Integral Plan of Socio-sanitary Attention to the Cognitive Deterioration in Extremadura [PIDEX] Junta de Extremadura - ESPAСA

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Integral Plan of Socio-sanitary Attention to the
Cognitive Deterioration in Extremadura PIDEX
Junta de Extremadura - ESPAÑA

• Manuel Cid Gala
• Servicio Extremeño de Promoción de la Autonomía
  Personal y Atención a a la Dependencia SEPAD
• Consejería de Sanidad y Dependencia

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Extremadura
Cáceres
Badajoz

• 1.073.381 inhabitants
• 41.634 km2 (26 inh/Km2)
• Inmigration mainly from Morocco and Romania
• Birth rate 9 - 10 per 1.000 inh. Similar death
  rate
• Persons with (recognized) disability 80.462
• 65 years old and above persons 209.312

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• More than 1.500 kms of inland coastline
• 12 protected natural areas
• 3 World Heritage Cities
• Royal Monastery of Yuste European Heritage site
  

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Royal Monastery of Yuste European Heritage Site
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PIDEX

• The Integral Plan of Sociosanitary Attention to
  the Cognitive Deterioration in Extremadura,
  organizes the attention to those persons with
  COGNITIVE DETERIORATION.
• 2. It consists of 3 areas
• DEGENERATIVE DEMENTIA
• Rehabilitation of ACQUIRED BRAIN INJURY that is
  potentially recoverable
• INFANCY COGNITIVE DEFICITS

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BASIC PROPS
1- The term cognitive deterioration refers to the
loss of ability (deficits) in one or more
intellectual functions memory, language,
perception, executive function, etc.. 2- The
first area of the PIDEX is focused on those
patients with tipically progressive deterioration
of cognitive function. 3- The most habitual
symptons that those patients or his/her
relative refer - I have problems to memorize
or to remember things - I cannot find the
right word
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Degenerative dementia

• Degenerative Dementia is a disease of the central
  nervous system CNS related to deterioration of
  the cognitive function, of progressive type and
  of any etiology.

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BASIC PROPS

• The treatment of cognitive progressive
  deterioration is demands sanitary, social and
  legal actions throughout the time
• There are two generally accepted models of
  treatment
• o     Sanitary from primary to specialized
  attention
• o     Social attention to dependence
• There are specified instruments of attention and
  evaluation approved/recognized
• It is a key aspect to introduce measurement and
  quality concepts in resources and services in
  both areas
• The fundamental aim is an integral and integrated
  approach through a socio-sanitary network
• o     to treat the behavioural, neurological and
  medical symptoms
• o    to increase the intervals of moderate
  dependence.

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Evolutionary profile
PHYSICAL
PSYCHIC
COGNITIVE
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Intervals of Moderate Dependence
slight
moderate
with sociosanitary approach
without sociosanitary approach
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• It is an agile operating model
• sanitary system
• attention to dependence system
• Effective cooperation between the above mentioned
  systems

SANITARY SYSTEM
SOCIAL SYSTEM
Exact diagnosis Filed etiology Appropriate
treatment Correct monitoring Classification of
disability and impairment
Attention to dependence Social diagnosis Social
intervention Social resources and services Social
monitoring
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PROFESIONALS
TOOLS
s a n i t a r y
DETECTION DIAGNOSIS TREATMENT MONITORING
INFORMATION
s o c i a l
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But the very important thing...
It isnt the model, but the result
The coverage of the real needs.
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Prevalence
In Spain there are approximately 500.000 cases of
dementia The prevalence of the disease doubles
every 5 years between the 65 and 90
years EXTREMADURA Approximately 15.000-20.000
estimated cases 50 of the dementia is in its
beginning, 30 in moderate, serious or moderate -
serious phase and 20 in slight degree, which is
key considering the importance of the precocious
detection for a more effective treatment.
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Then...

• It was necessary that the Plan were
• done by professionals of Extremadura SES and
  SEPAD
• based on the reality of Extremadura
• focused to optimize the existing resources and
  ready to implement
• applicable in the whole region
• associate to a sanitary approach
• TO SUM UP an integral, integrated and flexible
  but easily operated model, defined to take care
  of persons with dementia from a socio-sanitary
  point of view and appropriate to carry out it in
  Extremadura

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Thus...
Methodology

• 2 experts coordinated 12 socio-sanitary
• GROUPS OF EXPERTS
• SCIENTIFIC BIBLIOGRAPHY social and
• sanitary
• CONSENSUS IN 90
• Based on the REALITY OF EXTREMADURA

6 M O N T H S
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And everythig due to the fact that...
CORPORATIVE AND COOPERATIVE EMPOWERMENT (MULTILEVE
L GOVERNANCE)
WIN-WIN game
Inter-level relation
Communitary Model
Inter-sectorial relation
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Aims

