Small units specialising in dementia care in West Lothian.

Two small residential units specialising in dementia care in West Lothian are described. Residents were predominantly female with a mean age of 82.5 and all fulfilled ICD 10 criteria for dementia. Nearly all (93%) were known to the local old age psychiatry service prior to entry into the units, and using the Mini Mental State Examination (MMSE), most (70%) had dementia of moderate severity. On the Modified Crichton Royal Behavioural Rating Scale (MCRBRS) they showed significantly lower behavioural and dependence ratings than a group of patients with dementia recently admitted to psychiatric hospital long term care (p < 0.001). Both units received regular advice and support from community psychiatric nursing staff. In addition 48% of residents were formally reassessed by a consultant in old age psychiatry, 15% were admitted to hospital for further psychiatric assessment and 35% were eventually transferred to long term psychiatric hospital care. Only 49% remained in the units until the end of their lives. The average length of stay in the units was approximately 20 months and there was no evidence that placements were inappropriate. These units promote a positive and flexible approach to dementia care which should be strongly encouraged by health professionals. Old age psychiatry teams should aim to establish close links with special units where they can advise on psychiatric aspects of care. Such units can provide care to patients known to the psychiatric team, so this relationship can be mutually beneficial. This and other work suggests that service planners must bear in mind the inevitable progression of dementia which may result in a significant proportion of residents having to move on from specialised residential units to other forms of care as they become more dependent.