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11 TOP TIPS

11 TOP TIPS. Improving Dementia Care in Childwall & Belle Vale N eighbourhoods. Think Dementia as a team. Receptionists Pharmacists – patients getting confused with repeat prescriptions GP – patients presenting (repeatedly) with bizarre, nonsensical complaints

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11 TOP TIPS

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  1. 11 TOP TIPS Improving Dementia Care in Childwall & Belle Vale Neighbourhoods

  2. Think Dementia as a team • Receptionists • Pharmacists – patients getting confused with repeat prescriptions • GP – patients presenting (repeatedly) with bizarre, nonsensical complaints • Relatives or carers expressing concerns • Bank Managers & other unexpected sources

  3. Do the blood tests • Relevant bloods (QOF) to rule out other treatable causes of cognitive impairment • ECG – helpful where Donepezil contemplated

  4. Check for Depression • Can often present as cognitive impairment especially in older patients • PHQ9 • Geriatric Depression questionnaire

  5. Deafness ? • Check the patient’s ears !

  6. Use Chronic Disease Reviews • 50% of patients will have vascular dementia rather than Alzheimers • Consider adding 2 memory questions to chronic disease review • Practice nurses have more time / are less intimidating than GPs • Opportunity to improve control of risk factors

  7. New Dementia DES Targeted case finding of patients with: • Down’s syndrome over age 40 • Learning disability over age 50 • Cardio-vascular disease over the age 60 • Neurological disease

  8. Screen • 6CIT – on EMIS and validated for use in primary care. Easy to do in a GP or practice nurse consultation • GPCOG - checks about carer • Clock face test – especially Alzheimers

  9. Refer EARLY • Don’t be disappointed if patient returned to you with diagnosis of Mild Cognitive Impairment • 50% of patients will not progress to dementia but 50% will ! • Gerontologists and psychiatrists do not have long waiting lists in Liverpool

  10. Carer • Early identification of carer’s needs • More likely to feel supported • Less likely to have crisis presentation of dementia with associated emergency admission • Forward planning – Lasting Power of Attorney • Time for families to come to terms with diagnosis

  11. Flag Delirium admissions • Consider creating ‘At risk of dementia’ register • Look out for dementia appearing on discharge letter de novo • Check with care home managers and community matrons for patients with undocumented dementia • Cleanse data - memory loss or dementia ?

  12. End of Life Care plans • Working with Community Matrons and Dr Becky Bancroft • Patient and family prepared • Avoids unwanted unnecessary admissions • Peaceful death at home

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