Dementia

Dementia Health Needs Assessment

Content last reviewed: January 2016

View the complete Dementia Health Needs Assessment

Executive summary

This health needs assessment aims to systematically review the needs of people with dementia and their carers in Central Bedfordshire to guide the development of a renewed Dementia Strategy and improve the care and support available.

This report includes the descriptive epidemiology of dementia in Central Bedfordshire, the current evidence base for the prevention of dementia, mapping of existing local services, stakeholder experience, and most importantly qualitative research covering the views of people with dementia, their carers, and people who have previously cared for someone with dementia. The report culminates with key recommendations to address the issues identified. This report has been written with input from commissioners, providers, voluntary organisations, people with dementia, their carers, and people who have previously cared for someone with dementia.

Dementia is associated with a loss of general cognitive ability. There are many subtypes of this illness, with the most common being Alzheimer’s Disease. Although the prevalence of dementia increases with increasing age, dementia is not a normal part of aging. Nationally there have been several key policies aimed at increasing the number of people diagnosed with dementia as estimates suggest that nationally just over half the people with dementia have been diagnosed with the condition.

In Central Bedfordshire it is estimated that there are 3010 people with dementia (Dementia Prevalence Calculator, February 2015 dataset). Of these 1663 are predicted to have mild dementia, 980 moderate dementia, and 368 severe dementia. Every three days, two people are diagnosed with dementia via the memory assessment service in Central Bedfordshire. Overall, under the age of 75, dementia mainly affects males, while over the age of 75 females are most affected.

In 2014, the Alzheimer’s Society estimated that dementia cost the UK £26 billion a year. Estimating the costs of dementia in Central Bedfordshire poses a number of challenges. Section three explores the costs of unpaid care, social care and health care.

As part of this health needs assessment, an evidence review was conducted for primary, secondary and tertiary prevention. The key message from the primary prevention of dementia was ‘What’s good for the heart is good for the brain’. For - 9 - secondary prevention a growing body of evidence to promote a timely diagnosis of dementia and good evidence to support cognitive stimulation and peer support were identified. The review for tertiary prevention focussed on strategies to help people manage the condition such as supporting people to live alone, appropriate use of antipsychotic medication, supporting carers through education and respite provision, and advance planning for long term care.

Overarching these prevention strategies are two key areas, the reduction of stigma and increasing community support. In Central Bedfordshire there are now over 5000 dementia friends and champions helping to make Central Bedfordshire a dementia friendly community.

An analysis of stakeholders views in Central Bedfordshire identified a need for better communication with people with dementia, a lack of out of hours care, and a number of hidden populations (e.g. people with dementia living alone in rural areas). Qualitative research among people with dementia and their carers highlighted several key issues, including providing the right information at the right time and the importance of having consistent care.

The research carried out as part of this health needs assessment has led to the development of recommendations aimed at improving the quality of life for people with dementia and their carers.

Recommendations

Recommendation 1

Information, support and training is needed throughout the dementia pathway, providing a single point of contact early in the patient journey would be beneficial.

Rationale: People with dementia and their carers will need different information at different stages of the disease. A single point of contact can greatly support people with dementia and their carers in managing their own dementia journey. Training carers can equip carers with knowledge and techniques to better support the person they are caring for while being mindful of their own health and wellbeing needs. Ultimately this can lead to better health outcomes for the person with dementia and their carer.

Key sections in HNA and examples:

  • Support for Carers, including training for carers: Section 7 Page 104.
  • Single point of contact (e.g. similar to Admiral nurses model): Section 7 Page 106, Section 10 Page 140-1
  • Out of hours support: Section 10 Page 136.

Recommendation 2

Services for people with dementia and their carers should utilise a person centred care approach to ensure the support provided is tailored to the individual’s needs.

Rationale: Each person with dementia will experience their own unique disease characteristics and progression. The experience for carers will also vary and the level of support a carer needs will be unique to their situation. Offering the right support at the right time to the person with dementia and their carer can improve the quality of life for both.

Key sections in HNA and examples:

  • Services should recognise the different types of dementia and how the symptoms may manifest in people with different types of dementia: Table 10, page 32.
  • The needs of younger people with dementia and their families present different challenges and that should be catered for by support services: Section 4 Page 58, 61, 64 and 66.
  • Support services should cater for people with dementia that do not have a dedicated carer: Section 7 Page 100 and Section 10 Page 138.
  • Evidence based interventions to support people with dementia and their carers: Section 6 Page 95 and Section 7 Page104.
  • Support should consider providing the opportunity for carers to share their knowledge either during their experience or after the person they have cared for has passed away: Section 11 Page 153.

Recommendation 3

Health and social care providers should look to ensure staff training about dementia is appropriate and helpful to increase the patient and carer experience whether inpatient or outpatient.

Rationale: Identifying issues early can result in better care for people with dementia and access to support services. This can increase the quality of life for the person with dementia and help them remain in their own homes for longer if the appropriate support is provided.

Key sections in HNA and examples:

  • Correctly recording the status of people with dementia: Section 2 Page 37.
  • Appropriate training for different staff groups: Section 8 Page 113 and Section 10 Page 141.
  • Successfully managing patients that do not attend appointments: Section 10 Page 140.
  • Supporting patients with dementia while inpatient e.g. notifying a dementia nurse specialist on admission for dementia specific actions to be completed conducting a nutritional needs assessment): Section 11 Page 152.

Recommendation 4

CBC and BCCG can be a catalyst for dementia friendly communities. This could include:

  •  Increasing awareness of preventive measures e.g. linking dementia to existing key public health campaigns and services.
  •  Increasing awareness of dementia across public services and with private organisations.

Rationale: By raising awareness this should help to decrease stigma associated with Dementia, improving quality of life for people dementia and their carers.

Key sections in HNA and examples:

  • Promoting an integrated approach to key public health messages ‘What’s good for the heart is good for the brain’ and understanding the early signs of dementia and where to seek help: Section 5 Page 82 and Section 8 Page 113.
  • Consider Best practice from other parts of the UK for supporting communities to become dementia friendly: Section 8 Page 112-114, and Section 10 Page 139-141.
  • It is important to keep people with dementia involved in the community and provide support to encourage this: Section 4 Page 66 and Section 8 Page 112, Section 10 Pages 139-141 and Section 11 Pages 152 and 155.
  • The recommendations in this section should be considered with the Local Government Information Unit’s recommendations for local authorities Table 39 in Section 8 of the full report and recent publications, including the Alzheimer’s Society Dementia 2014: Opportunity for change, and the Department of Health Primer Minister’s challenge on dementia 2020. Summaries of the key recommendations in both of these reports can be found in Appendix 12.

Last updated Thursday, 20th April 2017