Major deficiencies in hospital services for patients with dementia have been identified in a new national audit.

The first Irish national audit of the quality of dementia care in acute hospitals shows that Ireland does not yet have standardised care for dementia in these hospitals.

It shows differences in the access to dementia-relevant services between hospitals, with poor access to many diagnostic and support services.

The Irish National Audit of Dementia, carried out in 35 hospitals last year, found that there was inadequate assessment of cognition, delirium, mood, and behavioural and psychological symptoms in people with dementia during their admission, and where assessed and discovered, issues were not highlighted on discharge.

It was found that people with dementia admitted from nursing homes were least likely to have cognitive and social assessments and had the shortest length of stay in hospital - 35% of people with dementia admitted from home were discharged to nursing homes, and these patients had particularly long lengths of stay in hospital.

The audit also found that in many cases, actual practice as stated in healthcare records was less than what was stated as the practice by senior managers and doctors.

For example, 62% of hospitals reported that an assessment of functioning using a standardised instrument is routinely carried out, but 36% of patients had this performed.

Also, 97% of hospitals reported that nutritional assessments were routinely performed, but only 76% of patients had a nutritional assessment recorded.

Only 43% of the people with dementia had a standardised cognitive test recorded in their hospital healthcare record.

Eleven per cent of hospitals reported having no access to geriatric medicine services and 21% of wards had no access to occupational therapy.

The survey also found that over one-third of wards audited had unfilled nursing vacancies, and 26% of wards had unfilled healthcare assistant vacancies and only 69% of wards were meeting their agreed minimum staffing levels.

Also, no hospitals had mandatory dementia awareness education/training for any staff, it was found.

Around half of hospitals had, or were developing, a protocol governing the use of interventions for patients displaying violent or challenging behaviour, aggression and extreme agitation, which is suitable for use in people with dementia who present with behavioural and psychological issues (BPSD).

However, only 18% of these hospitals reported that their protocol has specific evidence-based guidelines for the prescription and administration of antipsychotic drugs.

The audit recommends that each acute hospital must ensure that all staff are provided with basic training in dementia awareness, and a locally agreed and specified proportion of ward staff should receive higher level training.

It also recommends that appropriate psychiatry and geriatric medicine services should be available in all acute hospitals for people with dementia.

The audit says assessment of mental status should be an integral part of the hospital admission of people with dementia, using standardised assessment tools and collateral history.

The audit was carried out as part of a joint initiative by the Centre for Gerontology and Rehabilitation, University College Cork; the Centre for Ageing, Neuroscience and the Humanities, Tallaght Hospital Dublin and the HSE.

The Government is due to produce a national dementia strategy shortly.