Petrazzuoli, F., Vinker, S., Koskela, T.H., Frese, T., Buono, N., Soler, J.K., Ahrensberg, J., Asenova, R., Boreu, Q.F., Peker, G.C. and Collins, C.
Petrazzuoli at al. (2017) report the findings from a key informant survey of primary care physicians (PCPs)in 25 European countries, including Ireland.
Most physicians were found to willing and actively involved in both dementia investigation and assessment but time constraints were a major barrier. When it came to the management of dementia and particularly drug prescription, there was considerable variability between countries with Ireland being one of only five countries where primary care physicians have the right to start treatment with memantine and cholinesterase inhibitors. The authors also found variation in dementia management within countries. They conclude that attitudes to dementia work up are affected by the official rules of the country and that where PCPs are not entitled to prescribe dementia drugs, they are more likely to refer patients to secondary specialist care.
Based on evidence on dementia friendly communities in England, Wales and NI and drawing on the perspective of the general public, people with dementia and their carers, this report provides guidance to communities wishing to develop dementia friendly communities from scratch and to those communit
ies where the work has already begun. It presents examples of dementia friendly initiatives and the barriers that exist within communities. The report defines a dementia friendly community as “one in which people with dementia are empowered to have high aspirations and feel confident, knowing they can contribute and participate in activities that are meaningful to them”, and identifies ten areas of focus: involving people with dementia; challenging stigma and building understanding; offering accessible and inclusive community activities; the potential of people with dementia; ensuring access to early diagnosis and post-diagnostic support; providing practical support for engagement in community life; providing consistent and reliable travel options; ensuring the physical environment is accessible and easy to navigate; promoting respectful and responsive businesses and services.
The idea of creating dementia friendly communities was the subject of a 2012 report by the Alzheimer Society of Ireland. The report was based on work that the ASI undertook with a UK-based organisation Innovations in Dementia to gain a better understanding of the concept. The report briefly outlines the concept of dementia friendly communities and what it means to people with dementia. It reports on the issues arising from workshops that the Alzheimer Society of Ireland held with its staff and volunteers, outlines some of the initiatives aimed at making communities dementia friendly led by Alzheimer Society of Ireland staff and makes four recommendations for creating dementia friendly communities.
In this expert policy paper by Irving and McGarrigle (2012) and a book chapter bearing the same title (Irving et al., 2013), Integrated Care Pathways (ICPs) are defined as instruments designed to map out the direction of clinical and administrative activities for all care professionals working wi
th people who have a specific disease such as dementia. They scope out what Integrated Care Pathways are and consider the practical application of Integrated Care Pathways. They summarise the evidence pointing to the benefits of Integrated Care Pathways and outline the challenges that need to be addressed if Integrated Care Pathways are to be successful. They compare and contrast two cases studies, one from England and one from the Scotland, before looking at the relevance of Integrated Care Pathways for ROI, following which they highlight key issues relating to the health care system and the role of case management that need to be addressed if Integrated Care Pathways are to be successfully introduced in ROI. Cahill (2013), writing about dementia and integrated care, argues that although integrated care services is widely promoted in public policy in ROI, the evidence suggests that integrated care for people with dementia is more of an aspiration than a reality. She identifies several changes that are needed in service provision for integrated care to become a reality for people with dementia.
In order to address the knowledge deficits of care staff in ROI regarding dementia through a three-year National Dementia Education Programme funded by the HSE, a decision was taken to first ascertain what the knowledge deficits were through an educational needs analysis.
De Siún and Manning (2010) collected data from nurses and care attendants via postal questionnaires and focus groups. They found very low levels of dementia care training among both nurses and care attendants. Responses to the Approaches to Dementia Questionnaire, which aims to capture attitudes to people with dementia revealed that respondents scored quite well on the Person-centred dimension, which refers to the way in which people with dementia are responded to as unique individuals with the same value as any other person, but scored less well on the Hope dimension, which reflects a sense of optimism/pessimism towards the abilities and the future of people with dementia. The report concluded that there is a need for a core generic dementia education programme focusing on both personal attitudes and general care practices to be offered and one that could be provided on a modular basis to staff in all areas of work.
Based on the findings of the above Dementia Education Needs analysis and recommendations from a literature review, a generic dementia education and awareness programme for staff caring for older people with dementia in community, acute and long-stay care settings in ROI was developed fo
r delivery over three and a half education days. Its aim was to provide participants with the knowledge, skills and attitudes required to deliver high quality, person-centred care to people with dementia. The programme was piloted in two areas. An evaluation was carried out to capture the views of participants and facilitators on the content and delivery of the programme, the impact of the programme on staff knowledge and attitudes to dementia, and the views of managers on the impact of the programme on their organisation/area of work. The evaluation indicated that the programme has the desired impact on staff knowledge and attitudes. The content and delivery of the programme were evaluated very positively by both participants and facilitators who valued the experience of inter-disciplinary learning. Overall the programme was found to have provided an excellent model for improving staff knowledge, attitudes and care practices for dementia in ROI.
Irving, K., Piasek, P., Kilcullen, S., Coen, A-M., Manning, M.
HSE, DCU, The Atlantic Philanthropies
Building on the work by De Siún and Manning (2010a), this report by Irving et al. (2014) presents the results of a Dementia Educational Needs Analysis carried out in ROI in 2013/2014.
In contrast to De Siún and Manning (2010a), this report focuses on the information, training and education needs of a much wider range of stakeholders starting with the person with dementia, and including people in their care-giving network, healthcare system and the broader community in which they live. The report outlines the major gaps in education and provides recommendations for future educational and service reform. It identifies seven priority areas which are to provide the focus for the development of education and training programmes.
MCCARRON, M., MCCALLION, P., FAHEY-MCCARTHY, E., CONNAIRE, K.
Journal of Policy & Practice in Intellectual Disabilities
This paper by McCarron et al. (2010b) discusses three key themes emerging from focus groups with staff working in ID care settings and a specialist palliative care provider in ROI supporting persons with an intellectual disability and dementia at the end of life.
The three key themes were: readiness to respond to end of life care needs; the fear of swallowing difficulties and environmental concerns, and ageing in place.
MCCARRON, M., MCCALLION, P., FAHEY-MCCARTHY, E., CONNAIRE, K., DUNN-LANE, J.
In this paper, McCarron et al.
(2010a) highlight the complexity of providing good end of life care for people with an intellectual disability and dementia and the need for further training and support, suggesting a more collaborative approach between Specialist Palliative Care Services and Intellectual Disability Services.