How well are the diagnosis and symptoms of dementia recorded in older patients admitted to hospital?

Crowther, G.J.E. et al. Age & Ageing. Published online: September 10 2016

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Image source: Stephen Magrath – Wellcome Images // CC BY-NC-ND 4.0

Introduction: in the United Kingdom dementia is generally diagnosed by mental health services. General hospitals are managed by separate healthcare trusts and the handover of clinical information between organisations is potentially unreliable. Around 40% of older people admitted to hospital have dementia. This group have a high prevalence of psychological symptoms and delirium. If the dementia diagnosis or symptoms are not recognised, patients may suffer unnecessarily with resulting negative outcomes.

Discussion: this work suggests an under reporting of dementia and symptoms associated with it in the general hospital. Improving this requires closer collaboration between metal health and hospital healthcare services and training for staff on how to access diagnostic information and recognise common psychological symptoms.

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Family caregivers’ conceptualisation of quality end-of-life care for people with dementia

Davies, N. et al. Palliative Medicine. Published online: October 25, 2016

Background: People with dementia have been described as the ‘disadvantaged dying’ with poor end-of-life care. Towards the end of life, people with dementia cannot report on the care they receive. It is therefore important to talk to caregivers; however, few have explored the views about end-of-life care from the caregivers’ perspective. The majority of research on family caregivers has focussed on the burden and psychological impact of caring for a relative with dementia.

Aim: This study aimed to explore the views of family caregivers about quality end-of-life care for people with dementia.

Design: Qualitative study using in-depth interviews and analysed using thematic analysis.

Setting/participants: Purposive sampling from a third sector organisation’s caregiver network was used to recruit 47 caregivers in England (2012–2013), consisting of (1) family caregivers of someone who had recently received a diagnosis of dementia, (2) family caregivers currently caring for someone with dementia and (3) bereaved family caregivers.

Results: Three over-arching themes were derived from the interviewees’ discourse, including maintaining the person within, fostering respect and dignity and showing compassion and kindness.

Conclusion: End-of-life care for people with dementia does not differ from care throughout the dementia trajectory. Throughout the findings, there is an implicit underlying theme of conflict: conflict between family caregivers and an increasingly systematised service of care and conflict between family caregivers and professionals. This study has in particular demonstrated the importance of the psycho-social aspects of care, aligning with the holistic definition of palliative care.

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Local Authorities urged to make personal budgets dementia friendly

Deep-seated misconception of personal budgets and dementia is preventing local authorities from delivering person-centred care | Alzheimer’s Society

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Image source: Alzheimer’s Society

Alzheimer’s Society is calling on all local authorities in England to urgently break down the barriers preventing people with dementia accessing personal budgets.

Fewer than a third of people receiving social care support for problems with memory and cognition have a personal budget, despite the government’s aspirations for a person-centred care and support system. The Care Act gives everyone who is receiving support from social services the legal right to a personal budget, offering them greater choice and control over their care and support.

An Alzheimer’s Society audit of local authorities’ personal budgets processes has highlighted how the majority are falling at the first hurdle, with many failing to make people with dementia aware of their entitlement to a personal budget.

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Managing challenging behavior

Holle, D. et al. Aging & Mental Health. Published online: 3 November 2016

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Objective: Individualized formulation-led interventions offer a promising approach for analyzing and managing challenging behaviors in people with dementia. Little is known about which individualized formulation-led interventions exist and what effects these interventions have on people with dementia and their caregivers. Therefore, the review aims to describe and examine existing interventions and to review their evidence.

Methods: An integrative review of individualized formulation-led interventions for managing challenging behavior in people with dementia was conducted. PUBMED, PsycINFO [EBSCO] and CINAHL [EBSCO] databases were searched between February and April 2014 using key terms related to dementia, challenging behavior and individualized formulation- led interventions. The literature search was limited to German and English publications published from 1995. No limitations were placed on the type of paper, type of study design and stage of disease or setting. 37 relevant papers that met the inclusion criteria were included in this review.

