Discuss about the SNPG 956 Policy Critique and Document Criteria.
The Prevalence of Dementia
Old age is a time when the organs of human body start to lose its effectiveness. Along with immunity system, different integral organs become weak. As a result, old people become more prone to develop illnesses. With old age, the chances of contracting a disease rise. It is found that a large percentage of people having ailment is over 60 years old. Therefore, it can be said that old age is a stage where a person becomes vulnerable to catch diseases or disorders. Some of these diseases are curable while many of them are long term and cannot be entirely cured. Medications and counselling are used to keep such illnesses under control to help the patient lead a normal life (van Bussel et al. 2017). One such common long term disease is Dementia. Dementia is an illness involving memory of a person. A dementia affected person suffers from short term memory loss and tends to forget significant life incidents (Wang et al. 2016). It impacts of their regular activities in a negative way. It has been found that most of the dementia patients are over 60 years old. Hence, they need constant support of a care giver in order to carry out their functions. This report is regarding the policy which has been introduced by National Institute for Clinical Excellence (NICE) to enable proper support and care for the patients suffering from Dementia. The policy is having a number of guidelines which are critically analysed and evaluated in this report.
As the prevalence of Dementia is increasing rapidly in Europe, there was a need of suitable policy to cope with the situation. It has been found that old people are mostly affected by dementia, most of the patients aged above 60 years. NICE Dementia Guidelines had been introduced to allow the dementia affected people to lead a normal healthy life. The primary and major effect of Dementia is memory loss. Such type of illness may hamper the regular activities of a person, especially if the patient is an aged person (Dewing & Dijk, 2016). Therefore, care support is required for dementia patients so that they can effortlessly carry out their regular tasks. Dementia affects brain cells of the person, making a negative impact on their memory. The forgetfulness makes the patient confused and annoyed. Moreover, if the patient is over 60 years old, it is likely that the patient will be showing challenging behaviour. Therefore, it is important for the care staff to follow a number of guidelines while taking care of an aged person affected with dementia (Mast et al. 2016). The NICE Dementia Guidelines aim to improve the overall condition of dementia patients. The guidelines are related to-
- Involving people living with dementia in decisions about their care
- Care coordination
- Interventions to promote cognition, independence and wellbeing
- Pharmacological interventions for dementia
- Medicines that may cause cognitive impairment
- Managing non-cognitive symptoms
- Assessing and managing other long-term conditions in people living with dementia
- Risks during hospital admission
NICE Dementia Guidelines
The policy allows the patient to make decisions regarding the care they are being provided with. The patients are encouraged to share their opinions and views regarding the healthcare services. Additional communicative tools such as visual aids and simplified text can be used to enable effective communication between the patient and the care giver. Structured tools can be used as well to know the personal history of the dementia patient along with their likes, dislikes and daily routine (Karlsson et al. 2016). All these things are essential to render proper support to the patient suffering from dementia. According to the policy, sufficient information should be provided to the care giver regarding the condition of the patient. During diagnosis, it is mandatory to provide the care giver and the family members of the patient with the information regarding the dementia subtype from which the patient is suffering; the contact information of the healthcare or social care team assigned to handle the case; the affects dementia has on driving so that the DVLA or Driver and Vehicle Licensing Agency and car insurers can be informed beforehand; legal rights and responsibilities they possess; right to reasonable adjustments for those who are working or looking for the same; effectiveness and contact information of the local support group, national charities, online forums, legal and financial advisors, advocacy services etc (Pink, O’Brien, Robinson & Longson, 2018). The policy also suggests that the consent of the patient must be sought before providing the services. Which information is to be shared and with whom, this is sole decision of the patient, and the decision of the patient has to be documented (Lopes, 2016). Follow-up process, as per the guidelines, is optional; a patient may or may not opt for it. Dementia affected people and their care givers must be aware about the people or agencies with whom they can contact regarding changes in requirements (Vandrevala et al. 2017). The policy instructs to ask the dementia affected people to participate in different surveys and researches related studies. In advanced care planning, a dementia affected person is to share their wishes, beliefs, preferences, values regarding future care (Goodarzi et al. 2016). They can take decisions regarding refusal to treatment and place of death. However, changes can be made to these decisions during care review. To identify a dementia patient, initial assessment must be done through gathering background information and history (Lee, Weston & Hillier, 2018). On suspecting dementia, physical examination should take place. Cognitive testing is beneficial in this context. Although a normal score in cognitive instrument is not adequate to rule out the chances of dementia. On further suspicion the person should be referred to specialist dementia diagnostic service. Upon confirmation of dementia, the family of the patient and the care giver should get access to hospital or primary-care-based multidisciplinary dementia service or the memory service (McCormick, 2015). The dementia affected person should be helped with an experienced health or social care professional, who will render needful care coordination. The major task of the health or social care professional would be developing a proper care plan for the patient (Fleming, Goodenough, Low, Chenoweth & Brodaty, 2016). The professional would also review the plan, take decisions related to execution of the same, record the post execution progress and provide a copy of the plan to the care giver and family of the patient. According to the policy, it is the responsibility of the care providers to enable seamless transfer of relevant information to other care settings where the patient would be transferred. Relevant information regarding the health of the patient should be recorded and the support plan should be updated accordingly (Müller, Lautenschläger, Meyer & Stephan, 2017). The policy covers the wellbeing of the dementia affected people along with those who are not having any care giver, people who do not have access to transport or have difficulty in using the same, people with physical or psychological impairment or learning disabilities, people who are less likely to opt for health and social care services, people having other responsibilities regarding job, children etc. The policy allows a range of activities developed as per the person’s preferences which aim to promote wellness. People with mild or moderate dementia are directed to opt for group cognitive stimulation therapy or group reminiscence therapy or occupational therapy (Groot et al. 2016). As per the guidelines there are multiple services which must not be offered to the dementia patients such as acupuncture, ginseng, herbal formulations, and vitamin E supplements. There are also some significant guidelines in the policy related to the medications used for Alzheimer’s disease.
