Aileen Jackson
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Transcript of Aileen Jackson
DeAR-GP Dementia Assessment Referral to GP
for Care and Nursing Homes
Aileen Jackson – Senior Project Manager
Health Innovation Network
The Health Innovation Network is the
Academic Health Science Network
(AHSN) for South London, one of 15
AHSNs across England.
We connect academics, NHS
commissioners and providers, local
authorities, patients and patient groups,
and industry in order to accelerate the
spread and adoption of innovations and
best practice, using evidence-based
research across large populations.
Working as catalysts of change across
health and social care economies,
we enable health improvements and
economic growth.
Population
3 Million
Healthcare
Workforce of
60,000+
55Member
Organisations
12South London
Boroughs & CCGs
Rationale
75% - 89% of Care home residents have dementia;
many of these are undiagnosed. Lithgow, Jackson & Browne 012http://onlinelibrary.wiley.com/doi/10.1002/gps.2784/abstract
Stewart et al 2014 http://ageing.oxfordjournals.org/content/43/4/562)
Why diagnose?
Ability to care plan and case
manage properly
Better understanding of unmet need
Facilitates staff to interpret signs, symptoms, behaviours
Access post diagnostic support (eg. ‘Care Home Intervention Teams’)
Reduced acute sector admissions; lower length of stay
Human right
Focus groups with care workers
• Focus groups in four
care homes
• What do care workers
think about dementia
and dementia case-
finding?
• Can care workers use a
dementia case-finding
tool to identify residents
who are subsequently
diagnosed with
dementia?
Good knowledge of the signs
and symptoms of dementia
Positive and caring attitude to
those with dementia
Belief that dementia case-
finding should fall under the role
of the care worker as care
workers know the resident well
and can spot the signs
Had opinions on each of the
case-finding tools shown
Empowering Care Workers
To diagnose, the GP is the one
but to notice, those that are
close to him, the relatives or
the carer workers or the
nurses.
Design requirements of the tool
Uncomplicated and straight-forward
Accessible to people with English as a second language
Recognisable and easy to follow
Paper based
Opted for shortest cognitive test (AMT-4)
Include an ‘observational’ chart for context
The finished product
Referral
letter to
GP on
reverse
side
Results
Care Workers Feedback
‘We realised that the tool
was simple and something
that we could do without
needing lots of training’
We knew residents who we
thought had dementia but they
were not diagnosed’
It was easy for us to use the tool
with residents because they
knew us and were familiar with
us’
Roll out in South London
2015-16
Funding from Health Education
England to train 40 care homes in
Barbara’s Story and DeAR-GP
2016-17
Funding from London Dementia
Strategic Clinical Network to train 17
care homes in South London and
spread to North London
Free to download at www.dear-gp.org
Support for GPs
DiADeM – Diagnosis of Advanced
Dementia Mandate in Care Homes Protocol to support GPs to diagnose people with advanced dementia
Designed to be used only with people living with advanced dementia in
care homes
Five simple criteria
If all criteria are met, GP assured that s/he has a mandate to diagnose
dementia
http://www.yhscn.nhs.uk/mental-health-clinic/Dementia/care-
settings/CareHomes.php
Spreading beyond South London
• Endorsed by Alistair Burns
• Supported by the Alzheimer’s Society
• Article in the Nursing Standard (2016)
• Article in Nursing Older People (2016)
• New care models framework for Enhanced Health In Care Homes (2016)