Paramedics ill-equipped for realities of dementia
Expert Dr Danielle Jones says students must learn what to expect of this degenerative cognitive condition as part of their training
THE number of people living with dementia is only set to increase, but it's not just the social care sector that is ill-prepared – healthcare professionals need to adapt too.
Paramedics are often the first port of call when mishaps occur, but they are too-often ill-prepared for dealing with patients who are confused, erratic, and likely unable to communicate their woes or understand what's being asked of them.
Little wonder a leading dementia expert has called for specific training for student paramedics. But it's not just a matter for first-responders; it's an issue of increasing relevance across the wider health sector.
There is currently no compulsory requirement for undergraduates to study dementia, according to Dr Danielle Jones, associate professor in dementia studies at the University of Bradford, in West Yorkshire.
She believes that education on the degenerative condition should form an essential part of the paramedic curriculum.
"Dementia is one of the leading causes of death and disability in the UK and people with dementia often have complex needs meaning they are more likely to require emergency healthcare,” said Jones.
"Unlike other conditions, like cancer or heart problems, dementia is a cognitive condition which affects how a person communicates and behaves, posing additional considerations for paramedics needing to assess them.”
More than 900,000 people in the UK currently live with dementia, according to the Alzheimer's Society. By 2030, the numbers are projected to exceed one million, while 1.5 million will be afflicted by 2050.
Furthermore, 77% of people with dementia have one or more illnesses; co-morbidities, as they are called. These commonly include strokes and diabetes, but may also include conditions such as Chronic Obstructive Pulmonary Disease (COPD) affecting breathing. They are also more prone to frailty and falls that may result in broken bones.
Alzheimer’s Society figures cited by the university's Centre for Applied Dementia Studies, claim there were 279,265 emergency admissions for people with dementia in England in 2012-2013. This rose by 35% to 379,004 emergency admissions in 2017-2018.
A failure to appreciate the difficulties associated with dementia, or communicating effectively, can lead to inappropriate hospital admissions: not ideal for either the patient or overstretched NHS services.
"When an ambulance is called for someone with dementia, research shows they are then more likely to be transferred to hospital, stay in hospital longer, have poorer health outcomes, and they are more likely to die in hospital than other patients,” Jones said.
"A paramedic needs to know how to communicate with someone who has dementia to ensure they receive high-quality, dignified care. Research suggests that paramedics often transfer a patient with dementia to hospital because they don’t know what else to do with them, even though that patient might not need hospital care.
"I think dementia education should be prioritised in the curriculum for all allied health professionals, not just paramedics, but occupational therapists, physiotherapists and so on."
Joe Frankland, a paramedic lecturer at Bradford University, echoed her sentiments.
"Paramedics are under increasing pressure to manage patients with co-morbidities, including people living with dementia,” he said.
“This is a growing public health issue and the level of education required to be competent in this area has been moved towards asynchronous modules. However, there is no quantifiable evidence how patient outcomes are being impacted.
"In my opinion, there is a pressing need to focus education on urgent care and under-represented groups in society. As a result, I believe that we need to ensure paramedics receive adequate training and resources to handle these complex cases effectively."
For her part, Jones isn't just talking the talk; she's walking it too. “We want to see every paramedic student leaving Bradford with the knowledge and skills they need to be able to competently care for people with dementia," she said.
To that end, as part of her work at the Centre for Applied Dementia Studies, she has devised a six-hour education course for first year students on the university's BSc Paramedic Science course.
Her module includes case studies based on real life: drawn from the experiences of people living with dementia, which recount how they found their treatment by paramedics. So-called 'experts by experience' also give talks, sharing what it is like for them to live with dementia.
"We found really mixed experiences,” Jones said. “[S]ome people had a good experience, while others felt they weren’t listened to, or the paramedic only talked to their carer, which is a particularly common complaint amongst care home residents with dementia."
The six-hour course was recently evaluated to explore the difference it was making. The results were published in the British Paramedic Journal at the beginning of June. The results suggest it has had a positive impact:
Prior to the education session, only around a quarter of students – 26.8% – said they felt prepared to care for people living with dementia. Following the course, this rose to 81.3%
Afterwards, all students said they felt their knowledge of dementia had improved, and 87.5% reported their confidence and attitudes towards dementia also improved
Before the session, 36.5% of students reported feeling frustrated due to their lack of knowledge in how to care for a person with dementia. This dropped to just 6.25% – just two students – after the session
Almost 96% of students felt the dementia education received would improve their practice as a paramedic
"People with dementia aren’t inherently aggressive but they may become frustrated if they feel their needs are not met,” Jones said.
"If a paramedic understands how to meet the needs of a person with dementia and can communicate with them effectively, they will be more likely to be able to provide effective care at home, promoting better health outcomes and a better experience for people with dementia.
"In six hours, we cannot cover every aspect of dementia education. This initial training forms a good basis but ideally, the students need more dementia education, using more ‘hands on’ teaching approaches, going forward to ensure they are fully prepared for the work they will do."
Dementia training standards already exist. Commissioned and funded by the UK Government's Department of Health, the Dementia Training Standards Framework set targets for every healthcare professional working with someone with dementia to complete the relevant level of education.
Training on the job, however – as Jones points out – is easier said than done; easier to instil the knowledge and skills while they are taking their formal education before they start their working lives.
"When you’re working in practice, it’s hard to fit in extra training,” she said. “You have to get time off which might be difficult, teams are understaffed and existing staff are burnt out. We should be ensuring the workforce is better prepared to care for people with dementia before they start working in practice.”
MC