Guidelines Related to Diagnosis, Care Coordination, and Care Plan Development
The NICE Dementia Guidelines is undoubtedly a significant policy for the betterment of the dementia affected people. But it is necessary to bring about certain new and updated implementations which would increase the effectiveness of the same. In the meantime, improvement of a policy does not take place overnight. It requires a lot of research and study to recognize various aspects of a policy. Further analysis brings out certain loopholes which are replaced or updated in accordance to the requirement. It takes simultaneous research and review to identify problems within a system or a policy. Before implementing changes to a policy it is essential to discuss with significant people of the organisation. There is always a starting point of a change and in this case it started from identification of the issue. The issue is found in the context of elderly people suffering from dementia. At first both the positive and negative factors are to be identified and analysed critically in order to gain information having higher level of accuracy. In this context, information was gathered through effective communication with dementia affected people aged more than years. To identify the problem, the care givers and families of the elderly people suffering from dementia were interviewed thoroughly. After a number of interviews and effective chat session with dementia patients, the problem which was vogue earlier came out clearer. The issues were less trained care givers, difficulty in transferring medical records to different care settings, extreme challenging behaviour shown by patients, frequent clashes between families and staff members etc. These problems were discussed with the staff member of dementia care centres and health and social care professionals. After long brainstorming sessions a number of changes were made to the existing policy to make it more feasible. The updated policy required the care providers to go through extensive training, mandatory anger management classes, and updated system to enable seamless record keeping and record transferring. New ideas were formulated and tested before final implementation of updated policy. Valuable feedbacks were gained afterwards.
Comprehensive review of the new policies was made with the help of a number of relevant literature databases such as PubMed, CINHAL. The empirical evidence provided by these databases help in increasing effectiveness of the new policies. As far as this policy is concerned, the care providers should be careful about their actions as healthcare sector is a sensitive sector and long term illnesses like dementia require proper care. The most common issue with dementia patients is challenging behaviour. As the disease involves brain cells the patient experiences mood swings which sometimes come out as challenging behaviour. This affects care giver the most. As the policy suggests consent of patient before rendering service, a patient with challenging behaviour is difficult to handle. Therefore, the updated policy suggests that if the patient is found to be incapable of taking own decisions then the health or social care professional taking care of them can decide the services they will be going through. Dementia patients are mostly having poor decision making skill; therefore the care givers should be able to take certain decision which may impact the health of the patient (Chen, Huang, Yeh, Huang & Chen, 2015). The care givers should be well-equipped with skills which are needful to take care of a dementia affected person. Lack of adequate knowledge and skills in the care giver can result in deterioration of health of the patient (Barbosa, Sousa, Nolan & Figueiredo, 2015). Therefore, relevant skills are compulsory for dementia care givers. Also, to avoid conflicts between patient’s family and staff members, the updated policy introduces mandatory anger management classes for the care givers and staff members. In the updated policy, the care providers are strictly instructed to keep proper record of the patient’s condition and share the same with another care setting if the patient is moved there. Seamless transferring of data would allow better quality of care for the patients (Macdonald & Mears, 2018). The new updated policy also highlights that there must be no ill treatment towards the patient or the family. Any staff unable to follow the same would be suspended from the organisation. It is believed that this can make the bond between the patient and family with the care providers better and more trustworthy. The updated policy also focuses on organising training programmes for the newly recruited staff members to boost their effectiveness.
Guidelines Related to Information Sharing and Patient Involvement
After formulating new guidelines and adding some new relevant ones, these are to be implemented in the updated version of the policy. The new policy is aimed to meet the objectives of the organisation and providing desired outcome to the patients. To execute the new updated policy an action plan containing required steps needs to be followed.
Evaluation: The prime objective of the updated policy is to strengthen the dementia care policy by adding some relevant guidelines which would improve the health condition of the dementia affected people. From diagnosis to care provision, all these aspects are covered efficiently in the new version of policy. Effective communication is the key to build rapport with the patient which would help the care giver to render needful health and social care services to the patient (Zimmerman, Sloane & Reed, 2014).
