32 Dementia - Driving a Motor Vehicle - a Tough Decision for All [Update 5 - 14/10/14]

Introduction
There is no doubt that for many with living with dementia voluntarily giving up driving a car is a painful decision. In some instances the individual concerned will fight tooth and nail to maintain his or her status quo. A diagnosis of dementia has legal consequences. 

Following Formal Notification of Diagnosis
Diagnosis of dementia does not necessarily mean that the individual has to give up driving. He or she must, however, inform the DVLA of the condition by completing Form CG1 (five pages). Hardcopy or online means are available. [See  https://www.gov.uk/dementia-and-driving ]

The authorities may require the individual to undertake an formal assessment of their driving capability. In Kent we have South East Drive Ability who accept self-referrals and other referrals.[See  http://www.kentcht.nhs.uk/home/our-services/south-east-driveability/driving/ ]

Impact
For the family, friends and principal carer the person's gradual decline in driving capabilities is likely to have become apparent - hopefully without a crisis. However, if the driving is such as to be dangerous, self-reporting is essential: otherwise a family member or carer may need to take action. Normally, the person's GP would be able to advise. [See http://www.webmd.com/alzheimers/news/20100413/when-should-dementia-patients-stop-driving ]

Important questions arise for family members, carers, employers and the person with dementia, namely:

• who makes the decision
• when is the decision imperative
• if no action has been taken and a possible liability in law arises, who is responsible.  

Of course, happenings like the following may occur to anyone who is not paying attention, etc. If a persistent pattern arises concern may be engendered. Typical happenings might include:

• not recognising a familiar place or a turning 
• getting lost on a journey - not reaching the destination on a formerly well known route
• getting lost on a jouney - perhaps a little more serious, is not returning home or to a place of work
• driving the wrong way against the flow of traffic   
• not being able to correctly interpret traffic signs
• an accident involving injury or death - here a prosecution may result. 

Employment

Where an individual's employment involves driving, it is certain that the employer will need to know of a diagnosis of dementia. Reasons will include:

•  the need for an assessment of performance of duties
•  insurance concerns.

It is important that the employer have in place policies for assisting the employee to continue driving, subject to appropriate safety. concerns. 

31 Dementia Research and G8 Conference in London [Update 2 - 11/12/13]

We must hope that making the World a more dementia friendly community must be an outcome of the #G8 Conference which begins in London today. The television coverage has already had the UK Secretary for Health and the Chief Executive Officer of #Alzheimer's Society talking to me this morning. [Please do not be mislead I am watching them talking to the presenter.]  

The #G8 Summit on Dementia is intended to build a global approach to dealing with the various dementias which afflict increasing numbers of us - World population. Hopefully, you, I and many millions more will begin talking about dementia to our family, friends workmates and strangers. Awareness and information needs to increase markedly so that the fears and stigmas surrounding the dementias are mitigated or eliminated (latter is the final scenario).  

I'll try and give you  a few leads to what is being discussed at the G8 Summit as the few days pass.

Research        Expenditure on research on questions arising about dementia seems to be a theme - it was highlighted this morning at breakfast. My understanding is that in the Uk it is severely underfunded at present and that our national dementia strategy has an extra £66 million allocated by 2015 over what was set aside.

29B Dementia - Some of our World's Statistics [Update 3 - 10/12/13]

World's Figures
In April 2012 the World Health Organisation published estimates of current, ie at dates shown, and predicted growth of dementia in the World, ie again at the dates shown.

Current (2012)                35.6 million
Current (2013)                44.0 million*

Future (2012)        In 2030  65.7 million
Future (2013)        In 2030  76.0 million*

Future (2012)        In 2050 115.4 million
Future (2013)        In 2050 135.0 million*

The estimates suggest a rough 20-years doubling of our population who are living with dementia. 

Impact
It is almost certain that each of us will be affected by those with dementia. In different parts of the World in the last eight months or so I have had two friends diagnosed with dementia and two others who seem to have memory problems. The impact on their families has been varied. 

For instance, it is estimated that in the United Kingdom the 800,000 living with dementia who are or are not diagnosed, will have in some way touched the lives of 40 million of us!    

Action Needs for Awareness and Information
You may like to review how different countires are or are planning to deal with the predicted growth. At a basic level an increase in each population's awareness and information about dementia might be needed. 

