Factsheet : Dementia

Joint Strategic Needs Assessment 2017

The word dementia describes a set of symptoms that may include memory loss and difficulties with thinking,

problem-solving or language. (Alzheimer's Society)

With an estimated 850,000 people living with dementia in the UK in 2015, dementia represents a major public

health challenge. At present there is no cure and limited effective treatments for dementia. However, a healthy

diet, regular physical exercise, managing conditions like type 2 diabetes and high blood pressure and avoiding

smoking and excessive drinking can reduce risk of developing Alzheimer's disease and vascular dementia (UK

Health Forum, 2014). A clear message of 'What’s good for your heart is good for your head' is needed

throughout preventative public health interventions and campaigns to improve public understanding of how

people can reduce their risk of developing dementia.(Source: Alzheimer's Society)

1

What have we got, what are we doing?

2

Support Services for Patients and Carers after Initial

Diagnosis

• Post diagnostic meeting with patient (and carer) at CIDS

shortly after diagnosis.

• Support from dementia Advisor (Alzheimer’s Society) at

CIDS or home.

• Support from CIDS Primary Link Worker (CIDS business

plan not being implemented).

• Group for newly diagnosed patients.

• Peer group support and involvement meeting for dementia

patients.

• Training and support for newly diagnosed patients – primarily

those with early onset dementia who are still working.

• Emotional support counselling – at various times though the

progressive of illness.

• Management of behavioural problems in the community and

in care homes.

• Support from OTs (for both patients and carers) – ongoing

need throughout the illness.

• Support from dementia trained nurses in the community –

ongoing as needed to help with medical and behavioural

problems.

• Cognitive stimulation therapy for patients.

• Singing for Brain for Patients and carers.

• Reminiscence and chair exercise.

• LBH and private day centres with activities for patients with

dementia.

• Activities for early onset dementia patients.

• Activities for patients in later stages of dementia.

Support Services Primarily for Carers after Initial

Diagnosis

• Dementia training for carers (CRiSP).

• CIDS monthly carers groups.

• Community Partnership / INS training for carers.

• Community Support Programme – Alzheimer's

Society respite for carers.

• Community support for Carers in Hounslow (This

provides an interesting activity for people with

dementia as well as respite for carers).

The Cognitive Impairment & Dementia Service (CIDS) and Research Unit provides assessment and treatment for patients experiencing difficulty. The service has a number of sites and a dementia hub consisting of dementia consultants, psychiatrists, nurse prescribers and research staff. It includes;

Dementia Liaison Nurses are based in West Middlesex University Hospital support hospital staff with providing appropriate care for in-patients with incidence of dementia and follow up those patients once discharged home from hospital.

Dementia Link Workers are a new service aligning with 5 Community Locality Teams. The service aims to support patients in community and primary care once discharged from secondary care

What have we got, what are we doing?

3

The London Borough of Hounslow and NHS Hounslow’s Joint commissioning strategy for

older people’s mental health services (2013-17, March 2013)

The strategy addresses both functional and cognitive mental health problems. The key areas of focus

are;

• Promote positive mental health and prevent or delay the decline of an older person’s mental health

throughout their later life and in every care setting

• Increase early intervention and the capacity to offer an expert assessment of mental health

problems at every stage

• Improve the quality of care and ensuring that the right mental health support is available to patients

at the right time

• Chair and administer the Carers Partnership Board, and facilitate the Carers Operational Group

which allows carers to feedback to the Board on;

• Operational issues

• Review of documents – strategy, commissioning support project, reviewing website (LBH)

• Promote carers events

• Engage with social work teams as appropriate

The Joint Commissioning Team has set up a monthly operational meeting. The group consist of the Director of Joint Commissioning, the Mental Health Clinical Lead, the Primary Care Manager and the CIDS service manager. The purpose is to review the diagnostic rate and to improve the dementia care pathway, including End of Life Care.

How are we getting on, any key gaps?

4

Diagnosis

Hounslow’s dementia diagnosis rate in the population aged over 65 was 76.2% (1,416) in May 2016. This was higher than London (72.7%) and England (67.8%). The national diagnosis target is currently 66.9%.

