Early interventions

 

 

The importance of early diagnosis and intervention in dementia has been identified as a priority by the National Dementia Strategy and by the Darzi pathway for dementia within the West Midlands region. There is clear evidence that early diagnosis and intervention improves outcomes for people with dementia, their families and their carers, delays institutionalisation and reduces acute hospital admission. By intervening early in the illness and before cognitive deficits affect mental capacity, early diagnosis and intervention aims to maximise choice and autonomy, helping the person and their family adapt and make plans for the future.

 

 

Facilitation of Dementia Forums within Worcestershire and Herefordshire

ADS collaborated with the Alzheimer’s Society in Worcestershire to hold the first Dementia Forum, exploring the views of people living with dementia and their families on a range of issues. Reports on these forums can be found in the 'Documents' section of this page.

For further information concerning our work around early interventions please contact:

Dawn Brooker, d.brooker@worc.ac.uk 

 

EU Alcove project


 Alcove project

 

Sharing knowledge to advance healthcare policies in Europe for people living with dementia and their carers

Background

A report published by Alzheimer’s Disease International in 2011 suggested that up to 28 million of the 36 million people living with dementia across the world have yet to receive a diagnosis, limiting their access to treatment, information and care. The report also stated that lack of detection is a significant barrier to improving the lives of people with dementia as well as their families and their carers, and that the costs of early detection can be offset by projected future savings. The report recommended that every country should have a national dementia strategy that promotes early diagnosis and intervention.

The European Union has been quick to respond to this increasingly urgent agenda and to recognise the need to address the health, social and economic issues that dementia poses for society. In 2007 the European Commission (the EU’s executive body) funded the project “European Collaboration on Dementia – EuroCoDe”. This project, led by Alzheimer’s Europe, included work to provide an overview of national, international and European guidelines on the diagnosis and treatment of dementia.

In 2009, the European Parliament adopted a written declaration on the priorities in the fight against Alzheimer’s disease. This declaration called on the European Commission and the member states to develop a European Action Plan and to collaborate in order to improve early diagnosis and the quality of life of people with dementia and their carers. In July 2009 the European Commission issued a commitment to support member states in addressing the issue of dementia.

Project overview

The EU Joint Action on Alzheimer’s initiative (ALCOVE) was launched in 2011 in an effort to step up cooperation and support to improve prevention, diagnosis, treatment and care across European Member States. ALCOVE was a two-year project addressing four core areas:

  • How to improve data for better knowledge about dementia prevalence;
  • How to improve access to dementia diagnosis as early as possible;
  • How to improve care for people living with dementia and particularly those with behavioural disorders;
  • How to improve the rights of people with dementia, particularly with respect to advance declarations of will.

Project organisation

The project was split into seven Work Packages with each being lead by a different EU country:

  • Work Package 1 – France
  • Work Package 2 – Spain
  • Work Package 3 – Slovakia
  • Work Package 4 – Italy
  • Work Package 5 – UK
  • Work Package 6 – Finland
  • Work Package 7 – Belgium

ADS involvement

In December 2011 ADS was invited to tender by the Department of Health to lead Work Package 5 to address the issue of Early Diagnosis and Interventions with the following objectives:

  • To compare national recommendations for the diagnosis of dementia, in order to access a common definition;
  • To assess different approaches of healthcare systems to develop recommendations to improve early diagnosis. 

Since then we have worked alongside colleagues from countries all over Europe to produce a set of evidence-based recommendations for policy makers across the EU on dementia, specifically addressing:

  • Prevalence and Epidemiological Data
  • Quality and Timeliness of Diagnosis
  • Strategies for Behavioural and Psychological Symptoms
  • Ethical and Legal Issues for Advanced Directives and Competency Assessment
  • Antipsychotic Limitation in Dementia

The ADS team consisted of:

The Work Package 5 project team also included a number of key stakeholders from the UK:

  • Professor Alistair Burns – National Clinical Adviser for Dementia
  • Jerry Bird – Department of Health Project Manager on the Dementia Strategy
  • Dr Karim Saad – Department of Health Clinical Adviser on the ALCOVE project
  • Peter Ashley – Honorary Masters Degree from University of Worcester
  • Dr Bernie Coope – Lead Consultant for Older Adult Services with Worcestershire Mental Health Trust

The team worked with the following representatives and associate partners to coordinate the collection of information from each of the 27 EU Member States:

  • Anders Wimo – Sweden
  • Vladimirs Kuznecovs – Latvia
  • Petr Novak – Slovakia
  • Gemma Villanueva – Spain
  • Eleni Margioti – Greece
  • Armelle Desplanques – France
  • Daiva Rastenyte – Lithuania

The focus of the work was on:

  • Comparing mechanisms to provide for the early diagnosis of dementias e.g. Memory Clinics;
  • Exploring the role of general practitioners in ensuring early diagnosis;
  • Conducting an assessment of recommendations and strategies for systematic screening.

