1. Update on Dementia Care in Scotland
Shubha Moses-
Senior Dietitian
January 2013

2. Dementia in Scotland- Everyone’s business
Currently, approx 84,000 people have Dementia in Scotland, 3,500 of whom are under the age of 65 (Alz Scot 2012)
The number of people with dementia in Scotland is expected to rise to 164, 000 by 2036 (Alz Scot 2011).
1 in 4 of all general hospital beds in the UK are occupied by a person over 65yrs who has dementia (Alz Society 2009)
Of those older people in acute wards only 20% with dementia had been diagnosed before admission.

3. Types of dementia-
Alzheimer’s CJD
Alcohol Related
AIDs related
Vascular
Lewy Body
Frontal lobe dementia e.g. Picks
Dementia is a progressive & terminal condition, however it is possible to live having a good QOL.

4. Common Symptoms of Dementia
Memory loss
Communication (dysphasia/aphasia)
Carrying out tasks (dypraxia/apraxia)
Concentration
Recognition (agnosia)
Orientation
Perception/ Visuo-spatial difficulties/Hallucinations
Psychological changes

5. The 3 D’s- Dementia, Depression & Delirium
THINK DELIRIUM!
People who have delirium will either also have an underlying Dementia or have increased risk of developing Dementia
Common if aged >65 and acute illness/surgery/change in drugs
SQiD- Single Question in Delirium- Do you think X has been more confused lately? (Sands et al 2010)

6. National Drivers
Scottish Dementia Strategy June (key actions to improve knowledge & skills of staff working with people with dementia & their families)
In June 2011 ‘Promoting Excellence Framework’ & ‘Standards of Care for Dementia in Scotland’ was produced by NES (NHS Education for Scotland) & SSSC (Scotland Social Services Council) to support the implementation of the educational actions

7. SPACE- supporting good dementia care (www.rcn.org.uk/dementia)
Staff who are skilled & have time to care
Partnership working with carers
Assessment and early identification
Care that is individualised
Environment that are dementia friendly
The main therapeutic intervention for dementia is human care & treatment

8. Staff Education and Training- NHS HIS priority
Scottish Governments Promoting Excellence: a framework for all health and social services staff working with people with dementia, their families and carers
NES Dementia Care in Acute General Hospital Settings Learning Resource
NHS Learn pro module on Dementia
The Dementia Services Development Centre, Univ of Stirling
Dementia Champion programme provided by NES, SSSC, Alz Scot & UWS. 2011/ places & 2012/ places for Acute staff.

9. The Dementia Champion programme- 5 study days over 5 months
1) Intro to course & its aim
2) Person centred screening and assessment
3) The Hosp environment & Fundamentals of care
4) Communication, stress & distress
5) Planning for discharge
Person centred care
Vulnerability issues & working with carers
Legislative framework
End of life care
Ending the programme & moving forwards

10. Work based tasks/assignments
Activity
Written Work
Community Reflection
Arrange & attend a community placement
A reflective account of experience
Clinical Evaluation & Action planning
Carry out an evaluation of own clinical area, using the Supp Change workbook. Identify and prioritise key areas of need.
Report of activities
Change Assignment
Plan & carry out changes/actions to take place.
Evaluate work done so far.

11. Role of Dementia Champion- Supporting the person with dementia in an Acute setting
Model a positive, confident and non-discriminatory attitude to people with dementia and their carers when talking to and working alongside all your health and social care colleagues.
Apply and actively promote the Carter of Rights for people with dementia and their carers in Scotland in your day to day work.
Challenge all negative and discriminatory care, expressions and systems in a manner which encourages growth and positive change.
Develop educational activities tailored to your area of clinical responsibility which disseminates what you have learnt on the Dementia Champions programme.
Have an understanding of the needs of the people with dementia in your area of responsibility and support the team to ensure each person with dementia receives evidence based care and where all risks associate with being in hospital are managed assertively.
Introduce yourself and your role to all carers of people with dementia in your clinical area. Seek ways to develop partnership working between carers and staff in your clinical area.
Develop, implement and review a change management plan with your clinical team with the aim of improving the experience of people with dementia in your clinical area.

12. 2) Partnership working- Meeting the needs of family and carer 3) Assessment and Early identification- Tools used in Lothian- -AMT 4 (referral for specialist diagnostic assessment by Psychiatrist), -4AT, -NHS Lothian Principles and Procedure of care Management for adult patients (16+) with cognitive impairment within a generic hospital setting, -Doloplus -2 pain tool, -Challenging Behaviour Assessment , -Management guidelines for the agitated and wandering Patient. -SIGN 86 Management of patients with Dementia - ( - MUST

13. 4) Care that is individualised- patient centred care plan
4) Care that is individualised- patient centred care plan. -‘This is me’ document,
- Involve family/carers in care planning,
- Use tools such as MUST, Mental capacity assessment, Anticipatory care planning, Falls risk tool, Pain assessment
- Provide appropriate activity such as TAP,
- Availability of Dementia specialist Leads,
- Access to and availability of Palliative care
5) Environment that is dementia friendly-
- Minimal movements
- Appropriate lighting & floor coverings
- Personalised bed area
- Availability of staff to support rehab e.g. memory prompts, assistive technology (software digital e.g. react2.com, apps for iphone/ipads), alternative comm tools, flexible approach

14. The 8 Pillar models of support in the community for Dementia- Alz Scot 2012

15. Watch this space……. Solvenaid- ONS by Nutricia
ODE- wellbeing product to reawaken appetite & improve oral intake (
New digital diagnosis systems combining computer based tests &MRI brain scans

16. Any Questions?