The CIDS data suggest that the referrals received by the service decline from 819 in 2015 to 713 in 2016, however the diagnostic rate rose from 578 in 2015 to 672 in 2016. (CIDS data, 24/02/2017). This may reflect both more appropriate referrals and better awareness campaigns to increase the number of diagnosis in line with the expected numbers.

Treatment

In 2015/16 the percentage of dementia patients with a review in last 12 months was 86%, in line with the London average, this is an improvement on the 2014/15 position1.

During 2014/15, the rate of emergency admissions was significantly higher in Hounslow compared to the ten most similar areas 1.Hounslow prescribed relatively more rivastigmine when compared to ten most similar areas. Hounslow prescribing costs equated to £152 per 1,000 ASTRO-PU weighted population, compared to an average of £60 per 1,000 ASTRO-PU 1.

1NHS RightCare Commissioning for Value Focus Pack: Mental Health and Dementia May 2016 [online] available from:

https://www.england.nhs.uk/rightcare/intel/cfv/data-packs/london/#11 [last accessed: 25 April 2017] 2 POPPI = Projecting Older People Population Projection Information System ( http://www.poppi.org.uk/ ) & PSSRU = Personal Social Services Research Unit

– London School of Economy

There is a wide variance in the rate of diagnosed dementia by GP surgeries. The overall picture shows some contrast of the

localities in Hounslow, with the prevalence in Brentford nearly double that in the Heart of Hounslow area, this is irrespective of the

number of people living in a care homes with dementia.

How do our performance and services compare

with other areas?

5

Source: CCG data packs; https://www.england.nhs.uk/rightcare/intel/cfv/data-packs/london/#11

Whilst the number of patients diagnosed with dementia is above the required target, and the London average, further services for dementia

patients did not compare well to peers. The demographics in Hounslow were used to identify 10 similar areas, and Hounslow was compared

against the 5 best performing of those 10 areas. Areas of better performance in the other areas are shown in the chart below. Each bar in the

chart shows the necessary increase that would be required to match the average of the best 5. Therefore an additional 178 patients should

have a review, 80 fewer patients should be admitted as an emergency to hospital, (representing 886 fewer days) and 43 more patients should

be enabled to die in their usual place of residence.

(Local Value 69% : 81% average)

Difference: 178

(Local Value 32 days: 25 average)

Difference: 886 days,

(Local Value 2.4 days : 1.8 average)

Difference: 80

(Local Value 40%: 63% average)

Difference: 43 residents, -57%

-60%

-50%

-40%

-30%

-20%

-10%

0%

10%

20%

30%

40%

Dementia patients with a reviewin last 12 months, 2014/15 (%)

Average annual number of days(nights) spent in emergency

hospital admissions during thelast year of life of residents who

died (2013-15)

Average annual number ofemergency hospital admissions

during the last year of life ofresidents who died (2013-15)

Deaths in Usual Place ofResidence: people with dementia

65+, 2014 (%)

% Difference between Hounslow and average of 5 best out of 10 similar CCGs

Future plans, what will this mean for local people?

6

To promote positive mental health and preventing or delaying the decline of an older person’s mental health

throughout their later life and in every care setting;

By addressing diet, exercise, preventing social isolation, providing high quality domiciliary care, and

more activities targeted at over 60s, including transport and dementia specific activities.

Advocating Dementia Friends and community awareness of the difficulties patients with dementia can

face and how they can be helped

Increasing early intervention and the capacity to offer an expert assessment of mental health problems at every

stage;

By working towards enabling Hounslow residents to understand that while there is no cure for dementia

there are many clinical and social services which can help patients live well with dementia.

Improving the quality of care and ensuring that the right mental health support is available to patients post

diagnosis.

By increasing the number of patients receiving an annual assessment after diagnosis.

Develop more efficient treatment pathways for cognitive and functional mental health problems, thereby

increasing capacity and the ability to outreach to older people in community settings so that care is as local as

possible.

Increase independent and supported living options for older people with mental health problems, and reduce

reliance on bed based and residential care.

Identify and support family carers of patients with dementia and ensure advice and information is readily

available.

