Cumbria Dementia Strategy

Improving Recognition & diagnosis

David Storm- Clinical Lead: Dementia

Memory matters

Why early recognition and diagnosis is important:

• Positive Step- Early recognition can help identify and manage treatable forms of confusion and dementia

• Positive Step- diagnosis enables the person and their family to access advice, information, treatments & interventions and support that can make a difference to their quality of life

• Positive Step- There are many services, treatments & Interventions and supports available to help the person and their family. Some of these can slow down the progression of dementia and help the person continue to live well.

• Modernisation of Memory services across Cumbria

• Enable improved access and greater recognition

Improved early recognition and diagnosis:

• GP/ Primary Care protocol developed to encourage early referral (as part of developing Cumbria Dementia strategy Integrated care pathway)

• Closer working with GPs and practice staff (roll out following pilot of dementia training to practice nurses)

• Integrated approaches with dementia training and screening tool developed for staff in Community services, Community Hospitals with links to Community Memory services

•Memory services developed to offer flexible diagnosis and support irrespective of setting (e.g. clinic based, home based, surgery based)

• Improved information packs

Memory matters

Improving Recognition of Dementia

• At the start of this work 45% people with dementia were known as per GP records

• Current number of people on GP records is now over 3800

• We are now up to 63%

How can we improve this further?

• Support people with memory concerns• Enable them access to diagnosis• Facilitate extra support• Ensure the diagnosis is recorded by the GP• Enhance training for GP Practice Teams• Improve links and support to practices• Improve dementia friendly communities and awareness

Developments in the Pathway

• Primary Care Pathway• Memory Matters Screening Form (3 D’s)• Smoother referral process• Clear work up prior to referral• Closer Liaison with memory services and Dementia

Support– Each practice to have a Link Worker from the Memory

Matters Service

Improving Early Recognition:

• Link worker to work with practice (improve & coordinate referrals where required- enable easy access to memory clinic)

• Link worker able to provide training, advice, information ( GPs, Practice staff etc)

• Link worker provide training on 3D’s screening tool and act as support to use of tool.

• Local Dementia training

• Use of 3 D’s Screening tool in Community Hospitals, Community Nursing, Adult Social Care

Memory matters

What can you do…?

• Recognise early signs of memory problems

• Alert the person, family, supporters

• Encourage understanding and access dementia awareness training

• Reduce unnecessary confusion within environments

• Maintain good lighting etc

Improved early recognition

Memory Matters- Screening Form

GPCOG Screening Test, PHQ-4 & Delirium Screen

Unless specified, each question should only be asked once

1. Examination: Score 1. “I am going to give you a name and address. After I have said it, I want you to repeat it. Remember this name and address because I am going to ask you to tell it to me again in a few minutes: John Brown, 42 West Street, Kensington.” (Allow a maximum of 4 attempts).

2. What is the date? (exact only) correct- 1 incorrect -0

3. Clock Drawing: Ask patient to draw a clock face Please mark in all the numbers to indicate the hours of a clock (correct spacing required)

correct- 1 incorrect -0

Please mark in hands to show 10 minutes past eleven o’clock (11.10) correct- 1 incorrect -0

4. Information: Can you tell me something that happened in the news recently? (Recently = in the last week. If a general answer is given, eg “war”, “lot of rain”, ask for details. Only specific answer scores). correct- 1 incorrect -0

John Brown 42 West Street

5. Recall: What was the name and address I asked you to remember (score one point for each correct answer)

Kensington Total Score: (To get a total score, add the number of items answered correctly- total score out of 9)

If patient scores 9, no significant cognitive impairment and further testing not necessary. If patient scores 5-8, more information required. Proceed with Step 2, informant questionnaire * If patient scores 0-4, cognitive impairment is indicated. Conduct standard investigations consider referral to Memory services

Patient ID Label or RNN number: NHS number: Surname: Forename/s: Date of Birth: 3D’s

screening tool

Memory matters

Working together to improve quality of life for people with dementia

• Developing evidence based services with improved equity in line with Cumbrian Dementia Strategy enabling local variations but improved access to quality services

• Ability to wrap services around natural communities while still ensuring access to specialist interventions

• Training & development key to improving outcomes in all settings

• Quality of life central to improving health and well being

• Services focus on PERSON not illness- supporting person centred care and working in an integrated way to support the person’s changing needs

• Services working together to focus on Family and their well being- not illness in isolation

Memory matters

Further developments:

Improving the environment of care for people with dementia :

Improving closer to home Memory Assessment:

Improvements to Entrances, Reception and Way Finding within Community Hospitals throughout Cumbria- Joint application with Cumbria County Council, ‘ Dementia Friendly Extra Care Housing’ Cumbria County Council

The principles for the project will reflect the King’s Fund overarching design principles for developing supportive Design for People with dementia namely: Legibility, Meaningful Activity, Familiarity, Wayfinding, and Orientation.

Refurbishment of reception, way finding and memory room in 11 sites across Cumbria

Memory matters

References:

• National Institute of Clinical Excellence, (2006) Supporting People with Dementia and their Carers in Health and social Care. NICE Guideline 42. www.NICE.org uk

• National Institute of Clinical Excellence, (2010), Quality standards for Dementia. www.NICE.org uk

• NICE technology (2011) appraisal Donepezil, galantamine, rivastigmine andmemantine for the treatment of Alzheimer’s disease (review) www.nice.org.uk/guidance/TA217

• Dept. of Health (2009) Living well with dementia- a National Dementia Strategy. Dept. of Health London.

• Implementing the National Dementia Strategy –working together to improve life with dementia in Cumbria www.cumbria.gov.uk/adultsocialcare/partnerships/dementiagroup

• Smith S.C., Lamping D.L., Banerjee S., Harwood R., Foley B., Smith P., Cook J.C., Murray J., Prince M., Levin E., Mann A., Knap K. (2005) Measurement of health related quality oif life for people with dementia: development of a new instrument (DEMQOL) and an evaluation of current methodology Health Technology Assessment, Vol 9 Number 10. NHS R&D HTA Programme.