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Addressing Dementia in the Trust

Addressing Dementia in the Trust. Angela White M edical Director April 2013. Dementia - statistics. Demographic change increasing elderly population Worldwide 35 million costing £600 billion UK 800,000 people costing £23 billion 65-69 years 1:100 70-79 years 1:25 80+ years 1:6.

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Addressing Dementia in the Trust

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  1. Addressing Dementia in the Trust Angela White Medical Director April 2013

  2. Dementia - statistics • Demographic change increasing elderly population • Worldwide 35 million costing £600 billion • UK 800,000 people costing £23 billion • 65-69 years 1:100 • 70-79 years 1:25 • 80+ years 1:6

  3. Dementia Care Projections

  4. Hospital admission • Between 10 and 30% older people have delirium on admission • Up to 40% develop an episode of confusion during admission • >25% hospital beds occupied by persons with dementia • 70% medical beds occupied by persons over 70 years

  5. Implications • What does it mean locally? • How have we been coping? • How should we cope? • What is there to help us do our best for people with dementia?

  6. Trauma and orthopaedics • Elderly patients • Patients with hip fracture • Rehabilitation

  7. Hip fracture • More than 60,000 people a year • Growing challenge • Average age of patient is slowing climbing • 2000 – 81 years, now 83 years • Increasing number of co-morbidities

  8. Emergency Trauma Admissions • District General Hospital - 250,000 pop’n • 2000+ patients admitted to T&O per year • >50% over 65 years • >34% over 75 years • 300 hip fracture • 50% beds in trauma wards

  9. Profile • Average age 83 years • Female to male 4:1 • 75% admitted own home/sheltered housing • 12% residential care • 6% nursing care

  10. Co-morbidity Hip fracture (100%) Cardiovascular disease (53%) Respiratory (14%) Dementia (23%) Cancer (20%) Diabetes (9%) Acute Confusion (40%)

  11. Challenge for clinicians Mental state Heart, lungs, diabetes Hip fracture

  12. How can I do my best ? • Patient safety • Abbreviated Mental Test Score – variable completion, once only • Many staff, different disciplines • Inter ward transfers • Discharge advice and info to GPs • Communication with social care teams

  13. Diagnosis • ~ 40% formally diagnosed Recent Alzheimer’s / ‘You gov’ Survey: • 31% struggled to get diagnosis • 68% said gap 1 year between symptom and diagnosis

  14. Timely diagnosis • Explanation of symptoms • Planning for future • Making choices • Avoids admissions due to crises

  15. National CQUIN • Acute admissions >75 years age • Streamline care for patients with impaired cognitive function • Demonstrate high level of achievement • Report on performance • Financial incentive for hospital Trusts • £125,000 per £100 million contract value

  16. CQUIN process • The Three Stages (FAIR Process) • Find – Identify the patients • Assess and Investigate - carry out a diagnostic assessment including investigations to determine whether the presence of a dementia is possible. • Refer - For specialist diagnostic assessment by a clinician with appropriate skill or training

  17. Dementia Pathway Emergency Admission over 75 (Source – Department of Health) IMS MAXIMS - No known dementia Known dementia Dementia Pathway Diagnostic review if indicated Referral Clinical diagnosis of delirium Feedback to GP Diagnostic Assessment Positive No Yes Inconclusive Negative Has the person been more forgetful in the last 12 months to the extent that it has significantly affected their daily life? Yes Care as usual No

  18. Benefits for patients • Supports timely assessment and diagnosis • Improves patient safety • supports early access theatre, rehab, decreases LOS, improves outcomes • Provides continuity of care of eligible patients • Discharge information • Accurate and timely reporting

  19. Benefits for staff • Streamlines care pathway – inclusive eligible patients • Realtimeinformation in one place for all patients • Supports handover, transfers • Confidence for staff that doing best for patients

  20. Benefits for organisation • CQUIN remuneration for delivering right care • £125,000 per £100 million contract value Also: • Right care - decreased LOS Reduce LOS by one day per patient with dementia • Eg. 0.34 x 0.25 x 1000 x £200 = £17,000/1000 acute admissions

  21. Sources of information • http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_094058 • http://publications.nice.org.uk/dementia-cg42 • http://www.alzheimers.org.uk/dementia2012

  22. Thank you Visit us at Stand 58

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