27 Awareness, Assessment and Diagnosis for Memory Problems - Limbo Time [Update 2 - 13/11/13]

As the population gets older, the numbers with dementia are growing year by year. It is also likely that current life-style choices are  affecting younger citizens who may not otherwise develop to life with a dementia as they reach any decade over say 60. [Although seniors get dementia, younger persons, say 35 years onwards, may get young onset dementia.]    

England has over 300,000 individuals living with dementia which is not diagnosed. Also, many more persons have memory problems which may have dementia-like symptoms. Nationally as a policy it is recognised that early assessment and diagnosis are important. This post addresses issues surrounding this policy. 

 The West Kent CCG has recently issued a document which says that Sevenoaks has 1840 persons with dementia.
 http://www.e-watch.co/articles.php?viewarticle=4359&UID=4272&viaNL

Please note that the reference to Sevenoaks is likely to mean that part of the Sevenoaks District within the West Kent CCG area, ie roughly 100 square km. 

Awareness and Information
The country needs its people to be able to recognise dementia-like symptoms. The reason is that those with undiagnosed dementia will be encouraged to seek assessment and diagnosis. Where dementia is not the cause of the memory problems appropriate treatment for the condition follows, eg depression, drug abuse.

To this end a million volunteers who are being recruited to become Dementia Friends.  They have attended an awareness and information session about life with dementia and will spread this information to others. 

Preparedness of Health and Care Professionals
About 12 years' ago about 50% of doctors would probably be insufficiently trained to deal with assessment of dementia. Five or six years ago 30% of doctors in London would have said the same. By today many more local surgeries have doctors, practitioner nurses, reception staff  who are alerted respond to those with memory problems. More GPs are able to confidently carry out assessments and have the back up specialists in dementia who are based in local memory clinics. 

Specialist clinical training in assessment for dementia has been commissioned by the local Clinical Commissioning Group and given to doctors. Specialist nurses in dementia are being or will be attached to each of two surgeries.

In North West Kent the Alzheimer's and Dementia Support Services (ADSS), a charity, has devised a digital dementia appraisal package for dementia asssessment by doctors who want to use it.  

Limbo Time

As the local rate of assessments rises and and the diagnostic investigations are carried there may be an unfortunate delay - a person with memory problems may have to wait for the the result. 
In some areas the delay - limbo time - is sometimes as long as three months. Given that the national target is to increase diagnoses from about 45% to 66% Clinical Commissing Groups will need to consider any need to increase resources in memory clinics.

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. 

8 Dementia and a Community's Businesses [Update 4 - 14/12/13]

 If you are the owner or employee of a business, you are likely to have someone in the family or a friend or customer who is living with dementia. About 40 million of our population in England know at least one of the 600,000 or so who have one or more of the dementias.

Businesses are being or will encouraged in dementia friendly communities, eg Swanley, to build on good practice in developing ways of being more supportive of those with dementia, and their carers and families.

Just a short information and awareness session will be enough to create insights into the challenges you, your spouse, partner or another may face as a carer of someone just beginning to live with dementia.

Listed below are some of the matters which have or are being addressed by private, public and third sector businesses. It cannot be exhaustive and merely records findings from focused and casual searches; in some instances a note of changes have been given.

1. Employees who care for a person with dementia is likely to need flexi-time to accommodate the needs of the person living with dementia.
2. Employees who regularly meet members of the public are likely to meet in increasing numbers those with memory problems or a with one of the dementia. Many employees will need to be able to recognise the symptoms of a dementia, and learn to behave in an appropriate manner. In a dementia friendly community opportunities for in-house training are likely to become available. Much will be common sense but some behaviour can be challenging.
3. An employee who develops memory problems may not have dementia but it is pertinent to encourage him or her to seek the advice of their GP. The National Health Service has, under the national Dementia Challange, developed health and care pathways for assessment, diagnosis and the appropriate treatment of those with memory problems.   
4. It is posssible for an employee over say, 30 years of age to develop dementia: although the chance is that the onset will be at a much later age. If diagnosed the capability to continue working in their current position would need to be kept under review. At the same time concerns about about being able to work and so continue to support any family will need to be addressed. 
5. Many organisations are encouraging managers and other staff to become Dementia Friends in the workplace. Early in the formation of a dementia friendly community volunteers are likely to become Dementia Friends or Dementia Friends Champions (DFC). The latter will be able to offer in-house awareness and information sessions for potential Dementia Friends within a local organisation (see Post No 6). 
6. After such an awareness and information as is offered by a DFC a more targetted training might be required for those in certain kinds of business is likely to be more focussed, eg for a retail business, a bank or a public library, than would normally be offered by a Dementia Friend Champion (see Post No 6).
7. Nationally, some of the nations professions, particularly in the health sector, are adopting a strategy on dementia for their members, eg the Chief Fire Officers Association.
8. Similarly, many of the nation's large businesses and organisations have joined the National Dementia Action Alliance which is developing ways in which its members progress the policies and action progammes arising under the 18 objectives of the Dementia Declaration. 
9. At a more local level trends may or are emerging, namely:

• Local branches of the national orgaisations may be expected to adopt practices obtained from their national parent bodies - this is beginning to happen in Swanley
• Local Dementia Action Alliances are developing among county city or town dementia friendly communities
• Where a local Dementia Action Alliance exists it is likely that busineses will take onthe likes of a) staff training to become aware of dementia, b) take up specified training, c) premises are adapted to be more dementia friendly,  etc, then retail and other premises will post a distinctive dementia logo, eg a purple angel, in view of the street etc. 

Post 8A [30.10.13] gives details of the the initiative for the nation's financial institutions to become more dementia friendly.  Profiles 1 to 5 show how businesses and services in Kent around Swanley are meeting the challenges of dementia.