A case example. A woman in her eighties has dementia. Her husband looks after her day and night. At every appointment he says, "We're fine." A nurse asks if he would talk on his own for a few minutes. He says he has not slept a full night for months. NICE guidance says carers should be offered a confidential conversation about their own needs, separately from the person they care for.

If you look after someone, you can ask the council for help for yourself. The route depends on the nation. In England, under the Care Act 2014, a council must assess a carer when it appears that the carer may have needs for support, now or in future. It must do this whatever it thinks of the level of the carer's needs, and whatever money the carer has. In Scotland, under the Carers (Scotland) Act 2016, a council must offer an adult carer support plan to anyone it identifies as an adult carer, and must prepare one if you ask. Wales and Northern Ireland have their own laws.

NICE advises psychosocial and environmental measures as the first response to distress in a person living with dementia. Before any treatment, a structured assessment should look for reasons and check for causes such as pain, delirium or inappropriate care. Examples from practice include hearing aids and glasses in use, pain treated, curtains open and family welcome. Ask the nurse in charge what can be put in place today.

A 2020 review in Age and Ageing pooled 33 studies of delirium in adults on medical wards. The studies were published between 1980 and 2019. Overall, 23 in every 100 patients had delirium (the plausible range was 19 to 26 in 100). The figure did not change over the four decades, and neither did the average age of patients or the proportion with dementia. The authors note that some studies may not have been published, which could have hidden real changes (Gibb et al.). doi.org/10.1093/ageing/afaa0…