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6AB.. Dementia annual review (v10)
The face to face review should focus on support needs of the patient and their carer. In particular the review should address four key issues:
i. an appropriate physical and mental health review for the patient
ii. if applicable, the carer’s needs for information commensurate with the stage of the illness and his or her and the patient’s health and social care needs
iii. if applicable, the impact of caring on the care-giver
iv. communication and co-ordination arrangements with secondary care (if applicable).
A series of well-designed cohort and case control studies have demonstrated that people with Alzheimer-type dementia do not complain of common physical symptoms, but experience them to the same degree as the general population. Patient assessments should therefore include the assessment of any behavioural changes caused by:
• concurrent physical conditions (e.g. joint pain or intercurrent infections)
• new appearance of features intrinsic to the disorder (e.g. wandering) and delusions or hallucinations due to the dementia or as a result of caring behaviour (e.g. being dressed by a carer).
Depression should also be considered since it is more common in people with dementia than those without (Burt et al. Psychol Bull 1995; 117: 285-305).
The Audit Commission Report Forget Me Not 2002. www.auditcommission.
gov.uk/Products/NATIONAL-REPORT/3DFEF403-038C-464f-8518- 441477E92B15/forgetupdate.pdf
and the NSF for Older People www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=40030
66&chk=wg3bg0 both recommend that patients and carers should be given
relevant information about the diagnosis and sources of help and support (bearing
in mind issues of confidentiality). Evidence suggests that healthcare professionals
can improve satisfaction for carers by acknowledging and dealing with their
distress and providing more information on dementia (Eccles
et al. BMJ 1998; 317: 802-808). As the illness progresses, needs may change
and the review may focus more on issues such as respite care.
There is good evidence from well-designed cohort studies and case control studies of the benefit of healthcare professionals asking about the impact of caring for a person with dementia and the effect this has on the caregiver. It is important to remember that male carers are less likely to complain spontaneously and that the impact of caring is dependent not on the severity of the cognitive impairment but on the presentation of the dementia, for example, on factors such as behaviour and affect. If the carer is not registered at the practice, but the GP is concerned about issues raised in the consultation, then with appropriate permissions, they should contact the carer’s own GP for further support and treatment (see Eccles et al. BMJ 1998; 317: 802-808).
As the illness progresses, and more agencies are involved, the review should additionally focus on assessing the communication between health and social care and nonstatutory sectors as appropriate, to ensure that potentially complex needs are addressed. Communication and referral issues highlighted in the review need to be followed up as part of the review process.
The practice reports the percentage of patients with dementia on its register who have had their care reviewed in the previous 15 months.
Verification – PCOs may randomly select a number of case records of patients in which the review has been recorded as taking place to confirm that the four key issues are recorded as having been addressed, if applicable.
Prepared By Jean Keenan