scholarly journals 471 LET’S TALK DEMENTIA

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii1-ii4
Author(s):  
M Ashraf ◽  
A Mahmood ◽  
K Honney
Keyword(s):  
Hospital Admissions ◽  
Significant Rise ◽  
Screening Tools ◽  
Queen Elizabeth Hospital ◽  
Cognitive Screening ◽  
Baseline Measure ◽  
Improvement Project ◽  
Mental Test Score ◽  
The Government ◽  
Medical Wards

Abstract Introduction By 2021 over one million people will be living with dementia (1) costing the government an estimated £30bn a year (2). However, cognitive decline is often misdiagnosed or missed completely in hospital admissions, resulting in delays in detection and treatment for patients. Quick and simple screening tools such as the Abbreviated Mental Test Score (AMTS) could help provide early detection and faster treatment times for such patients. Data from Queen Elizabeth Hospital Kings Lynn showed that only 56.8% of patients over the age of 75 were being assessed for cognitive function on admission, while the national targets are set at 90%. Methods A multi-cycle, trust wide, quality improvement project was used to improve screening outcomes for dementia in QEHKL. A baseline measure of screening was taken by QEHKL coding department. Five PDSA (Plan Do Study Act) cycles were undertaken, implementing interventions to aid screening at each stage. Examples include improved medical clerking booklets, trust wide education and allocated ward ‘Dementia Champions’. Performance was assessed by auditors, through patient notes and discharge letters. Results Over a 4-month period, 432 patient notes were inspected on six medical wards. Results after interventions showed a significant rise in Dementia Screening from 58.7% to 89.8%. AMTS completion was 70.7% in September 2020 on medical wards which improved to 85.7% in November 2020. Results were collected during the COVID-19 pandemic however, COVID wards were excluded. Conclusion The QI project has highlighted that education and accessible tools can improve cognitive screening numbers. An important note is, due to increased pressures during the COVID pandemic it is plausible that screening rates were adversely affected. Despite this, our figures still show positive improvement. The next cycle of our project includes surgical wards and we expect by the time of presentation to have this data to show.

A Memory Clinic at a Geriatric Hospital: A Report on 577 Patients Assessed with the CAMDEX Over 9 Years

2003 ◽  
Vol 37 (3) ◽  
pp. 319-326 ◽  
Author(s):  
Joe A. Stratford ◽  
Dina Logiudice ◽  
Leon Flicker ◽  
Roslyn Cook ◽  
Wendy Waltrowicz ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
The Elderly ◽  
International Classification Of Diseases ◽  
Screening Tools ◽  
Cognitive Screening ◽  
Memory Clinic ◽  
Mental Test Score ◽  
Patient Demographics ◽  
Significant Difference ◽  
Icd 10

Objective: To report 9 years’ experience of an Australian memory clinic using the Cambridge Mental Disorders in the Elderly Examination (CAMDEX) assessment schedule, summarizing patient demographics, diagnoses at presentation and the utility of four instruments used in distinguishing patients with and without dementia. Methods: All patients seen at the clinic between December 1989 and September 1998 were assessed using the CAMDEX. Diagnoses were determined according to criteria of the International Classification of Diseases, tenth edition (ICD-10). Results: The mean age of 577 patients seen was 72.9 years and 60.8% were female. Over 40% fulfilled ICD-10 diagnostic criteria for dementia in Alzheimer's disease. A further 24% had another dementing illness. Only 28 patients were ‘normal’. There was no significant difference in the ability of the 107-item Cambridge cognitive examination, the 30-item mini-mental state examination, the 10-item abbreviated mental test score and the 26-item informant questionnaire on cognitive decline in the elderly to differentiate dementia patients from those who were normal or had functional psychiatric disorders. The four cognitive screening tools had high correlations with one another (r = −0.57 to 0.93). Conclusion: Patient demographics and diagnoses were similar to those found in other clinics. Most people who attended the memory clinic had significant cognitive or psychiatric disorders.

scholarly journals Optimizing The Diagnosis and Management of Dementia Within Primary Care: A Systematic Review of Systematic Reviews

2021 ◽  
Author(s):  
Brooklynn Fernandes ◽  
Zahra Goodarzi ◽  
Jayna Holroyd-Leduc
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Systematic Reviews ◽  
Family Physicians ◽  
Outcome Data ◽  
Screening Tools ◽  
Care Practice ◽  
Cognitive Screening ◽  
Mental Test Score ◽  
Diagnosis And Management

