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.

26 Dementia - Living at Home Alone [Update 1 - 07/12/13]

Living at home alone is often difficult and lonely for a person with dementia.  Life could be easier, safer and more enjoyable if he or she had visitors, help and advice. A better life is much less likely for the many who are not assessed or diagnosed. For the latter changes will often come about after a crisis - a serious illness, an accident, or when other type of emergency arises, eg the person is lost and found by the emergency services. 

From then any assessment will, on referral, be followed by diagnosis of a dementia (if that is the case). As a result in a care pathway is likely to be established. Hopefully, if this is the person's wish this will be at home but his or her destination may well be in a dementia care home.    

Where the diagnosis and appropriate treatment results in life at home changes which could result in adaptations and improvements to make life easier, safer and less stressful. So called assistive technology covers many devices and systems used by local organisations. For instance, the fire and rescue service may fit fire safety equipment. Many homes are fitted with water mist sprinklers - so reducing the impact of a fire caused by the person with dementia not remembering that a cooker is on and a pan catches fire.  

25 Dementia - Planning, Development, and Building for Homes and Care Settings {Update 1 - 09/12/13]

Dementia is at the forefront of the health and social professions policy concerns at the moment. However, this post signposts some of the concerns for entrepreneurs and professionals in property and building industries which will arise from the ever-formulating national strategy for dementia.

In some areas some of the spin-offs from the National Declaration include calls for:

• increased assessment, diagnosis and treatment of those who may have dementia, say, some 300,000 as yet not so diagnosed
• emphasis on those living with a dementia residing their home  
• adaptation of dementia wards and care homes to make them more dementia friendly
• dementia friendly improvements and changes in residences for a) fire safety, b) falls safety, c) retro-decoration, d) retro-furnishing, and e) assistive tecnology 
• planning applications for homes, care homes and other care settings suitable for those with dementia.  

Kent County Council are preparing advisory documentation for developments which involve aspects of dementia in project proposals. 

Details are awaited but I would expect the report to include concerns for:

• housing - both social and private sector developments
• developments for dementia care settings, eg care homes. 

Also, given the pending growth in neighbourhood planning it might be timely to include advice on making townscapes, green infrastructure, etc more dementia friendly.

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.