• To detect prematurely the slight cognitive
  deterioration and the dementia in PRIMARY
  ATTENTION
• To realize a diagnosis in the COGNITIVE
  DETERIORATION SPECIALIZED CONSULTATIONS
• To evaluate the situation of dependence that
  generates the dementia individual and relatives
• To offer a continued and high quality sanitary
  and attention to dependence treatment
• To provide COGNITIVE STIMULATION as a habitual
  treatment for those patients who need it
• To offer the treatments and necessary
  interventions to the caregiver of the persons
  with dementia

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Primary Attention
FUNCTION
TOOL
PREVENCIÓN
Primaria y Secundaria

DETECCIÓN
Test cognitivos
MMSE, MIS, TIN, otros
Listado de signos de Alarma
LSA
Descartar enfermedades posibles
Guía Práctica Clínica
DIAGNÓSTICO
Impresión diagnóstica
Guía Práctica Clínica
TRATAMIENTO
Alteración conductual
Guía Práctica Clínica
Alteración sistémica
Práctica clínica habitual
Alteración neurológica
Guía Práctica Clínica
SEGUIMIENTO
Coordinación
Socio-sanitaria
Educación
Enfermera, Médico
Seguimiento clínico
Práctica habitual
Complicaciones según fases
Práctica habitual y GPC
FASE TERMINAL
Cuidados Paliativos
Cuidados Paliativos
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Hospital/Specialized Attention
Diagnóstico Especializado
Prevalencias
Tratamiento
Pronóstico
Actuación Social
Seguimiento
ETC
BASE OF THE DIAGNOSIS
ETIOLOGÍA y TTO de DD
Caracterización del DETERIORO COGNITIVO
foundation in the farmacoterapia
Elaboration of the Clinical Judgment Request of
complementary specific Tests Consideration of the
finds of NEUROPSYCHOLOGY Differential diagnosis
and Etiológico Escala of Gravity of
Dementia pharmacological specific Treatment
Specializing Anamnesis, Neurological
Exploration neuroimagen, Report
Neuropsicológico, Neuropatología and
Neurochemical Resources
Characterization of the COGNITIVE DETERIORATION
the presence or DC's absence Determine Degree of
Cognitive Deterioration differential Diagnosis
demencia/no dementia Spoil cortical vs.
subcortical focal Deterioration diffuse vs.
cognitive affected and not affected Functions
Gravity of the Cognitive Deterioration
Correlation with parameters they injure
Indication of Cognitive Stimulation Indication
of Guidelines of Cognitive Stimulation Valuation
of the Intellectual Disability
HERRAMIENTAS
Anamnesis especializada, Exploración Neurológica,
Pruebas de neuroimagen, Otras pruebas, Informe
Neuropsicológico, Neuropatología y Neuroquímica
HERRAMIENTAS
ADAS-COG, ENM.dem, WCST, T. Londres, CIF, LNS,
COWAT, POPPELREUTER...
Informe Clínico completo y SEGUIMIENTO Derivación
a AP
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Attention to dependence
Informe protocolizado desde AE con un Diagnóstico
de DETERIORO COGNITIVO DEGENERATIVO
Valoración social
PAUTAS DE ACCIÓN
Evaluación de la necesidad de ayuda
Red Social de Apoyo
Evaluación de situaciones Potenciales de estrés
Evaluación realizada en el medio habitual
GRADO
RED SOCIAL DE APOYO
RED SOCIAL DE APOYO FRÁGIL
SIN RED SOCIAL DE APOYO
DCL, GDS 3
Recursos
Unidades de Demencia en Residencias, Servicios de
estancias diurnas para demencias, Asociaciones
de Familiares de Enfermos con Demencia...
DEMENCIA LEVE
Servicios
DEMENCIA MODERADA
Ayudas Técnicas, Ayuda a domicilio de Cuidados
Personales y Atención Doméstica, Lavandería y
comedor social, Servicio de Apoyo a la Familia,
Seguimiento social a domicilio, Teleaistencia,
Comida y lavandería a domicilio
DEMENCIA GRAVE
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Resources and services
GENERALES
PARA DEMENCIAS
Network(Net) of Primary care of Health
Teleassistance helps to domicile of elegant
personnels social follow-up helps to domicile of
domestic attention to domicile food and
laundry to domicile laundry and social dining
room sanitary services to domicile care
palliative
6 CONSULTATIONS SPECIALIZING IN DC 2 RESIDENCES
FOR DEMENCIAS 197 beds 17 DAY CENTERS 520
squares 11 ASOC FOR RELATIVES 33 SERVICES
COGNITIVE STIMULATION resources deprived
SERVICES OF SUPPORT coordinate TO FAMILIES
information orientation telephone demencias
training attention psicosocial to familares 3
UNITS OF ATTENTION SPECIALIZED TO DEMENCIAS IN
RESIDENCES
The resources are mainly public, with little
private presence
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To sum up...
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Conclusions

• PIDEX
• Arranges a sociosanitary attention to the
  cognitive deterioration.
• Assures the continuity of care.
• Is based on precocious detection.
• Promotes and maintains the person with dementia
  in his/her own domicile.
• Offers attention and direct support to the
  caregiver.
• Demands private presence to make the system
  sustainable and to support and coordinate with
  the public services.