National
Introduction
The NHS is a huge organisation, with many different parts. In most instances your GP will be your first point of contact, and will refer you to other professionals within the health service as required. This page aims to give an overview of the health professionals you are most likely to encounter in relation to dementia.
GPs and Surgeries
As well as referring the person with dementia to specialists, the GP will of course continue to deal with day to day health problems and illnesses.
It is important to address health concerns as soon as possible when someone has dementia. Some problems (such as chest or urinary infections), can increase confusion. Admission to a general hospital ward is often unsettling for the person with dementia: early treatment may sometimes be able to prevent this.
The health care team based at the GP surgery is also likely to include District Nurses, Practice Nurses, and Health Visitors. The GP can also arrange services such as community physiotherapy, chiropody, supervision for taking medication at home, and sometimes alternative / complementary therapies.
For more information see Alzheimer's Society factsheet How the GP can help.
Memory Clinics
Becoming forgetful does not necessarily mean that a person has dementia so it is worth discussing concerns with your G.P.
Making a diagnosis of dementia is often difficult,
particularly in the early stages, so G.P.'s will often refer to a Memory
Clinic for assessment.
See Getting
a Diagnosis for more information.
Memory Clinics operate throughout the county at
main community locations and offer assessment, support, information and
advice to those with memory problems and their carers.
How to get an appointment
Referral for an appointment is normally via a GP so that preliminary screening can be carried out. It is important that the doctor investigates and treats any underlying physical illness and is able to assess the features of the memory problem. If mobility or travelling difficulties are a problem, your GP can request that a specialist visits at home, rather than you having to attend an appointment at the Memory Clinic.
Aims of the Memory Clinic
- Early identification of memory problems and any related disorders.
- Comprehensive assessment and diagnosis.
- Support and advice for patient, relatives or friends.
- To consider a trial of medication.
- Make available information about other service providers.
What happens at the Memory Clinic?
The first appointment may take between 1 and 2 hours. It is difficult to be precise about timing as all cases and circumstances are different and may need varying amounts of time.
This appointment involves a doctor or nurse talking with the patient and a relative (or close friend), who is able to explain the difficulties or problems being experienced and their effect on daily living. The team will carry out some tests to find out the strengths and weaknesses of memory, so it is important to take along reading glasses or hearing aids if these are used. It also involves gathering detailed information about the patient’s background, past medical history, any current medical problems and medications currently being taken.
By the end of the appointment the clinic team aim to have completed an assessment, discussed the results and helped plan any future treatment or care. Details of other services which may be helpful will also be made available.
What happens next?
A follow-up appointment will usually be made after
three months to undertake a progress review. This appointment takes about
half an hour and is an opportunity to discuss any concerns and assess the
benefits of any advice or medication that has been given. As dementia progresses people may experience continence
problems with bladder or bowels. This may be because they are unable to
find their way to the toilet anymore: in which case leaving the toilet
door open, and measures such as a highly visible red toilet seat may help
for a time. The Alzheimer's Society factsheet Incontinence
has more information. Urinary incontinence is more common, and pads are
usually used to manage this when someone has dementia. This is because
measures such as urinary catheters are unfamiliar, and therefore a foreign
object to the person with dementia, who may well pull the catheter out,
causing themselves considerable pain and possibly physical damage. However
if the person with dementia is already used to having a urinary catheter
this may continue to be tolerated. A small clip is available to prevent
inappropriate emptying of the leg bag (e.g. the Bard
Urilock). Continence assessment and care is provided through
the District Nurses. Everyone is entitled to free continence care on the
NHS, including provision of pads if required. In some counties there is
a policy to promote washable, rather than disposable, continence products.
If the use of washable products is difficult for you talk to the District
Nurse who in "exceptional circumstances" is able to make other
products available to you. If you are willing to purchase continence products
yourself there is a wide range available to meet the full spectrum of
needs, including pull on disposable pants that incorporate high absorbency:
these are ideal if the person with dementia sees a pad as a foreign object
to be removed from their underwear. Such products can be ordered through
Boots
(their own brand is Staydry),
or independent chemists (e.g. TENA
products). You can also order through a number of mail order companies
online. For further information on these products please go to: Youreableshop.co.uk.
Further information is available
on The
Continence Foundation website or for the Continence Foundation
Helpline phone: 0845 345 0165 Monday to Friday, 9:30am to 1:00 pm. For most health concerns your GP will be your first
point of contact. In emergencies you can of course ring 999 for an ambulance.
If the person with dementia has a minor injury, such as a cut that you
think may require stitching, it may be better to seek your GP's advice
initially rather than attend A&E, as casualty departments may involve
long waits in a potentially confusing environment. If the person with
dementia does need to attend A&E make sure that staff are made aware
of the dementia diagnosis. If you are unsure about whether something needs
medical attention, or would like general health advice, you may find it
useful to visit the NHS
Direct website. The NHS Direct website is part of the National
Health Service, and aims to provide high quality health information and
advice. If you are feeling unwell you can telephone NHS
Direct on 0845 4647 for individual advice and information, given by nurses,
24 hours a day.
For further information please go to our about Memory
Clinics page.
Help with Continence
Health Advice
NHS Direct
Mental Health Services for Old People and Inpatient Units
In Kent and Medway the "Mental Health Services for Old People" are also the specialists in dementia care. If you are a Younger Person with dementia it may seem strange to be referred to older adult specialists, but this is because they have the most experience in the field of dementia care.
The Mental Health Services in Kent and Medway,
work with colleagues across the In-Patient Units, Day Hospital Assessment
Units, Memory Clinics, and Community Mental Health Teams. However each
of these areas has its own nursing team.
The Kent and Medway Partnership Trust (KMPT) provides a number of different
mental health services to people of all ages living in Kent and Medway.
Their services are more specialised than services provided by your GP.
Most of their mental health services are more provided through:
• Inpatient units
• Outpatient units
• Community teams
Community services, in-patient and out-patient units
are generally split into services
for adults and services
for older people (over 65 years) over local areas. KMPT have
a specialist Child
and Adolescent Mental Health Service for children in west Kent.
In addition to the community, in-patient and out-patient
services, they we also provide a number of specialist services across
the county and some learning disability services.
The Acute Hospital Dementia Liaison Team
The aim of the Acute Hospital Dementia Liaison Team is to provide a focussed service that works closely with the Medway Maritime Acute NHS Foundation Trust to undertake the identification of possible mental health issues that require specialist input.
This multi professional team provides a rapid, high quality specialist assessment and input into care planning for those patients admitted to Medway Hospital with a confirmed diagnosis of dementia and for those patients exhibiting a possible dementia.
The majority of people referred to the service will be over the age of 65, however, age in itself should not be a determinant of eligibility and access should be determined by the needs of the individual.
The assessment and care planning is holistic and person centred and the team also provide support and advice to the carers and families of people with a dementia.
The team cover all of the in-patient wards and they also work closely with the A&E Department and the Medical Assessment Unit once the person’s physical problem has been addressed. The advantage of working with A&E and MAU is the opportunity to influence admissions to hospital when some people with dementia may be better managed by diversion to an alternative service.
The team provides skilled help and specialist intervention tailored to the individual patients needs to facilitate early discharge from the acute wards to avoid delays in discharge from hospital and ensure early diagnosis of dementia is made. We also liaise closely with the care agencies of Care Management and Social Services to promote effective collaborative practice.
They also provide regular training packages to all staff across the wards in respect of dementia care and also facilitate a Dementia Interest Group to promote awareness and education to inter-professional services, e.g. Nursing, Physiotherapists, and Occupational Therapists, etc.
The team currently comprises of a Senior Practitioner, Senior Occupational Therapist, Mental Health Nurse / Nurse Prescriber and are appointing a Clinical Psychologist and Specialist Doctor to the team within the next few months.
The service operates from Monday to Friday, 9.00 am to 5.00 pm. Out of hour support would be from the person's GP or the MAST team, on 01634 833 095
Contact details:
Duty Person
The Acute Hospital Dementia Liaison Team
Elizabeth House
Holding Street
Rainham
Kent
ME8 7JP
Tel: 01634 382 080
Fax: 01634 375 533
Email: Liz.kimatta@kmpt.nks.uk
Learning Disability Services
KMPT run learning disability services across West Kent, Medway, Swale and
East Sussex. The aim is to support individuals in the community that gives
them the rights, choices and freedom to live as enjoyable, independent,
inclusive and fulfilling life as much as possible. For further information
and local teams please go to
Learning Disabilities Teams.
For more information, on Mental Health Services for Older People, including travel information for the In-Patient Units, visit the Kent and Medway Partnership Trust website.
CPNs and Community Mental Health Teams
If you have dementia you may receive regular support from a Community Psychiatric Nurse (CPN). The CPNs are key members of the Community Mental Health Teams, which may also include occupational therapists. They visit people with mental health problems and dementia in their own homes to carry out assessments, and provide treatment, care and support. They can advise people with dementia and their carers on ways of coping, and of improving their health and quality of life.
Multi-Disciplinary
Community Mental Health Teams
Community Mental Health Teams (CMHT) provide services
to people living in the community aged between 16 and 65 who are experiencing
mental health problems.
Referrals to the teams are normally made directly through a GP.
Multi-disciplinary teams work in a variety of settings and provide enhanced,
intake and assertive outreach services. The intake element of teams acts
as a single point of access for all referrals to mental health services
that we provide.
If you are referred to a team, they will assess you, signpost and offer
short-term treatment as close as possible to your home.
The teams are made up of social workers; community
psychiatric nurses; occupational therapists; technical instructors; Support
Time and Recovery Workers; consultant psychiatrists and medical staff
and administration and secretarial staff.
For more information about teams including how to contact them, please
use the following links:
• Ashford
Community Mental Health Team
• Canterbury
Community Mental Health Team
• Coastal
Community Mental Health Team
• Deal
Community Mental Health Team
•
Dover Community Mental Health Team
• Shepway
Community Mental Health Team
• Swale
Community Mental Health Team
• Thanet
Community Mental Health Team
Further Information
You may find the Alzheimer's Society factsheet
How
health professionals can help of interest.
Last updated: 14th May 2012