22 Dementia - Universities, Colleges and Schools [Update 3 - 24/11/13]

Introduction
Managers, teachers and support staff in each of our universities, colleges and schools may need to develop a vision, objectives and a strategy for:    a)  dementia studies, b)  research, and c)  staffing which embraces the developing national scenarios. 

The concerns and issues now arising with increasing awareness and information are likely to embrace some of the following:

• distressed students who are falling behind with their studies - a parent or grandparent has demenia
• distressed employees, governors and others who are caring for a family member living with dementia
• members of staff or mature students who begin to have memory problems or dementia
• a local settlement which is developing a policy of becoming a more dementia friendly community
• pressures from various groups of stakeholders in a particular industry, eg professions, employers and students, which may be facing concerns about dementia
• many kinds of studies where awareness and information about dementia from research are being drawn into curriculum development and delivery, eg design for dementia friendly care settings, buildings and grey and green environments
• pressures for monies to be allocated for new dementia-related research questions
• finally, there may be other like institutions collaborating though their new membership of a Local Dementia Action Alliance.  

24 Inter-generational Activities for those with Dementia - Children and Young Adults [Update 1 - 20/12/13]

Many families, schools, colleges and universities find that their children or students benefit from involvement in appropriately organised:

• being offered awareness and information session (say 60 minutes) so as to become a dementia friend
• in-class studies about dementia 
• learning sessions which involve those living a journey with dementia and /or their carers, eg discussion  
• leisure or recreation sessions,  
• researching, reviewing and presenting findings, eg a book review
• voluntary work. 

Where voluntary work or other inter-actional activities are held the appropriate safeguarding would be needed to protect both students and those with dementia.

As a subject dementia itself might be an appropriate way to develop an understanding, covering: 

• types 
• symtoms 
• stages of life with dementia
• life-style and other causes
• assessment, diagnosis, and clinical treatment
• social and end-of-life care
• the law of mental capacity 
• legal safeguards to provide that the wishes of the individual are observed as far as possible. 

Leisure and recreation activities provide opportunities for the likes of:

• reminiscing 
• inter-generational transfer of skills
• activities involving information and communication technology
• playing games 
• music and dance 
• walking and other exercise.

Voluntary work, subject to age and other constraints, might include:

• assisting in setting up a dementia friendly community or organisation
• assisting in recreational activities in a care home
• assisting in event management.

A school, college or university might consider that a team of staff become a Dementia Friend or a  Dementia Friend Champion. This is  as a good beginning to get a measure of dementia awareness and information. 

Any adult whether a Dementia Friend or not might go on to become a Dementia Friend Champion (DFC). Awareness and information  sessions are conducted by a DFC but it is not necessary to be a Dementia Friend before becominga DFC! 

An 18 year old student might also be encouraged to become a DFC, perhaps having become a dementia friend at primary school or later.

23 Dementia-related changes in Local Authorities [Update 1 - 23/11/13]

Signposts to possible ways for local authorities to become more dementia friendly  are given in this post. With an expected substantial growth in the numbers of those living with dementia, like France in the early 2000s, a national policy for England is evolved, albeit several years later.  

Elements of these policies are likely to increase the work of local authorities. In particular the following:

• Dementia friendly communities -  both settlements and organisations, even industries
• Dementia Friends and Dementia Friends Champions  - residents, business owners, and employees are becoming one of a million “dementia friends”, including “dementia friends champions”.

Local authorities will need develop corporate strategy and objectives to meet the challenge of dementia. Awareness under the national initiatives will increase the rate of diagnoses for greater proportion of those living with dementia, eg from say, 50% to say        66%. If this happens what will the impact be on social care? Dementia friendly communities, dementia friends, carers, and others also induce a need for change.          

          Many departments of local authorities are developing dementia-related policies, including: community safety, highways, planning, public health, revenues, and social care.