Abstract Background: To understand how best to approach dementia care within primary care and its challenges, we examined the evidence related to diagnosing and managing dementia within primary care.Methods: Databases searched include: MEDLINE, Embase, PsycINFO and The Cochrane Database of Systematic Reviews from inception to 11 May 2020. English-language systematic reviews were included if they described interventions involving the diagnosis, treatment and/or management of dementia within primary care/family medicine and outcome data was available. The risk of bias was assessed using AMSTAR 2. The review followed PRISMA guidelines and is registered with Open Science Framework.Results: Twenty-one articles are included. The Mini-Cog and the MMSE were the most widely studied cognitive screening tools. The Abbreviated Mental Test Score (AMTS) achieved high sensitivity (100%, 95% CI: 70%-100%) and specificity (82%, 95% CI: 72%-90%) within the shortest amount of time (3.16 to 5 minutes) within primary care. Five of six studies found that family physicians had an increased likelihood of suspecting dementia after attending an educational seminar. Case management improved behavioural symptoms, while decreasing hospitalization and emergency visits. The primary care educational intervention, Enhancing Alzheimer's Caregiver Health (Department of Veterans Affairs), was successful at increasing carer ability to manage problem behaviours and improving outcomes for caregivers.Conclusions: There are clear tools to help identify cognitive impairment in primary care, but strategies for management require further research. The findings from this systematic review will inform family physicians on how to improve dementia diagnosis and management within their primary care practice.

Delirium in palliative care: Detection, documentation and management in three settings

2013 ◽  
Vol 13 (6) ◽  
pp. 1541-1545 ◽  
Author(s):  
Jennifer Hey ◽  
Christian Hosker ◽  
Jason Ward ◽  
Suzanne Kite ◽  
Helen Speechley
Keyword(s):  
Palliative Care ◽  
Screening Tools ◽  
Cognitive Screening ◽  
Mental Test Score ◽  
Management Plans ◽  
Hospital Patients ◽  
Screening And Identification ◽  
Delirium Management ◽  
Hospice Palliative Care ◽  
Hospital Team

AbstractObjectives:Delirium is characterized by disturbances of consciousness and changes in cognition that develop rapidly and fluctuate. It is common in palliative care, affecting up to 88% of patients with advanced cancer, yet often remains insufficiently diagnosed and managed. This study sought to compare rates of screening, documentation, and management of delirium across three palliative care settings — two hospices and one hospital team — and to determine whether definitive documentation of delirium as a diagnosis is associated with improved management of the disorder.Methods:A retrospective review of patient case notes was performed in three U.K. palliative care settings for the presence of: cognitive screening tools on first assessment; the term “delirium” as a stated documented diagnosis; documented terms, descriptions, and synonyms suggestive of delirium; and management plans aimed at addressing delirium.Results:We reviewed 319 notes. The prevalence of delirium as a documented diagnosis ranged from 0 to 8.4%, rising to 35.7–39.2% when both documented delirium and descriptions suggestive of delirium were taken into account. An abbreviated mental test score (AMTS) was determined for 19.6 (H1) and 26.8% (H2) of hospice admissions and for 0% of hospital assessments. Symptoms suggestive of delirium were managed in 56.3% of cases in hospital, compared with 66.7 (H1) and 72.2% (H2) in hospices.Significance of results:Use of the term “delirium” was infrequent in both hospital and hospice palliative care settings, as was the use of routine screening. Many identified cases did not receive targeted management. The definitive use of the term as a diagnosis was associated with clearer management plans in hospital patients. The authors suggest that better screening and identification remains the first step in improving delirium management.

scholarly journals Optimizing the diagnosis and management of dementia within primary care: a systematic review of systematic reviews

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Brooklynn Fernandes ◽  
Zahra Goodarzi ◽  
Jayna Holroyd-Leduc
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Systematic Reviews ◽  
Family Physicians ◽  
Outcome Data ◽  
Screening Tools ◽  
Care Practice ◽  
Cognitive Screening ◽  
Mental Test Score ◽  
Diagnosis And Management

Abstract Background To understand how best to approach dementia care within primary care and its challenges, we examined the evidence related to diagnosing and managing dementia within primary care. Methods Databases searched include: MEDLINE, Embase, PsycINFO and The Cochrane Database of Systematic Reviews from inception to 11 May 2020. English-language systematic reviews, either quantitative or qualitative, were included if they described interventions involving the diagnosis, treatment and/or management of dementia within primary care/family medicine and outcome data was available. The risk of bias was assessed using AMSTAR 2. The review followed PRISMA guidelines and is registered with Open Science Framework. Results Twenty-one articles are included. The Mini-Cog and the MMSE were the most widely studied cognitive screening tools. The Abbreviated Mental Test Score (AMTS) achieved high sensitivity (100 %, 95 % CI: 70-100 %) and specificity (82 %, 95 % CI: 72-90 %) within the shortest amount of time (3.16 to 5 min) within primary care. Five of six studies found that family physicians had an increased likelihood of suspecting dementia after attending an educational seminar. Case management improved behavioural symptoms, while decreasing hospitalization and emergency visits. The primary care educational intervention, Enhancing Alzheimer’s Caregiver Health (Department of Veterans Affairs), was successful at increasing carer ability to manage problem behaviours and improving outcomes for caregivers. Conclusions There are clear tools to help identify cognitive impairment in primary care, but strategies for management require further research. The findings from this systematic review will inform family physicians on how to improve dementia diagnosis and management within their primary care practice.

