20 Dementia in Kent - Facing the Moving Target - Need for Dementia Friendly Communities [Update 2 - 28/11/13]

Kent has been developing or refreshing policies and practices for those with dementia. The number of dementia friendly communities is now six, namely  

• Westgate
• Northfleet
• Swanley - in Sevenoaks District
• West Malling - in Tunbridge and West Malling District
• Canterbury
• Eastry.

Each place is developing in its own manner with with guiding hands of the Project Officer for Dementia Friendly Communities (in the Kent County Council SILK office). What is the nature of the task for Kent?

Diagnosis of those with dementia in Kent is improving and stands at about 30,000. Nevertheless the prevalence of those diagnosed with dementia is less than 50% (but probably higher than 45%). It seems that some individual General Practices have rates of diagnosis as high as 70%. Dartford Gravesham and Swanley Clinical Commissioning Group have, it is understood,  a rate of 51% and a target of 66% by 2015!

Commissioning and developmental policies in the area of the DGS CCG have included:

• training of GPs (those primary care doctors' surgeries) in assessment of those with memory problems
• specialist dementia nurses appointed to cover two surgeries in a community
• application of the NICE dementia protocol
• shared development of the volunteer Dementia Buddy Scheme at Darent Valley hospital
• shared development of the upgrading of dementia care settings in hospitals and care homes
• specialist dementia nurses appointed to liaise with staff at the Ellenor Lions Hospice
• assessment for memory problems or dementia  of all patients (aged 75 and over) admitted to hospital for at least 72 hours.   

All this suggests that increasing numbers of residents with dementia will be diagnosed, but the target is moving. The natural growth in the the numbers of those in each of the 10 year-cohorts of residents over the age of 65 years means greater numbers of those diagnosed with dementia! The demand for social care, including end-of-life care will increase. One reason for dementia friendly communities lies in this growth "vector".

Those with dementia tend to have relatively more acute injuries and illnesses which arise from the nature of their symptoms. Once in hospital they tend to stay longer and are relatively challenging patients - again because of their symptoms.

Dementia friendly communities might address these issues in several ways:

• greater friendliness usually means less stress, etc and greater help when those with dementia are out and about in busy streets and business premises
• greater friendliness usually means everyday transactions are easier to handle for those with dementia
• greater friendliness usually means more opportunities for leisure and relaxation for carers as well as those with dementia
• greater friendliness usually means that homes, care settings, other buildings and green and town or village environments are adapted or designed to be helpful to those with dementia.   

Finally, a successful dementia friendly community comes about because residents, visitors, health and social care workers, businesses and others take the trouble to find out what those with dementia:

• say they need, 
• say they want to do,
• say they have decided / chosen X or Y or Z. 

Profile 1A Dementia Services at Darent Valley Hospital (DVH) [Update 1 - 28.10.13]

See also Profile No1[25.10.13] for a brief description of Darenth Valley Hospital (DVH).

The prevalence of dementia in the area of the NHS Dartford, Gravesham and Swanley Clinical Commissioning Group (CCG) is now about 51% - some 49% of those living with dementia are, therefore, not currently diagnosed.  In line with national diagnosis standards the CCG has commissioned services so that the rate is targetted to rise to about 66% by 2015.

All this is important since those living with dementia who may be expected to go to DVH are likely to increase in the immediately foreseable future. They will be going fort the following reasons:

• a non-dementia related crisis in their health 
• a routine consultations with a consultant on health matters which are non-dementia related
• a person with memory problems who may be referred to the hospital's memory clinic after assessment by say, their GP
• after an event where a person has been found lost, they may be taken to the memory clinic at the hospital 
• after an event where a person has been found lost - wandering - they may be taken to the memory clinic at the hospital or, temporarily, to the secure unit for an assessment, etc 

In addition it may be noted that any patient over the age of 75 who is admitted for more than 72 hours will normally be assessed for memory problems. If the possibility of dementia should be indicated, he or she will be referred for diagnosis.

[The Dementia Buddy programme of volunteers at DVH is an important developoment which is being rolled out to other hospitals in Kent (see Post 13) when published shortly)].  

Profile 1 Darent Valley Hospital - Dementia Care Settings, Services and Staff [Update 1 - 18/11/13]

Related Posts
Profile 1A for dementia-related matters for admittance at Darent Valley Hospital (DVH).
Profile 1B  for the volunteer Buddy Scheme at DVH.

Introduction
DVH is the principal hospital within the area of Dartford, Gravesham Swanley Clinical Commissioning Group (DGSCCG). Most of the population living in Swanley are likely to be admitted there.

Numbers
The number of people with diagnosed dementia in the area of the DSGCCG is 1256 (July 2013), which means there are likely to be another 1200 or so who are not diagnosed. (The latter are more likely to require admission to DVH as a result of a crisis.)

Patients with dementia who are admitted to hospital with non-related conditions, eg a stroke, or following a severe injury in dementia- related crisis, eg a fall, will be cared for in the specialist ward for the illness or a dementia ward.

Accommodation
DVH has specialist units for dementia, including:

• several  dementia wards
• a memory clinic for those with memory problem - providing assessment, diagnosis and, if appropriate, treatment 
• a secure unit temporary admission for those who may harm themselves or other treatment.

The dementia wards and other care facilitities have been or are being redesigned and redecorated to make them more dementia friendly. This initiative is in line with policy and funding under the national Dementia Declaration (see Post No 5).

Key Staff

In the last few years personnel concerned with the treatment and care of those living with dementia at DVH have been appointed, or further trained and developed. The key staff for dementia include:

• consultants
• nurses, at least one of whom is a specialist dementia nurse 
• a group of volunteers known as "Dementia Buddies"
• NHS who have become Dementia Champions (seemingly a different role to that of Dementia Friends Champions) .

DGSCCG (July 2013) Dementia - The forgotten disease, DGSCCG