Dementia Master Class

Dr Helen MartinDr Harry Allen

Dementia Master ClassIntroductionsObjectives for LES/DES and MasterclassWhy has dementia become such an important

issue?How do we do in Manchester? What are the opportunities?Order of play for today

Objectives for LES and DES

DES: national case finding: Asking those who are at risk if they would like memory review

LES: for those with established diagnosis in Central Manchester

LES: Highlight the potential gaps in care and tailor an approach so your practice can bridge them

Use masterclass and patient review document to support this

Objectives Master ClassConsider our own practice with the help of

learning needs assessment: identify gaps in careUse peer discussion and expert workshops to

help generate a realistic action plan for your practice to improve the care of patients with dementia.

Develop knowledge of clinical and legal issues so you can be a resource in your practice

Consider the needs of your patients for future master class and commissioning decisions

Dementia Master ClassIntroductionsObjectives for LES/DES and MasterclassWhy has dementia become such an important

issue?What are the opportunities? How do we do in

Manchester?Order of play for today

Importance: demographicsand economics

1/20 of older people has dementiaPrevalence 1.3%Central Manchester estimated prevalence 1167Diagnosed 525BAME prevalence rising faster (7-fold in 40y)£19 billion in England25% of hospital beds2/3 of people living in care homes

Importance: National Dementia Strategy

Improve knowledge and reduce fear and stigma

Earlier diagnosis: information support and care

Equal and high quality of care

Diagnosis GapThere is a gap…why?Central Manchester 525/1167= 48%National Dementia Challenge: Increase

diagnosis rate to 66% by 2015Why? Lack of confidence in what can we offer

patients

Opportunities: earlier and timely diagnosis

Diagnosis: gateway to making informed choices‘I would want to know so I can plan ahead’Advanced care planning‘It was too late to get power of attorney by the

time diagnosis was given, which caused problems and financial hardship as we were unable to access Dad’s savings account when he needed a ramp to get outside, and had to use a credit card for expenses which obviously cost more.’

Opportunities: Carer Support

550,000 carers in England£7billion unpaid care In one study of substantial carers, over half the

sample said they were in good health, but General Health Questionnaires (GHQs) indicated that 94% could be identified as having psychiatric disorders;

Problems associated with carer was a contributing factor in 62% of readmissions

Support for carers reduces hospital and residential care admissions

Opportunities: vascular risk factors

Up to 50% have a vascular component20% have predominantly vascular aetiologyBJGP: inequalities in 22/30 QoF measuresEvidence for intervention? NICE guidelines, King’s college review dueLosartan and ACE inhibitorsHyVet study showed that the benefits of treating

hypertension in terms of reduced mortality and stroke were evident at 12months

Opportunities: co-morbidities

Painful Osteoarthritis prevalence is 1/5 (50-59)1/2 of those aged over 80yBMJ 2011: treating agitation with analgesics

resulted in significant improvement, regular NOT prn

VisionHearingDental health

Opportunities: anticipation of problems and risk

Hospital admission reductionCare package can be increasedPredictable outcomes with intercurrent illnessBetter hospital care if identified

Summary of Importance & Opportunities

CommonEstablished dementia often not diagnosed.Earlier diagnosis and high quality care are

national prioritiesBenefits in planning ahead are importantLots of clinical gain for patients and families if

we take a comprehensive view of care.

Today2.00 Helen Martin2.15 Learning Needs Assessment: peer

discussion2.40 Workshop 13.10 Workshop 23.40 Break3.50 Workshop 34.20 Action Plans: small groups4.45 What’s Next

Learning Needs Assessment

DiagnosisCarersBuildingNon clinical staffComprehensive management including end of

lifeManagement of challenging behaviourWhat are your priorities??

Action PlanQualitative review of patients with behaviour

that challengesHow will you prioritize?How will you implement?SMART

SummaryWe only know about half of our patientsWe have a lot to offerSecondary preventionSupporting carersMaintaining independenceReducing admissionsPlanning ahead

What next?Practices will: Facilitate a multi disciplinary team meeting identifying key

areas for improvement Audit the quality of Dementia Care using Patient Review

Template as a guide Undertake a Qualitative review of 5 dementia patients with

BPSD Formulate and implement practice Action Plan Contribute to the agenda for next Master Class Undertake the 1st of two Dementia Patient Reviews