Mapping end-of-life and anticipatory medications in palliative care patients using a longitudinal general practice database

2021 ◽  
pp. 1-7
Author(s):  
H. Khalil ◽  
M. Garett ◽  
A. Byrne ◽  
P. Poon ◽  
K. Gardner ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
General Practice ◽  
End Of Life ◽  
Nurse Practitioners ◽  
Hospital Admissions ◽  
Population Level ◽  
Screening Tools ◽  
Care Needs ◽  
Stakeholder Consultation

Abstract Objective End-of-life and anticipatory medications (AMs) have been widely used in various health care settings for people approaching end-of-life. Lack of access to medications at times of need may result in unnecessary hospital admissions and increased patient and family distress in managing palliative care at home. The study aimed to map the use of end-of-life and AM in a cohort of palliative care patients through the use of the Population Level Analysis and Reporting Data Space and to discuss the results through stakeholder consultation of the relevant organizations. Methods A retrospective observational cohort study of 799 palliative care patients in 25 Australian general practice health records with a palliative care referral was undertaken over a period of 10 years. This was followed by stakeholders’ consultation with palliative care nurse practitioners and general practitioners who have palliative care patients. Results End-of-life and AM prescribing have been increasing over the recent years. Only a small percentage (13.5%) of palliative care patients received medications through general practice. Stakeholders’ consultation on AM prescribing showed that there is confusion about identifying patients needing medications for end-of-life and mixed knowledge about palliative care referral pathways. Significance of results Improved knowledge and information around referral pathways enabling access to palliative care services for general practice patients and their caregivers are needed. Similarly, the increased utility of screening tools to identify patients with palliative care needs may be useful for health care practitioners to ensure timely care is provided.

scholarly journals Implementing family based treatment in a child and youth eating disorder program: impact on admissions

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Hayley Thompson ◽  
Kim Hurst ◽  
Heather Green ◽  
Jodie Watkins ◽  
Nigel Collings ◽  
...  
Keyword(s):  
Home Environment ◽  
Hospital Admissions ◽  
Female Adolescent ◽  
Retrospective Data ◽  
Treatment As Usual ◽  
Program Impact ◽  
Cumulative Length ◽  
Family Based Treatment ◽  
Family Based ◽  
Medical Wards

AbstractObjectivesAnorexia Nervosa (AN) treatment is frequently associated with high costs often due to the use of hospitalization. In Family Based Treatment (FBT) a main goal is to manage recovery of AN in the home environment rather than relying on lengthy hospital admissions. This study examined whether the use of hospitalization altered following the introduction of FBT to a youth eating disorders program in 2009.MethodThis study compared retrospective data of 71 female adolescent patients diagnosed with AN: 10 who received treatment as usual prior to the implementation of FBT; 10 who were treated immediately after FBT implementation; and a further 51 adolescents who received FBT since 2009.ResultsResults indicate that since the implementation of FBT there was a significant reduction in admissions to the medical ward and a significant reduction in cumulative length of stay on both the psychiatric and medical wards in adolescents presenting with AN.

scholarly journals Screening tools for the identification of dementia for adults with age-related acquired hearing or vision impairment: a scoping review

2017 ◽  
Vol 29 (11) ◽  
pp. 1771-1784 ◽  
Author(s):  
Annie Pye ◽  
Anna Pavlina Charalambous ◽  
Iracema Leroi ◽  
Chrysoulla Thodi ◽  
Piers Dawes
Keyword(s):  
Hearing Impairment ◽  
Cognitive Assessment ◽  
Negative Impact ◽  
Sensory Modality ◽  
Vision Impairment ◽  
Assessment Tools ◽  
Screening Tools ◽  
Screening Tests ◽  
Cognitive Screening ◽  
Age Related

ABSTRACTBackground:Cognitive screening tests frequently rely on items being correctly heard or seen. We aimed to identify, describe, and evaluate the adaptation, validity, and availability of cognitive screening and assessment tools for dementia which have been developed or adapted for adults with acquired hearing and/or vision impairment.Method:Electronic databases were searched using subject terms “hearing disorders” OR “vision disorders” AND “cognitive assessment,” supplemented by exploring reference lists of included papers and via consultation with health professionals to identify additional literature.Results:1,551 papers were identified, of which 13 met inclusion criteria. Four papers related to tests adapted for hearing impairment; 11 papers related to tests adapted for vision impairment. Frequently adapted tests were the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MOCA). Adaptations for hearing impairment involved deleting or creating written versions for hearing-dependent items. Adaptations for vision impairment involved deleting vision-dependent items or spoken/tactile versions of visual tasks. No study reported validity of the test in relation to detection of dementia in people with hearing/vision impairment. Item deletion had a negative impact on the psychometric properties of the test.Conclusions:While attempts have been made to adapt cognitive tests for people with acquired hearing and/or vision impairment, the primary limitation of these adaptations is that their validity in accurately detecting dementia among those with acquired hearing or vision impairment is yet to be established. It is likely that the sensitivity and specificity of the adapted versions are poorer than the original, especially if the adaptation involved item deletion. One solution would involve item substitution in an alternative sensory modality followed by re-validation of the adapted test.

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