old woman I am concerned about the focus on delirium and frailty, linked to "mental confusion" which might lead to an incorrect early diagnosis of dementia.  For I think that going into hospital for any treatment can be traumatic for patients young and old.  Away from home and the familiar. 

I would rather it was Think Person-Centred.  Treating each person as an individual human being, not seeing being old as a sign of weakness.  There are so many benefits to being older.  I can testify to this.  There is life experience, the stories gathered over the years, the memories which give colour and depth to life.  I'm not keen on these images in the blog, older people's faces with words stamped on them.  It can be seen as stigmatising or discriminatory.  Old age = Frailty = Delirium. 

Since entering my 60's I have become a prolific writer, activist and campaigner in mental health matters.  Age has not slowed me down.  I am an unpaid carer, supporting two sons who have mental health difficulties.  I participate in many events as an "expert by experience".  My life is very full and interesting.  I look upon old age as an opportunity to use my life skills, qualifications and experiences to their maximum.  I wouldn't like to think that because of my older age my words were somehow less valuable.

I realise that this blog is geared towards nurses and hospital staff but for me as a potential patient it is offputting to hear how I might be viewed if confused after hospital procedures.  At risk of labelling in the medical notes as frail or delirious or demented.  That is indeed frightening.  It would make me think twice about going in to hospital for treatment.  Would I come out again as a person or as a diagnosis of dementia? 

Let's not lose sight of the many benefits of old age and the elderly in our communities.  We are a resource and the means by which stories are passed down the family, from generation to generation.  Think Positively about us as People First, is my exhortation."

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