Doctors say threats from older patients with dementia had worsened in recent years, and were now "untenable". Photo: Supplied
Senior doctors say staff on general wards are being put in life-threatening situations because hospitals are pressuring them to admit physically and sexually aggressive older psychiatric patients.
Wellington senior medical doctor Cindy Towns said a nurse in the region was stabbed by an older patient with dementia last year.
"There have been numerous and serious assaults on our staff - a nurse was stabbed last year [in the region] and there have been numerous other assaults. There have also been incidents nationally and internationally where patients have been assaulted by older adults with these psychiatric symptoms of dementia where they become violent and unmanageable."
Towns was one of nine senior physicians calling for secure settings for patients with the behavioural and psychological symptoms of dementia, after a spate of serious assaults on staff both locally and nationally, she said.
She said they were speaking out publicly after their concerns fell on deaf ears.
"It's been going on a long time, but the population ageing and dementia has dramatically increased."
Older dementia patients could be stronger than people realised, she added.
"This is serious - we have numerous [instances of] biting, hitting, it's serious violence. These patients, they're not all frail and inoffensive in terms of what they can do. We have no risk stratification; our hospitals are expecting medical wards to manage even the most violent people."
She said Australia proposed "risk stratification" - categorising patients into different risk groups - two decades ago.
"This is an example of New Zealand just not planning ahead.
"These patients require specialist services, these are severe presentations and require secure, locked dedicated rooms, managed by trained staff, not just defaulted to medical wards in general hospitals."
The situation had worsened in recent years, and it was now "untenable", she added.
"Many years ago when I started, it was an occasional 'picking up the pieces' for the psych ward, seen as helping out, but now, it seems an expectation. We're put under undue pressure to admit these patients, which often puts our patients and staff at risk."
There was a "large and worsening shortage of mental health beds for older adults", she said.
"But rather than address this pressing need, hospitals are pressuring medical wards to admit these purely psychiatric presentations."
Patients suffering psychiatric symptoms of dementia came to emergency departments when they were "unmanageable, very intrusive, when they're sexually aggressive or violent".
New Zealand hospitals had a shortage of single rooms, even though this was becoming commonplace overseas, she added.
The group had made a submission to the 2018 Government Inquiry into Mental Health and Addiction and recently wrote to the health select committee, but it was yet to hear back.
"It's deeply concerning, there seems to be a real lack of willingness to engage in what is obviously a difficult topic but a really important one from the perspective of safety and basic standards of care."
Towns said the news that the revised plans for Dunedin Hospital meant cutting back on psychiatric geriatric beds was "almost incomprehensible" in the face of an ageing population and increase in dementia.
Alzheimer's New Zealand said by 2050 one in four New Zealanders will die with the condition. There are about 70,000 people with the condition now, but in 25 years that will hit almost 170,000.
"Those demographic trends are well known, they're on the Te Whatu Ora Health New Zealand website and yet we're slashing them [the psychger beds]. That to me is incomprehensible. More importantly, its frankly unsafe, where are they going to put those patients?"
In a written response to RNZ, Health NZ group director of operations for Capital, Coast and Hutt Valley Jamie Duncan said the agency understood the challenges staff faced when treating older dementia patients, who were "unaware of the impact their sometimes aggressive behaviour can have".
"Our hospitals and ED staff do their best to manage all patients presenting for care in a way that keeps both them, and those around them, safe.
"In Wellington specifically we have developed recent initiatives to improve the experience of both patients and staff presenting to ED with a mental illness or challenging behaviour, including those with dementia."
These included:
- Shifting the Wellington Crisis Resolution services nearer to Wellington ED
- Partnering with Kites Trust to embed peer support specialists in Wellington ED
- Increasing the number of mental health specialists - psychiatrists, nurses and nurse practitioners - based in Wellington ED and able to complete crisis assessments
- Partnering with Wellington City Mission to provide an alternative safe space for people in mental distress
- Working with Pathways Trust to establish a six-bed acute alternative service
- Developing a regional extended care facility that will provide more appropriate placement for people, especially those with dementia.
Dr Matthew Croucher, spokesperson for the Faculty of Psychiatry of Old Age at the Royal Australian and New Zealand College of Psychiatrists, said while they understood and shared the safety concerns of healthcare staff, these issues were symptoms of a health system poorly equipped to support a rapidly ageing population.
He said aggressive incidents involving people with dementia were "relatively rare", and stigmatising language could deter families from seeking help.
"These are people who need care when they're struggling, and turning them away from services is not the solution," he said.
He said the Government needed to give Health NZ the resources to implement a plan made in 2020, called "Dementia Mate Wareware" which outlined evidence-based solutions.
"For seven years since the Government Inquiry into Mental Health and Addiction, the Faculty and the College have been advocating for greater investment in community, hospital, and residential care services that are properly resourced to meet the needs of older people requiring psychiatric care," he said.
"The Action Plan calls for investment upstream - at the top of the cliff - rather than just crisis responses at the bottom, though all levels need equitable resourcing to meet this challenge."
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