1. 11 TOP TIPS Improving Dementia Care in Childwall & Belle Vale Neighbourhoods

2. Think Dementia as a team Receptionists Pharmacists – patients getting confused with repeat prescriptions GP – patients presenting (repeatedly) with bizarre, nonsensical complaints Relatives or carers expressing concerns Bank Managers & other unexpected sources

3. Do the blood tests Relevant bloods (QOF) to rule out other treatable causes of cognitive impairment ECG – helpful where Donepezil contemplated

4. Check for Depression Can often present as cognitive impairment especially in older patients PHQ9 Geriatric Depression questionnaire

5. Deafness ? Check the patient’s ears !

6. Use Chronic Disease Reviews 50% of patients will have vascular dementia rather than Alzheimers Consider adding 2 memory questions to chronic disease review Practice nurses have more time / are less intimidating than GPs Opportunity to improve control of risk factors

7. New Dementia DES Targeted case finding of patients with: Down’s syndrome over age 40 Learning disability over age 50 Cardio-vascular disease over the age 60 Neurological disease

8. Screen 6CIT – on EMIS and validated for use in primary care. Easy to do in a GP or practice nurse consultation GPCOG - checks about carer Clock face test – especially Alzheimers

9. Refer EARLY Don’t be disappointed if patient returned to you with diagnosis of Mild Cognitive Impairment 50% of patients will not progress to dementia but 50% will ! Gerontologists and psychiatrists do not have long waiting lists in Liverpool

10. Carer Early identification of carer’s needs More likely to feel supported Less likely to have crisis presentation of dementia with associated emergency admission Forward planning – Lasting Power of Attorney Time for families to come to terms with diagnosis

11. Flag Delirium admissions Consider creating ‘At risk of dementia’ register Look out for dementia appearing on discharge letter de novo Check with care home managers and community matrons for patients with undocumented dementia Cleanse data - memory loss or dementia ?

12. End of Life Care plans Working with Community Matrons and Dr Becky Bancroft Patient and family prepared Avoids unwanted unnecessary admissions Peaceful death at home