Dementia Master Class Dr Helen Martin Dr Harry Allen
Feb 24, 2016
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