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Management of Dementia in Primary Care Dr R C Barnes Consultant in Old Age Psychiatry Mossley Hill Hospital Liverpool.

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Presentation on theme: "Management of Dementia in Primary Care Dr R C Barnes Consultant in Old Age Psychiatry Mossley Hill Hospital Liverpool."— Presentation transcript:

1 Management of Dementia in Primary Care Dr R C Barnes Consultant in Old Age Psychiatry Mossley Hill Hospital Liverpool

2 Dementia in Primary Care u Plan for the talk/learning points u General facts about dementia u Dementia in primary care u Care pathway for dementia

3 General facts about Dementia u Most age-related u Clinical diagnosis u Not all are untreatable u Not protective against anything u Make many things more likely u A perpetually changing and fascinating process

4 “Geography” of Dementia u Moderate/severe dementia v ~ 5% of over 65s v ~20% of over 80s u 33% of patients in residential care u 90% of mild dementia live in community u Over 70% of severe dementia

5 Dementia in the Community u Local figures –10% in NHS beds –20% in residential care –20% living alone –50% living with family (mostly spouses) u Dementia is a primary care issue –as you know

6 GPs and Dementia u Little undergraduate teaching u Not much postgraduate teaching u It ’ s a big scary world out there u GPs often first line of call v limited range of responses v inconsistent liaison with staff v limitations of time u Multidisciplinary working

7 A Care Pathway for Dementia u Identifying dementia u Initial assessment u Pre referral workup u Referral u What to expect from your memory service u Subsequent involvement

8 Identifying Dementia u Index of suspicion u Family concerns u Others services –Social services –Police –Pharmacy etc etc etc u Screening

9 Initial Assessment u Establishing a problem –Clinical history –Cognitive assessment u Acute vs chronic u Organic vs functional u Baseline screening

10 Baseline Screening u Bloods –FBC, U&E, LFT, TFT, Bone, B 12 & Folate –Possibly ESR and others as relevant u ECG u Other tests –CXR etc –Probably not

11 Other Pre-Referral Things u Social Services u Carer support u Voluntary services u Other medical opinions u Others u I don ’ t necessarily mind if these aren ’ t done

12 Who to Refer u Everybody? u Certainly –The young –The undiagnosed –The complex –The carer in need –The high risk u Maybe this is, in fact, everybody

13 The Minimal Acceptable Referral u Patients name and address u Contact for informant u A clue … u … that ’ s it really (!) u NB There is not necessarily consensus on this view

14 The Memory Clinic u The function of a memory clinic u Memory clinic controversy u Who to provide the service u What you should expect u What your patients should expect u What the carers should expect

15 A Good Memory Clinic u Easy access u Diagnosis u Drug prescription u Follow up u Community assessments u Specialist professionals in specialist teams u Carer support u Post diagnostic counselling u Continuity of care u Liaison with others u Team working and flexibility u Carers groups/cognitive help groups

16 Memory Clinic Accreditation u Royal College of Psychiatrists u Independent and external u Three year cycle –Annual assessment u High standards u Accreditation u Clinics should be accredited as a minimum

17 On-going Input u When to discharge back to primary care? u Access to re-referral u Open referral u Care navigators u Monitoring change u End of life care


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