A Profile of Dementia in a small rural practice. Dr. Iain Brooker, Macduff Medical Practice 2014 Macduff Medical Practice looks after 2750 patients scattered through the towns of Banff, Macduff, Whitehills and the surrounding area of Aberdeenshire. The Practice population is similar in profile to Aberdeenshire. 2 Care Homes, a very sheltered housing complex and a community hospital in Banff provide additional facilities to support patients and families experiencing dementia. The Old Age Psychiatry team are based in Chalmers Hospital, but in-patient facilities for dementia assessment are sited in Fraserburgh, approximately 35 minutes drive. Public transport links to Fraserburgh are poor. Alzheimer Scotland have an active presence in the community. The Dementia Timebomb outlined in our first tutorial was interesting to me, as I couldn’t think we had too many patients affected in our Practice. But the figures given [ 25 people or 0.95% of the practice population] indicated we had roughly the right number of people coded as having a dementia. I wanted to do a more in-depth profile of what kind of patients were affected, what pattern of care we currently provided, and what characteristics should determine how we provided care to them. I identified 24 people with dementia in the Practice. All of them had either been seen or had been referred to Old Age Psychiatry. The discrepancy in numbers partly due to the time period of my study being later, and occurring shortly after 2 patients with dementia died. Every patient identified as having dementia, had been seen, and the diagnosis confirmed by the Old Age Psychiatry team. It was often unclear whether they were still under review by the CPN or outreach team. 24 patients were diagnosed over a 10 year period All 12 patients on acetylcholinesterase inhibitors, were diagnosed as Alzheimer’s dementia. “Other” types were either “mixed” or alcohol related. All 4 patients on antipsychotics (always Quetiapine) had been started on specialist advice, but no advice on duration of treatment had been given. I plan to review each patient and withdraw the antipsychotic if possible. 7 of the 12 Care Home residents had transferred from another GP when they required to move to their Care Home. Only 4 patients had Adults with Incapacity forms completed, and none had a management plan. This will be addressed at their next review. Although the absolute numbers are small, patients with dementia do pose challenges for our healthcare team, and planning anticipatory care for people with dementia can be complex. Telecare is often utilised as part of the solution, and it was interesting to learn more of the technical solutions available at the Horizons workshop. Dementia is a complicating factor when planning discharge from our community hospital back in to the person’s home environment, as they may need additional care in place, or may need to secure a place in a more supported environment. Over time, patients seem to deteriorate and need to move to a Care Home, unless death intervenes. Our data on 26 deaths in 2013, show that dementia was a leading primary cause of death, and the data show it as a contributing factor to other deaths e.g. chest infection and septicaemia. The Scholarship Programme has been very informative, and prompted me to look in detail at my current practice. I intend to improve our anticipatory care plans, and review antipsychotic medication. 24 cases 12 Alzheimer's 8 Vascular 4 other 12 on acetyl- cholinesterase inhibitors 4 on Quetiapine or antipsychotic drug 12 are resident in a Care Home 7 Transferred in after diagnosis 4 have adults with incapacity form