1. Do we need a paradigm shift for discussing Power of Attorney with patients? Dr Julia House, Garthdee Medical Group, Aberdeen 2014 Introduction The subject of who will care for us and who to trust are big issues in the last decade of most people’s lives. Unfortunately there is still no cure for dementia and 1:3 of over 65yr olds will develop this disease before death. Of the 5 pillars of care proposed for dementia care, planning for future decision making while struggling with the diagnosis is a difficult area to discuss, both for doctors and patients. At the start of cognitive decline many patient’s feel they are loosing mental and physical control so this is not an easy time to be open to this kind of discussion. The current tool for planning of financial and welfare decisions in the future is the selection and approval of attorneys through the POA system operated by the Office of the Public Guardian I chose to look at how many of our diagnosed dementia patients have documented evidence of POA, how we as GPs felt about discussing the matter and when and how we felt it should be done. Method Searches were run using Vision on the Garthdee patient list for dementia, POA. As these numbers were low, I then looked at next of kin coding and found that POA information had often been added in free text. Docman was checked to see if any copies of the POA had been made. A questionnaire was sent to my partners and PBSGL group asking about who they discussed POA with, whether they always discussed it with their dementia patients, if they felt they had adequate knowledge and tools to do this and if they knew how to check a POA was registered. Results: Evidence of planning for future decision making at Garthdee: Dementia diagnosis 96 Number of over 65yr olds 1430 Dementia diagnosis and registered POA 24 POA with the next of kin details so this number rose to 78 None of the POA documents had been verified. 81% of people with dementia diagnosis had a POA discussion recorded Evidence for how GPs view their role in discussing POA and whether they have the knowledge and tools 50% of GPs had discussed POA with patients whom they were concerned had cognitive decline. This increased when dementia diagnosis made. Only one GP considered discussing POA before any concerns were raised, however the dementia diagnosis rate appears to be lower than expected. Several commented that they felt POA would have been discussed by the psychiatrist and so may not need to do so themselves. Only 30% respondents felt they had adequate knowledge to discuss POA None of the GPs had a leaflet to give out and all would like to have one. Only one GP had ever checked to see if a POA was active. Conclusions: Statistically it seems likely that many people with cognitive decline at Garthdee do not go on to have a diagnosis of dementia. Of those with a formal diagnosis the coding for POA is often not coded and the information has not been verified. It would appear from the questionnaire that GPs do not consider future planning for decision making until a patient is already in their 7 th decade by which time confidence and anxiety about coping may already be compromised. GPs were also unaware of the excellent leaflet available from the OPG and did not have it to hand in consultations. Suggestions for changes to practice:  Families and older people may not be computer literate so paper leaflets should be available to both doctors and patients regarding POA.  GPs might consider making POA discussion or handing out the leaflet as part of health checks and prevention discussions for people in their 40s and 50s, so that is may become as normal as pension planning or considering a statin for raised cholesterol. Learning points from Dementia fellowship Increased confidence around assessing & diagnosing dementia Better understanding of capacity assessment It has given me a framework to help patients and families suffering from this difficult disease It has allowed me to cascade out information to colleagues Better understanding of the effect high function can have on progress of dementia and behavioural difficulties and a framework for dealing with them. I am sorry not to be at the presentation of our projects, but one of the reasons I decided to apply for the fellowship was experience of high function dementia in my own family. I cannot attend today as my mother is currently under detention in an acute dementia unit. I hope that because of attending this course I will be able to improve the path walked by other families in the progress of this disease in their loved ones.