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Dementia SCIE NICE kb SSIA

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					Dementia


November 2006
       This presentation covers:

Background

Key recommendations

Interventions

Implementation
               National Institute for
      Health and Clinical Excellence

NICE is the independent organisation in the
NHS, responsible for producing guidance based
on the best available evidence of effectiveness
and cost effectiveness to promote health and to
prevent or treat ill health.
                 Social Care Institute
                       for Excellence

SCIE develops and promotes knowledge-based
practice in social care. It produces
recommendations and resources for practice
and service delivery and improves access to
knowledge and information in social care by
working in partnership with others.
                   Who is this NICE-SCIE
                     guideline aimed at?

This is the first joint guideline produced by NICE
and SCIE.

It covers the care provided by social care
practitioners, primary care, secondary care and
other healthcare professionals who have direct
contact with, and make decisions concerning the
care of, people with dementia.
                    What the guideline covers
                        Risk factors,
  Diagnosis                                        Diagnosis and assessment
                  screening and prevention

  Promoting                       Promoting independence
independence



                  Cognitive symptoms      Non-cognitive          Comorbid emotional
Interventions     and maintenance of      symptoms and              Disorders
                        function       challenging behaviour




Palliative Care
                                   Palliative and end-of-life care
                  Non-discrimination


People with dementia should not be excluded
from any services because of their diagnosis,
age (whether designated too young or too old)
or a coexisting learning disabilities.
                           Valid consent


Health and social care practitioners should
always seek valid consent from people with
dementia.
If the person lacks the capacity to make a
decision, the provisions of the Mental Capacity
Act 2005 must be followed.
                                        Carers

The rights of carers to an assessment of needs
as set out in the Carers (Equal Opportunities)
Act 2004 should be upheld.

Carers of people with dementia who experience
psychological distress and negative
psychological impact should be offered
psychological therapy, including cognitive
behavioural therapy, by a specialist practitioner.
       Coordination and integration of
               health and social care
Health and social care managers should
coordinate and integrate working across all
agencies involved in the treatment and care of
people with dementia and their carers.

Care managers/coordinators should ensure the
coordinated delivery of health and social care
services for people with dementia.
                     Memory services

Memory assessment services should be the
single point of referral for all people with a
possible or suspected diagnosis of dementia.

Services may be provided by a memory
assessment clinic or by community mental
health teams.
                         Structural imaging
                              for diagnosis
   Structural imaging should
be used to assist in the
diagnosis of dementia, to aid
in the differentiation of type
of dementia and to exclude
other cerebral pathology.
   Magnetic resonance imaging (MRI) is the
 preferred modality to assist with early diagnosis
 and detect subcortical vascular changes,
 although computed tomography (CT)
 scanning could be used. (Neuropsychological
 assessment for mild or questionable dementia)
         Behaviour that challenges

People with dementia who develop behaviour
that challenges should be assessed at an early
opportunity to establish the likely factors that
may generate, aggravate or improve such
behaviour.

Common causes include depression,
undetected pain or discomfort, side effects of
medication and psychosocial factors.
                                       Training

Health and social care managers should ensure
that all staff working with older people in the
health, social care and voluntary sectors have
access to dementia-care training that is
consistent with their role and responsibilities.
                       Mental health needs
                        in acute hospitals
Acute and general
hospital trusts should
plan and provide services
that address the specific
personal and social care
needs and the mental
and physical health of
people with dementia
who use acute hospital
facilities for any reason.
                           Interventions
The guideline recommends a range of
non-pharmacological and pharmacological
interventions for cognitive symptoms,
non-cognitive symptoms and behaviour that
challenges, and for comorbid emotional
disorders.

It incorporates the recommendations of the
Alzheimer’s technology appraisal.
                             Alzheimer’s
                     technology appraisal

NICE was asked to review the evidence on
donepezil, rivastigmine, galantamine and
memantine.

