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Welcome to the Dementia online newsfeed. Here you’ll find all the latest research, news stories, policy updates and guidelines. View our other newsfeeds for more subject-specific news.

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Recorded Dementia Diagnoses March 2018

Number of people diagnosed with Dementia according to GP records up to the 31 March 2018

This publication presents at England level: recorded prevalence and how this compares with research based studies at different ages, and how prevalence differs at different ages depending on comorbidity; CCG level: the rate of emergency hospital admissions for dementia per person recorded with a dementia diagnosis.

Key Facts:

  • Recorded dementia prevalence at 31 March 2018 was 0.765 per cent (1 person in 131). When considered alongside monthly data previously collected, this indicates a decrease in recorded prevalence from March 2017 (0.766) to March 2018 (0.765).
  • The number of people over 65 with dementia was estimated to be 645,507. Of these, 67.5 per cent have a coded dementia diagnosis recorded.
  • 9.3 per cent of patients with a recorded dementia diagnosis were prescribed antipsychotic medication in the 6 weeks to 31 March 2018.

Full document available via NHS Digital

When does cognitive decline begin?

Karr, J. E. et al. | When does cognitive decline begin? A systematic review of change point studies on accelerated decline in cognitive and neurological outcomes preceding mild cognitive impairment, dementia, and death |  Psychology and Aging |  Vol 33 (2), 195-218

Abstract:

Older adults who ultimately develop dementia experience accelerated cognitive decline long before diagnosis. A similar acceleration in cognitive decline occurs in the years before death as well.

To evaluate preclinical and terminal cognitive decline, past researchers have incorporated change points in their analyses of longitudinal data, identifying point estimates of how many years prior to diagnosis or death that decline begins to accelerate.

The current systematic review aimed to summarize the published literature on preclinical and terminal change points in relation to mild cognitive impairment (MCI), dementia, and death, identifying the order in which cognitive and neurological outcomes decline and factors that modify the onset and rate of decline.

A systematic search protocol yielded 35 studies, describing 16 longitudinal cohorts, modeling change points for cognitive and neurological outcomes preceding MCI, dementia, or death.

Change points for cognitive abilities ranged from 3–7 years prior to MCI diagnosis, 1–11 years prior to dementia diagnosis, and 3–15 years before death. No sequence of decline was observed preceding MCI or death, but the following sequence was tentatively accepted for Alzheimer’s disease: verbal memory, visuospatial ability, executive functions and fluency, and last, verbal IQ.

Some of the modifiers of the onset and rate of decline examined by previous researchers included gender, education, genetics, neuropathology, and personality. Change point analyses evidence accelerated decline preceding MCI, dementia, and death, but moderators of the onset and rate of decline remain ambiguous due to between-study modeling differences, and coordinated analyses may improve comparability across future studies.

Full detail at American Psychological Association

Multimorbidity: a priority for global health research

This report was undertaken to summarise the existing research evidence about the burden, determinants, prevention, and treatment of multimorbidity | The Academy of Medical Sciences

multi
Image source: acmedsci.ac.uk

The term multimorbidity  refers to the existence of multiple medical conditions in a single individual. For many regions of the world, there is evidence that a substantial, and likely growing, proportion of the adult population is affected by more than one chronic condition.

Health conditions that frequently group together include heart disease, high blood pressure, diabetes, cancer, depression, anxiety, chronic obstructive pulmonary disease (COPD) and chronic kidney disease.  Why this happens is poorly understood, making it difficult to predict which patients may be most in need of preventive or increased care.

The report also highlights how physical conditions, such as type 2 diabetes, can affect mental health, and vice versa. But the division between health services treating mental and physical health often means that patients with physical and mental conditions are at particular risk of poor care.

Full report: Multimorbidity: a priority for global health research | The Academy of Medical Sciences.

See also:

Improving clinical services in the areas of musculoskeletal (MSK), falls, fractures and frailty.

A new guide compiled by the Oxford Academic Health Science Network showcases the extensive range of programmes being delivered by AHSNs to improve clinical services in the areas of musculoskeletal (MSK), falls, fractures and frailty – all key priorities for the NHS 

ahsn
Image source: http://www.oxfordahsn.org/

Across England’s 15 AHSNs there is a wealth of experience and practical skills in working with NHS organisations to improve services in these clinical pathways. Evaluations have shown that they have led to improved patient outcomes and better use of resources.

