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1 – 10 of over 2000Lesley Jones, Nicky Cullum, Ruth Watson and John Keady
This study aims to address this need. In the UK, people with dementia admitted to National Health Service mental health in-patient dementia assessment wards [dementia assessment…
Abstract
Purpose
This study aims to address this need. In the UK, people with dementia admitted to National Health Service mental health in-patient dementia assessment wards [dementia assessment wards] present as complex and experience a number of changed behaviours, such as excessive walking, agitation and aggression. The complexity of the presentation of dementia has been identified as underpinning pre-and post-admission to these care environments, but limited study has so far been conducted to explore the boundaries and meaning of complexity and its relationship to dementia assessment ward practice.
Design/methodology/approach
An online electronic survey of UK-based national dementia leaders was conducted in 2018. Nineteen completed questionnaires were returned, and mental health nurses comprised the largest sub-sample. Qualitative data of the free-text responses were analysed using manifest content analysis.
Findings
Four routes to admission to a dementia assessment ward were identified. Multiplicity of needs and interconnectedness were seen as important domains in uncovering the meaning of complexity. The importance of life story and formulation approaches were highlighted. Challenges uncovered included, better understanding changed behaviour and its relationship to complexity, the need for understanding the boundaries of complexity and making visible care practices on these specific wards.
Originality/value
Findings can be used to produce a heightened awareness about the meaning and function of complexity in dementia assessment wards. Policymakers and researchers need to increase the emphasis on this area of mental health and dementia care. Further training for the multidisciplinary team on formulation approaches could help to improve the evidence-base for practice.
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Hannah Jethwa and Geraldine Cassidy
Dementia is a condition that involves inevitably progressive deficits in numerous cognitive domains, including thought, language, memory, understanding and judgement. A difference…
Abstract
Dementia is a condition that involves inevitably progressive deficits in numerous cognitive domains, including thought, language, memory, understanding and judgement. A difference in behaviour may be noted, as well as overall loss of skills. Dementia is more than four times as prevalent in people with intellectual disabilities as in the general population. Diagnosis of the condition in people with intellectual disabilities, however, is often difficult due to lack of baseline skill assessment, high staff turnover in supported accommodation and low expectations of capabilities. Current National Institute for Health and Clinical Excellence (NICE) guidelines on anti‐dementia medication state that treatment should not be initiated until the condition has reached moderate severity. Determining whether symptoms are at this stage in people with intellectual disabilities is difficult because their skill level is already impaired. An accurate and extensive record of baseline skill levels in people with intellectual disabilities is therefore crucial, and regular comparison with baseline is key to early diagnosis of dementia.
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This paper aims to describe three dementia assessment services for people with intellectual disabilities to provide professionals with insight into planning this type of service.
Abstract
Purpose
This paper aims to describe three dementia assessment services for people with intellectual disabilities to provide professionals with insight into planning this type of service.
Design/methodology/approach
Three services in England were contacted via email and telephone to collect data on their service provision. They were asked about the average age of individuals when receiving a baseline assessment, frequency of follow-up assessment, assessment instruments used and descriptive aspects of their services.
Findings
All three services offered proactive dementia assessment services to people with Down's syndrome (DS), with one service providing systematic screening via the GP. None offered proactive screening to people with intellectual disabilities who did not have a diagnosis of DS. All offered reactive assessment to this population if they experienced a decline in function. Services differed in terms of age at which baseline assessments were offered, frequency of follow-up and instruments used.
Originality/value
To the best of the authors’ knowledge, this is the first paper to compare dementia assessment provision between different services in England.
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The dementias are important disorders of ageing which result in cognitive and functional decline, behaviour change, increasing dependency and premature death. Alzheimer's disease…
Abstract
The dementias are important disorders of ageing which result in cognitive and functional decline, behaviour change, increasing dependency and premature death. Alzheimer's disease and other dementias are at least as prevalent in older people with learning disabilities as in the general population. In addition, people with Down's syndrome have high rates of early onset Alzheimer's disease. Assessment of dementia in people with learning disabilities is confounded by pre‐existing cognitive and functional impairments and high rates of comorbid disorders. This paper discusses assessment of dementia in people with learning disabilities from a clinical perspective, with reference to the current evidence base.
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The purpose of this paper is to consider the issue of types of assessment offered by services for people with learning disabilities from the research study “A Comparison of…
Abstract
Purpose
The purpose of this paper is to consider the issue of types of assessment offered by services for people with learning disabilities from the research study “A Comparison of Dementia Assessment Services for People with Intellectual Disabilities”.
Design/methodology/approach
The commentary is based on a review of the associated literature.
Findings
Assessment for possible dementia is a complex activity. The gold standard is to ensure that the assessment process is comprehensive including both direct assessments with the person and gathering information from key informants. The issues in not adopting this methodology are considered, as are issues in what services and assessments are called.
Originality/value
The commentary considers the studies presented from a practitioner perspective.
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Marjan Ghazirad, Olivia Hewitt and Sarah Walden
The use of anti-dementia medication in people with intellectual disabilities has been controversial and requires additional research to assess the efficacy of such medications. An…
Abstract
Purpose
The use of anti-dementia medication in people with intellectual disabilities has been controversial and requires additional research to assess the efficacy of such medications. An essential part of this treatment (both in terms of research and clinical practice) is having robust outcome measures to assess the efficacy of these medications for individuals. Currently there is no consensus in the UK regarding which outcome measures, in conjunction with clinical judgement, are effective in informing clinicians’ decision-making regarding anti-dementia medication management and this paper aims to present useful outcome measures.
