Dementia - Update and implications for Later Life Training

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Dementia -Update and implications for Later
Life Training
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Session overview

• Why dementia now ? strategy and implementation
  and LLT
• The strengthening evidence - summary
• Implications for LLT programmes and tutors
• LLT next steps

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Purpose of session

• To understand the importance of dementia to Later
  Life Training and tutors
• To begin to look at issues and topics that
  (might) affect the delivery of LLT courses
• To highlight sources of information and learning
  for LLT tutors
• Next steps

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Why dementia and LLT now ?

• The number of people with dementia is increasing
  as our population ages
• To ensure where possible, the inclusion of all
  (frailer) older people in LLT programmes
• At last, significant activity in national policy
  and strategy development
• Evidence re physical activity and exercise is
  getting stronger we have a role to play
• Our audience is asking

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A growing concern

• Increasing with the ageing population
• Impact on society huge, on the individual even
  greater
• A cure may be some 25 -30 years away
• Causes are not fully understood but lifestyle
  factors are know to be significant
• Not a normal part of ageing, it is a disease
• 40 of the population are affected
• The New Cancer ?

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At the top of the agenda ?

• National Strategy (England) launched Feb 2009
• Complimentary implementation activity across the
  UK
• NICE SCIE Guidance already published (2006)
• Whole systems approach, not just mental health
  services
• Cochrane reviews of evidence
• Current costs (17 B) already outstrip CHD,
  cancer and stroke put together

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Stand by your man !

• Jack Wooley has Alzheimers Disease
• He is being sprung out of the Willows Nursing
  Home by Peggy
• Where are we going dear ?
• A sustained story

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Eastenders ?

• (Nana) Moon
• Alzheimers or water on the brain ?

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(No Transcript)
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We face a tsunami of Alzheimers !

• Terry Pratchett
• Government spends less on researching the
  disease than the cost of building one mile of
  motorway !
• (30 million)
• 2 of MRC budget, ¼ of that spent on cancer
• (Lib Dem Conference 2009)

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The Dementia Strategy (England)

• Three Key components
• Improving public and professional awareness of
  dementia
• Early diagnosis and intervention
• High quality care and support for people with
  dementia and their carers
• www.dh.gov.uk/en/SocialCare

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Complimentary activity in Scotland, NI and Wales

• Implementation - England 18 Peer Educator and
  19 information service programmes
• Strengthening role of GPs in diagnosis
• Specialist memory clinics
• Implementation Scotland Local Heat Targets
  33 increase in diagnosis
• Integrated care pathways - dementia specific
  standards
• Accredited dementia design premises
• Dementia champions in care homes

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The potential to contributee.g. to the Dementia
Strategy

• Key components
• Improving public and professional awareness of
  dementia (our professional audiences ?)
• Early diagnosis and intervention (quality of
  life, independence and mobility)
• High quality care and support for people with
  dementia and their carers (programming carer
  support and functioning)

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The potential to contribute -
physical activity and exercise

• The evidence is getting stronger all the time
• Prevention (lifestyle factors)
• Treatment (delay of progression) and care
  (maintaining independence)
• Related health/risk factors e.g. stroke,
  diabetes, falls
• People with dementia will experience a range of
  associated benefits (improved mood, sleep,
  digestion, social inclusion)
• Physical functioning, quality of life of
  care-givers
• (Cochrane review 2008)

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Emerging evidence

• RCTs world-wide on health of people living with
  dementia e.g. Eggermont _at_ Scheder (2006) Robinson
  et al 2006, 2007. Livingstone et al 2005, Penrose
  2005, Cohen Mansfield (2001), Tilly (2003)
• Dementia is a risk factor for falls, evidence is
  emerging but not strong
• Reduction in falls found for people with dementia
  from carer-directed home exercise program and ...
• Carer-directed home exercise programs maintain
  quality of life for people with dementia over 12
  months.
• (Megan J. Wraith 2008)

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Key questions

• What type of physical activity ?
• Access throughout the dementia journey ?
• Fit - to person centred care models ?

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What type of physical activity ?

• No consensus/guidelines currently available
• Aerobic activity (circulation, oxygen transport)
• Strength (depression and physical function) and
  balance
• Activity with meaning and purpose (QOL)

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Matching needs to the dementia journey
Early dementia, e.g. mild cognitive impairment Early to middle dementia, e.g. mild Alzheimers Disease Middle to late dementia, e.g. moderate Alzheimers Disease Late dementia e.g. Severe Alzheimers Disease
Person centred planning
how dementia affects movement (tasks, actions)
Structured, formal, task focused Open ended, more flexibility, goal directed, physical activity imitative and reflexive movement
Exercise Choice of mode and activity Falls and function Movement and circulation
Dance (music) Performance of choice rhythmic activity singing, rocking and listening
Walking with purpose Health walks buddy walks assisted walks
Sports and Games - Competitive, structured adapted/modified playful moments
Water activities Swimming, canoeing, aquacise engaging the senses, bathing, paddling
Outdoors and nature Climbing, rambling gardening being outdoors, fresh air
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Person centredness in planning (Kitwood 1992)
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Concerns for instructors/teachers

• What are our audiences/participants saying ?
• Assessment of potential and risk
• Understanding the impact of dementia upon
  movement
• Communication strategies
• Challenging behaviours
• Adaptation and performance
• What else ?

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Questions for LLT Tutors

1. How does LLT meet your training needs ?
2. Application to delivery of our current programmes
   how ?
3. Balance between mainstreaming and CPD
4. Tutor training and delivery for specific courses

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Next steps for LLT

• Level 4 long way away ? - agreement on evidence
  based intervention
• Summary of evidence and looking at guidelines
  (with BHF NC)
• New products in pipeline
• Awareness raising, physical activity and exercise
  (not activity) for services
• Working towards CPD for CBE and Otago
• Working towards CPD for PSI

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Follow up

• CPD pilot (Cambridge and Sandwell)
• Awareness raising (Loughborough and Manchester)
• Resource list for LLT tutors (dementia specific)
• LLT website
• Tutor involvement in new LLT products

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• Thank you
• and we would welcome your thoughts, ideas, skills
  and experience as we move this forward