Over the past four months as I have sorted through the paper and the processes that follow death and necessarily provide time for reflection, I have thought a lot about her, and about what I have learned as I watched her live with her illness and die.
I am a GP. I understand the pathology. I have watched patients go through the same inevitable decline as an interested and concerned bystander but it’s different when it’s someone you love.
I saw the best and the least that the NHS provides. I have felt proud and frustrated and angry at times.
One thing I know: hospital is not a good place for people with dementia!
Unless people really need to be in hospital, keep them away. The ground that people lose when they are away from the familiar and the safe is rarely, if ever, made up.
The reasons for hospital admission were never clear
Each time my mum was admitted, it did not matter how kind or thoughtful or caring (or not) the staff were - she came home smaller than before she went in. Each time she had no treatment to speak of. The reasons for her admission were never clear and were usually more about the person sending her in than her.
So my advice to GPs, both in and out of hours, to community nurses and paramedics, is: be brave and keep people at home if you can. Challenge the system. Do not see hospitals as risk-free places of safety if you are not sure. They aren’t!
Admitting someone to hospital may make you feel you have done the safe thing but you critically underestimate the impact of your decision on their future functioning. In the end it has to be an assessment of the balance of risks. Hopefully, if there are good domiciliary services in place, keeping people like my mum at home will be an easier choice.
It is Dementia Awareness week. I read that dementia is now the number one cause of death for women and the fourth for men. My generation are witnesses to our parents’ struggle with the disease and I wonder how it will form and change our approach to our own care as we get older.
- Dr Pleydell is GP and healthcare commissioning lead for Hambleton, Richmondshire and Whitby CCG