Conclusion: Dementia is a much talked about illness. There are a large number of elderly people suffering from different forms of dementia across Europe. The updated policy aims to reduce the number of dementia affected people with its well-defined guidelines and critically analysed methods. The new updated policy suggests that care givers should be well-trained and more sensible while taking care of a dementia affected person. Challenging behaviour should be managed with efficacy and effective communication should be initiated between the care givers and patients so that a deeper understanding can be obtained regarding their condition (Dam, de Vugt, Klinkenberg, Verhey & van Boxtel, 2016). This would allow the patients to lead a normal life and reduce the number of affected people across the globe.
Barbosa, A., Sousa, L., Nolan, M., & Figueiredo, D. (2015). Effects of person-centered care approaches to dementia care on staff: a systematic review. American Journal of Alzheimer's Disease & Other Dementias®, 30(8), 713-722.
Chen, H. M., Huang, M. F., Yeh, Y. C., Huang, W. H., & Chen, C. S. (2015). Effectiveness of coping strategies intervention on caregiver burden among caregivers of elderly patients with dementia. Psychogeriatrics, 15(1), 20-25.
Dam, A. E., de Vugt, M. E., Klinkenberg, I. P., Verhey, F. R., & van Boxtel, M. P. (2016). A systematic review of social support interventions for caregivers of people with dementia: are they doing what they promise?. Maturitas, 85, 117-130.
Dewing, J., & Dijk, S. (2016). What is the current state of care for older people with dementia in general hospitals? A literature review. Dementia, 15(1), 106-124.
Fleming, R., Goodenough, B., Low, L. F., Chenoweth, L., & Brodaty, H. (2016). The relationship between the quality of the built environment and the quality of life of people with dementia in residential care. Dementia, 15(4), 663-680.
Challenges Faced by Care Providers and Changes Made to the Policy
Goodarzi, Z., Mele, B., Guo, S., Hanson, H., Jette, N., Patten, S., ... & Holroyd-Leduc, J. (2016). Guidelines for dementia or Parkinson’s disease with depression or anxiety: a systematic review. BMC neurology, 16(1), 244.
Groot, C., Hooghiemstra, A. M., Raijmakers, P. G. H. M., Van Berckel, B. N. M., Scheltens, P., Scherder, E. J. A., ... & Ossenkoppele, R. (2016). The effect of physical activity on cognitive function in patients with dementia: a meta-analysis of randomized control trials. Ageing research reviews, 25, 13-23.
Karlsson, S., Bleijlevens, M., Roe, B., Saks, K., Martin, M. S., Stephan, A., ... & RightTimeCarePlace Consortium. (2015). Dementia care in European countries, from the perspective of people with dementia and their caregivers. Journal of advanced nursing, 71(6), 1405-1416.
Lee, L., Weston, W., & Hillier, L. (2018). Education to improve dementia care: Impact of a structured clinical reasoning approach. Family medicine, 50(3), 195-203.
Lopes, M. A. (2016). PREVALENCE OF DEPRESSION IN ELDERLY INPATIENTS WITH COGNITIVE AND FUNCTIONAL IMPAIRMENT AND DEMENTIA. Alzheimer's & Dementia: The Journal of the Alzheimer's Association, 12(7), P496.
Macdonald, G., & Mears, J. (Eds.). (2018). Dementia as Social Experience: Valuing Life and Care. Routledge.
Mast, G., Fernandes, K., Tadrous, M., Martins, D., Herrmann, N., & Gomes, T. (2016). Persistence of antipsychotic treatment in elderly dementia patients: a retrospective, population-based cohort study. Drugs-real world outcomes, 3(2), 175-182.
McCormick, S. (2015). Choosing make believe: pretence or re-orientatation in the care of individuals living with dementia?.
Müller, C., Lautenschläger, S., Meyer, G., & Stephan, A. (2017). Interventions to support people with dementia and their caregivers during the transition from home care to nursing home care: A systematic review. International journal of nursing studies, 71, 139-152.
Pink, J., O’Brien, J., Robinson, L., & Longson, D. (2018). Dementia: assessment, management and support: summary of updated NICE guidance. bmj, 361, k2438.
van Bussel, E. F., Richard, E., Arts, D. L., Nooyens, A. C., Coloma, P. M., de Waal, M. W., ... & Smeets, H. (2017). Dementia incidence trend over 1992-2014 in the Netherlands: Analysis of primary care data. PLoS medicine, 14(3), e1002235.
Vandrevala, T., Samsi, K., Rose, C., Adenrele, C., Barnes, C., & Manthorpe, J. (2017). Perceived needs for support among care home staff providing end of life care for people with dementia: A qualitative study. International journal of geriatric psychiatry, 32(2), 155-163.
Wang, C., Gao, S., Hendrie, H. C., Kesterson, J., Campbell, N. L., Shekhar, A., & Callahan, C. M. (2016). Antidepressant use in the elderly is associated with an increased risk of dementia. Alzheimer disease and associated disorders, 30(2), 99.
Zimmerman, S., Sloane, P. D., & Reed, D. (2014). Dementia prevalence and care in assisted living. Health Affairs, 33(4), 658-666.
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