Judy Deimel Nurse Practitioner CALHN MEMORY SERVICE Judy Deimel Nurse Practitioner

Content CALHN Memory Service (CMS) model of care CMS approach to dementia diagnosis Case study

Model of care Currently in Australia around 244 persons are diagnosed with dementia each day. Some 25,938 persons are estimated to be living with younger onset dementia in Australia in 2017(IGPA, University of Canberra 2017). Various referral options for specialist diagnosis: Memory clinics, geriatrician, neurologist or psychiatrist. CMS offers flexible age criteria, not limited to 65 years and over. Single integrated specialist memory service across CALHN. Developed by CALHN Memory Service Working Group.

Central Adelaide Local Health Network

Model of Care Clinical governance: Interdisciplinary team - specialist medical, neuropsychology, nursing and administration professionals (watch this space for ‘allied health’). Reporting to single clinical director - accountability for patient safety, monitoring and improving the quality of clinical care. Site: Ambulatory clinic at TQEH Main Bldg. Ward 5C. Coming soon – Ambulatory clinic at St Morris. Maintaining strong links with GP’s, Dementia Australia and community service providers. NHMRC Partnership Centre for Dealing with Cognitive and Related Functional Decline in Older People 2016

Model of Care Aim for cognitive symptoms explored, when first raised by the person with symptoms and/or carer/family/GP. CMS core business: diagnostics, clinical, social, preventative, educative and care planning. Aim to promote health and wellbeing of people with cognitive concerns. Aim to delay cognitive and functional decline. Enhanced communication between CMS, consumer and GP verbal and written feedback. Service delivery face to face; telephone, telehealth / videoconferencing.

Model of Care deliverable aims Aim 1: Early diagnosis and intervention for people with mild to moderate cognitive impairment. Aim 2: Consumer directed care for people with dementia and their family and carer’s: Consumer engagement throughout treatment and management plan. Individualised and tailored plan of care.

Model of care aims Aim 3. Vulnerable population. One in five individuals with dementia are from a cultural and linguistically diverse background. Aboriginal and Torres Strait Islanders have 3-5 times the risk of developing dementia than non-Indigenous persons. Culturally safe care by culturally competent staff, for indigenous and culturally diverse persons. Access to interpreters when required. Use of culturally appropriate assessment tools.

CMS systematic approach for diagnosis and care Triage Nurse Practitioner informs referring clinician the patient does not meet referral criteria, alternate referral pathway offered e.g. Geriatrics, psychiatry, GP mental health plan, Palliative Care. Patient and informant history Cognitive assessment Medication review Blood tests and computed tomography or magnetic resonance imaging of the brain 1st clinical contact with triage Nurse Practitioner (NP) Diagnosis of dementia sub-type at feedback meeting, written management plan provided 1st Appointment with medical specialist or NP NP Cognitive Care Clinic Supporting patients and families when expression of needs is communicated via actions and behaviour Discharge back to the community. Advised if there are any concerns with memory changes to phone CMS NP for advise or potential review appointment. Abbreviations: ED: Emergency Department GP: General Practitioner MCI: Mild Cognitive Impairment NAD: No abnormality detected NP: Nurse Practitioner PTT: (Inpatient) Primary Treatment Team

Key Performance Indicators Effectiveness of service: Total number of new referrals: Total number of referrals given appointments. Total number of referrals sent to Geriatrics or Psychiatry / Mental Health. Number of ‘Did Not Attend’ at initial appointment. Time between referral being accepted and first appointment. Dissemination of outcomes to patient and family. Feedback from consumer, family and GP Total number of new referrals Total number of referrals given appointments Time between referral being accepted and appointment Number of DNA’s to initial appointment Not entirely sure how to measure “coordination of care”. May be best to call it effectiveness of service?? Maybe – Number of new patients assessed Average baseline MMSE prior to treatment total no. of new Diagnoses – neurodegenerative vs others number of neurodegenerative p’s started on treatment number of referrals to community service providers number Feedback surveys from GP’s and carers – maybe these individual responses should make up a separate slide?

Prevention better than cure?

Social determinants of dementia Dementia risk increases in the elderly, the frail, women, and the socioeconomically and educationally disadvantaged. Risk factors are contributed across the lifespan (Lancet Commission 2017)

Potential brain mechanisms for preventive strategies in dementia (Lancet Commission 2017) Increase brain cognitive reserve Preserve hearing Cognitive training Education ↓Depression Rich social network ↓obesity Exercise Stop smoking Reduce brain inflammation ↓Brain damage (vascular, neurotoxic, oxidative stress) Healthy eating: Mediterranean diet Non-steroidal anti-inflammatories Treat diabetes, hypertension, ↑ serum cholesterol

Case study

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