Dementia case finding in the housing sector Health Innovation Network (HIN), south London’s Academic Health Science Network (AHSN), is one of the 15 AHSNs across England. HIN is a membership organisation connecting academics, NHS commissioners and providers, local authorities, patients and industry in order to accelerate the spread and adoption of evidence based innovations and best practice. One of the clinical priorities for HIN is Healthy Ageing and includes a significant focus on dementia.
In recent years the government and NHS England have placed a focus on improving dementia diagnosis rates (Department of Health, 2012). A timely diagnosis enables access to information, advice and support and access to a pathway of effective treatment and care (Prince et al., 2011). In response to this in 2015 and in recognition of the low diagnosis in residential and nursing homes HIN worked with three care homes to co-design the Dementia Assessment Referral to GP (DeAR-GP).
DeAR-GP is a case-finding tool which supports care workers in care homes to identify people who are showing signs of dementia and refer them to their GP for review. DeAR-GP incorporates a set of observations along with the Abbreviated Mental Test-4 scale to be completed by the care worker. Supported by the Alzheimer’s Society, since its launch, there has been national uptake and it is recognised as a ‘low-cost, high-impact intervention’ (NHS England, 2016). Dear-GP also features on NICE Shared Learning Database and AHSN Atlas of Solutions.
It is estimated that two-thirds of people with dementia live in the community (Alzheimer’s Society, 2017). Many of these people may be receiving support from district nurses or support staff in older adult housing schemes. Further, there is a growing recognition that training front line housing staff to identify the signs of dementia and seek support for early diagnosis is a key priority (Alzheimer’s Society, 2017). Recognising this, HIN worked with housing providers across three London boroughs (Newham, Lambeth, Kingston) to pilot whether DeAR-GP can be adapted for use by housing staff. HIN worked in partnership with three housing providers (Genesis Housing Association, Royal Borough of Kingston upon Thames, Metropolitan Housing Association). In total there were six housing pilot sites, three were extra care housing schemes and three were sheltered housing schemes. The tool was also piloted in Kingston with the Older and Vulnerable Peoples Support Service (OVPSS). Early on housing staff at the pilot sites provided feedback that DeAR-GP was applicable to their roles. Based on feedback minimal adaptations of the original DeAR-GP tool were required housing. Once the design was finalised housing staff were trained on the appropriate use of DeAR-GP in their setting by a facilitator from HIN. In some housing schemes Dementia Friends training was delivered alongside the DeAR-GP training. Pilots took place over a period of 4-6 week period in the housing schemes. Key findings are listed below. There was considerable variation in dementia training levels amongst staff. Many staff had not received any formal training whereas in some schemes, staff had received Dementia Friends Training or some form of internally developed dementia awareness training.
All staff had experience and awareness of some of the signs and symptoms of dementia. There was a consensus that even though working with dementia was challenging, it was also rewarding and “provided a sense of purpose”.
Two referrals were made using the DeAR-GP tool. Although there was limited opportunity for housing staff to test the tool, feedback from the staff remained overwhelmingly positive.
Prior to this project a dementia case finding tool did not exist for the housing sector. DeAR-GP supports the Dementia Friendly Housing Charter by promoting awareness of dementia and contributing towards developing and maintaining dementia friendly communities (Alzheimer’s society, 2017).
DeAR-GP adds to the skill base of front line housing staff and also acts as a communication aide between front line staff and GPs. Staff found DeAR-GP accessible and easy to use. The project has been accepted as a poster submission at the UK Dementia Congress October 2017 and is due to be published article in the Pharmaceutical Journal in autumn 2017.