DeAR-GP Dementia Assessment Referral to GP

for Care and Nursing Homes

Aileen Jackson – Senior Project Manager

Health Innovation Network

The Health Innovation Network is the

Academic Health Science Network

(AHSN) for South London, one of 15

AHSNs across England.

We connect academics, NHS

commissioners and providers, local

authorities, patients and patient groups,

and industry in order to accelerate the

spread and adoption of innovations and

best practice, using evidence-based

research across large populations.

Working as catalysts of change across

health and social care economies,

we enable health improvements and

economic growth.

Population

3 Million

Healthcare

Workforce of

60,000+

55Member

Organisations

12South London

Boroughs & CCGs

Rationale

75% - 89% of Care home residents have dementia;

many of these are undiagnosed. Lithgow, Jackson & Browne 012http://onlinelibrary.wiley.com/doi/10.1002/gps.2784/abstract

Stewart et al 2014 http://ageing.oxfordjournals.org/content/43/4/562)

Why diagnose?

Ability to care plan and case

manage properly

Better understanding of unmet need

Facilitates staff to interpret signs, symptoms, behaviours

Access post diagnostic support (eg. ‘Care Home Intervention Teams’)

Reduced acute sector admissions; lower length of stay

Human right

Focus groups with care workers

• Focus groups in four

care homes

• What do care workers

think about dementia

and dementia case-

finding?

• Can care workers use a

dementia case-finding

tool to identify residents

who are subsequently

diagnosed with

dementia?

Good knowledge of the signs

and symptoms of dementia

Positive and caring attitude to

those with dementia

Belief that dementia case-

finding should fall under the role

of the care worker as care

workers know the resident well

and can spot the signs

Had opinions on each of the

case-finding tools shown

Empowering Care Workers

To diagnose, the GP is the one

but to notice, those that are

close to him, the relatives or

the carer workers or the

nurses.

Design requirements of the tool

Uncomplicated and straight-forward

Accessible to people with English as a second language

Recognisable and easy to follow

Paper based

Opted for shortest cognitive test (AMT-4)

Include an ‘observational’ chart for context

The finished product

Referral

letter to

GP on

reverse

side

Results

Care Workers Feedback

‘We realised that the tool

was simple and something

that we could do without

needing lots of training’

We knew residents who we

thought had dementia but they

were not diagnosed’

It was easy for us to use the tool

with residents because they

knew us and were familiar with

us’

Roll out in South London

2015-16

Funding from Health Education

England to train 40 care homes in

Barbara’s Story and DeAR-GP

2016-17

Funding from London Dementia

Strategic Clinical Network to train 17

care homes in South London and

spread to North London

Free to download at www.dear-gp.org

Support for GPs

DiADeM – Diagnosis of Advanced

Dementia Mandate in Care Homes Protocol to support GPs to diagnose people with advanced dementia

Designed to be used only with people living with advanced dementia in

care homes

Five simple criteria

If all criteria are met, GP assured that s/he has a mandate to diagnose

dementia

http://www.yhscn.nhs.uk/mental-health-clinic/Dementia/care-

settings/CareHomes.php

Spreading beyond South London

• Endorsed by Alistair Burns

• Supported by the Alzheimer’s Society

• Article in the Nursing Standard (2016)

• Article in Nursing Older People (2016)

• New care models framework for Enhanced Health In Care Homes (2016)