Centre for Research in Geriatric Medicine T HE K NOWLEDGE T RANSLATION P ATHWAY FOR TIMELY D IAGNOSIS OF D EMENTIA Catherine Travers

Centre for Research in Geriatric Medicine PROJECT FOCUS  Service Models  Improving access  Diagnosis of Dementia

Centre for Research in Geriatric Medicine Research Support  Co-Investigators Dr. Melinda Martin-Khan PhD Centre for Research in Geriatric Medicine, The University of Queensland, AUS Dr. David Lie Older Persons Mental Health, Queensland Health, AUS Dr. Catherine Travers PhD Queensland Dementia Training Study Centre (DTSC), Queensland University of Technology, AUS  Financial Support –Dementia Collaborative Research Centre – Early Detection and Prevention

Centre for Research in Geriatric Medicine Background: When …..  Diagnosis of dementia: OPTIONS FOR IDENITFICATION….. –Gene testing –Risk assessment –Early Screening –Case finding –Review of existing symptoms

Centre for Research in Geriatric Medicine Background: Why …..  Diagnosis of Dementia –Protracted process –Challenging to diagnosis in the early stages  Delays can occur because –Lack of recognition of early cognitive decline –Limited understanding of any potential benefits of early recognition of dementia –Delayed access in the diagnostic process

Centre for Research in Geriatric Medicine Background: Why….. Cahill, S., M. Clark, H. O'Connell, B. Lawlor, R. F. Coen and C. Walsh (2008). "The attitudes and practices of general practitioners regarding dementia diagnosis in Ireland." International Journal Of Geriatric Psychiatry 23(7):

Centre for Research in Geriatric Medicine Background: Why….. Armari, E., A. Jarmolowicz and P. K. Panegyres (2013). "The needs of patients with early onset dementia." American Journal Of Alzheimer's Disease And Other Dementias 28(1):

Centre for Research in Geriatric Medicine Background: Policy Recognition…..  International Frameworks for Dementia include:  Public education campaigns to improve public and professional awareness and understanding of dementia  Promotion of early/ timely diagnosis  Increase the workforce to meet the likely increase in demand for services as a result of education  Provide sufficient guidance and support for people with dementia and their carers Travers, C., D. Lie, L. Halliday and M. Martin-Khan (2012). Towards a National Framework for Dementia Prevention, Promotion and Early Intervention: What are the Options? Report for the Dementia Collaborative Research Centre - Prevention, Early Intervention and Risk Reduction (DCRC-EDP). Brisbane, The University of Queensland.

Centre for Research in Geriatric Medicine Background: The need…..  Recognised long gap between when people first seek help and when they finally receive a definitive diagnosis  Focus on improving the support for people who are at the point where they are seeking help

Centre for Research in Geriatric Medicine Aim Identify models of service described in the published literature which focus on improving access to a dementia diagnostic process (usually formal assessment by a specialist or general practitioner)

Centre for Research in Geriatric Medicine Method  LITERATURE SEARCH –Medline, PubMed, Cinahl, Health Source: Nursing Academic Edition –Completed November 2013 –Excluded: Non-English papers, Publications prior to 1990  INCLUSION/EXCLUSION CRITERIA INCLUSIONEXCLUSION Reference to DementiaTreatment of Dementia DiagnosticDiagnostic tool development Focus on implementation related to timing (interventions improving access) Epidemiological studies (describing risk profiles or prevalence) Models of serviceBarriers or Enablers (Patient specific) Older adultsGeneral mental health services

Centre for Research in Geriatric Medicine Method  KEY WORDS –Dementia, and Alzheimer’s Disease (and the dementia sub-types) –Diagnosis (including ‘delayed diagnosis’; ‘early diagnosis’) –Access (‘Health services accessibility’ and ‘Health care access’) –Health Services Research  SEARCH STRATEGY –TWO COMBINATIONS (1) Dementia AND Diagnosis AND Access; (2) Dementia AND Diagnosis AND Health Services Research Either 1 OR 2

Centre for Research in Geriatric Medicine Method

Centre for Research in Geriatric Medicine R ESULTS : E XAMPLES OF M ODELS OF S ERVICE

Centre for Research in Geriatric Medicine Referral to Memory Clinics  LOCATION: NETHERLANDS –Memory clinics moving away from Tertiary teaching hospitals (increased collaboration with regional care organisations) Ramakers, I. H. G. B. and F. R. J. Verhey (2011). "Development of memory clinics in the Netherlands: 1998 to 2009." Aging & Mental Health 15(1): –Usually two or more specialists –Referral required to the memory clinic –Traditional assessment process –Improving Access: Increasing number of clinics

Centre for Research in Geriatric Medicine Referral to Memory Clinics Banerjee, S., R. Willis, D. Matthews, F. Contell, J. Chan and J. Murray (2007). "Improving the quality of care for mild to moderate dementia: an evaluation of the Croydon Memory Service Model." International Journal Of Geriatric Psychiatry 22(8):  LOCATION: ENGLAND –Fast assessment process –Service Model Developed: Croydon Memory Service Model (CMSM) Generic clinical team All individuals, regardless of clinical background can make a diagnosis of dementia Assessment (and care) provided at the patient’s home –Improving Access: Modify memory clinic model

Centre for Research in Geriatric Medicine Referral to Memory Clinics  LOCATION: ENGLAND –Single point of referral for all memory clinics –Focus on low referral areas and provide targeted education –Improved Access: Modification of system Thomas, H. (2010). "Monitoring referrals to mental health services." Nursing Older People 22(1):

Centre for Research in Geriatric Medicine Primary Care Clinic  LOCATION: ENGLAND –Identification at the primary care clinic –Assessment at the clinic –Review by a visiting specialist –Improving Access: Equipping the Primary Care Clinic (GP) to assess; Specialist visit the clinic (monthly) Greaves, I. and D. Jolley (2010). "National Dementia Strategy: well intentioned--but how well founded and how well directed?" The British Journal Of General Practice: The Journal Of The Royal College Of General Practitioners 60(572):

Centre for Research in Geriatric Medicine Education (Publication) Boyd, R. (2013). "Early diagnosis and access to treatment for dementia patients." Nurse Prescribing 11(4):  LOCATION: ENGLAND –Education for Nurse Prescribers –Publication in professional journals –Improving Access: Improving general knowledge

Centre for Research in Geriatric Medicine Education (Pocket Guides) Horvath, K. J., N. Tumosa, S. Thielke, J. Moorer, T. Huh, S. Cooley, S. Craft and T. Burns (2011). "Dissemination strategies: the evolution of learning resources on the evaluation of delirium, dementia, and depression." Gerontology & Geriatrics Education 32(1):  LOCATION: AMERICA –Target group: Primary care practitioners (doctors, nurses) –Pocket guide with information on diagnostic process for dementia and delirium –Evaluation completed –Improving Access: Improving general knowledge

Centre for Research in Geriatric Medicine Conclusion  Agreement that the diagnostic process is challenging  Different approaches to access –Training for primary care physicians –Education for staff –Support for primary care clinics –Improved access to memory clinics –Revised referral model  Clear evidence of recent focus on improving access

Centre for Research in Geriatric Medicine