Matthew is a psychiatrist of old age working for the CDHB. He has been involved in leadership of the dementia sector over the last ten years and is the current chair of the New Zealand Dementia Cooperative. He works to improve teaching and training, advocates for health sector change, and advises governance authorities so that health and social services systems can better meet the neuropsychiatric and psychosocial needs of New Zealand's Elders. After all, the health care of adults in old age already makes up the bulk of daily hospital and clinic medical practice in Australia and New Zealand and this trend will only increase over all of our practice lifetimes!
General Medical Services and Cognitive Impairment. Change, Maybe?
We are responsible for a system where people experiencing significant brain failure are admitted to our public hospitals, get worse, and are then discharged - all without a diagnosis or a management plan for their major organ failure. This would be difficult to imagine if we were talking about lungs, hearts, or kidneys. Although this problem crosses all our service boundaries, it is not an interface issue – it’s a fundamental fault-line transecting the whole health system. Could it be that society's triple-whammy stigmatisation of people with mental disablement, people in their old age, and people with limited socioeconomic resources has infiltrated a peculiarly inert health system that is over-reliant on medical technologies and geared up for the acute care of mid-life adults, resulting in a lack of confidence and will among stretched health professionals to diagnose and manage common neuropsychiatric problems? It's a good thing the prevalence of dementia is only going to double in Australasia over the next twenty years or so! What to do, what to do?