1. mpairment CIRCLe Clinic Cognitive Impairment Review Clinic Phil Dillon RGN : (CNM2 Day hospital) Phil Dillon RGN : (CNM2 Day hospital) Deirdre Mc Govern RGN :(CNM2 EMI unit) Deirdre Mc Govern RGN :(CNM2 EMI unit) Dr Rory Mc Govern Consultant Geriatrician Dr Rory Mc Govern Consultant Geriatrician Sacred Heart Hospital, Carlow

2. Elderly Care Day hospital : Problem ? Increasing number of referrals (5000 > 65 y/age ) Increasing number of referrals (5000 > 65 y/age ) Frailty / Falls/ Reduced Mobility Frailty / Falls/ Reduced Mobility Cognitive Impairment Cognitive Impairment Assessment for LTC Assessment for LTC Limited capacity in Off-site day hospital (Carlow) Limited capacity in Off-site day hospital (Carlow) 3 new patients and 12 reviews / week 3 new patients and 12 reviews / week Emphasis on new patients ( Diagnosis and MDT Assessment) Emphasis on new patients ( Diagnosis and MDT Assessment) Routine Review patients just not being seen Routine Review patients just not being seen New Junior Doctors every 3/12 New Junior Doctors every 3/12

3. Primary Care Referrals

4. Solution ? Nurse –led clinic? Nurse –led clinic? Parkinsons disease clinic ( 60 patients) Parkinsons disease clinic ( 60 patients) Diabetic clinic Diabetic clinic Ulcer clinic Ulcer clinic Physio led falls and exercise clinic Physio led falls and exercise clinic Physio led Parkinsons Disease class Physio led Parkinsons Disease class Dementia specific clinic? Dementia specific clinic?

5. CIRCLe clinic Nurse- led : Nurse- led : Day –hospital CNM2 and EMI unit CNM2 Day –hospital CNM2 and EMI unit CNM2 All patients referred from day-hosp geriatric OPD All patients referred from day-hosp geriatric OPD Full medical investigation and MDT Assessment Full medical investigation and MDT Assessment Commenced July 14 th 2010 Commenced July 14 th 2010 Wednesday pm: 3 patients and Carers Wednesday pm: 3 patients and Carers 54 patients ( 22 male and 32 female) 54 patients ( 22 male and 32 female) Capacity for 120 + per year Capacity for 120 + per year Age –range (70-90 yrs) Age –range (70-90 yrs)

6. Assessment : Multi-domain Nursing / Medical BP (postural drop) BP (postural drop) U/A (MSU) U/A (MSU) Weight / BMI ( change since last review) Weight / BMI ( change since last review) Annual routine bloods Annual routine bloods Medication Medication Compliance ( venalink system) Compliance ( venalink system) Trial of cholinesterase inhibitors Trial of cholinesterase inhibitors Side/effects profile ( opiate analgesia) Side/effects profile ( opiate analgesia)

7. Assessment : Function Functional Ability ADLs ADLs Instrumental ADL ( driving) Instrumental ADL ( driving) Referral to Allied Health Professionals Referral to Allied Health Professionals Social Support Home help / MOW / Day Centre / Home help / MOW / Day Centre / Advice to Carers (respite?) Advice to Carers (respite?) PHN / Alzheimers Society PHN / Alzheimers Society Family meeting Family meeting

8. Assessment : Mental state Cognition Cognition Annual MMSE Annual MMSE Mood Mood Patient and Carer Patient and Carer BPSD ( 12 separate behaviours) BPSD ( 12 separate behaviours) If + perform NPI If + perform NPI

9. CIRCLE: documentation

10. CIRCLE: documentation 2

11. CIRCLe referrals

12. Negatives Is it a memory Clinic? Is it a memory Clinic? No comprehensive psychological assessment No comprehensive psychological assessment Psych of Old Age input Psych of Old Age input

13. Positives : Patient Focused Comprehensive Comprehensive Accessible Accessible Supportive Supportive Defined referral pathways Defined referral pathways MDT MDT Community Community Acute Secondary Care Acute Secondary Care LTC LTC