Exploring the perspectives of patients with dementia about the hospital environment

Hung, L. et al. International Journal of Older People Nursing. Published online: 18 April 2017

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Background: Recognising demographic changes and importance of the environment in influencing the care experience of patients with dementia, there is a need for developing the knowledge base to improve hospital environments. Involving patients in the development of the hospital environment can be a way to create more responsive services. To date, few studies have involved the direct voice of patients with dementia about their experiences of the hospital environment.

Conclusions: Patient participants persuasively articulated the supportive and unsupportive elements in the environment that affected their well-being and care experiences. They provided useful insights and pointed out practical solutions for improvement. Action research offers patients not only opportunities to voice their opinion, but also possibilities to contribute to hospital service development.

Read the full article here

Dementia: Best practice repository for clinical commissioning

NHS England has developed a repository of examples and case studies of best practice, which is available via the online Learning Environment.

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In March 2016, NHS England introduced a new CCG Improvement and Assessment Framework (CCG IAF). This framework brings together a range of key indicators, enabling NHS England and CCGs to work together to drive improvement for patients.
The CCG IAF framework has indicators for six national clinical priority areas, including dementia. The dementia indicators are:

  • Estimated diagnosis rate for people with dementia.
  • Dementia care planning and post-diagnostic support.

NHS England recognises that CCGs will have varying levels of need for support based on their performance against the indicators, and in October 2016 published a support offer to help with this.

To substantiate the support offer, the NHS England Dementia Team has developed the Best Practice Repository on the NHS England Learning Environment website. This repository is currently being developed and case studies will be added to the NHS England Learning Environment website along with links to other resources.

View an overview of the resource here

Search for case studies here

Best practice in Memory Services: Learning from across England

This report summarises the findings from a series of visits carried out by NHS England’s National Clinical Director for Dementia

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The visits were to a number of memory services which were experiencing longer waiting times from referral to assessment. The audit found that there had been significant successes in a number of clinics in improving access times over the past year, often in challenging circumstances.

Common features of the services which were reducing waiting times were:

  • Reviewing the assessment pathway and reconfiguring workforce to match demand. Some achieved this through upskilling existing staff, using vacancy funding creatively or investing in new staff.
  • Developing joint clinical protocols for referral and diagnosis, follow-up care, access to and reporting of scans and care home management
  • Supporting memory services in primary care 3,4.

Based on the findings the top ten tips to service improvement are:

  1. Involve service users and carers at every step
  2. Understand current and future demand and map against available capacity
  3. Review referral protocols
  4. Review brain scan (CT/MRI) protocols
  5. Examine DNA rates
  6. Ensure correspondence clearly states diagnosis and accompanying ‘Read Codes’
  7. Identify education and training opportunities
  8. Consider protocol for diagnosis in primary care including care homes
  9. Review with commissioners the role of specialist nurses
  10. Become MSNAP accredited and share best practice examples

Read the full report here

Redesigning a Memory Service the Devon way

NHS England’s National Clinical Director for Dementia and a Devon-based consultant psychiatrist review impressive changes to dementia diagnosis and care in the West Country | NHS England

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A pan-Devon partnership project group was established in October 2012 with a number of local partners of whom Devon Partnership NHS Trust was the lead.

Following a review, including patient and carer experiences, four objectives were formed. First, there should be a fully integrated person-centred care pathway. Second, that early diagnosis should be made by a specialist memory clinic, with a clear referral pathway and a person-centred, ‘One Stop’ approach. Third, all GPs should be made able to make a diagnosis in the moderate to later stages of the illness. Fourth, that all patients should have consistent access to evidenced-based interventions wherever they were diagnosed

The redesign process was at all times in consultation with patients and carers, GPs, the voluntary sector and with reference to best practice. Project groups of clinicians from each organisation and locality were set up to design and deliver the new integrated service which was implemented across Devon nine months later.

Read the full news story here

Healthcare organisation and delivery for people with dementia and comorbidity

Bunn, F. et al. BMJ Open. Published online 18 January 2017

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Objectives: People living with dementia (PLWD) have a high prevalence of comorbidty. The aim of this study was to explore the impact of dementia on access to non-dementia services and identify ways of improving service delivery for this population.

Conclusions: This study suggests that, in order to improve access and continuity for PLWD and comorbidity, a significant change in the organisation of care is required which involves: coproduction of care where professionals, PLWD and family carers work in partnership; recognition of the way a patient’s diagnosis of dementia affects the management of other long-term conditions; flexibility in services to ensure they are sensitive to the changing needs of PLWD and their family carers over time; and improved collaboration across specialities and organisations. Research is needed to develop interventions that support partnership working and tailoring of care for PLWD and comorbidity.

Read the full article here

Effects of smartphone-based memory training

Seo Jin Oh et. al. Effects of smartphone-based memory training for older adults with subjective memory complaints: a randomized controlled trial. Aging & Mental Health.  Published online: 10 Jan 2017

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Objectives: We explored whether newly developed application (Smartphone-based brain Anti-aging and memory Reinforcement Training, SMART) improved memory performance in older adults with subjective memory complaints (SMC).

Method: A total of 53 adults (range: 50-68 years; 52.8% female) were randomized into either one of two intervention groups [SMART (n = 18) vs. Fit Brains® (n = 19)] or a wait-list group (n = 16). Participants in the intervention groups underwent 15-20 minutes of training per day, five days per week for 8 weeks. We used objective cognitive measures to evaluate changes with respect to four domains: attention, memory, working memory (WM), and response inhibition. In addition, we included self-report questionnaires to assess levels of SMC, depression, and anxiety.

Results: Total WM quotient [t(17) = 6.27, p < .001] as well as auditory-verbal WM score [t(17) = 4.45, p < .001] increased significantly in the SMART group but not in the control groups. Self-reports of memory contentment, however, increased in the Fit Brains® group only [t(18) = 2.12, p < .05).

Conclusion: Use of an 8-week smartphone-based memory training program may improve WM function in older adults. However, objective improvement in performance does not necessarily lead to decreased SMC.

Producing a joint strategic needs assessment for mental health

The Centre for Mental Health has published Meeting the need: what makes a ‘good’ joint strategic needs assessment (JSNA) for mental health or dementia?

This report explores how five local councils across England went about understanding the mental health needs of their communities, and taking action to meet them more effectively.

The report finds that JSNAs for mental health and dementia can help to direct investment, improve services and help local agencies work together more effectively. To have the biggest impact, they need a clear purpose, effective leadership and advocacy, and partnerships that continue after the JSNA is completed to ensure that they lead to action.

Report author Andy Bell highlights eight key success factors behind the creation of an effective and impactful needs assessment: