Dementia

1. Dementia Produced by Wessex LMCs in partnership with: Wessex AHSN Dr Nicola Decker, GP Alzheimer’s Society

2. This is designed as an interactive session to use in general practice to increase the understanding of a condition that affects many of your patients and has a significant impact on their family.

3. Dementia What is it? How common is it? What are the usual symptoms and signs?

4. Dementia – what is it? This is a term used to cover a number of conditions The term dementia describes a set of symptoms including memory loss, mood changes, and problems with communicating and reasoning. Dementia is not part of growing old. It is caused by diseases of the brain, the most common being Alzheimer's.

5. Dementia • Two common forms: • Alzheimer’s disease (60%) • Vascular dementia (20%) • Mixed picture (10%)

6. Alzheimer’s disease • Most common cause of dementia. • A physical disease affecting the brain. • Protein 'plaques' and 'tangles' develop in the structure of the brain, leading to the death of brain cells (often in the temporal lobe). • It also leads to a shortage of some important chemicals in the brain. • Over time more parts of the brain are damaged and the symptoms become more severe.

7. Vascular dementia • The second most common form of dementia. • Caused by problems in the supply of blood to the brain due to damage to the vascular system (the network of blood vessels). • Damage to the vascular system could be caused by strokes, high blood pressure, heart problems, high cholesterol and diabetes.

8. FEELINGS THINKING LOGIC REASONING ACTION BEHAVIOUR X

9. Dementia - how common is it? Two thirds of people with dementia are women One in three people over 65 will develop dementia In the UK 800,000 people are known to have dementia Dementia is most common in older people but younger people (under 65) can get it too. 40-64 years: 1 in 1,400 65-69 years: 1 in 100 70-79 years: 1 in 25 80+ years: 1 in 6

10. Symptoms and signs • Dementia affects different people in different ways • Difficulty in remembering recent event but can recall things from the past • Finding it hard to follow conversations or programmes on TV • Forgetting the names of friends or everyday objects • Repeating yourself or losing the thread of what you are saying • Problems with reasoning • Confused even when in a familiar environment • A decline in the ability to talk, read or write

11. Common symptoms • Memory loss • Common early symptom • Mood swings • Inability to follow a conversation

12. Common symptoms Disorientation in time and space Change in personality or behaviours This may cause a problem for family and carers

13. Common symptoms Difficulty with everyday tasks Poor judgement Misplacing things

14. Visual Difficulties • Hallucinations: an experience of something that is not really there. They can occur for all the senses, though visual hallucinations are the most common • Visual Misperception: when the individual mistakes something for something else for example…

15. This mirror at the loo entrance has caused residents to leave, thinking it was occupied although the persons were seeing their own reflections.

16. This carpet in a Dementia unit was mistaken for a pond with goldfish & lilies... a

17. The lift looks like a corridor to somewhere

18. A lady says “there’s a mouse in the bin”

19. Does this floor look slippery,wet or confusing?

20. Common symptoms Loss of initiative Loss of interest in hobbies Problem with words Wandering

21. Perceptions of what life is like for people with dementia… • 58% thought quality of life was fairly bad or very bad • 52% thought that care provided was fairly bad or very bad • 61% thought inclusion in communities was fairly bad or very bad YouGov survey 2011

22. People with dementia feel that their community could help by: • Better understanding of dementia and less social stigma • More public awareness of the condition • More local activities and opportunities to socialise • More tolerance and patience from others • More community spirit Source: Alzheimer’s Society Dementia 2012 Report

23. What is a Dementia Friendly Community? Where the greatest number of people: • can live a good life • can live independently and be part of their community • are met with understanding and given support when needed

24. NHS Commitment to raising awareness Awareness – understanding symptoms, recognising signs, challenging behaviour; Knowledge of the condition – types of dementia, differences between dementia, delirium, depression etc Communications, listening skills and supporting people with dementia; Person centred care – sign posting to advice and guidance, medication, ethics, impact on families.

25. ‘ Suffering’from dementia • Culture change • Society • Doctors • NHS …………to ‘living well’with dementia

26. What do you think are the main risk factors?

27. Risk factors for developing dementia Age Poor physical health Poor diet Smoking Excess alcohol Lack of physical exercise Genetics Learning disabilities

28. Modifiable Risk Factors

29. Diagnosis – the earlier the better Only 1/3 of people with dementia have a proper diagnosis. Early diagnosis means that: There is more time to plan ahead and support self management The carer is able to cope for longer The need for placement of the patient away from their home is delayed

30. What can we do? Become “dementia friends” (see ’Video about dementia friends’ if access to the internet is available) Support national campaigns Become a ‘Dementia Friendly Practice’

31. Our role as a dementia friendly practice Maximise health and well-being and help people to remain independent Improve patient and carer experience Improve teamwork Improve clinical consultations – better prescribing & improved referrals Improved care planning for the future Improved quality of life for our patients Know & be able to sign post patients to available services

32. Becoming a………Dementia Friendly Practice

39. Where can you find more information? • www.alzheimers.org.uk • www.dementia.org.uk. • www.dementiafriends.org.uk • www.scie.org.uk (e-learning)

40. So………… What do we want to do as a practice?