Dementia and incentives on GPs to diagnose it

Press Release put out 24.10.14.

CO-Gas Safety, the Carbon Monoxide and Gas Safety society considers that plans to financially incentivise GPs to diagnose dementia will place many thousands of people, particularly the elderly, at increased risk of misdiagnosis of chronic carbon monoxide (CO) poisoning.

It is well-known that the effects of chronic carbon monoxide poisoning can mimic dementia. Many medical experts believe that the scale of the problem has been greatly under-estimated. One study, conducted at Hebrew University in 1998, ( found significant impairment of cognitive function at levels which are as low as 17-100 ppm (parts per million). European safety standard EN 50291 sets the lowest trigger threshold for domestic CO alarms at 120 minutes’ exposure to 30 ppm: however, based on the result of the 1998 study, doses just below this level may be sufficient to cause significant harm, especially if experienced on a daily 24 hour basis. Medical research is currently underway at John Moores University in Liverpool using more sensitive detection devices to assess the actual levels of CO in domestic air and to correlate them against ill-health (see and see the earlier research by Dr Ben Croxford of UCL

The elderly are at higher risk of domestic boiler carbon monoxide poisoning for three reasons. Firstly, they spend a greater proportion of their time at home. Rising fuel prices also mean that if they need to use their heating, they will often be confined to one small room and will keep doors and windows tightly closed. Secondly, retired people on low incomes may be unable to afford regular boiler and other appliance servicing. And thirdly, when friends and family notice that older patients seem slightly ‘vague’ or ‘a bit forgetful and they present to their GPs with memory problems, they are frequently told that they have age-related memory loss. Far too often in our experience, this is the final contact they will ever have with a doctor before the they die of CO toxicity.

While dementia sufferers do need better levels of care, it is unhelpful to skew doctors’ clinical judgement by offering cash incentives for one diagnosis rather than to consider the alternative possibility of CO poisoning. GPs should be standing in the front line to protect their patients against this silent killer. Misdiagnosing CO can and does kill.

The real problem is that there is so little awareness of the dangers of carbon monoxide and the other products of combustion (which we call CO+) and even less acceptance of the possible numbers involved.  Medics themselves know little about CO and even less about CO+. CO-Gas Safety has lobbied since 1995 for a sustained campaign of prime time TV warnings and other media about the dangers of CO from all fuels (gas to wood), all appliances (boilers to barbecues) and all accommodation (bungalows to boats). The fuel companies certainly have the wealth and Baroness Finlay estimates that the existing deaths and injuries are costing the taxpayer £178 million a year.

For further information about CO+ and the numbers that could be being affected see here.

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