Drugs are appraised within their licensed
indications (acetylcholinesterase inhibitors for
mild to moderate disease, memantine for
moderately severe to severe disease).
                           Alzheimer’s
                  Technology Appraisal

Consider the acetylcholinesterase inhibitors
donepezil, galantamine and rivastigmine for
moderate Alzheimer’s disease (a Mini Mental
State Examination [MMSE] score of 10–20
points) only and under a number of conditions.
Memantine is not recommended as a treatment
option for people with moderately severe to
severe Alzheimer’s disease except as part of
well designed clinical studies.
See www.nice.org.uk/TA111 for details.
                               The NICE-SCIE clinical guideline
                            When not to rely on the MMSE score
         In those with an MMSE score >20, who have moderate dementia
              as judged by significant impairments in functional ability
          and personal and social function compared with premorbid ability

    In those with an MMSE score <10 because of a low premorbid attainment
   or ability or linguistic difficulties, who have moderate dementia as judged by
              an assessment tool sensitive to their level of competence


                         In people with learning disabilities



 In people who are not fluent in spoken English               Tools used to assess
or in the language in which the MMSE is applied             the severity of dementia
                                                      in people with learning disabilities
                                                               should be sensitive
                                                          to their level of competence


                                    Cambridge Cognitive Examination
                    Modified Cambridge Examination for Mental Disorders of the Elderly
                                                  DMR
                               Dementia Scale for Down Syndrome (DSDS)
                  Other interventions

Cognitive symptoms of dementia and mild
cognitive impairment (MCI).

Non-cognitive symptoms and behaviour that
challenges.

People with comorbid emotional disorders.
                      Cognitive symptoms

Offer cognitive stimulation programmes for mild
to moderate dementia of all types.

Vascular dementia: do not use
acetylcholinesterase inhibitors or memantine for
cognitive decline except as part of properly
constructed clinical studies.

Mild cognitive impairment (MCI): do not use
acetylcholinesterase inhibitors except as part of
properly constructed clinical studies.
             Non-cognitive symptoms and
                behaviour that challenges
Consider medication for non-cognitive symptoms or
behaviour that challenges in the first instance only if there
is severe distress or an immediate risk of harm to the
person or others (can use AchEI for DLB or AD)

• Use the assessment and care-planning approach as
soon as possible.

• For less severe distress and/or agitation, initially use a
non-drug option e.g. aromatherapy, music

See www.nice.org.uk/CG042 for details.
                  People with comorbid
                   emotional disorders
Assess and monitor people with dementia for
depression and/or anxiety.

Consider cognitive behavioural therapy.

A range of tailored interventions such as
reminiscence therapy, multisensory stimulation
etc should be available.

Offer antidepressant medication.
                        Integration and
              co-ordination of services

Follow the checklist in ‘Everybody’s business’
(www.everybodysbusiness.org.uk) when
developing services.

Promote incentives to improve implementation
using the Quality and Outcomes Framework
(QoF) and relevant targets such as the 18 week
wait.
                        Service provision

Provide a single assessment process.

Ensure health and social care managers jointly
agree written policies and procedures.

Combine care plans between health and social
services and ensure the person with dementia
and/or carers endorse it.
                      Communication,
                 education and training

Review communication
and training arrangements
within and across partner
organisations.

Work with mental capacity act networks.

Use best practice tool from Department of
Health.
                       Communication,
                  education and training
Collaborate with your local workforce
development directorate, local dementia
specialists, social services, higher education
institutions and voluntary agencies to consider
training in dementia as part of CPD for health
and social care staff.
Consider using Skills for Care Knowledge Set
(www.skillsforcare.org.uk).
Ensure approved social workers’ training
contains relevant material.
                      Access tools online

This slide set.
Implementation advice.
Audit criteria.
Costing tools – costing
report and local costing
template.
Available from www.nice.org.uk/CG042
                        Access the guideline
                                      online
• The quick reference guide – a summary of the
recommendations for health and social care staff.
• ‘Understanding NICE-SCIE guidance’ – information for
people with dementia and their carers.
• The NICE-SCIE guideline – all the recommendations.
• The full guideline – the recommendations, how they
were developed and summaries of the evidence.

Available from www.nice.org.uk/CG042 and
www.scie.org.uk/publications
            Access further information
                             from SCIE

• Practice guides – summaries of information on
a particular topic to update practice at the health
and social care interface.

• Research briefings – information, research and
current good practice about particular areas of
social care.

Available from www.scie.org.uk/publications

				
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