Dementia LES Information Sheet No.2 – March 2014
Dementia Enhanced Service uptake
47 practices signed up to the enhanced service
44 action plans have been submitted
35 practices had a visit from link nurse and Alzheimer’s Society’s post-diagnostic worker
Diagnosis rate increased from 43% (October 2012)  52% (April 2013)
Hopefully we will hit our 65% target by April 2014 and we will report on this in issue 3.
To find out how your practice is doing, see the following link: Dementia Practice Calculator http://www.dementiaprevalencecalculator.org.uk/
Some examples of what practices have done to raise dementia awareness :
 Message with medication prescription: if you worry about their memory, see your GP
 Display boards during national dementia week / fl u clinic / National Alzheimer’s Day
 Reviewing patients at risk: e.g. vascular health, learning disabilities
- NEXT DEMENTIA AWARENESS WEEK IS 18-24 MAY 2014.
Please contact the local A lzheimer’s society branch for information materials if you want to raise dementia awareness during this week: 0161 483 4446
A wealth of practical support is available for GPs regarding end of life conversations with people affected by dementia, including:
 A range of resources produced by the National Council for Palliative

Care to help those commissioning and providing services for people affected by dementia: www.ncpc.org.uk/dementia
The Dying Matters leaflet 'Time to talk' offers specific information for people with dementia:
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
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 www.dyingmatters.org/sites/default/files/user/Leaflet%2011_WEB.pdf
A new training DVD to increase the confidence of GPs in initiating conversations with people affected by dementia: Find out more about and order 'Time to Talk, Doc?'
Difficult Conversations guidance, co-produced with people affected by dementia, offers practical advice and tips on opening up and continuing conversations: www.dyingmatters.org/page/people-dementia
Guidance to register dementia patients on EPACCS is published on the CCG website.
New local guidance to support people with dementia with eating and drinking (guidance for staff and informal carers) is available on the CCG website (dementia page).
Different types of dementia
See the link below for an overview of all types and their cause and presentation: http://alzheimers.org.uk/Facts_about_dementia/What_is_dementia. To ensure targeted support, it is important that every diagnosis you make includes the type of dementia.
NEW
Vascular dementia information sessions : please refer your patients to dementia link nurse Paulette Myers to book a place for free session where patients can learn more about management of their condition and become better informed about vascular risk factors.
People can book a place for the information sessions via Patricia Seville: pseville@nhs.net
/
0161 716 4505.
Frontal Temporal Dementia (Lewy Body) leaflet: please ask your link nurse or contact the memory service to order free copies Leaflet is designed for professionals, patients and carers. Copies can be ordered via Stockport Dementia Care training: 0161 716 4531.

Useful resource developed by the Alzheimer’s Society: the Dementia Guide! http://www.alzheimers.org.uk/dementiaguide
You can order a box of 25 free of charge to hand out to your patients.
Why diagnosing?
The link nurses are often asked why we should diagnose dementia. Some answers:
- to rule out other conditions that may have symptoms similar to dementia and may be treatable, including depression, chest and urinary infections, severe constipation, vitamin and thyroid deficiencies and brain tumours.
- to rule out other possible causes of confusion , such as poor sight or hearing; emotional changes and upsets such as moving or bereavement; or the side-effects of certain drugs or combination of drugs.
- to review how memory problems may interfere with a person’s other health conditions e.g. remembering to take important medication for other conditions such as diabetes, heart disease or high blood pressure
– especially regarding vascular dementia.
Benefit of an early diagnosis:
- have timely access to advice, information, training and support (emotional, practical and financial)
- allow the person with dementia to take control, plan and make arrangements for the future
- for some types of dementia it is beneficial to start with medication as soon as possible to maintain daily function for as long as possible.
See for a useful resource pack: http://dementiapartnerships.com/wpcontent/uploads/sites/2/DPC-resource-pack-v3.pdf
Key Contacts for your practice:
* Dementia specialist link nurses for Primary
Care
Dementia link nurses: Ruth Kelly, Paulette
Myers, Carolyn Cottom, Jenny Prole
- for arranging an annual information / education session for your practice
- for asking advice regarding patients on the shared care pathway
 Your first point of contact is Carol Rushton, clinical lead memory service: carolrushton@nhs.net / 0161 - 716 4505.
* CCG funded post-diagnostic support worker - Alzheimer’s Society Stockport
- to refer all your newly diagnosed patients / carers for peer support, financial advice, management of condition, advanced decision making, emotional support and much more.
- for ordering info materials for display boards / to hand out to patients to arrange information events in your practice e.g. during flu clinic or dementia awareness week (18-24 MAY 2014)
 Primary care contact: Angela Payne: Angela.Payne@alzheimers.org.uk
/ 0161 483 4446.
* Stockport dementia care training – free information sessions for informal carers
- provide information sessions for informal carers on dementia on useful strategies for caring for someone with dementia, how to cope & how to look after yourself. These courses are well valued by carers. Please mention them to carers. For information phone: 716 4531.

Key messages anti-psychotic audit 2012-2013
Less people with dementia were prescribed with an antipsychotic (10% instead of 17% of registered population)
For increased number (40% instead of 25%) of patients non-pharmalogical approaches were tried first
Increased number of people cardiovascular risks considered (plus 5%)
Increased number of discussions with carer / patient about risks (plus 18.3%)
Slight increase of anti-psychotics initiated by GPs (3% increase to 26%)
Still low number for prescribed Risperidone – which is the only licensed anti-psychotic to treat
BPSD – Alzheimer’s. Risperidone is the only licensed anti-psychotic to treat BPSD, it can be used for 6 weeks (maximum 12) in patients with Alzheimer’s. Across Stockport only 6% of dementia patients were being treated with Risperidone (in 2011 this was only 4%).
Length that people are on anti-psychotics has gone down, but only slightly (8%)
60% of dementia patients were treated with an anti-psychotic for longer than 12 months which is a decrease of 8% compared with 2011.
More annual reviews have been taken place (improvement of 10%) but we still don’t achieve on recommended 3 monthly reviews (only 8%)
40% of prescriptions had been reviewed within 12 months which is an improvement of 10%. 3 monthly reviews are recommended by Pennine Care in line with R oyal College of Psychiatrists’ advice, this happened only in 8% of the cases.
More attempts to reduce or withdrawn treatment (38% of cases instead of 36%) – however, still room for improvement.
In 62% of all reviewed cases there was no evidence of an attempt to reduce or withdraw treatment.
This is an improvement compared with 2011 when in 74% of cases no evidence of an attempt to reduce or withdraw was shown. There are limited circumstances when anti-psychotics are recommended beyond three months and discontinuation should be attempted more often.
Nice guidance you might find helpful http://www.nice.org.uk/media/7E8/5E/AcademicDetailingAidLowDoseAntipsychoticsInPeople
WithDementia.pdf
E-learning modules
A new online training resource has been launched to deliver dementia training through elearning to nurses and health care assistants (part of the Prime Minister’s Challenge on
Dementia).
Staff can access three 30-minutes sessions of learning which will support staff with difficult questions such as ‘I am worried about Dad’ that could be asked of anyone in contact with patients and families on a day to day basis. It also covers the importance of public health messages and addressing social stigma as essential in making a difference in caring for people with dementia. The sessions are available through open access but do not generate a record of completion. The open sessions can be found at: http://www.elfh.org.uk/projects/dementia/open-access-sessions/
We hope you found this information sheet helpful. For feedback please email Heather
Fairfield on H.Fairfield@nhs.net
who is standing in for Nicole (who wrote this Newsletter) and who is now on leave until January 2015.