Early Intervention in Dementia – a whistle stop tour! Joy Harris, SLT Mental Health

Background Service first established in 1995 Now has 3 SLTs (1.3wte) with a.4 wte vacancy Service works across East and Midlothian (pop 101,360 and 84,700 respectively) Aim of our service is to offer early intervention as well as interventions as necessary throughout the patient journey.

Older Peoples’ Service in East Lothian Community team Day Hospital Assessment ward (At MCH) Long Term Care Ward Outreach to Nursing Homes (Psychiatrist,EMPAT, SLT)

Multi Disciplinary Team 3 Psychiatrists 9 CPNs (6 organic, 3 functional) EMPAT (2 CPNs,1 OT, 1 psychologist) 3 OTs 3 SLTs Psychologist Nursing staff (day hospital)

Referral to SLT Usually following initial memory assessment if communication difficulty evident or self reported. Determined by response to ACE 111 and clinical judgement Referral is either to inform differential diagnosis or for direct interventions to support communication.

Most common types of referral Fronto temporal dementias Atypical Alzheimers Early vascular dementias Cortico basal degeneration Posterior cortical atrophy

What do we do? Assessment of language disorder to inform differential diagnosis Assessment of language to inform ourselves, carers,MDT and to determine areas for specific intervention or support Typical interventions are activities for Word finding and provision of personal vocabulary books or communication passports. Use of AAC where appropriate.

What we do We aim to ensure carers expectations of communication are realistic and reduce stress and burden by providing specific management strategies We contribute to multi professional problem solving and care planning We assess capacity to consent to treatment and care when communication is a significant contributory factor.

What we do  Dysphagia referrals come mainly from GP’s and Nursing Homes but also via MDT  Manage dysphagia via a telephone triage system which means that visits are reduced by approx 50%  We support EMPAT work when communication identified as a specific issue

Position Paper Role &Competencies Assessment re differential diagnosis Assessment to outline needs and inform interventions Interventions for people with Dementia and their carers Assessment and Management of eating, drinking and swallowing difficulties

Position paper and competencies Training – only on individual basis (no resources for on going programme) Research and Development – continually aiming to improve our service and processes but could do better.