Each country might, for example, develop a cohort of volunteer grassroot or barefoot providers in different contexts, The volunteers could spread ideas, knowledge, and understanding about practical help for families, carers, and of course those on the dementia journey.

*Note: Figures published by Alzheimer's Society on 4 December 2013  - just before the G8 Dementia Conference in London, starting on 11 December 2013.

29A Dementia Statistics - 1 Diagnosis 2 Cost [Update 1 - 10/12/13]

1       People living with Dementia in England: 

   All                              Diagnosed                        Not diagnosed
670,000                           319,000   (48%)                   351,000

                                Range of Percentages  
                                     
   Highest:  Corby 75%             Lowest: Herefordshire  32.8%

   2      Cost to the Economy

   Estimated cost to the economy:      £23 billion.

29 Dementia - Statistics, Statistics and yet more Statistics

The statistics given in this series of posts are intended to demonstrate the scale of problems for those dealing with dementia.

The posts in the series are likely to need updating frequently. It is intended as a running note of findings from newspapers and other sources. It may contain fortuitous inaccuraties, but attempts will be made to cross-check findings. 

Broadly covering several levels, it will include:

• 29A   International numbers
• 29B   UK and England numbers
• 29C   Kent numbers, and 
• 29D  Sevenoaks District, 
• 29E  Swanley numbers.
• etc.

30 Dementia - Awareness of Possible Memory Problems or Cognitive Decline

Memory problems do not necessarily signpost dementia: depression, accidental brain injury or other conditions may be  the cause. With this in mind, as a start, much of dementia friendliness towards a person with memory difficulties hinges on a family member, friend, neighbour, or another person becoming aware of seeming memory problems. Secondly, a sensitive approach may be needed to encourage a person to seek a professional assessment, usually by their GP.

A key is a basic knowledge and understanding of the main dementias, typical symptoms, and characteristic behaviours associated with memory problems. Typically, this will come from books, the internet, and so on: other sources are to hand. Of the latter, four examples are given in this post.

They are: 

1. An awareness and information session for prospective Dementia Friends - taking about one hour which is delivered by a Dementia Friends Champion
2. Trained staff at a NHS Health Check conducted in the public health staff of the district council (This will be for residents from 40 to 74 years.)
3. Nursing, etc staff at a hospital making a NHS assessment for those over 75 years staying in hospital at least 72 hours
4. Fire service staff following a call for assistance, eg at a fire incident or some other reason. They carry out an on-the-spot assessment of possible cognitve impairment in a person over 60 years - this would be carried out by fire and rescue service staff who are specially trained. 

28 Dementia - Lifestyle Choices, Illnesses and Other Possible Causes of Dementia [Update 3 12/12/13]

This post examines the content of two short pieces on dementia.

Five Life-style Factors
Firstly, I was in the local KCC Library and picked up a recent leaflet promoting the national NHS Health Check Scheme. It highlights the benefits of certain changes to my lifestyle (should I need to change). The purpose is to reduce my risk of developing dementia.  
Briefly, the following are key things that we all might want to do:

• Maintain a certain level of physical activity
• Measure your key biometrics, blood pressure, cholesterol
• Keep any alcohol drinking within certain levels
• Eat to a healthy diet
• Quit smokng. 

The leaflet's messages point to preventing or mitigating my chances of the following:

• diabetes
• heart disease
• kidney disease
• obesity  
• strokes or mini-strokes.

In a sense these checks may be regarded as part of a comprehensive dementia friendly community. For Swanley they are a local public health service programme carried out by the Sevenoaks District Council.  The purpose of these checks is to reduce  health inequalities, in the sense they hope to discover residents who do not visit their doctor regularly or are not registered with NHS GP surgery. 

Causes
Secondly, this weekend when opening my newspaper I found a short newspaper report which looked at possible causes of dementia. It emphasised the prevalence of dementia to be linked to diabetes, and other chronic long term conditions. 

Dementia Populations 
The projections of dementia population growth with, furthermore, increasing numbers of us with these diseases, augers for a gathering pace of those with dementia (see Posts 29, 29A, and 29B). 

Medicines
Another aspect of dementia is some evidence that regularly taking medicines following, for instance, a mini-stroke, may help to prevent or delay dementia. I suppose the jury is out on this one, but hopefully the G8 Dementia Summit induced spurt on research expenditure will enable the veracity or otherwise of this one.