Dementia Pathways. For Primary Care in ireland

Dementia e-learning module

In August 2018, the PREPARED project, working in collaboration with the ICGP, launched a fully accredited dementia e-learning module.

Split into 10 lessons, and with 10 external and 2 internal CPD credits available on completion, the e-learning module is available to GPs via the GP e-learning platform on the ICGP website at https://www.icgp-education.ie/ (login required).  It is also available for Practice Nurses on the IPNA website at https://www.ipna-education.ie/modules/ (login required)

 

The module provides current and practical information for GPs and other members of the Primary Care Team, addressing all aspects of dementia care - including diagnosis & management, the challenges posed by BPSD, and issues around sensitive legal issues, nursing homes and palliative care. 

Lesson 1: Prevalence, Aetiology & Prevention of Dementia

This lesson outlines a symptom-based definition of dementia, explores common dementia subtypes, highlights risk reduction through modifiable risk factors, and considers the role of the GP in dementia care.

Lesson 2: How to Make a Diagnosis of Dementia

This lesson highlights the DSM diagnostic criteria for dementia, and the importance of making a timely diagnosis. A step-wise approach to diagnosing dementia is outlined which includes - history & collateral history, physical examination, medication review, appropriate investigations, and testing of cognitive function. Difficulties around disclosure are addressed in an accompanying supplementary video.

Lesson 3: Post-Diagnosis Care & Review in Patients Living with Dementia

The quality of care provided to patients living with dementia can be improved by focusing on key areas at regular intervals. This lesson provides a framework for review visits which includes - screening for depression, physical examination, review of medications, social care review, risk assessment, and review of the health & wellbeing of carers.

Lesson 4: Involving Members of the Primary Care Team

Each member of the Primary Care Team can bring a unique professional dimension to improving the quality of life of a person living with dementia, and GPs should consider involving other members of the primary care team in dementia management. This lesson focuses on the skills, approach, and added value, which each member of the team can bring to dementia care.

Lesson 5: Medications in Dementia

This lesson highlights the need for all medications used by people living with dementia to be reviewed regularly, and should include consideration of - current indication, continuing benefit, side-effects, potential interactions, and adherence. The use of Cholinesterase Inhibitors and Memantine is also discussed.

Lesson 6: Behavioural & Psychological Symptoms of Dementia (BPSD)

BPSD describes a collection of symptoms and behaviours experienced and displayed by patients living with dementia. Assessment is the corner-stone of management of BPSD and includes - out-ruling a physical cause (particularly delirium), and identifying unmet needs & potential triggers (including pain, medications, environmental & psychological factors). This lesson outlines non-pharmacological strategies for management for BPSD, and highlights the limited role of drug treatments. Concern over the safe use of antipsychotic medication is discussed in an accompanying supplementary video.

Lesson 7: Legal Capacity, Enduring Power of Attorney, and Advance Healthcare Directives

It is important that doctors understand the concept of capacity and are clear about what it entails. GPs have 3 main roles regarding legal matters in the context of patients with dementia - assessing testamentary capacity, assessing a patient's capacity to grant an enduring power of attorney (EPA), and understanding Advance Care Directives. GPs should also be aware of the implications of the Assisted Decision Making (Capacity) Act (2015), and of their responsibilities arising from it.

Lesson 8: Determining Fitness to Drive in People Living with Dementia

Making decisions regarding fitness to drive, or even raising the issue, can be challenging for GPs - however they have an obligation to provide clear advice to a driver where an illness or injury may increase the risk to themselves or others while driving. This lesson outlines RSA guidelines on fitness to drive in mild cognitive impairment (MCI) and dementia, discusses issues to consider when determining a patient's fitness to drive, highlights the value of input from occupational therapists and on-road driving assessors, and explains how to proceed when a decision has been made.

Lesson 9: Nursing Home Care in Dementia

In addition to medical management of their patients, GPs have a number of roles in dementia care in nursing homes including - medication monitoring & review , management of BPSD, cautious consideration of antipsychotic use & withdrawal, and end-of-life care. While most of these issues are also addressed elsewhere in this eLearning Programme, this lesson aims to tie together issues which arise for patients living with dementia in nursing home care.

Lesson 10: Palliative Care in Patients Living with Dementia

Palliative care services should be available to people with dementia in the same way they are available to people who do not have dementia. This lesson highlights the importance of timely referral to Palliative Care services.