Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
delay not the case
- Glyn Phillips (11 January 2008)
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Dementia
- nadir sher (24 January 2008)
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War of Dementia versus the battles of everyday life
- Roshelle Ramkisson (25 January 2008)
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probolems of elderly
- Ruchi Thakur (27 January 2008)
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Dementia in learning disability - The forgotten tribe.
- Rehana Shakir, Adrian Edwards, Rajnish Attavar (10 February 2008)
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Responsibilities in dementia care
- Clive E Bowman (25 February 2008)
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Glyn Phillips, GP East Kilbride G75 8TT
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The rather sweeping statement 'Primary care doctors often defer the diagnosis because they think it is futile—that the condition is not treatable, it carries stigma, and it will leave people feeling hopeless.' does not appear to carry a specific reference to justify it. My experience is that the opposite is the case, and that when patients and their families first present to primary care, investigation and referral commences quite quickly. We prescribe cognitive enhancers regularly so it seems odd to state that we as a group feel the condition is untreatable. What evidence is there for these opinions? Competing interests: None declared |
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nadir sher, emergency Physician with Gp interests Ireland
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It is interesting to know that dementia has a high mortality but in my experience mortality varies according to the causes of dementia. The different types of dementia are vascular,alzheimers lewy body and temporal lobe dementia. The mortality also depends on the total care of the patients in terms of co morbidities.The mortality of vascular dementia can be improved with better control of hypertention , stopping smoking,using aspirin and statins. Patients with dementia needs a holistic care in multidisciplinary approachundre the supervision ofprimary care physician. carers should be encouraged to participate adequaltly in the care plan of the patient. carers needs should be addressed all the times and the stress level in carer should be recognised and addressed at the right time.The burden of care in the family and on the indisual should be adequatly shared by primary care and community. Competing interests: None declared |
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Roshelle Ramkisson, ST 2 Psychiatry Bolton. Salford & Trafford Mental Health NHS Trust,Meadowbrook Unit, M 68 HG
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Now this is an interesting statement that outlines the principle of the management of Dementia…. ’what can be done’, which is at the core of the work of the Psycho geriatrician. A lot can be done, but that in no means ameliorates the heartache and devastation the diagnosis brings to families and carers of a loved suffering from it. Firstly, we look for those few and far between cases which maybe reversible, however from my experience to date, I have yet to see one of those myself. Regardless of the cause, the multidisciplinary approach offers all possible assistance and support.This can be as simple as an empathetic ear to a distressed family member to occupational therapy input and appropriate accommodation. As a clinician our innate desire is to treat and we search for our pen to prescribe, which is where I am afraid the difficulty lies. We have no ammunition to win the war against the illness, yet the small things that can be done to help those affected live their days with dignity and respect, are the little battles we should not forget. Competing interests: None declared |
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Ruchi Thakur, Specialty Registrar ,Old age Psychiatry UCL
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Caring for dementia needs empathy and working with the attitude of providing care when none can possibly be reciprocated by the patient. It is important that the staff employed by care homes and the doctors working with them continue to show quality care e.g. a warm touch, a smile ,can go long ways even if the patient cannot probably understand the language. These patients though suffering from dementia do realise whether they are loved or not. Dementia can be associated with depression which usually comes as a surprise to people .It is difficult to detect and its important we are aware of this and how to recognise it so that we can make appropriate referral to the specialist services. Recognising behaviour problems and those that are manageable at primary care is also crucial. We have all heard of racism but now its becoming evident a lot of people are ageist as well. They do not understand and do not want to understand the elderly. By encouraging our junior doctors and medical students to undergo training even if briefly in geriatric medicine or old age psychiatry we may help in reducing some ageism in our future doctors. Competing interests: None declared |
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Rehana Shakir, Staff Grade Ridgeway Partnership, Manor House, Aylesbury, HP20 1EG, Adrian Edwards, Rajnish Attavar
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This was an interesting article, however as clinicians working with people with learning disabilities we could not help but notice the forgotten tribe of people who suffer dementia with a learning disability had been completely ignored. We wondered what reasons were behind the under recognition of this group? “Alzheimer’s disease occurs in aging people with learning disabilities at the same rate as in the general population, with exception of individuals with Down’s syndrome who develop dementia earlier.” “Serial examinations of dementing Down’s syndrome individuals demonstrate a progressive decline in short and long term memory and orientation comparable with changes seen in the general population (Das and Mishra, 1995).” [Seminar series in Learning Disability RCPsych] “Personality change is a frequent presenting symptom, and while not uniformly found , apathy, withdrawal, and irritability may be seen. “[ Seminar series in Learning Disability RCPsych.] This presentation of undisagnosed Dementia in Learning Disability,may be misunderstood as challenging behaviour if the clinicians are not aware. Looking at the NICE guidelines 42 it says that: - “Health and social care staff working, such as those catering for people with learning disabilities, should be trained in dementia awareness. “ “People with learning disabilities and those supporting them should have access to specialist advice and support regarding dementia.” As I mentioned above it is an important part in dementia to include people with learning disabilities and this article sadly did not address this issue. In our own service we are aware that this problem of Under diagnosis of this condition and hence we are currently in the process of auditing the case notes of people with dementia and learning disabilities. We are also in the process of looking at a new care pathway for people with dementia which may address the deficiencies . Competing interests: None declared |
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Clive E Bowman, Medical Director BUPA Care Service, Bridge House, Outwood Lane, Horsforth, Leeds LS18 4UP
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The Editorial “Caring for people with Dementia” strikes a welcome constructive note. Perhaps surprisingly for an editorial written from a Nursing and Psychologist perspective medical responsibilities are defined namely, diagnosis, explanation, monitoring and continuing management of health. Clinical diagnosis continues to rest largely on exclusion of treatable causes whilst the contentious application of disease/symptom modifying treatments continues to be undermined by inadequate evidence for which clinicians and researchers have a responsibility to remedy. What recent investment has been made in supporting people with advancing dementia has been made inconsistently both geographically and professionally. In practice this means that the responsibility for continuing clinical surveillance is often vested in front line care workers who often have little or no guidance on who and under what circumstances they should initiate referral. Sadly, when care workers do seek help they are not uncommonly met with diffidence through evasion to outright hostility. The reality of partnership is quite different from the notion! The upshot is that the best intentions of care staff are undermined and the potential for lurid allegations and headlines of a failure in care legion. A key clinical role which Downs and Bowers allude to but do not make strongly enough is the communication of clinical status. If there is a clinical understanding that an individuals disease has progressed to a point where the individual can be positively identified as being on a terminal decline and this is clearly communicated to care staff, families and friends a dignified end to an often difficult disease can be planned. It may seem unfair but from a medical perspective having had a focus brought on the importance definition of the medical role in the management of dementia perhaps there is a need to make clear other professional roles and responsibilities. The size of the challenge and costs of systems make this most pressing. Competing interests: Medical Director of care homes providing dementia care |
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