Search

Table of contents

Evidence of what works

Adults :: Dementia :: Evidence of what works

'Department of Health (2009) Living Well with Dementia: a national dementia strategy': This strategy provides a strategic framework within which local services can; deliver quality improvements to dementia services and address health inequalities relating to dementia; provide advice and guidance and support for health and social care commissioners and providers in the planning, development and monitoring of services provide a guide to the content of high-quality services for dementia.

'Department of Health (2013) Dementia: A state of the nation report on dementia care and support in England': This Dementia report, with its accompanying map of variation, available at http://dementiachallenge.dh.gov.uk/map/, shines a light on the quality of dementia care in England. The very best services are excellent and show what is possible. But the worst show that we still have some way to go. The message is clear: we can and must do better.

'Dementia Challenge (2012)': The Prime Minister's Dementia Challenge launched in March 2012. It sets out plans to go further and faster in improving dementia care, focusing on raising diagnosis rates and improving the skills and awareness needed to support people with dementia - and their carers. It also has details of plans to improve dementia research.

'Dementia Partnerships (2012)': Dr Edana Minghella, proposes a new understanding of the dementia journey and a revised model of care for dementia, aimed at improving experiences and outcomes, and informing service redesign and commissioning.

'The Prime Minister's Challenge on Dementia (2012): delivering major improvements in dementia care and research by 2015: Annual report of progress': The progress of the Dementia Challenge is overseen by three groups of 'champions'. This is their latest progress report.

'NICE/Social Care Institute for Excellence (2006) CG42 Dementia: supporting people with dementia and their carers in health and social care': This guideline makes recommendations for the identification, treatment and care of people with dementia and the support of carers. Settings relevant to these processes include primary and secondary healthcare, and social care. Wherever possible and appropriate, agencies should work in an integrated way to maximise the benefit for people with dementia and their carers.

'NICE (2010) End of life care for people with dementia: commissioning guide: implementing NICE guidance': This commissioning guide has been developed to help support the local implementation of NICE clinical guidelines to commission integrated end of life care services for people with dementia. The guide makes the case for commissioning end of life care for people with dementia, highlighting key benefits.

'NICE (2011) Dementia: care pathway.': This pathway covers supporting people with dementia and their carers in health and social care. It considers pharmacological and psychosocial interventions.

'SCIE (2012) End of life care for people with dementia living in care homes': This research briefing is about the care provided in care homes to people with dementia in the period leading up to the end of their lives. It aims to provide an overview of a range of issues important to care home residents, carers and providers.

'Alzheimers Society (2011) Optimising treatment and care for people with behavioural and psychological symptoms of dementia ': This best practice guide was developed in consultation with an advisory group of leading clinicians specialising in dementia. It is aimed at a wide range of health and social care professionals caring for people with dementia who have behavioural and psychological symptoms to provide evidence-based support, advice and resources.

'Dementia Partnerships (2014) Dementia: 10 key steps to improving timely diagnosis': This Briefing is designed to support GPs and primary health care teams to improve the recognition, diagnosis and management of dementia.

Pharmacological Interventions

There are no drug treatments available that can provide a cure for Alzheimer's disease. Although there are medicines have been developed that can improve symptoms, or temporarily slow down their progression10. Medicines will not be effective for all individuals though. The brains of people with Alzheimer's disease show a loss of nerve cells that use a chemical called acetylcholine as a chemical messenger. The loss of these nerve cells is related to the severity of symptoms that people experience. Donepezil, Rivastigmine and Galantamine prevent an enzyme known as acetylcholinesterase from breaking down acetylcholine in the brain. Increased concentrations of acetylcholine lead to increased communication between the nerve cells that use acetylcholine as a chemical messenger, which may in turn temporarily improve or stabilise the symptoms of Alzheimer's disease.

Non-Pharmacological Interventions

An increasing number of non-pharmacological therapies are now available for people with dementia. These include standard therapies such as behavioural therapy, alternative therapies such as art or music therapy and brief psychotherapies such as cognitive behavioural therapy[1]. Each approach is rarely used in isolation, therefore a combination of treatments tailored to the individual requirements of the patient may be necessary.

Receiving and early diagnosis

Obtaining an early diagnosis enables a person with dementia and their family to receive help in understanding and adjusting to the diagnosis and to prepare for the future in an appropriate way. This might include making legal and financial arrangements, changes to living arrangements, and finding out about aids and services that will enhance quality of life for people with dementia and their family and friends. Early diagnosis can allow the individual to have an active role in decision making and planning for the future while families can educate themselves about the disease and learn effective ways of interacting with the person with dementia. There is evidence that the currently available medications for Alzheimer's disease may be more beneficial if given early in the disease process[2]. These medications can help to maintain daily function and quality of life as well as stabilise cognitive decline in some people. Early diagnosis allows for prompt access to medications and medical attention.

Dementia Friendly communities

A dementia-friendly community is one in which people with dementia are empowered to have aspirations and feel confident, knowing they can contribute and participate in activities that are meaningful to them. Many villages, towns and cities are already taking steps towards becoming dementia-friendly communities. One area that has successfully utilised this model is Motherwell in Scotland. It has involved working with shop assistants, public service workers, religious groups, businesses, police, transport and community leaders.

Outcomes have been positive and included a range of activities undertake to increase community awareness of dementia including; promotional materials being distributed widely throughout the town, a successful Football Memories event held at Motherwell FC, awareness sessions with local fire fighters, Training of police officers and arrangement with Boots to distribute Alzheimer Scotland helpline cards.


References

[1]   S Douglas IJ. . CB. Non-pharmacological interventions in dementia Advances in psychiatric treatment 2004; 10: 171-177.
[2]   Alzheimer's Society. Factsheet: Learning disabilities and dementia 2011; Alzheimer's Society. http://alzheimers.org.uk/site/scripts/download_info.php?fileID=1760 .