Early identification of dementia in secondary care

Eyes on Evidence, February 2016.

A Cochrane review reported that the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) test could be used to identify risk of dementia in older people presenting to secondary care, although this tool was less effective in specialist memory settings than in general hospital settings.

image source: http://onlinelibrary.wiley.com/

Read more here

Full reference: Harrison et al. 2015 Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) for the diagnosis of dementia within a secondary care setting

On the Influence of Primary Care Quality Upon Hospital Admissions by People with Dementia in England: Exploring the Limits of Intervention (CHE / PloS One / BMJ)

Dementia and Elderly Care News


A recent study by the Centre for Health Economics (CHE) found that GP practices which review their dementia patients as part of Quality and Outcomes Framework (QOF) tend to have relatively fewer emergency hospital admissions by persons with dementia. There was a shorter average length of hospital stay for people with dementia discharged to community.

The impacts of QOF were relatively modest however, according to this briefing on the impact of the quality of dementia care upon the interface between primary and secondary care (i.e. concerning the practical scope for reducing hospital admissions, avoidable re-admissions, length of stay etc).

Executive Summary


Higher quality dementia care. York: Centre for Health Economics (University of York), January 28th 2016.

This relates to an earlier article:

Full Text Link


Kasteridis, P. Mason, AR. [and] Goddard, MK. [et al] (2015). The influence of primary care quality on hospital admissions for people…

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Views from health professionals on accessing rehabilitation for people with dementia following a hip fracture

Stephen T Isbel & Maggie I Jamieson. Dementia: February 2, 2016


rehabThe literature reports that rehabilitation for elderly patients with mild-to-moderate dementia who have a hip fracture improves functional outcomes. However, access to rehabilitation may be difficult due to misconceptions about the ability of these patients to engage in and benefit from rehabilitation. Additionally, people who are admitted from residential care may not have the same options for rehabilitation as those admitted from home.

This study sought to understand from expert clinicians how and why decisions are made to accept a person with dementia post-fracture for rehabilitation. In this Australian-based qualitative study, 12 health professionals across a state and territory were interviewed. These clinicians were the primary decision makers in accepting or rejecting elderly patients with dementia post-fracture into rehabilitation.

Three key themes emerged from the data: criteria for accessing rehabilitation, what works well and challenges to rehabilitation. The participants were unanimous in the view that access to rehabilitation should be based on the ability of the patient to engage in a rehabilitation programme and not assessed solely on cognition. In terms of clinical care, a coherent rehabilitation pathway with integration of geriatric and ortho-geriatric services was reported as ideal. Challenges remain, importantly, the perception of some health care staff that people with dementia have limited capability to benefit from rehabilitation. Rehabilitation for this growing group of patients requires multiple resources, including skilled practitioners, integrated clinical systems and staff education regarding the capabilities of people with dementia. Future research in this area with patients with moderate-to-severe dementia in residential care is warranted.

View the article abstract here

Palliative care, personhood and ethics in dementia

Royal Society of Medicine: Published on Feb 1, 2016

To watch the full lecture visit: http://bit.ly/1nYaCz

About this lecture: Dr Julian Hughes discusses the philosophical aspects of caring for patients with dementia nearing the end of life. Dr Hughes covers clinical issues in palliative care and the ethics of treating a patient with dementia. Dr Hughes also finds a philosophical explanation of personhood and the soul.

This lecture was part of the ‘Mind, body and soul: an update on psychiatric, philosophical and legal aspects of care of patients nearing the end of life’ event at The Royal Society of Medicine in London.

Greater weight loss during aging associated with increased risk of mild cognitive impairment

An overview of the original research article and commentaries

1. Alhurani, R. et al. Decline in Weight and Incident Mild Cognitive Impairment. JAMA Neurology. Published online: February 01 2016.

Importance: Unintentional weight loss has been associated with risk of dementia. Because mild cognitive impairment (MCI) is a prodromal stage for dementia, we sought to evaluate whether changes in weight and body mass index (BMI) may predict incident MCI.

Objective: To investigate the association of change in weight and BMI with risk of MCI.

Design, Setting, and Participants: A population-based, prospective study of participants 70 years of age or older from the Mayo Clinic Study of Aging, which was initiated on October 1, 2004. Maximum weight and height in midlife (40-65 years of age) were retrospectively ascertained from the medical records of participants using a medical records–linkage system. The statistical analyses were performed between January and November 2015.

Main Outcomes and Measures: Participants were evaluated for cognitive outcomes of normal cognition, MCI, or dementia at baseline and prospectively assessed for incident events at each 15-month evaluation. The association of rate of change in weight and BMI with risk of MCI was investigated using proportional hazards models.

