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Improving the Care and Support
of People With Dementia
Dr Oliver J CorradoConsultant Geriatrician and
‘Dementia Champion’ Leeds Teaching
Hospitals NHS Trust
Scope of Talk
What is dementia?
Its causes and how common is it?
How is the LTHT helping to improve the detection of dementia?
How can hospitals improve the care of people with dementia
and support their carers
What initiatives is LTHT undertaking?
Dementia Friendly Leeds
Background
• Dementia affects 800,000 people in UK
• 8400 people with dementia in Leeds, will rise to 12000 by 2026
• 20% people aged over 80 have dementia
• 45000 with dementia in UK are aged under 65 years
• 25% of general hospital beds used by people with dementia, longer stay, delayed discharges and readmissions
• Dementia is under recognised and under diagnosed. Only 60% have a formal diagnosis in UK, but improving
LTHT’s Role in Identifying Dementia: the “CQUIN”
• National hospital based ‘screening’ process introduced in 2012 to identify people aged over 75 who may have dementia
• LTHT changed its medical and nursing assessment process
• As a result approx 25 people per month referred to GP/Memory clinic for further assessment
Dementia
NOT a normal part of ageing
Progressive decline in intellectual function severe enough to affect an individual’s personal and social functioning.
Damage to the brain causes brain cells not to work properly which can affect memory, communication, reasoning and decision making.
Dementia and co-morbidity
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
1 2 3 4 5 6 7
Number of long-term conditions (including dementia)
Pro
port
ion o
f th
ose o
n d
em
entia d
iagnosis
regis
ters
in L
eeds
The Goggle Box Question !
Q. “What’s the difference
between Dementia and
Alzheimer’s?”
Steph: A. “Alzheimer’s is worse”
Leon: A. “It’s the same thing”
Causes of Dementia
Alzheimer’s Disease 50%
Vascular Dementia (poor blood flow to brain, as a result of stroke or mini strokes) 20%
Dementia with Lewy Bodies
Frontotemporal dementias
Mixed causes
Prevention
“What’s good for the Heart is Good For The Head”
• No Smoking
• Regular exercise
• Low consumption of alcohol
• Mediterranean style diet
• Socialise
• Keep brain active (learn a second language etc)
• Reduce vascular risk factors (blood pressure,
diabetes, cholesterol, smoking)
Improving the Hospital Care of people with
Dementia and supporting their carers
Sheehan B et al 2009. The care of older people
with dementia in general hospital. J Qual Res Dem
Paraphrased in DH/RCN Guide
“What happens in general hospitals can
have a profound and permanent effect on
individuals with dementia and their
families, not only in terms of inpatient
experience, but ongoing functioning
relationships, wellbeing, quality of life and
fundamental decisions made about their
future”
A Typical Story !
Moderately severe dementia, you develop a urine infection which makes
your confusion worse.
You spend 2 hours on a trolley in A and E and get moved to an
admissions ward. The antibiotic your GP prescribed gives you diarrhoea
and you’re moved into a side ward in case you have infective
gastroenteritis.
After 2 days you are given the all clear and moved back out again
At frequent intervals people come and take blood from you and take your
blood pressure and because they are busy they don’t spend as much
time as they would like explaining what they are going to do.
What effect would that have you?
Improving Dementia Care: Think SPACE !
• Staff who are skilled
• Partnership working with carers
• Assessment and early identification of dementia
• Care plans which are person centred
• Environments which are dementia friendly
Care plans which are person centred and individualised
• Know Who I Am good way of
seeing patient with dementia
as a Person not just a
patient
• Starts engagement process
with carers
• Care plans: support,
information, nutrition,
continence, mobility, risk,
aids and adaptations, carers
needs
Raising Awareness
Schemes to raise
Awareness:
Forget Me Not symbol and
the Butterfly Scheme
Ward staff aware a person
has dementia, how it affects
them and facilitates
communication with, and
about that person
BAME Communities (% population) in Yorks and Humber
Challenges in providing good dementia
care for BAME Communities
Languages and dialects (communication and assessment). No word for dementia in 5 main South Asian languages
Stigmatisation of dementia in some communities, seen as ‘madness’
Poor awareness of available services
Carers wanting help but afraid to seek it
Kings Fund 5 DF Design Key Principles
DF Design Principles
1. Orientation
Artwork, calendars, large face clocks, outside spaces,
local photos, signage, visible staff
2. Wayfinding
Different colours to identify bays, artwork, signage
3. Familiarity
Dining areas, domestic seating, personal items, photos/memory
boxes, domestic crockery, cutlery
4. Meaningful activities
Books and games, drinks and snacks, resting points, social
spaces
5. Legibility
Clear sight lines, no clutter, matt finish, even flooring,
noise reduction
Remember Carers !
• 7 million carers in the UK (1 in 10 people)
• 65% of carers aged 60-94 have health
problems of their own
• Ill health, depression and financial problems
are common
Carers’ Survey
John’s Campaign
Hospital Carer
Support
WorkersHow we can help
We can provide support, information and
advice to carers of people with dementia
within the hospital setting, whether the
cared for person or the carer is the
patient. For example this might be
support around the discharge process,
information about support in the
community, benefits advice or emotional
support.
We can accept referrals from members of
staff or self referrals from carers and we
are very much looking forward to being a
visible presence on the wards.
To make a referral or to find out more
about what we can offer please get in
touch.
The Team!
Lorraine Lumb Jo FosterSJUH LGI
Contact:[email protected]@[email protected] via Carers Leeds Advice Line 0113 380 4300
Better and safer prescribing
• People often come to hospital on lots of medication
• Risk of not taking them or taking too many
• The side effects of medication can make people drowsy or more forgetful
• Avoid anti-psychotic (tranquiliser) drugs
• Hospital good opportunity to review medication, assess need and use devices to improve compliance
End of Life Care (EoL)
“How people die remains in the
memories of those who live on”
Dame Cecily Saunders (founder of Hospice
movement)
People with dementia need good EoL care and
access to palliative/hospice care too
Dementia Friendly Leeds
Dementia Friendly Leeds
YAS Dementia Friendly
Summary
1. Dementia is extremely common and LTHT treats a lot
of patients with dementia
2. LTHT has done a lot to improve the care of people
with dementia and support their carers - but we can
and must do even more