Summary information and data sources

7

Links to data sources: Alzheimer's society: https://www.alzheimers.org.uk/

Dementia diagnosis monthly workbook: https://www.england.nhs.uk/mentalhealth/dementia/monthly-workbook/

Quality and Outcomes Framework (QOF) - 2015-16: http://www.content.digital.nhs.uk/catalogue/PUB22266

POPPI: http://www.poppi.org.uk/

Public Health England: https://fingertips.phe.org.uk/profile-group/mental-health/profile/dementia

RightCare CCG Data Packs: https://www.england.nhs.uk/rightcare/intel/cfv/data-packs/london/#11

Key messages for Hounslow:

The 2015/16 prevalence of dementia in the Hounslow registered population was 0.50% (1,428), it

is estimated that the prevalence in adults over 65 will increase to 2,268 by 2020 and to 3,059 by

2030. With this growth there is a requirement for more general awareness and for services to

become Dementia Friendly.

There is a very wide variance in dementia gap rates between GPs, which could mislead

interpretation of the dementia prevalence rate for the CCG. (QOF 2015/16).

The rates of emergency admission to hospital and the consequent number of days spent in

hospital for patients with dementia are significantly high, more up to date information should be

routinely available to actively monitor and reduce this.

The percentage of patients with dementia not dying in their usual place of residence is

significantly low

An evaluation of the new Dementia Link workers in Primary Care is underway.

PHE Dementia Profile

8

https://fingertips.phe.org.uk/profile-group/mental-health/profile/dementia

Prevalence by GP surgery

9

Source: QOF 2015/16

Dementia prevalence in the registered population in Hounslow in 2015/16 was 0.52% (1,582 persons).

Between 2014/15 and 2015/16 there was a 5.4% increase in dementia prevalence in the registered population in

Hounslow from 0.49% (1,478) to 0.52%(1,582) This was higher than the increase in London (4.8%) and England

(2.9%).

Prevalence by Local Authority

10

There are 53 GP Practices in Hounslow. Nearly half of them (24) had a dementia prevalence figure above the

London average (0.51%) and 10 of them above the England average (0.76%).

Hounslow’s dementia diagnosis rate in population aged 65+ is 76.2% (1,416 persons). This is higher when

compared to London (72.7%) and England (67.8%).

Prevalence projections

2015 2020 2025 2030

Hounslow 2% 18% 36% 59%

London 2% 15% 32% 53%

England 3% 18% 38% 62%

0%

10%

20%

30%

40%

50%

60%

70%

Projected percentage increase in Dementia (65+), Hounslow, London and England, 2015-2030

11

Source: http://www.poppi.org.uk/

POPPI uses a report into the prevalence and cost

of dementia prepared by the Personal Social

Services Research Unit (PSSRU) at the London

School of Economics and the Institute of Psychiatry

at King’s College London, for the Alzheimer’s

Society, 2007. The prevalence rates from this

report are summarised by gender and age in the

table below.

POPPI applies the above rates on ONS population

projections in order to calculate estimates of people

with dementia. The figures on the left show

estimated numbers of people with dementia in

Hounslow and estimated change in dementia

between 2015 and 2030 in Hounslow, London and

England.

The data indicates that there is a steady increase in

the prevalence of dementia over time in Hounslow

and also in London and England. This is strongly

related to older people living longer over time.

Therefore there will be more older people with

dementia in the future.

Age range % MalesMale

(number) % Females

Females (number)

65-69 1.5 68 1 49

70-74 3.1 98 2.4 88

75-79 5.1 133 6.5 195

80-85 10.2 209 13.3 352

85-89 16.7 159 22.2 311

90+ 27.9 112 30.7 292

Dementia related hospital admissions

12Source: Hounslow CCG, March 2017

There were 3,367 hospital

admissions for Hounslow

where a patient was

diagnosed with Dementia

between April 2014 and

January 2017.

The majority of the dementia

patients are female, they make

59% of the total admissions.

The majority of the patients

are aged 85 or over.

The majority of the patients

with dementia are British

(61.8%)

There is a relatively large

proportion of patients (8.4%)

where ethnicity was not

recorded

Hounslow CCG – Dementia diagnosis in hospital,

April 2014 to January 2017

13

Source: Hounslow CCG, March 2017