Update on Dementia Care in Scotland Shubha Moses- Senior Dietitian January 2013

Dementia in Scotland- Everyone’s business Currently, approx 84,000 people have Dementia in Scotland, 3,500 of whom are under the age of 65 (Alz Scot 2012) The number of people with dementia in Scotland is expected to rise to 164, 000 by 2036 (Alz Scot 2011). 1 in 4 of all general hospital beds in the UK are occupied by a person over 65yrs who has dementia (Alz Society 2009) Of those older people in acute wards only 20% with dementia had been diagnosed before admission.

Types of dementia- Alzheimer’s CJD Alcohol Related AIDs related Vascular Lewy Body Frontal lobe dementia e.g. Picks Dementia is a progressive & terminal condition, however it is possible to live having a good QOL.

Common Symptoms of Dementia Memory loss Communication (dysphasia/aphasia) Carrying out tasks (dypraxia/apraxia) Concentration Recognition (agnosia) Orientation Perception/ Visuo-spatial difficulties/Hallucinations Psychological changes

The 3 D’s- Dementia, Depression & Delirium THINK DELIRIUM! People who have delirium will either also have an underlying Dementia or have increased risk of developing Dementia Common if aged >65 and acute illness/surgery/change in drugs SQiD- Single Question in Delirium- Do you think X has been more confused lately? (Sands et al 2010)

National Drivers Scottish Dementia Strategy June 2010- (key actions to improve knowledge & skills of staff working with people with dementia & their families) In June 2011 ‘Promoting Excellence Framework’ & ‘Standards of Care for Dementia in Scotland’ was produced by NES (NHS Education for Scotland) & SSSC (Scotland Social Services Council) to support the implementation of the educational actions

SPACE- supporting good dementia care (www.rcn.org.uk/dementia) Staff who are skilled & have time to care Partnership working with carers Assessment and early identification Care that is individualised Environment that are dementia friendly The main therapeutic intervention for dementia is human care & treatment

Staff Education and Training- NHS HIS priority Scottish Governments Promoting Excellence: a framework for all health and social services staff working with people with dementia, their families and carers NES Dementia Care in Acute General Hospital Settings Learning Resource NHS Learn pro module on Dementia The Dementia Services Development Centre, Univ of Stirling Dementia Champion programme provided by NES, SSSC, Alz Scot & UWS. 2011/12- 100 places & 2012/13- 200 places for Acute staff.

The Dementia Champion programme- 5 study days over 5 months 1) Intro to course & its aim 2) Person centred screening and assessment 3) The Hosp environment & Fundamentals of care 4) Communication, stress & distress 5) Planning for discharge Person centred care Vulnerability issues & working with carers Legislative framework End of life care Ending the programme & moving forwards

Work based tasks/assignments Activity Written Work Community Reflection Arrange & attend a community placement A reflective account of experience Clinical Evaluation & Action planning Carry out an evaluation of own clinical area, using the Supp Change workbook. Identify and prioritise key areas of need. Report of activities Change Assignment Plan & carry out changes/actions to take place. Evaluate work done so far.

Role of Dementia Champion- Supporting the person with dementia in an Acute setting Model a positive, confident and non-discriminatory attitude to people with dementia and their carers when talking to and working alongside all your health and social care colleagues. Apply and actively promote the Carter of Rights for people with dementia and their carers in Scotland in your day to day work. Challenge all negative and discriminatory care, expressions and systems in a manner which encourages growth and positive change. Develop educational activities tailored to your area of clinical responsibility which disseminates what you have learnt on the Dementia Champions programme. Have an understanding of the needs of the people with dementia in your area of responsibility and support the team to ensure each person with dementia receives evidence based care and where all risks associate with being in hospital are managed assertively. Introduce yourself and your role to all carers of people with dementia in your clinical area. Seek ways to develop partnership working between carers and staff in your clinical area. Develop, implement and review a change management plan with your clinical team with the aim of improving the experience of people with dementia in your clinical area.

2) Partnership working- Meeting the needs of family and carer 3) Assessment and Early identification- Tools used in Lothian- -AMT 4 (referral for specialist diagnostic assessment by Psychiatrist), -4AT, -NHS Lothian Principles and Procedure of care Management for adult patients (16+) with cognitive impairment within a generic hospital setting, -Doloplus -2 pain tool, -Challenging Behaviour Assessment , -Management guidelines for the agitated and wandering Patient. -SIGN 86 Management of patients with Dementia - (www.sign.ac.uk)- - MUST

4) Care that is individualised- patient centred care plan 4) Care that is individualised- patient centred care plan. -‘This is me’ document, - Involve family/carers in care planning, - Use tools such as MUST, Mental capacity assessment, Anticipatory care planning, Falls risk tool, Pain assessment - Provide appropriate activity such as TAP, - Availability of Dementia specialist Leads, - Access to and availability of Palliative care 5) Environment that is dementia friendly- - Minimal movements - Appropriate lighting & floor coverings - Personalised bed area - Availability of staff to support rehab e.g. memory prompts, assistive technology (software digital e.g. react2.com, apps for iphone/ipads), alternative comm tools, flexible approach

The 8 Pillar models of support in the community for Dementia- Alz Scot 2012

Watch this space……. Solvenaid- ONS by Nutricia ODE- wellbeing product to reawaken appetite & improve oral intake (www.myode.org) New digital diagnosis systems combining computer based tests &MRI brain scans

Any Questions?