The new guide, compiled by Alison Gowdy, Clinical Innovation Adoption Manager at Oxford AHSN, with input from all AHSNs, provides a valuable overview of these projects.

It is hoped the guide will help shape discussions with Sustainability and Transformation Partnerships (STPs), commissioners and providers regarding future work to improve services and patient outcomes in these areas, while enabling others to share in learning to help implement and/or build on an existing, proven concept.

Download the guide here

Advance Care Planning for people with dementia

My future wishes: Advance Care Planning (ACP) for people with dementia in all settings | NHS England | Alzheimer’s Society | tide

future wishes
Image source: http://www.england.nhs.uk

The guide provides signposting, information and support for colleagues in health, social and community care settings, around advance care planning for people living with  dementia. It identifies key actions from the point of an initial diagnosis of dementia through to the advanced condition, in order to highlight and prompt best practice irrespective of care setting.

It also considers situations where it has not been possible to initiate an ACP / future wishes conversation early and provides some tips on how to manage this.

The aim of this resource is to help practitioners, providers and health and social care commissioners:

  • create opportunities for people living with dementia to develop an ACP through
    initiating and / or opening up conversations;
  • ensure advance care planning is fully embedded in wider inclusive, personalised care and support planning for dementia;
  • ensure people living with dementia have the same equal opportunities as those
    diagnosed with other life limiting conditions / diseases, in terms of accessing palliative care services / support.

Full document: My future wishes: Advance Care Planning (ACP) for people with dementia in all settings 

Dementia support guide for councils

This publication highlights some notable and innovative practice by councils in supporting people living with dementia after their diagnosis | Local Government Association | Dementia Action Alliance

The guide offers the following Key learning points:

1. Engage with people with dementia. A forum or regular meeting with people with dementia is an excellent way to build self-sustaining networks and help shape services. Local people often don’t have an awareness of all support in the community. Ensure all feedback and actions from the forum are well publicised. By doing this people feel listened to and actions are taken as a consequence.

2. Offer information in a range of ways. Design information in partnership with people with dementia and/or representative organisations.

3. Build a dementia friendly community. Work with local partners in business, health, the voluntary sector and across local authority departments to ensure that your local area is dementia friendly.

4. The ability to work positively in collaboration across partners and establish common goals of practitioners is crucial.

5. It is beneficial to have an awareness of likely demand on service in order to plan effectively.

6. Consistent workforce development is essential for shared understanding and awareness of services across all sectors.

7. People with dementia and their carers are given the opportunity to think about what ‘home’ means and plan for their future housing needs, alongside financial planning.

8. Informal settings are important for delivering information to people who might not naturally identify dementia in themselves or a loved one.

Full document: Dementia Post diagnosis support

Age UK report: ‘Why call it care when nobody cares?’

Age UK |  2018 | Older people and their families tell politicians about the problems they face with care

A new report by Age UK – ‘Why call it care when nobody cares?’ – summarises the results of a series of listening events the charity  held with older people who are receiving care and their family carers earlier this year. 127 people participated in 13 sessions in total, which took place in the North, Midlands and South of England, in urban and rural places, and in more affluent and poorer areas.

Each of the listening events, were hosted by local Age UKs and had two parts:

  • in the first older people and their family carers talked about their personal experiences of care, highlighted the problems they faced and what would make life better;
  • and in the second they discussed various funding proposals and what they would mean for them and their families.

Age UK designed these events to help policymakers understand the real-life issues facing older people in need of care and their family carers in their constituencies, and to provide an opportunity to discuss potential solutions.  There was much commonality in the issues raised, and the same issues featured throughout the country,  showing that the problems facing adult social care are national.

The top five reasons mentioned the most in the sessions:

1. ‘Too many professional carers are in a rush and there’s no continuity

2. ‘Care often it isn’t very good’

3. ‘Social care is very expensive and often not good value for money’

4. ‘We family carers feel abandoned and unsupported by the NHS and social care’

5. ‘The social care system is dysfunctional and navigating it is a nightmare’

Older people suggested possible solutions to these issues:

1. ‘Everyone should contribute in some way’

2. ‘We’re only willing to pay more if we get a better service in return’

3. ‘We want any extra funds that are raised to be ring-fenced for care’

4. ‘We believe we need a new and better contract with family carers in our society’

5. ‘We older people and our families desperately want security’ (Age UK)

The full news piece can be read at Age UK 

You can read the full Age UK report here