Approaches to and availability of post-diagnostic support Dr Sarah Jane Smith 14 November 2018 Approaches to and availability of post-diagnostic support

Approaches to and availability of post-diagnostic support Overview What is Post-diagnostic support? Assessment of Need Adjusting to diagnosis Cognitive Interventions Formal/informal Social/Emotional Interventions 14 November 2018 Approaches to and availability of post-diagnostic support

What is Postdiagnostic Support? Psychosocial interventions Cognitive Social Emotional Information/Signposting Care Planning Driving Formal or Informal support Peer support 14 November 2018 Approaches to and availability of post-diagnostic support

Psychosocial Interventions Ways to support people to overcome challenges and maintain good health Can help with: Coming to terms with a diagnosis of dementia Maintaining social life and relationships after diagnosis Reducing stress and improving mood Thinking and memory (cognitive) Living Independently Quality of Life Support for families Guss et al., (2014). A guide to Psychosocial interventions in Early Stages of Dementia 14 November 2018 Approaches to and availability of post-diagnostic support

Approaches to and availability of post-diagnostic support Assessment of Need What domains of (cognitive) functioning are affected? What is important to the person? What is the person’s coping style? What is the quality/quantity of their social networks? Is their an impact on family carers/friends? Is anyone at risk? Does the person have other health related needs? 14 November 2018 Approaches to and availability of post-diagnostic support

Approaches to and availability of post-diagnostic support Awareness Neurological or Psychological basis for lack of awareness? Self adjusting vs Self Maintaining Use of internally vs externally generated strategies 14 November 2018 Approaches to and availability of post-diagnostic support

Adjusting to Diagnosis Post-diagnostic Counselling Support concerning: information about diagnosis and prognosis, time to talk, time to discuss care planning, counselling to deal with the emotional impact One to three individual sessions Post-diagnostic Groups/Courses Content: A set number of group sessions Peer support and expert speakers 14 November 2018 Approaches to and availability of post-diagnostic support

Advanced Care Planning Any time after diagnosis Discussing and recording preferences Advance decisions to refuse treatment Advanced statements of wishes and preferences Lasting Power of Attorney (LPA) End of life care 14 November 2018 Approaches to and availability of post-diagnostic support

Psychosocial Interventions 14 November 2018 Approaches to and availability of post-diagnostic support

Cognitive Interventions ‘all people with mild/moderate dementia of all types should be given the opportunity to participate in a structured group cognitive stimulation programme ... provided by workers with training and supervision ... irrespective of any anti-dementia drug received ...’ 14 November 2018 Approaches to and availability of post-diagnostic support

Preparing for Cognitive Interventions (assessment of need) What is the rationale- taking into account General Cognitive Functioning Long Term Memory Prospective Memory Working memory Attention Executive Function Perception Language Motor Skills 14 November 2018 Approaches to and availability of post-diagnostic support

Approaches to and availability of post-diagnostic support Cognitive Training Cognitive training consists of guided practice on a set of standard tasks designed to target and “exercise” particular cognitive functions (such as planning, attention or memory). Can be offered on an individual basis (e.g. Davis, 2001; or in group sessions (Bernhardt, 2002). Sessions are facilitated by practitioners, but the training can also be completed individually or with input from family support (Quayhagen, 2000). Can be offered in a variety of formats with some tasks emulating everyday activities, some being cognitive-based paper and pencil tasks, and some computerised or based on virtual reality (Clare, 2003). 14 November 2018 Approaches to and availability of post-diagnostic support

Cognitive Stimulation Aims to reduce excess disability, rebuild confidence and self-esteem, and enhance general social and cognitive functioning. Includes elements of reality orientation (Holden & Woods, 1995), reminiscence (Woods et al., 2005) and engagement in activity. (commonly) delivered in a social context (group format) Once or twice weekly basis for 14 or more sessions of 45 – 75 minutes each. E.g. fashion, food, working life, birthday People with Mild-moderate dementia 14 November 2018 Approaches to and availability of post-diagnostic support

Cognitive Rehabilitation Improve a person’s ability to successfully manage those aspects of day-to- day life that have a cognitive component includes ”any intervention strategy or technique which intends to enable clients or patients, and their families, to live with, manage, by-pass, reduce or come to terms with deficits precipitated by injury to the brain” (Wilson, 1997, p. 488) Applied through individually tailored interventions that employ the principles of effective learning and information processing to address specific goals in real-life settings. Personally relevant goals can include things such as (re-) learning to use equipment (e.g., a mobile phone, or a microwave oven), re-learning everyday tasks (e.g., doing the shopping, baking) and (re-)learning names (e.g., grandchildren or club members). Development of the intervention requires a full analysis of the difficulties a person with dementia is having with a task, understanding of their cognitive strengths and weaknesses, awareness, and the environmental context and resources. 14 November 2018 Approaches to and availability of post-diagnostic support

Techniques for Cognitive Rehab! New learning of information – Errorless learning Spaced Retrieval Subject Performed Tasks Assistive Technologies Communication aids Safety aids e.g. automatic gas shut off Tablet computers for socialising Electronic aids for medication 14 November 2018 PRESENTATION TITLE AND AUTHOR

Cognitive: What is available locally? 14 November 2018 PRESENTATION TITLE AND AUTHOR

Emotional & Social Interventions Targeted to enhance Social Support or ameliorate emotional distress Psychotherapy Cognitive Behaviour Therapy Educational Interventions Arts based interventions Art, music, dancing Animal assisted therapy or Activity 14 November 2018 Approaches to and availability of post-diagnostic support

What is available locally? 14 November 2018 Approaches to and availability of post-diagnostic support

What is available to your patients? Formally? Informally? Referral Pathways? Who is the support for? What are the envisaged benefits?? 14 November 2018 PRESENTATION TITLE AND AUTHOR

Post Diagnostic Support Aims To enable primary care professionals to work as a Practitioner with a Special Interest in Dementia by developing skills in ongoing support approaches for people living with dementia and their carers, including appropriate psychosocial/non-pharmacological and pharmacological treatments and assisting access to appropriate support services. Content Consider attitudes to some of the behaviours that people with dementia and their carers may find difficult or worrying. Apply a biospychosocial framework when assessing people’s individual needs; the biological, psychological and social needs of the person in order to develop a holistic and comprehensive approach assessing the ongoing support that an individual may require. Consider the role of family members and carers in this assessment process. (weeks 1-3). Introduce a range of psychosocial interventions in detail and reflect upon the availability of psychosocial interventions in your region Introduce pharmacological approaches the treatment of cognitive, psychological and emotional changes in dementia. Current recommendations regarding these treatments, and consider issues such as adherence, side effects, and shared care Consider how to deal with comorbidities such as vascular problems, falls management and nutrition. Examine the national guidelines regarding end of life care for people with dementia Introduce models of integrated care 14 November 2018 Approaches to and availability of post-diagnostic support

Arts and Activities- PG Cert 14 November 2018 Competencies and Training: Assessment, Diagnosis and Postdiagnostic Support

Approaches to and availability of post-diagnostic support 14 November 2018 Approaches to and availability of post-diagnostic support