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Nigel's surgery 42: Caring for people with dementia
When we inspect GP practices, we look at how key population groups are cared for. One such group is people with poor mental health, including people with dementia.
In 2013/14, we carried out a thematic review of the care people living with dementia receive when moving between care homes and acute hospitals. The “Cracks in the Pathway” review found variation in the quality of care received. It recognised that improvements were needed to extend far beyond institutional boundaries. This was to make sure everyone living with dementia received good care.
Health and social care has developed further to include holistic models of care. These are based on health and social needs.
They emphasise the importance of:
- proactive care planning
- living well for longer and
- collaborative working between health and social care providers.
In the social model approach to dementia care, the focus is placed on the person’s cognitive needs. It concentrates on their remaining abilities and skills. Activity is centred on stimulating the mind.
The medical model of dementia focuses on the brain diseases which can cause dementia. It studies neurological and chemical changes in the brain itself. This has led to development of drug interventions. It may one day mean that dementia can be prevented or even cured.
Dementia Care Mapping™ is an established way to achieve and embed person-centred care for people with dementia. It is recognised by the National Institute for Health and Clinical Excellence.
Important considerations when caring for someone living with dementia are:
- early diagnosis
- care planning and
- living well.
GPs have a duty to recognise those at risk of dementia. They should provide timely diagnosis and refer to specialist services. NHS England has published a useful guide to support GPs:
Dementia UK has provided information on getting a diagnosis.
Alzheimer’s UK provide information on the symptoms and diagnosis of dementia to to help GPs offer support post-diagnosis.
GPs may refer patients to memory clinics. Clinics can offer further diagnosis, memory tests and more support to people living with dementia. The organisation Live Better With Dementia provide more information on memory clinics.
Care planning for people living with dementia
Caring for people with dementia in primary care demands the same approach as other long‐term conditions. The systematic follow‐up of people with dementia should be integrated into primary care. This should also include their carers or care givers.
NHS England has produced dementia guidance and other resources on care planning. This is available to help with caring for people living with dementia.
The plan should be tailored to a person’s individual needs. Consideration should be given to:
- medicines management
- talking therapies to help mood and behaviour
- alternative therapies to support sleep and agitation.
Many GP practices carry out social prescribing to support people living with dementia and their caregivers. Job titles can vary from care navigators to social prescribers. The role enables people to access other forms of support such as voluntary services and those local authorities offer. For example, memory cafes and carer support groups.
Support for caregivers
Caring for a person living with dementia often is a 24 hours commitment. It has a significant impact on the health and welfare of caregivers. GPs are expected to actively identify caregivers. Practices should signpost caregivers to services which may be able to provide support.
Consideration should also be given to ethnicity of people living with dementia and their caregivers. It is important to recognise that some ethnic groups prefer to provide all care themselves. This may be part of their culture. GPs need to respect this, while supporting caregivers effectively.
GP practices should show they have given consideration to their environment. They should consider how this may affect a person living with dementia when they access services. Examples include:
- contrasting colours for walls and floors
- handrails in corridors
- effective signage
- a quiet area where it is ‘safe’ for people to wait without feeling anxious.
Often, longer appointment times will be necessary at quieter times of day. Alzheimer’s Society provide information about dementia friendly GP practices.
Sometimes a person living with dementia may lack capacity. Consideration must be given to best interest decisions about health and social care. A GP may be asked to become involved in certifying Powers of Attorney. This can be for both health and social needs, as well as financial decisions. More detail can be found at Gov.uk’s power of attorney page and Mythbuster 10 GPs and the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.
Further information and signposting
- Dementia Carers Count - support for carers including a virtual carers centre and dementia courses. They also offer information for health professionals and information about research.
- Royal Voluntary Service offers practical ways to support people living with dementia
- Alzheimer’s Society National Dementia Helpline on 0300 222 1122
- Age UK’s Advice Line on 0800 055 6112 (free)
- Independent Age on 0800 319 6789 (free)
- Dementia UK Admiral Nurse Dementia helpline on 0800 888 6678 (free).
- Last updated:
- 05 October 2020