Improved asthma and dementia care from community pharmacists under new quality scheme

Most community pharmacies in England are now providing improved asthma and dementia care |  NHS England 

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Thousands of community pharmacists took up incentives to offer new patient services, such as providing asthma checks and undertaking training to become more dementia aware, as part of a programme to improve care.

The uptake figures from NHS England show that 97 per cent (11,410) of community pharmacies are now signed up to the Quality Payments Scheme, which provides an incentive to deliver new clinical services in a bid to encourage more people to use their local pharmacist.

An assessment of the new scheme shows that since April 2017, 70,000 pharmacy staff have become ‘Dementia Friends’ in order to offer greater awareness regarding the needs of people with dementia. ​

NHS England issued guidance in December 2016 on how community pharmacies could qualify for the scheme, which ran between December 2016 and March 2018, and is currently considering how best to implement the successes of this scheme over the long-term.

Full story at NHS England

Dementia-friendly public toilets

Many older adults avoid travelling and social interaction because of the scarcity of public toilets or their inaccessibility. Furthermore, where public toilets are provided, poor design and signage can preclude independent use, particularly for people living with dementia | The Lancet

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Image source: Martin Sotirov – Flickr // CC BY 2.0

In general, there is a gap between current public toilet provision and toilet design appropriate for individuals living with dementia, who might have behavioural change, poor level of motivation, loss of mobility and manual dexterity, or abnormalities in visual information processing. In response to research and anecdotal evidence, many guidelines are available to inform and improve the design and independent usability of toilet facilities for people living with dementia. Examples include the use of familiar or automatic flush systems, non-reflective surfaces, good lighting, contrast between doors and surroundings and between the toilet and toilet seat, sinks that do not resemble urinals, well labelled taps and soap dispensers, and the careful placing of mirrors.

However, as highlighted by a substantial amount of anecdotal evidence, the absence of simple and clear way-out signs negates any positive influence of a well designed toilet facility. Such an omission can result in distress, anxiety, embarrassment, and reluctance to use the toilet in the future. Common examples reported to investigators include instances of people having to enter opposite sex toilet facilities to guide their partners out, or going through the wrong door and into undesired or incorrect locations. A fire exit sign showing someone running with a directional arrow is also easily misunderstood as an exit sign, which can result in misdirection with people ending up outside the building and, in some cases, wandering on to a road. Similarly, doors that are both a fire exit and the route back to a public area can cause confusion, and might elicit a reluctance to open them, primarily because of the fear of setting off a fire alarm.

Full reference: Tales, A. et al. (2017) Dementia-friendly public toilets. The Lancet Vol. 390 (no. 10094) pp. 552–553

Dementia-Friendly Hospital Design

We report the findings of a knowledge synthesis research project on the topic of dementia-friendly acute care (D-FAC) design | The Gerontologist

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This exploratory project systematically mapped what is known about D-FAC physical design in hospitals. We discuss our challenges in locating reportable evidence and the implications of such design for maximizing independent function while ensuring safety and harm reduction in older people living with dementia.

A total of 28 primary studies plus expert reviewers’ narratives on the impact of design and architectural features on independent function of hospitalized older people with dementia were included and evaluated. Items were mapped to key design elements to describe a D-FAC environment. This scoping review project confirms the limited nature of available acute care design evidence on maximizing function.

Physical design influences the usability and activity undertaken in a health care space and ultimately affects patient outcomes. Achieving safe quality hospital care for older people living with dementia is particularly challenging. Evidence of design principle effectiveness is needed that can be applied to general medical and surgical units where the bulk of older persons with and without dementia are treated.

Full reference: Parke, B. et al. (2017) A Scoping Literature Review of Dementia-Friendly Hospital Design. The Gerontologist. Vol. 57 (No. 4) pp. e62-e74.

Dementia-friendly housing charter

Housing organisations urged to unite against dementia | Azheimers UK

The charity Alzheimer’s UK has published the Dementia-friendly housing charter to help housing organisations better understand dementia and how housing, its design and supporting services can help improve and maintain the wellbeing of people affected by the disease.

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Image source: http://www.alzheimers.org.uk

Research from the leading dementia charity has previously found that 85 per cent of people want to stay living at home for as long as possible when diagnosed with dementia, but that a third of the general public would not know where to find information about how to make their home and living environment suitable.

The charter, developed in partnership with Housing & Care 21, is the latest innovation from Alzheimer’s Society’s Dementia Friendly Communities programme, which aims to ensure people affected by dementia feel understood and included in all aspects of community life.

The publication can be downloaded here

Exploring the impact of dementia-friendly ward environments on the provision of care

Brooke, J. & Semlyen, J. Dementia. Jan 2017 ; p. 1471301216689402

Dementia-friendly wards are recent developments to improve care for patients with dementia in acute hospitals. This qualitative study used focus groups to understand the impact of dementia friendly ward environments on nurses experiences of caring for acutely unwell patients with dementia. Qualified nurses and health care assistants working in an acute NHS Trust in England discussed their perceptions and experiences of working in a dementia-friendly ward environment.

Four themes developed from the thematic analysis:

  1. ‘It doesn’t look like a hospital’: A changed environment,
  2. ‘More options to provide person-centred care’: No one size fits all,
  3. ‘Before you could not see the patients’: A constant nurse presence and
  4. ‘The ward remains the same’: Resistance to change. Recommendations and implementations for practice are discussed.

Read the abstract here

The impact of dementia-friendly ward environments on the provision of care

Brooke, J  & Semlyen, J. Exploring the impact of dementia-friendly ward environments on the provision of care: A qualitative thematic analysis | Dementiapublished online: January 19, 2017

Dementia-friendly wards are recent developments to improve care for patients with dementia in acute hospitals. This qualitative study used focus groups to understand the impact of dementia friendly ward environments on nurses experiences of caring for acutely unwell patients with dementia.

Qualified nurses and health care assistants working in an acute NHS Trust in England discussed their perceptions and experiences of working in a dementia-friendly ward environment. Four themes developed from the thematic analysis:

  • (1) ‘It doesn’t look like a hospital’: A changed environment,
  • (2) ‘More options to provide person-centred care’: No one size fits all,
  • (3) ‘Before you could not see the patients’: A constant nurse presence and
  • (4) ‘The ward remains the same’: Resistance to change.

Recommendations and implementations for practice are discussed.

Read the full paper at Sage Journals

Dementia services

Healthwatch has published Dementia services: findings from the Healthwatch network.

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This briefing summarises findings from fourteen reports on dementia and numerous visits to care homes by local Healthwatch.  It finds that people want to see improvements in: information for improving dementia awareness; making sure people with dementia and their carers have the support they need; and making the environment more dementia-friendly.

Full report: Dementia services – findings from the Healthwatch network

Additional link: Healthwatch press release