Dementia: supporting people with dementia and their carers in health and social care

National Institute for Health and Clinical Excellence

Key priorities for implementation

The following recommendations have been identified as priorities for implementation

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 coexisting learning disabilities

Valid consent

• Health and social care professionals should always seek valid consent from people with dementia. This should entail informing the person of options, and checking that he or she understands, that there is no coercion and that he or she continues to consent over time. If the person lacks the capacity to make a decision, the provisions of the Mental Capacity Act 2005 must be followed

Carers

• Health and social care managers should ensure that the rights of carers to receive an assessment of needs as set out in the Carers and Disabled Children Act 2000 and the Carers (Equal Opportunities) Act 2004 are upheld
• Carers of people with dementia who experience psychological distress and negative psychological impact should be offered psychological therapy, including cognitive behavioural therapy, conducted 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, including jointly agreeing written policies and procedures. Joint planning should include local service users and carers in order to highlight and address problems specific to each locality
• Care managers and care coordinators should ensure the coordinated delivery of health and social care services for people with dementia. This should involve:
  • a combined care plan agreed by health and social services that takes into account the changing needs of the person with dementia and his or her carers
  • assignment of named health and/or social care staff to operate the care plan
  • endorsement of the care plan by the person with dementia and/or carers
  • formal reviews of the care plan, at a frequency agreed between professionals involved and the person with dementia and/or carers and recorded in the notes

Memory services

• Memory assessment services (which may be provided by a memory assessment clinic or by community mental health teams) should be the single point of referral for all people with a possible diagnosis of dementia

Structural imaging for diagnosis

• Structural imaging should be used in the assessment of people with suspected dementia to exclude other cerebral pathologies and to help establish the subtype diagnosis. 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. Specialist advice should be taken when interpreting scans in people with learning disabilities

Behaviour that challenges

• People with dementia who develop non-cognitive symptoms that cause them significant distress or who develop behaviour that challenges should be offered an assessment at an early opportunity to establish the likely factors that may generate, aggravate or improve such behaviour. The assessment should be comprehensive and include:
  • the person's physical health
  • depression
  • possible undetected pain or discomfort
  • side effects of medication
  • individual biography, including religious beliefs and spiritual and cultural identity
  • psychosocial factors
  • physical environmental factors
  • behavioural and functional analysis conducted by professionals with specific skills, in conjunction with carers and care workers

Individually tailored care plans that help carers and staff address the behaviour that challenges should be developed, recorded in the notes and reviewed regularly. The frequency of the review should be agreed by the carers and staff involved and written in the notes

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 (skill development) that is consistent with their roles 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

full guideline available from…
National Institute for Health and Clinical Excellence, MidCity Place, 71 High Holborn, London WC1V 6NA
guidance.nice.org.uk/CG42

National Institute for Health and Clinical Excellence. Dementia: supporting people with dementia and their carers in health and social care. Quick Reference Guide. November 2006