Identifying, Diagnosing and Managing Dementia A Pilot Study to Build Capacity Among Tasmanian General Practice Registrars Dr Amanda Lo
Objectives To articulate the evaluation findings of a program pilot conducted with GPTT registrars in dementia education To give a brief overview of the concepts that form the backbone of the dementia workshop
Background Why Talk about Dementia? 2011: 266,574 people with dementia 2050: projected 942,624 people with dementia Around one million people care for a relative or friend with dementia Up to 80% of patients with early stages of dementia are not being diagnosed in primary care GPs have a key role in the diagnosis and management of dementia
Method Workshop Development Partnership between GPTT, Wicking Dementia Research and Education Centre (WDREC) and Dementia Training Study Centre (DTSC) 2 x 0.5 day aged care/dementia workshop developed Material sourced from DTSC and WDREC Train the trainer of GPTT medical educators through DTSC and WDREC Run in November 2013 at GPTT
Method Dementia Workshop Objectives To raise awareness of dementia in the GP community To assist GP participants to: Better diagnose and manage dementia Modify risk factors that may impact on progression of dementia Better understand behavioural and psychological changes in patients with dementia Be aware of the carer burden Be aware of referral agencies to support both individuals and the carers Recognise that dementia is both a social and medical condition
Method Dementia Workshop Structure Part 1 half day Part 1 Recognising Dementia in General Practice Part 2 Diagnosing Dementia in General Practice Part 3 Managing Dementia in General Practice Part 2 half day Palliative Care Geriatrician, aged care nurse Aged Care Cases (polypharmacy, BPSD, Parkinsons) Consultant pharmacist, GPTT ME
Criteria for Diagnosis of Alzheimer s and Vascular Dementia Inclusion Criteria: Gradual onset of poor memory Worsening of memory problem Failure of function Cortical dysfunction dysphasia, agnosia, dyspraxia (for vascular dementia, add neuro sign or CT evidence of stroke) Exclusion criteria: Delirium, other organic cause, psychiatric illness
Stages of Care for People with Dementia The first stage: Still at home Dignity through independence GOC maintain independence and enjoyment The second stage: Now needing 24 hour care Dignity through safety GOC To keep safe and maximise any quality The third stage: No more quality Dignity through emphasis on comfort GOC To provide comfort and dignity
Dementia Trajectory
5 Domains that Dementia Involves 1. Cognition Memory, registration, judgement, language, empathy 2. Function ADLs basic/instrumental 3. Psychiatric conditions Depression, delusions, hallucinations, anxiety, BPSD 4. Behaviour Disinhibition, wandering, calling out, BPSD, delirium 5. Physical deficits Mobility, planning, praxis, continence, swallowing and motility
5 Domains in Alzheimer s
Method Evaluation Survey completion prior to and after the workshop: Dementia Knowledge and Assessment Tool Version 2 Ageing Care in General Practice: GP Attitudes and Confidence Survey Participants were asked to evaluate the program content and delivery
Results Dementia Knowledge
Results Attitudes Towards Dementia
Results Attitudes Towards Dementia
Results Participant Evaluation of Workshop
Discussion Successful collaborative approach Refinement of the program Subsequent stages of the project will continue to address the barriers faced by GPs in the diagnosis and management of dementia
What Next? Train the trainer Supervisor and ME workshops Wicking research team will facilitate evaluation at all sessions No cost for training Program champion
Questions?