11 TOP TIPS

Improving Dementia Care in Childwall & Belle Vale Neighbourhoods

Think Dementia as a team

• Receptionists• Pharmacists – patients getting confused with

repeat prescriptions• GP – patients presenting (repeatedly) with

bizarre, nonsensical complaints• Relatives or carers expressing concerns• Bank Managers & other unexpected sources

Do the blood tests

• Relevant bloods (QOF) to rule out other treatable causes of cognitive impairment

• ECG – helpful where Donepezil contemplated

Check for Depression

• Can often present as cognitive impairment especially in older patients

• PHQ9• Geriatric Depression questionnaire

Deafness ?

• Check the patient’s ears !

Use Chronic Disease Reviews

• 50% of patients will have vascular dementia rather than Alzheimers

• Consider adding 2 memory questions to chronic disease review

• Practice nurses have more time / are less intimidating than GPs

• Opportunity to improve control of risk factors

New Dementia DESTargeted case finding of patients with:

• Down’s syndrome over age 40• Learning disability over age 50• Cardio-vascular disease over the age 60• Neurological disease

Screen

• 6CIT – on EMIS and validated for use in primary care. Easy to do in a GP or practice nurse consultation

• GPCOG - checks about carer• Clock face test – especially Alzheimers

Refer EARLY

• Don’t be disappointed if patient returned to you with diagnosis of Mild Cognitive Impairment

• 50% of patients will not progress to dementia but 50% will !

• Gerontologists and psychiatrists do not have long waiting lists in Liverpool

Carer

• Early identification of carer’s needs• More likely to feel supported• Less likely to have crisis presentation of

dementia with associated emergency admission

• Forward planning – Lasting Power of Attorney• Time for families to come to terms with

diagnosis

Flag Delirium admissions

• Consider creating ‘At risk of dementia’ register• Look out for dementia appearing on discharge

letter de novo• Check with care home managers and

community matrons for patients with undocumented dementia

• Cleanse data - memory loss or dementia ?

End of Life Care plans

• Working with Community Matrons and Dr Becky Bancroft

• Patient and family prepared• Avoids unwanted unnecessary admissions• Peaceful death at home