Dementia Master Class

Dr Helen MartinDr Harry Allen

Dementia Master ClassIntroductions

Objectives for LES/DES and Masterclass

Why has dementia become such an important issue?

How do we do in Manchester?

What are the opportunities?

Order of play for today

Objectives for LES and DES

DES: national case finding: Asking those who are at risk if they would like memory review

LES: for those with established diagnosis in Central Manchester

LES: Highlight the potential gaps in care and tailor an approach so your practice can bridge them

Use masterclass and patient review document to support this

Objectives Master ClassConsider our own practice with the help of

learning needs assessment: identify gaps in care

Use peer discussion and expert workshops to help generate a realistic action plan for your practice to improve the care of patients with dementia.

Develop knowledge of clinical and legal issues so you can be a resource in your practice

Consider the needs of your patients for future master class and commissioning decisions

Dementia Master ClassIntroductions

Objectives for LES/DES and Masterclass

Why has dementia become such an important issue?

What are the opportunities? How do we do in Manchester?

Order of play for today

Importance: demographicsand economics

1/20 of older people has dementia

Prevalence 1.3%

Central Manchester estimated prevalence 1167

Diagnosed 525

BAME prevalence rising faster (7-fold in 40y)

£19 billion in England

25% of hospital beds

2/3 of people living in care homes

Importance: National Dementia Strategy

Improve knowledge and reduce fear and stigma

Earlier diagnosis: information support and care

Equal and high quality of care

Diagnosis GapThere is a gap…why?

Central Manchester 525/1167= 48%

National Dementia Challenge: Increase diagnosis rate to 66% by 2015

Why? Lack of confidence in what can we offer patients

Opportunities: earlier and timely diagnosis

Diagnosis: gateway to making informed choices

‘I would want to know so I can plan ahead’

Advanced care planning

‘It was too late to get power of attorney by the time diagnosis was given, which caused problems and financial hardship as we were unable to access Dad’s savings account when he needed a ramp to get outside, and had to use a credit card for expenses which obviously cost more.’

Opportunities: Carer Support

550,000 carers in England

£7billion unpaid care

In one study of substantial carers, over half the sample said they were in good health, but General Health Questionnaires (GHQs) indicated that 94% could be identified as having psychiatric disorders;

Problems associated with carer was a contributing factor in 62% of readmissions

Support for carers reduces hospital and residential care admissions

Opportunities: vascular risk factors

Up to 50% have a vascular component

20% have predominantly vascular aetiology

BJGP: inequalities in 22/30 QoF measures

Evidence for intervention?

NICE guidelines, King’s college review due

Losartan and ACE inhibitors

HyVet study showed that the benefits of treating hypertension in terms of reduced mortality and stroke were evident at 12months

Opportunities: co-morbidities

Painful Osteoarthritis prevalence is 1/5 (50-59)

1/2 of those aged over 80y

BMJ 2011: treating agitation with analgesics resulted in significant improvement, regular NOT prn

Vision

Hearing

Dental health

Opportunities: anticipation of problems and risk

Hospital admission reduction

Care package can be increased

Predictable outcomes with intercurrent illness

Better hospital care if identified

Summary of Importance & Opportunities

Common

Established dementia often not diagnosed.

Earlier diagnosis and high quality care are national priorities

Benefits in planning ahead are important

Lots of clinical gain for patients and families if we take a comprehensive view of care.

Today2.00 Helen Martin

2.15 Learning Needs Assessment: peer discussion

2.40 Workshop 1

3.10 Workshop 2

3.40 Break

3.50 Workshop 3

4.20 Action Plans: small groups

4.45 What’s Next

Learning Needs Assessment

Diagnosis

Carers

Building

Non clinical staff

Comprehensive management including end of life

Management of challenging behaviour

What are your priorities??

Action PlanQualitative review of patients with behaviour

that challenges

How will you prioritize?

How will you implement?

SMART

SummaryWe only know about half of our patients

We have a lot to offer

Secondary prevention

Supporting carers

Maintaining independence

Reducing admissions

Planning ahead

What next?Practices will:

Facilitate a multi disciplinary team meeting identifying key areas for improvement

Audit the quality of Dementia Care using Patient Review Template as a guide

Undertake a Qualitative review of 5 dementia patients with BPSD

Formulate and implement practice Action Plan

Contribute to the agenda for next Master Class

Undertake the 1st of two Dementia Patient Reviews