1. Dementia Master Class Dr Helen Martin Dr Harry Allen

2. Dementia Master Class Introductions 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

3. 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

4. Objectives Master Class Consider 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

5. Dementia Master Class Introductions 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

6. Importance: demographics and 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

7. Importance: National Dementia Strategy Improve knowledge and reduce fear and stigma Earlier diagnosis: information support and care Equal and high quality of care

8. Diagnosis Gap There 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

9. 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.’

10. 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

11. 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

12. 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

13. Opportunities: anticipation of problems and risk Hospital admission reduction Care package can be increased Predictable outcomes with intercurrent illness Better hospital care if identified

14. 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.

15. Today 2.00 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

16. Learning Needs Assessment Diagnosis Carers Building Non clinical staff Comprehensive management including end of life Management of challenging behaviour What are your priorities??

17. Action Plan Qualitative review of patients with behaviour that challenges How will you prioritize? How will you implement? SMART

18. Summary We only know about half of our patients We have a lot to offer Secondary prevention Supporting carers Maintaining independence Reducing admissions Planning ahead

19. 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 1 st of two Dementia Patient Reviews