Design/methodology/approach
A comprehensive literature search was conducted to identify relevant outcome measures. Outcome measures focused on aspects of patients’ presentation such as cognition, activities of daily living, neuropsychiatric presentation or the impact of their presentation (either on themselves, or on others). These outcome measures were critically appraised to ascertain their suitability in informing clinician’s decisions regarding management of anti-dementia medication. The focus of this appraisal was on good quality measures that are practical and accessible and can be easily used within clinical NHS services.
Findings
This paper provides advice for clinicians on using appropriate outcome measures, depending on patients’ presentations and the symptoms of dementia being targeted, that can be used alongside their clinical assessment to enhance their anti-dementia medication management. Two case studies are presented to illustrate the use of such outcome measures.
Originality/value
The case for using a range of assessments that are both broad in focus, and those specifically selected to measure the areas of functioning targeted by the anti-dementia medication, is presented.
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Caroline Duncan, Ewan Wilkinson, Sujeet Jaydeokar and Daniel James Acton
This study aims to evaluate the dementia assessment and diagnosis care provided to adults with intellectual disability. The authors selected recommendations from the National…
Abstract
Purpose
This study aims to evaluate the dementia assessment and diagnosis care provided to adults with intellectual disability. The authors selected recommendations from the National Institute for Health and Care Excellence (NICE) standards which could be evidenced in clinical notes and aimed to identify characteristics which may be associated with improved adherence to these recommendations.
Design/methodology/approach
The study population was adults with an intellectual disability who were diagnosed with dementia between January 2019 and December 2022 by a UK-based intellectual disability service. Data to demonstrate adherence to selected recommendations and demographic and clinical characteristics were extracted from electronic patient records.
Findings
The authors identified 41 individuals. A mean of six of the eight recommendations were adhered to. There was low adherence with structural imaging to support dementia subtype diagnosis (9 individuals, 22%). This may be linked with the low percentage of people diagnosed with vascular dementia (1 individual, 2%) despite a national figure of 20%. No demographic or clinical characteristics were associated with level of adherence recorded. The authors found incomplete recording of diagnostic clinical coding in electronic patient records. This may disadvantage this population, as they cannot be readily identified for post diagnostic support or resource allocation.
Originality/value
To the best of the authors’ knowledge, this is the first study to examine adherence to these NICE guidelines in this population.
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Pamela Roach, John David Keady and Penny Bee
Standards of care and care pathways for younger people with dementia vary greatly, making clinical development and service planning challenging. Staff working in dementia services…
Abstract
Purpose
Standards of care and care pathways for younger people with dementia vary greatly, making clinical development and service planning challenging. Staff working in dementia services identify that they use biographical knowledge of families to influence clinical decision making. This information is not collected or implemented in a formal manner; highlighting an important knowledge-practice gap. The paper aims to discuss these issues.
Design/methodology/approach
The development of a family-centred assessment for use in dementia care has three core components: first, thematic development from qualitative interviews with younger people with dementia and their families; second, clinical input on a preliminary design of the tool; and third, feedback from an external panel of clinical and methodological experts and families living with young-onset dementia.
Findings
The 12-item Family Assessment in Dementia (Family-AiD) tool was developed and presented for clinical use. These 12 questions are answered with a simple Likert-type scale to determine areas of unmet need and identify where families may need additional clinical support. Also included is a series of open-ended questions and a biographical timeline designed to assist staff with the collection and use of biographical and family functioning information.
Originality/value
A dementia-specific clinical family assessment tool, which also collects background biographical data on family units may be a useful way to document information; inform clinical decision making; and address otherwise unmet needs. Family-AiD has potential to improve clinical care provision of people with dementia and their families. Evaluation of the feasibility and acceptability of its implementation in practice are now required.
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Amanda Bayley, Annika Amoako and Mohamed Omer El-Tahir
The purpose of this paper is to discuss the findings of a service evaluation project of the Specialist Memory Clinic for people with intellectual disabilities in South Wales using…
Abstract
Purpose
The purpose of this paper is to discuss the findings of a service evaluation project of the Specialist Memory Clinic for people with intellectual disabilities in South Wales using the Dementia guidelines published by the British Psychological Society and the Royal College of Psychiatrists (BPS/RCPsych, 2015).
Design/methodology/approach
Clinical audit using case notes of patients attending Memory Clinics during 2011 and 2015 benchmarked against best practice guidelines; carers feedback from Memory Clinic attendance; and evaluation of the training sessions to carers.
Findings
Audit findings show full compliance with standards (100 per cent) except for the baseline assessment for people with Down syndrome. Carer’s evaluation and feedback was positive and constructive. Training evaluation indicates improvement in knowledge and positively received sessions.
Research limitations/implications
The small number of people included and possibility of high motivated team may affect the service evaluation result.
Practical implications
It is possible for the Community Learning Disability team to meet the standards published (BPS/RCPsych, 2015) through multidisciplinary working.
Originality/value
Initial service evaluation completed after published guidelines for Dementia care by the BPS/RCPsych (2015).
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Through a literature review, this article aims to identify the needs of those people with dementia who wish to remain at home, and those of their carers. It goes on to model a…
Abstract
Through a literature review, this article aims to identify the needs of those people with dementia who wish to remain at home, and those of their carers. It goes on to model a range of services that can be linked together to meet these needs comprehensively.