Professor William Molloy, University College Cork, outlines his range of research and assessment projects at the Centre of Gerontology and Rehabilitation
Atlantic’s investment has supported and facilitated a wide number of different research strands at University College Cork, initially in education and training in medical gerontology, but later in co-funding specific dementia research projects. This work was supported through the establishment of the Centre for Gerontology and Rehabilitation.
A key part of the work has focused on improving care in acute hospital settings by, firstly, focusing attention on the issue, funding pilot improvement projects and seeking to influence public policy using research evidence. Key programmes undertaken include:
- National Audit of Dementia in Acute Hospitals – to gain an understanding about dementia in hospital settings and the gaps that exist in knowledge in that sector.
- The Cork IDEAS Project – is about improving care for the person with dementia in the Mercy University Hospital and in the community. The objective is to develop an integrated care pathway for people with dementia so that there will be capacity to accelerate supported discharges from acute care and diversion of patients from presenting to emergency departments through advance planning with community-based health and social care support.
- National Computerised Dementia Assessment and Treatment Database – to keep a record of all dementia patient information, generating a consultation record which can then be sent to patients’, GPs and primary care givers. It provides a personal Healthcare Record for the patient.
- The Community Assessment of Risk Tool and Treatment Strategies (CARTS) – A risk intervention strategy, the first of its kind in Ireland, that aims to identify, quantify, stratify and manage risk related to adverse outcomes, frailty and functional decline amongst older people living in the community, including people with dementia.
- QMCI Screen – Quick Mild Cognitive Impairment Screen or “Quick” – a rapid (3-4 minute) cognitive instrument to discriminate between normal and mild cognitive impairment and dementia. This is complemented by the development of the Caregiver Cognitive Screen (CCS).
- Let Me Decide Advance Directive (LMDAD) – allows people to make their own choices about their future and about care at end of life. The programme also provides for palliative care education for staff – giving them confidence in providing end of life care.
On the Ground
The recommendations from the National Audit of Dementia in Acute Hospitals fed into the National Dementia Strategy and helped shape the Strategy’s policy around care for people with dementia in acute hospital settings. The audit also opened the way for funding for a number of pilot projects which allowed for the implementation of many of those recommendations.
CARTS is helping to ensure that services are being utilised efficiently and people are being provided with the services and care that they really need. The big plus – the risk assessment takes just a few minutes, doesn’t burden nurses and care staff and is easy to carry out.
QMCI (Quick) has been found to be more sensitive at differentiating normal cognitive and dementia than existing cognitive instruments.
Ambitious for People
The Cork Dementia Study examined 600 admissions of older people to six acute hospitals, 29% of whom had dementia. Of those that were found to have dementia, just over a third had a formal diagnosis and a fifth of them were coded as having dementia on discharge. This study was important because of the information that it provided on prevalence and dementia case recognition. It also allowed for the investigation of delirium – a reversible cause of dementia in acute settings – 57% of older people had delirium when admitted to acute settings.