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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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
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16. Cognitive: What is available locally?
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17. 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

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

19. What is available to your patients?
Formally?
Informally?
Referral Pathways?
Who is the support for?
What are the envisaged benefits??
14 November 2018
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20. 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

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

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