This programme is now complete and we presented our findings at a ministerial level event to launch the main outputs in Paris on 28th March 2013. Professor Dawn Brooker and Dr Karim Saad presented the work from the UK alongside Professor Anders Wimo. Also in our delegation were Jenny La Fontaine, Jennifer Bray, Jerry Bird and Peter Ashley.

The audience included delegates from 24 countries and speakers included:

  • Jean-Paul DELEVOYE, President of the French Economical, Social and Environmental Council 
  • Jean-Luc HAROUSSEAU, President of the French National Authority for Health
  • Michael HÜBEL, Head of Programmes & Knowledge management, Health & Consumers DG, European Commission
  • Alistair BURNS, National Clinical Director for Dementia, United Kingdom
  • Michèle DELAUNAY, French Minister of the Elderly and the Autonomy

The recommendations and associated reports will be of interest to all those working in the field as they tackle some of the most challenging issues facing health and social care.

project summary is available.

Additional information:

For further information about ALCOVE please contact simon.evans@worc.ac.uk or d.brooker@worc.ac.uk

 

Dementia advisers Worcestershire

Worcestershire PCT, ADS, the Alzheimer’s Society and Health and Care NHS Trust were successful in their bid to host one of the National Demonstrator sites for the Dementia Advisers. Two advisers were appointed to work alongside the Worcestershire Early Intervention Dementia Service, as well as receiving referrals from Community Mental Health Trusts, the Alzheimer’s Society and self referrals. ADS were commissioned by Worcestershire County Council and NHS Worcestershire to evaluate the work of the Dementia Advisers involved in the Worcestershire Demonstrator Site. This evaluation study sought to deliver a robust assessment of the impact, experience and effectiveness of the work of the Dementia Adviser, as well as determining the skills, facilitators and barriers to the success of the role.

A multi-method approach was utilised which involved seeking the perspectives of the Dementia Advisers themselves, people who use their service and those who inform the development of the service or are influenced by their work. In addition, the perspectives and experience of a smaller group of people who had not received a Dementia Adviser service were sought to gain some insight into possible differences between their experiences and those who have received a service.

The Dementia Adviser Service has since been expanded to cover the whole of Worcestershire.

Further information can be found at:

Alzheimers society

Worcestershire PCT

Department of Health

Dementia adviser service final report PDF  

 

Dementia workforce competencies

Workforce Competencies for Primary Care Liaison Worker & Dementia Co-ordinator

This project was funded by the West Midlands Strategic Health Authority and sought to support the implementation of the West Midlands Darzi Pathway on Dementia. ADS collaborated with Staffordshire University, Centre for Ageing and Mental Health on the development of a job description, competencies and person specification for two new roles for dementia services.

Primary Care Liaison Role

To address the needs of the public/patients who present at GP practices with a range of memory loss, behavior changes, changes in cognitive functioning symptoms. The new role is intended to be commissioned by a practice based commissioning cluster of GPs, working with GP practices and lists and for working with these presenting clients to signpost them into the memory assessment process so that a differential diagnosis then follows.

Dementia Care Pathway Coordinator

This role/service starts as soon as the diagnosis has taken place and this role/service then is the key to helping the person and their family to navigate their journey through the course of dementia and ensure they receive services to which they are entitled.

Further information can be found at the workforce development pdf

 

Early intervention Dementia service

Worcestershire Mental Health Partnership Trust, in collaboration with NHS Worcestershire and Worcestershire County Council, has established an Early Intervention Dementia Service (EIDS), whose aims are to provide assessments for all adults with a possible diagnosis of early dementia. The service includes:

  • Pre-assessment information and counselling
  • Evidence-based assessment
  • Making the diagnosis well
  • Sensitively sharing the diagnosis to the individual and their family where appropriate
  • Providing appropriate and timely interventions, information, care and support after diagnosis to enable the person to live well with dementia

The service was recently awarded a £35,000 prize in the NHS Innovation Challenge Prize for Dementia 

The Association for Dementia Studies (ADS) delivered an education programme to assist the EIDS team to meet the demands for understanding the early intervention remit, ensuring evidence is used consistently to support practice as demands emerge and to support the team safely and effectively. To this end an Action Learning Set comprising a series of best practice seminars took place throughout the first year of team operation. The team had the opportunity to consider each of these seminars in depth within their service context and to operationalise consistent best practice. It was intended that the education programme would equip staff with relevant knowledge in order that they can utilise an evidence based, reflective approach to:

  • Deliver a competent, specialist assessment across the range of people suspected of having dementia presenting to their services
  • Sensitively communicate the results of assessment to the person with dementia and their family and carers
  • Offer interventions following diagnosis for the person with dementia and their families and supporters

EIDS is committed to providing a robust assessment of the effectiveness of the service. This includes ensuring that the perspectives of people who have received a service, and their families and supporters are sought and results integrated into evaluation at all stages. The Association for Dementia Studies worked with EIDS to design and develop their evaluation framework. For more information about the first year of evaluation, please see an executive summary from our report.