Dementia Care - a Forward View and a note on the Nottinghamshire Healthcare Strategy Professor Martin Orrell Director, Institute of Mental Health 1

High hopes for drugs…. 2

Person-centred care Choice and autonomy Life experiences Quality of life Needs being met Optimising function Activities Psychosocial aspects of dementia - not just a brain disorder 3

and the future……  Faster diagnosis with guaranteed quality of care  Less stigma and people live more active lives  Better psychosocial interventions  Coaching to maintain abilities in the community  Making technology and the arts more useful and meaningful  Better crisis support to maintain people at home  Better physical health and fewer falls (Harwood)  Better support for carers BETTER CARE & SUPPORT PROVIDER OF CHOICE 4

Memory Services National Accreditation Programme  110 members  A heterogeneous mix  Widespread across UK  Reduced waiting time  Improving quality  Improved satisfaction  Better funding for training 5

Longitudinal changes in lifestyle, cognition and ageing  Impact of changing lifestyles on cognition and ADL  Economic models of social and lifestyle changes  Prevalence of dementia Developing and piloting the social intervention  Consensus process/PPI  Social intervention manual  3 Sessions - dementia advice worker  Pilot/feasibility work  Qualitative data  Adherence/implementation work Social and personal constructs of dementia  Comparison with other chronic conditions  Lived experience of memory problems with focused observations in practice Promoting Independence in Dementia (PRIDE) ESRC/NIHR 6

Multicentre, pragmatic, single blind randomised controlled trial of the social intervention  Memory services  Clinical and cost effectiveness  Fidelity Checklist  Qualitative study Career development and capacity building INTERDEM Academy ESRC Doctoral Training Centre - 3 PhD studentships Expert workshops/seminars Interdisciplinary mentoring GREAT PLACE TO WORK Florianopolis study Brazil  Epidemiological study  Adapting and piloting the social intervention 7

Cognitive Stimulation Therapy (CST) for dementia  Cognitive and social activities in group or with family carer  Easy to deliver using standard manuals & DVD  CST principles also useful in practice  Good evidence for benefits to cognition and quality of life (Spector et al., 2003; NICE, 2006, Woods et al., 2012; World Alzheimer Report ADI, 2011; Orrell et al., 2014).  Cost effective (Knapp et al 2006) and savings to NHS of potentially £54 million/year (Institute for Innovation 2011). BETTER VALUE & USED ACROSS TRUST  Works well with cholinesterase inhibitors  Used in 80% of UK memory services and in 21 countries  CST website: 8

 Based on successful OT intervention in Netherlands  Randomised controlled trial 135 people > 65 with mild/moderate dementia with 10 sessions of OT over 5 weeks  Cognitive and behavioural interventions, carer coping behaviours and supervision  Process and performance skills improved (AMPS/IDDD)  Carer burden reduced and competence improved  Cost effective (Graff et al. 2006, 2008)  To adapt, develop, evaluate in a large national clinical trial  To promote independence, meaningful activity and quality of life  For people with dementia and their carers living in the community 9

Carer support and case management  START programme - manual based coping strategy improved mood and quality of life for carers of people with dementia. Livingston et al.,  Systematic review: case management in dementia - 13 clinical trials - At 18 months follow up reduced admissions to care homes, reduced BPSD, and improved carer depression and quality of life. Reilly et al.,

multi-disciplinary, intersectorial educational research framework for Europe to improve technology and care for people with dementia 11

TANDEM - The Arts and Dementia-Doctoral Training Centre  Strong interest from people with dementia and their carers in arts-based activities  Evidence needed to shape the development and delivery of arts interventions for people with dementia in community and care settings  Living well with dementia  Advancing knowledge about the impact of engagement with creative activities on people with all stages of dementia and on their family and professional carers. BETTER CARE & SUPPORT 12

Causes of crises and appropriate interventions: views of people with dementia, carers and professionals.  Specialist home care was highly valued by all groups.  Hazards in home (gas, electricity, cooking) were concern for carers and people with dementia. Interventions such as equipment/adaptations assistive technology were valued to help prevent or manage a crisis.  Family carer education/ training and support groups for carers in crisis (carer burden and mental ill health).  Staff often suggested more intensive interventions eg crisis visits  Carers and people with dementia often prefer the less resource intensive approaches. 13

Managing crises in dementia  Specialist home care was highly valued  Hazards in home (gas, electricity, cooking) were concern for carers and people with dementia.  Family carer education/ training and support groups for carers  Staff often suggested more intensive interventions eg crisis visits  Carers and people with dementia often prefer the less resource intensive approaches - equipment/adaptations assistive technology. AQUEDUCT study – improve management of crises in dementia and increase quality of UK crisis teams GREAT PLACE TO WORK & BEST VALUE 14

Thank you 15