Patient story Resources

When a person experiences symptoms that are suspected to be a possible dementia, they may be referred for specialist memory assessment. However, in the initial diagnostic stages, delirium and depression are differential diagnoses that require consideration, with attention paid to ruling these out as they can mimic the presentation of dementia. Similarly, delirium and depression can be superimposed on a person who already has an existing diagnosis of dementia. In both instances, this can be distressing and debilitating  and requires community nurses to be able to differentiate between the conditions and to take appropriate measures to enable rapid identification and assessment and, when required, onward referral for treatment and management. The differentiating signs and symptoms of the three conditions can vary in their subtlety and similarity and require vigilance to identify in a timely manner. Community nurses have a significant role to play in the screening, identification, assessment and management of patients with dementia, delirium and depression. This paper is the fifth in a series that follows two patient stories in their experiences of dementia.

Awareness of the incidence of chronic oedema in the UK, and the consequences of inadequate management has grown over the last 10 years. Moffatt et al (2019) identified that over 50% of patients cared for by community nurses had an element of chronic oedema. A failure to identify and manage chronic oedema can result in the disease progressing to more advanced stages, which are more costly for patients and healthcare services to manage (Wound Care People, 2019). This article tells the story of Anne and her journey with chronic oedema. Her story exposes many inadequacies ranging from prevention to diagnosis, management, and prevention of harm. These culminated in a hospital admission and lengthy rehabilitation calculated to have cost in the region of £35,000. The use of an evidence-based care pathway is advocated and the potential impact which its use might have had for Anne at a number stages in her journey are explored. The combination of Anne’s story, and the financial analysis of the outcome and other potential outcomes had a care pathway been followed, make a powerful argument for change.