Dementia Pathways. For Primary Care in ireland

The Dementia Review

 

The quality of care provided to patients with dementia can be improved by focusing on the following 6 key areas at this regular review. This applies both to patients in the community and nursing home residents.

1. Medication Review

  • Is the patient on an antipsychotic? Is it necessary? Is it monitored? Can it be reduced or withdrawn?
    • Link below to our information on antipsychotic use in dementia - we have pages on how to monitor and withdraw antipsychotics
  • Is the patient on a medication such as an anticholinergic that could worsen cognition? 
    • Visit the link below to our 'medication review' page for list of medications that can contribute to impaired cognition
  • Is the patient on an acetylcholinesterase inhibitor (e.g Donepezil)? If yes, is the dose therapeutic? Are there any side effects?
    • Visit our information page below on acetylcholinesterase inhibitors & memantine
  • Does the patient have adequate pain relief?
  • Is the patient experiencing any medication side effects?

2. Mental Health

  • Is there evidence of depression? Depression is often difficult to detect in people with dementia. If uncertain consider using a depression screening tool such as:
    • The Geriatric Depression Scale - this is a relatively short 15-item questionnaire and has been vailidated for use in mild dementia, however, is not as suitable in more advanced dementia as the patient may lack the ability to comprehend the questions. (PDF below)
    • The Cornell Scale for Depression in Dementia - this tool is dementia specific but can take up to 20 mins to perform (PDF below)

3. Physical Factors

  • Hearing, vision, nutrition, bowel, bladder
  • Advise dental review

4. Risk Assessment

  • Inadvertent self-harm e.g kitchen accidents, medication mistakes
  • Deliberate self-harm
  • Risk to others e.g.  driving, aggression
  • Evidence of elder abuse

5. Assessment of Carers Needs

  • Consider caregiver burden: Does the carer regularly get time to themselves? Do they have adequate support? Are they themselves feeling down/anxious/irritable? 
  • Consider using a scale to formally measure caregiver burden, however, these are often quite lengthy. (See PDF below)
  • If appropriate consider directing carers to online resources designed to support carers:
    • Visit link to our 'information resource for carers' for more information on places to direct carers and relatives to.

6. Social Supports Review

  • Are there social supports in place? Does the carer, or person with dementia, access any support groups, go to Alzheimer cafes, avail of day care or respite services?
    • Visit our service directory for information on services & supports in your area.