Improving the Care and Support

of People With Dementia

Dr Oliver J CorradoConsultant Geriatrician and

‘Dementia Champion’ Leeds Teaching

Hospitals NHS Trust

Scope of Talk

What is dementia?

Its causes and how common is it?

How is the LTHT helping to improve the detection of dementia?

How can hospitals improve the care of people with dementia

and support their carers

What initiatives is LTHT undertaking?

Dementia Friendly Leeds

Background

• Dementia affects 800,000 people in UK

• 8400 people with dementia in Leeds, will rise to 12000 by 2026

• 20% people aged over 80 have dementia

• 45000 with dementia in UK are aged under 65 years

• 25% of general hospital beds used by people with dementia, longer stay, delayed discharges and readmissions

• Dementia is under recognised and under diagnosed. Only 60% have a formal diagnosis in UK, but improving

LTHT’s Role in Identifying Dementia: the “CQUIN”

• National hospital based ‘screening’ process introduced in 2012 to identify people aged over 75 who may have dementia

• LTHT changed its medical and nursing assessment process

• As a result approx 25 people per month referred to GP/Memory clinic for further assessment

Dementia

NOT a normal part of ageing

Progressive decline in intellectual function severe enough to affect an individual’s personal and social functioning.

Damage to the brain causes brain cells not to work properly which can affect memory, communication, reasoning and decision making.

Dementia and co-morbidity

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

1 2 3 4 5 6 7

Number of long-term conditions (including dementia)

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iagnosis

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in L

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The Goggle Box Question !

Q. “What’s the difference

between Dementia and

Alzheimer’s?”

Steph: A. “Alzheimer’s is worse”

Leon: A. “It’s the same thing”

Causes of Dementia

Alzheimer’s Disease 50%

Vascular Dementia (poor blood flow to brain, as a result of stroke or mini strokes) 20%

Dementia with Lewy Bodies

Frontotemporal dementias

Mixed causes

Prevention

“What’s good for the Heart is Good For The Head”

• No Smoking

• Regular exercise

• Low consumption of alcohol

• Mediterranean style diet

• Socialise

• Keep brain active (learn a second language etc)

• Reduce vascular risk factors (blood pressure,

diabetes, cholesterol, smoking)

Improving the Hospital Care of people with

Dementia and supporting their carers

Sheehan B et al 2009. The care of older people

with dementia in general hospital. J Qual Res Dem

Paraphrased in DH/RCN Guide

“What happens in general hospitals can

have a profound and permanent effect on

individuals with dementia and their

families, not only in terms of inpatient

experience, but ongoing functioning

relationships, wellbeing, quality of life and

fundamental decisions made about their

future”

A Typical Story !

Moderately severe dementia, you develop a urine infection which makes

your confusion worse.

You spend 2 hours on a trolley in A and E and get moved to an

admissions ward. The antibiotic your GP prescribed gives you diarrhoea

and you’re moved into a side ward in case you have infective

gastroenteritis.

After 2 days you are given the all clear and moved back out again

At frequent intervals people come and take blood from you and take your

blood pressure and because they are busy they don’t spend as much

time as they would like explaining what they are going to do.

What effect would that have you?

Improving Dementia Care: Think SPACE !

• Staff who are skilled

• Partnership working with carers

• Assessment and early identification of dementia

• Care plans which are person centred

• Environments which are dementia friendly

Care plans which are person centred and individualised

• Know Who I Am good way of

seeing patient with dementia

as a Person not just a

patient

• Starts engagement process

with carers

• Care plans: support,

information, nutrition,

continence, mobility, risk,

aids and adaptations, carers

needs

Raising Awareness

Schemes to raise

Awareness:

Forget Me Not symbol and

the Butterfly Scheme

Ward staff aware a person

has dementia, how it affects

them and facilitates

communication with, and

about that person

BAME Communities (% population) in Yorks and Humber

Challenges in providing good dementia

care for BAME Communities

Languages and dialects (communication and assessment). No word for dementia in 5 main South Asian languages

Stigmatisation of dementia in some communities, seen as ‘madness’

Poor awareness of available services

Carers wanting help but afraid to seek it

Kings Fund 5 DF Design Key Principles

DF Design Principles

1. Orientation

Artwork, calendars, large face clocks, outside spaces,

local photos, signage, visible staff

2. Wayfinding

Different colours to identify bays, artwork, signage

3. Familiarity

Dining areas, domestic seating, personal items, photos/memory

boxes, domestic crockery, cutlery

4. Meaningful activities

Books and games, drinks and snacks, resting points, social

spaces

5. Legibility

Clear sight lines, no clutter, matt finish, even flooring,

noise reduction

Remember Carers !

• 7 million carers in the UK (1 in 10 people)

• 65% of carers aged 60-94 have health

problems of their own

• Ill health, depression and financial problems

are common

Carers’ Survey

John’s Campaign

Hospital Carer

Support

WorkersHow we can help

We can provide support, information and

advice to carers of people with dementia

within the hospital setting, whether the

cared for person or the carer is the

patient. For example this might be

support around the discharge process,

information about support in the

community, benefits advice or emotional

support.

We can accept referrals from members of

staff or self referrals from carers and we

are very much looking forward to being a

visible presence on the wards.

To make a referral or to find out more

about what we can offer please get in

touch.

The Team!

Lorraine Lumb Jo FosterSJUH LGI

Contact:lorraine.lumb@carersleeds.org.uklorraine.lumb@nhs.net07854481024jo.foster@carersleeds.org.uk0707495263791Or via Carers Leeds Advice Line 0113 380 4300

Better and safer prescribing

• People often come to hospital on lots of medication

• Risk of not taking them or taking too many

• The side effects of medication can make people drowsy or more forgetful

• Avoid anti-psychotic (tranquiliser) drugs

• Hospital good opportunity to review medication, assess need and use devices to improve compliance

End of Life Care (EoL)

“How people die remains in the

memories of those who live on”

Dame Cecily Saunders (founder of Hospice

movement)

People with dementia need good EoL care and

access to palliative/hospice care too

Dementia Friendly Leeds

Dementia Friendly Leeds

YAS Dementia Friendly

Summary

1. Dementia is extremely common and LTHT treats a lot

of patients with dementia

2. LTHT has done a lot to improve the care of people

with dementia and support their carers - but we can

and must do even more