The Interface between Old Age Psychiatry & Learning Disability Susan M Benbow Wolverhampton City PCT & Staffordshire University Norwich November 13 th 2008

A CKNOWLEDGEMENTS Dr S. Bhaumik Dr S. Black Dr K. Dodds Members of the Interface Group

C ONTEXT

K EY POLICY DOCUMENTS Valuing people NSF for Mental Health NSF for Older People Apply to ALL people

O LDER P EOPLE S M ENTAL H EALTH Standard 2 NSF-OP: Person-centred care NHS and social care services treat older people as individuals and enable them to make choices about their own care

V ALUING P EOPLE Based on people having Their rights as citizens Inclusion in local communities Choice in daily life Real chances to be independent

E VERYBODY S B USINESS 1.2m people with mild/ moderate LD 210,000 People with severe LD in England 25,000 aged 60+

EB CONT. Most psychiatric disorders more common in people with LD High risk of dementia in people with Downs 55% at age Life expectancy increasing

K EY ELEMENTS 1 Cognitive assessments in adulthood for people with Downs Better information & signposting of services Support for family carers & others Involve people in planning, monitoring & delivery of services Special consideration for people from BME groups Joined up working Joint training

K EY ELEMENTS 2 Consider joint teams Joint protocols Better collaboration between Primary Care OPMH LD services Consider in Transport Aids & adaptations Access to routine medical investigations

N OTHING ABOUT US WITHOUT US DH Strategy User Group All services should include people with learning difficulties properly in everything they do … not just one person as a token but several people who can support each other.

National Dementia Strategy Consultation doc 2008

C OLLEGE WORK

4 MAIN AREAS OF WORK : Joint protocol for people with Downs syndrome + dementia in partnership with BPS & others Training Days/ CPD events Psychiatrists Other staff working in both specialist areas College publication Survey of LD & OA psychiatrists

DRAFT 7 – 22 nd September 2008 Dementia and People with Learning Disabilities: Guidance on the assessment, treatment and support of people with learning disabilities who develop dementia

A IMS OF JOINT PROTOCOL To collate evidence-based practice, clinical opinion & experience to provide a framework for good practice to promote assessment, treatment and support for PWD, their staff & carers guidance for service developers & commissioners to provide a set of standards of good practice to promote service development to provide a training framework to guide future service development

C OMPARATIVE R ATES OF D EMENTIA - D OWN S SYNDROME, L EARNING DISABILITIES, G ENERAL P OPULATION Cooper, personal communication DS LD GP

Key points: assess every adult with Downs syndrome at age 30 to establish a baseline against which to compare future suspected changes in functioning. consider screening all adults with Downs syndrome over 40 regularly because of increased risk of dementia prevalence of undetected treatable illnesses.

Sharing the information with the person with learning disabilities: Steps should be taken to share the information with the person with learning disabilities at all stages ……. This process should be undertaken as good practice irrespective of the mental capacity of the person concerned.

consider the persons happiness, comfort and security. The focus of care should move away from targets to quality of life.

Key Points: Wherever possible, people with learning disabilities and dementia should remain in familiar environments. Environments can be adapted to make them dementia friendly and enable the person with dementia to make sense of where they are living.

Dying in place where the person can stay where they are currently living with appropriate supports adapted and provided. This means that the person stays with what is familiar in their long term memory.

4 MAIN AREAS OF WORK : Joint protocol for people with Downs syndrome + dementia in partnership with BPS & others Training Days/ CPD events Psychiatrists Other staff working in both specialist areas College publication Survey of LD & OA psychiatrists