         

          Staff induction, training and development opportunities are likely to become more dementia orientated for many in England's local govermnet. They will include: elected members, officers, frontliners, eg meeters and greeters, professionals in departments, and officers in systems which will be available to those with dementia, eg revenues collection.

12 Dementia - Early Decisions, Documents and Action for End of Life

Although some of us will become vulnerable in some way, the matters listed below probably apply to any of us, fit or otherwise. They are for many very difficult matters to even contemplate. They are listed here as being important for those with memory problems or dementia.  Probably not exhaustive, they include:

• Will
• Lasting Power of Attorney for a) property and finance, and  b) health and care 
• Preferred place for any end of life treatment and care
• Decisions for refusal of treatment
• Funeral arrangements 
• Donations of organs and pacemaker, etc
• Family records and history for future generations
• Messages for family members and friends 
• Decisions about distribution of sentimental items
• Declutting of papers, records and chattels
• Trusts and other arrangements for vulnerable members of the family.

Relared posts include Post 12A.

Case Study 1 Kent's Dementia Friendly Communities - Swanley [Update 3 - 28/11/13]

Kent County Council identified 12 priority areas for dementia friendly communities (DFCs). Now we have at least six underway in early stages. Those known to me are Northfleet, Swanley, Westgate, West Malling, Canterbury, Eastry, and Dartford.

The "models" developing are probably different. For instance, in Swanley the approach includes:

• Several months of desk research into the state of play for Swanley (mainly discovered from internet browsing and local literature searching. This resulted in: a) a draft directory of services, b) a rolling diary of events, c) a raft of governmental visions, policies, projects and  programmes and  d) a sense of the dementia journey, stage by stage.
• This blog - which identifies many of the items listed above.
• An invitation to a county-wide meeting convened by KCC's SILK office - which later resulted an intended Swanley DFC being accepted as the third such community in Kent in principle [see Post 1]. 
• With SILK's guidance and action, a First Community Meeting was convened of residents, community groups, local service providers and others. As a result Swanley DFC was underway.
• A   baseline evaluation using several questionnaires and other information is now being esatablished.
• A Panel of Speakers is being created.

At the Second Community Meeting a form of Action Plan was agreed together with a public information and awareness meeting in December.

The intention is that actions should incorporate the stated wishes and needs of those with dementia, their families, and their carers.

21A Dementia - Community Groups finding their Way in a Dementia Friendly Community [Update 1 - 17/11/13]

Your community group will have an "agenda" for your particular mission, objectives, and projects and programmes in the locality. Unless specifically involved, your group will probably not have anything to do with dementia or those living with dementia. Nevertheless some of your members may have memory problems and even dementia, but the latter may not yet be assessed or diagnosed by a doctor or specialist.  

Many members of your group may be personally involved or be affected directly by a person living with dementia - it seems that about 40 million individuals in the UK are so affected.  The latter may be family, friend or neighbour  of someone living with dementia. 

Also, all members of your group are likely to meet someone with memory problems or dementia in the wider community - city, town, village, etc. He or she may be a fellow member who has recently been assessed and then diagnosed

If they have not done so already all groups in the community are likely to become aware of the national movement towards dementia friendly communities. How should the your management committee address any local initiative for a dementia friendly community? What needs to be considered in terms of  your group's policies and practices so as to help your community to become more dementia friendly?

Firstly, as individuals you and other group members, particularly committee members might consider the need to get knowledge and insights into the following:

• An awareness of the difficulties, particularly any stigma, experienced by a person living with dementia
• An awareness of the different types of dementia and their causes or sources

• An awareness / recognition of the symptoms of dementia, particularly certain types of dementia

• A sense of the stages of the life journey of someone living with dementia

• A recognition that about half those with dementia have not been diagnosed, and many with memory problems may not have dementia  

• An understanding that life with dementia is not easy but can go on for a long time, with many skills, activities and so on are maintained

• An understanding that emotions can be retained longer than other facets of life - even say, after recognition and communication has become increasingly difficult. 

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.