What is the Irish National Audit of Dementia?
National and international research confirms that admission to an acute hospital can be distressing and disorientating for a person with dementia, and is often associated with a decline in their cognitive ability and levels of functioning around activities of daily living. In response to the need for more Irish data on dementia care in acute hospitals, the first Irish National Audit of Dementia Care in Acute Hospitals (INAD) was undertaken in 2013 to measure criteria relating to care delivery known to impact on people with dementia admitted to hospital. The report of the first Irish National Audit of Dementia Care in Acute Hospitals (INAD) was published in January 2014. The audit, kindly funded by Atlantic Philanthropies and The Meath Foundation, was carried out in all 35 acute public hospitals that admit adults with known/suspected dementia. Relevant parameters included policies and governance within the hospital that recognise and support the needs of people with dementia, elements of comprehensive assessment, involvement of carers, discharge planning, and identified changes to support needs during admission. INAD was based on the UK National Audit of Dementia (2011) in acute hospitals which found many deficits in practice. Our aim was to, with permission, replicate the UK audit, using minor modifications for the Irish setting.
The audit had three parts:
- Hospital organisational audit (interview with senior hospital staff about hospital policies and procedures)
- Environmental audit (observation of the structural environment within a number of areas in the hospital)
- Case note audit (examining the care received by people with dementia through an audit of case notes)
A second audit (INAD-2) was completed in 2019 in 33 acute and orthopaedic hospitals in the Republic of Ireland. This audit aimed to provide an overview of dementia care in acute hospitals. The report of the INAD-2 was published in autumn 2020.
Findings were compared with the findings of INAD from 2013 in order to inform local and national education plans, staffing and resource allocation.
The Poster for INAD-2 and Information Sheet for INAD-2 are available to download. For more information on INAD-2, please visit the INAD-2 page. Two further waves of the INAD are planned.
Why is INAD important?
Currently, there are approximately 64,142 people with dementia in Ireland. By 2046 however, it is estimated that this figure will rise to 150,131. Dementia is linked with increased utilisation of medical services. National and international research confirms that an admission to an acute hospital can be distressing and disorientating for a person living with dementia, and is often associated with a decline in their cognitive ability and levels of functioning. If the quality of hospital care for patients with dementia can be improved in Ireland, this will lead to a decrease in the overall cost of dementia care, reduced staff burden, and importantly, more positive health outcomes for patients with dementia.
In the UK, the second round of follow up of the National Audit demonstrated that the publication of the first round audit results had led to significant improvements in the quality of care received by patients (Royal College of Psychiatrists, 2013). The findings from INAD-2 were published in September 2020 and included systemic recommendations requiring action at a national level. In follow up to this, the National Dementia Office secured funding through the HSE National Service Plan for a number of dementia-specific posts for the acute care setting. As well as this, hospital group-level and individual hospital-level data were returned to hospital groups for local action.