Author Topic: Dementia care map published.  (Read 1227 times)

AccessOfficer

  • Guest
Dementia care map published.
« on: 29 Nov 2013 03:48PM »
The Department of Health has published an interactive online map to show people the level of dementia care and support in their local area.

The map is part of the Government’s ‘State of the Nation’ report which has examined the quality of dementia care in England, with a range of data including diagnosis rates, referral rates and how often anti-psychotic drugs are prescribed to patients.

http://www.localgov.co.uk/index.cfm?method=news.detail&id=111810

Regards
AO

Sunny Clouds

  • Charter Member
  • Super Hero Member
  • ******
  • Posts: 5179
Re: Dementia care map published.
« Reply #1 on: 29 Nov 2013 05:49PM »
I hate this drive towards diagnosing dementia.  Some time around the end of the last government or the start of this, it was suggested that everyone over 70 admitted to hospital should be automatically tested for it.  Ugh!

What successive governments and certain people with an interest in dementia don't take on board, not everyone wants to know whether they've got dementia, and in the earlier stages, dementia diagnosis is a far from certain thing.

There are conditions you can be diagnosed with that may deteriorate but may not, but at present there's no treatment that causes dementia to improve or even not deteriorate, although there are drugs that in relation to some forms of dementia can slow down deterioration.

A dementia diagnosis can affect employment and insurance and financial matters.  Want a secured loan?  Best not to have a dementia diagnosis.  Want health insurance?  Best not to have a dementia diagnosis.  Applying for a new job?  Best not to have a dementia diagnosis.

I'm afraid I'm firmly on the side of choice and I actively dislike pushing the early diagnosis approach without also explaining the disadvangages and without explaining the difference between drug company hype and reality.

And preparing for the future?  Why not just encourage everyone to prepare for the future?  If you don't get dementia you may still get some other condition where forward planning would help.  The idea that you only need to think about things like powers of attorney and sheltered housing if you have a dementia diagnosis is a sign of a big divide between dementia organisations and other organisations.

I've seen the impact of dementia on my family.  I've seen the impact of a diagnosis.  I've been tested for it myself by a psychiatrist who didn't tell me until afterwards that that was what he was testing for.   I was not amused when I found out.

Talking of which, the tests commonly used to diagnose (the question type ones not the scans) are very imprecise.  Dad does better on a lot of parts of his tests than I do, when answering them silently in my head.  I don't have dementia, I have a different type of mental impairment (my memory problems relate to an attentional problem so that I don't pay attention long enough to lay down a memory, not an inability to lay down and retrieve memories) but you'd think from the tests the psychiatrists and hospital doctors administer that I had worse dementia than Dad.

Grrhh.   >steam<
(I'm an obsessive problem-solver, so feel free to ignore any suggestions or solutions I offer, even if they sound terribly insistent.)

Sunny Clouds

  • Charter Member
  • Super Hero Member
  • ******
  • Posts: 5179
Re: Dementia care map published.
« Reply #2 on: 29 Nov 2013 06:52PM »
Aargh, I've just looked again at the map.  They're showing the proportion of patients over 75 tested for it.  There are hospitals where it's 100%.  Did they really get informed consent from all of them for testing, or did they just do it routinely without asking?  What other conditions would we test for without asking?  Imagine if you went for treatment for, say, appendicitis or cataract surgery or a potassium imbalance and were routinely tested without your consent for STDs or personality disorders or variant CJD?  What if you didn't want to know?  What if you didn't want them to know?  Why's it different for dementia?

One reason why I get angry about this is that successive governments have successfully reframed dementia as a social condition. 

Let's be under no illusion about this - you start of with minor symptoms and eventually it kills you unless something else gets you first.  However, if you die from cancer, you stand a chance of dying in a hospice but if you die of dementia, you'll probably die in a nursing home, and you'll probably be paying for the privilege of dying there.  Forget daily or even weekly doctors' ward rounds, forget being seen by a nurse every day (a nursing home only has to have one nurse even if it's massive). 

That's what you have to look forward to, and in the meantime?  Well, I've seen how Dad gets treated.  Have depression and anxiety?  They might take it seriously.  Get dementia and depression and anxiety?  They'll just take it that depression and anxiety are perfectly reasonable given dementia and make maybe a half-soaked attempt to deal with them.

Dad kept falling over.  He is physically impaired not only by his dementia but with a deformed foot.  Not surprisingly once they diagnosed the dementia, they lost all interest in his foot, which needs surgery. 

Does dementia mean any extra adjustments?  Not on your nelly.  It would be nice, for instance, to have a written summary in easy language of what he has been treated for and what will happen next but there's not a chance in hell of his having one.

No, my experience of watching my father with it and his encounters with the NHS is that as soon as they know he has dementia the attitude is that this is a social problem and he can bog off. 

Having said that, the ambulance service is fantastic.  They're the ones who seem to actually care.  It's not that other NHS personnel don't care, but they seem to be part of a different culture.  The ambulance service see their role in relation to people with dementia as the ones that do what others don't.  Their attitude seems to be don't hesitate to call us if you need us, especially if you fall over.
(I'm an obsessive problem-solver, so feel free to ignore any suggestions or solutions I offer, even if they sound terribly insistent.)

seegee

  • Charter Member and Volunteer
  • Super Hero Member
  • ******
  • Posts: 5166
Re: Dementia care map published.
« Reply #3 on: 29 Nov 2013 07:09PM »
Testing on admission to hospital is a pretty stupid idea anyway.  By definition all those people are ill & you're much more likely to be confused & inattentive when you are unwell. 
I'm sure being in an unfamiliar place with all your usual routines upset & surrounded by strange people all day as well as being ill must give some results that exaggerate the prevalence.

devine63

  • Guest
Re: Dementia care map published.
« Reply #4 on: 30 Nov 2013 12:05AM »
Hi Sunny

just one of the reasons why the verbal question based tests you mention don't work very well is because they are being conducted by psychiatrists and other doctors - these people typically have no formal training in the use of psychometric tests and are not competent at using them, so they should not be.  The training to be a psychometrician is part of the training of some but not all psychologists and it is usually a minimum of three years of post-graduate study.   For example the psychiatrist who "tested" you (Sunny) for dementia without your consent was not only behaving unethically he was demonstrating his incompetence by not taking into account that your personal history (both the attentional problem and your MH diagnosis and the drug treatments for that) would automatically mean the test result was effectively invalid and certainly extremely difficult to interpret without an extremely detailed medical history.

Psychiatrists and neurologists and sometimes other doctors use a test called the Mini Mental State Examination which is a very brief (under 5 mins) screening test involving questions like what's today's day and date?  what year is it?  who is the Prime Minister?   asking you to remember a simple address for a moment and repeat it back (they don't tell you they will ask for it again at the end - if the doc remembers to ask.   If that patient cannot answer all those correctly it suggests they may have some kind of neurological problem - but in older people it can be as simple as having a urinary infection causing the problems.   

regards, Deb