Results: The literature review provided 14 different individualized formulation-led interventions. The effects on people with dementia were diverse, as only half of the studies showed a significant reduction in behaviors compared with the control group. Family caregivers felt less upset about the challenging behavior and more confident in their ability to manage the behavior.

Conclusion: There is a clear need for further research on individualized formulation-led interventions. The results of this review have the potential for developing interventions and for designing methodological robust evaluation studies that take into account the effectiveness of individualized formulation-led interventions on patient and caregiver outcomes.

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A new person-centered approach for dementia-friendly emergency department care

Parke, B. & Hunter, K.F. Know me – A new person-centered approach for dementia-friendly emergency department care. Dementia. Published online before print November 3, 2016

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Image source: Scott & White Healthcare – Flickr // CC BY-NC-ND 2.0

A visit to an emergency department can be a disorientating experience for someone with dementia. Empowered caregivers can mitigate harm stemming from communication issues to support a successful emergency department visit.

A qualitative study determined the feasibility of the structure, format, and content of eight hospital-readiness communication tools. Data collection involved English and French-language caregiver focus groups in two Canadian provinces.

Study findings have the potential to (a) improve safety in emergency care to older people with dementia and their caregivers, and (b) offer cost-effective communication tools for web-based knowledge translation activity in acute care.

 

 

NHS England offering support to CCGs to improve dementia care

Following publication of the CCG improvement and assessment framework 2016/17, NHS England is offering support to CCGs to improve dementia care | NHS England

NHS England introduced a new CCG improvement and assessment framework in 2016/17, fully aligned to the Five Year Forward View and NHS planning guidance. This brings together a range of key indicators, enabling NHS England and CCGs to work together, using the indicators to drive improvement for patients.

There are national ambitions for transformation in a number of vital clinical priorities, including Dementia.  Each priority area has a number of indicators in the framework and the areas are assessed by independent panels, with a separate, clear rating.  These ratings are published on MyNHS.   Each area has its own support programme for CCGs, which may already be in place or is being introduced in stages.

The dementia support offer recognises that CCGs will have varying levels of need for support and provides three levels, which can run concurrently.  The more bespoke levels of support will be focused on a smaller number of CCGs with the greatest identified need.

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The positive aspects of caregiving in dementia

Lloyd, J. The positive aspects of caregiving in dementia: A critical review of the qualitative literature. Dementia. November 2016 vol. 15 no. 6 1534-1561

https://www.flickr.com/photos/hendry/2392073292/in/photolist-4Do13Y-5FcsH-6zzLkk-ceBQC-ipxhz-7Nur9Z-H7xgNC-sgJkHN-o79TFS-w2DihN-n9ZTh7-5CQWYT-dSuoLj-eTcnyd-aaF85P-fmr18k-johahH-cs7SRs-cs7V6U-riNBj9-johGJb-joh9T6-fmFb2o-jofDM4-johGqL-6UFqmj-dcRnMc-7cxzo3-auYgkD-jofEde-av1XHh-9TvNFp-nN3GyG-JQ32cg-e96xoV-johFZA-jofDFH-dRsLkh-ByRfh-vKEkb7-jcJpma-o9qDsS-brLUaE-eFhd3H-WN5Tq-6n3cJk-9qAu5q-bYMKhu-dS7zHK-brLTSN
Image source: Kai Hendry – Flickr//CC BY 2.0

Abstract:

Positive aspects of caregiving in dementia have been identified as important in understanding the experiences of carers, yet the research base lacks clear definitions of key concepts.

This qualitative research explores carers’ experiences of positive aspects of caregiving in rich detail which lends itself to supporting theory development. The aim of this review was to critically evaluate the empirical findings of qualitative studies that have explored positive aspects of caregiving in dementia.  A systematic search of the literature revealed 14 studies that met this aim.

Carers described multiple positive dimensions of caregiving and identified several factors that were important in supporting their positive caregiving experience. The present review evidences a solid base of understanding of the positive aspects of caregiving in dementia from which concepts and theories can be further developed. Clinical and research implications are discussed.