Results: Over a mean follow-up of 4.4 years, 524 of 1895 cognitively normal participants developed incident MCI (50.3% were men; mean age, 78.5 years). The mean (SD) rate of weight change per decade from midlife to study entry was greater for participants who developed incident MCI vs those who remained cognitively normal (−2.0 [5.1] vs −1.2 [4.9] kg; P = .006). A greater decline in weight per decade was associated with an increased risk of incident MCI (hazard ratio [HR], 1.04 [95% CI, 1.02-1.06]; P < .001) after adjusting for sex, education, and apolipoprotein E (APOE) ε4 allele. A weight loss of 5 kg per decade corresponds to a 24% increase in risk of MCI (HR, 1.24). A higher decrease in BMI per decade was also associated with incident MCI (HR, 1.08 [95% CI, 1.03-1.13]; P = .003).

Conclusions and Relevance  These findings suggest that increasing weight loss per decade from midlife to late life is a marker for MCI and may help identify persons at increased risk for MCI.

Read the original research abstract here

2. Alzheimer’s Society. Greater weight loss during aging associated with increased risk of mild cognitive impairment, study suggests. Published 1 February 2016.

Increasing weight loss per decade as people aged from midlife to later life has been associated with an increased risk of mild cognitive impairment (MCI).

Researchers identified 524 of 1,895 cognitively normal participants who developed MCI. Others factors may have played a role, as those who developed MCI were older, more likely to be carriers of a specific gene, and more likely to have diabetes, hypertension, stroke or coronary artery disease compared with study participants who remained cognitively normal.

Participants who developed MCI had a greater average weight change per decade from midlife than those who remained cognitively normal (-4.4 lbs vs. -2.6 lbs).
People with MCI are at an increased risk of developing dementia.

Read the full commentary here

3. Greater weight loss during aging associated with increased risk for mild cognitive impairment. ScienceDaily. Published 1 February 2016.

MCI is a prodromal (early) stage of dementia with about 5 percent to 15 percent of people with MCI progressing to dementia per year. Changes in body mass index (BMI) and weight are associated with increased risk of dementia but overall study findings have been inconclusive. An association of declining weight and BMI with MCI could have implications for preventive strategies for MCI.

Rosebud O. Roberts, M.B., Ch.B., of the Mayo Clinic, Rochester, Minn., and coauthors studied participants 70 or older from the Mayo Clinic Study of Aging, which started in 2004. Height and weight in midlife (40 to 65 years old) were collected from medical records.

During an average of 4.4 years of follow-up, the authors identified 524 of 1,895 cognitively normal participants who developed MCI (about 50 percent were men and their average age was 78.5 years). Those who developed MCI were older, more likely to be carriers of the APOE*E4 allele and more likely to have diabetes, hypertension, stroke or coronary artery disease compared with study participants who remained cognitively normal.

Read the full commentary here



Higher Quality Dementia Care Report

Kasteridis, P. et al. CHE. 2016


higher quality dc
Image source: york.ac.uk



A key policy priority Dementia is a high-level government priority for action and the care of dementia patients in a hospital setting is a major policy focus. At any one time, a quarter of acute hospital beds in England are in use by people with dementia and compared to people with the same underlying conditions but without dementia, hospital stays are longer and costs are higher.

policy research.PNG
Image source: york.ac.uk

Entry into emergency care can be a defining moment in the life of someone with dementia and often heralds an avoidable downward health spiral. The longer people with dementia stay in hospital, the more likely it is that they will be discharged to a nursing home, reducing opportunities for independent living.

National and international policy recognises the importance of ensuring that the wide range of support and services for those with dementia and their carers is well co-ordinated and integrated. Good quality primary care can help people to maintain their health and wellbeing and avoid unnecessary admissions to hospital or prolonged lengths of stay

Read the full report here




Quality standard for people with sight loss and dementia in an ophthalmology department

Ophthalmic Services Guidance

quality standard
Image source: RCO

Executive Summary:

Many patients who attend ophthalmology departments also have dementia. This quality standard has been developed to help ophthalmology departments provide high quality care for these patients. It addresses staff training, support to participate in decisions about care, the design of clinical areas, waiting times and appointment durations, provision of information, assessment of vision and referral for support. The breadth of what should be considered in providing care to patients with dementia in an eye clinic requires liaison between all staff, managers, and commissioners of care within the care pathway.

Patients with dementia can benefit from being identified in advance of attending their appointment; staff who have specific training around dementia; and, being provided with support to participate in decisions about care. A pathway for best interest meetings and obtaining informed consent should be identified where patients lose the capability to do so themselves.

The ophthalmology department can be designed and adapted to meet the needs of people with dementia, including lighting, colour schemes, and signage. Shorter waiting times, being offered longer consultation times and receiving accessible information about vision and eye care can be beneficial. If patients cannot use a vision chart then a functional visual assessment is useful to record in their notes. Referral to local support services can be helpful, and issuing a Certificate of Vision Impairment (CVI) (BP1 in Scotland and A655 in Northern Ireland) can facilitate someone being brought to the attention of social care services. The involvement  of an Eye Clinic Liaison Officer (ECLO) or Sight Loss Adviser can be helpful.

Read the full guidance here