Creating a culture of Education in Dementia Care

1
Creating a culture of Education in Dementia Care

• Steve Iliffe
• Reader in General Practice
• Centre for Ageing Population Studies, UCL

2
The workforce issue

• To deliver dementia care in England to the NSF
  gold standard by 2010 we will need
• 9 more general practitioners
• 29 more old age psychiatrists
• 15 more community mental health nurses
• 14 more clinical psychologists
• 35 more health care assistants
• and 39 more social workers

3
Care pathways

• Distribution of skills not job demarcation
• Interviews, groups, participant observation
• Jane Wilcock Deborah Haworth
• Funding from Eisai/Pfizer
• Iliffe S, Wilcock J Haworth D A toolbox of
  skills to share across dementia care. Journal of
  Dementia Care, 2004 12 (4)
• Iliffe S Wilcock J The identification of
  barriers to the recognition of and response to
  dementia in primary care using a modified focus
  group method. Dementia 2005412-23

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Good practice

• Identify cases
• Diagnostic work-up
• Disclosure
• Information giving
• Systematic follow-up needs assessment
• Reinforce abilities
• Carer support
• Shared care of medication use
• Problem-solving for behaviour changes
• End-of-life care

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Changes in behaviour, mood or memory
Confusion in an acute crisis
Impaired activities of daily living
SKILLS
Revelatory problem
Pattern recognition, with rich illness scripts
allowing subtle and complex changes to be
understood as dementia
What is happening?
Recognition
Deductive synthesis of clinical findings,
cognitive function testing, informant history,
simple tests. Dealing with uncertainty
Diagnosis
Disclosure
Risk assessment (how does PWD see ageing ill
health?), dialogue with PWD carer,
Communicating bad news Planning (anticipation)
What does this person now need?
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What does this person now need?
Integrating multiple perspectives, decision
making, needs assessment capabilities
From perspectives of PWD, carer professionals
Networked into local services, shared care for
medication management, with case management
capabilities and disability (rather than disease)
perspective?
Meeting needs for information, support, symptom
control, care
New problems emerge
Problem analysis - In terms of impact of other
pathologies, caused by others activities,
intrinsic to dementia or due to
depression/psychotic symptoms changing context
Understanding causes of new problems
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Actions

• Distribution of skills not job demarcation
• Learn from every person with dementia
• Significant event analysis
• Workplace learning
• Joint learning?
• Joint working?
• IT solutions