Dementia is a progressive condition and over time, many people with the diagnosis experience physical frailty. This is particularly true for older people.
Frailty may increase the future risk of mild cognitive impairment (MCI) and all-cause dementia in cognitively unimpaired populations, as well as accelerate cognitive decline of these individuals.
Frailty is strongly associated with dementia risk and affects the risk attributable to genetic factors. Frailty should be considered an important modifiable risk factor for dementia and a target for dementia prevention strategies, even among people at high genetic risk
It is important to understand, recognise and manage frailty so that the person with dementia and their family can access the right care and support and have a better quality of life.
Relevant Legislation
Mental Capacity Act
Health and Social Care Act
Equality Act 2010
Human Rights Act 1998
Resources
https://www.hee.nhs.uk/our-work/dementia-awareness/core-skills
Pre and Post Knowledge Assessment
HCPA have developed word documents which can be used as a guide for pre and post knowledge assessments of the different levels outlines in this framework. The questions in this document can be copied into other formats such as Microsoft Forms or Excel and are a guide to the type of information you need your staff to know.
Dementia Awareness Pre & Post Assessment Click here
Dementia Intermediate Pre & Post Assessment Click here
Dementia Advanced Pre & Post Assessment Click here
Learning Objectives
Day to Day Care and Symptom Management
Staff should have a good understanding how Dementia affects people on a day to day basis. By taking a proactive approach staff will establish a baseline for individuals and therefore be better placed to detect early risk factors of frailty.
Awareness
For staff providing care to people living with Frailty.
- Staff understand the importance for individuals with dementia to maintain good physical, mental and oral health through food, drink, exercise and a healthy life style that includes social engagement
- Staff know how to take action in response to dehydration and hunger (including unplanned weight-loss), how to improve the provision of good nutrition and hydration through monitoring food and drink intake using appropriate tools
- Staff know how to recognise and manage pain in people with dementia according to care plan
- Staff understand the complexity of ageing and co-morbidity in dementia
- Staff know and understand common side effects of medication such as taste disturbances and a dry mouth
- Staff are aware of issues around polypharmacy for people with dementia
- Staff understand the importance of recording and reporting side effects and/or adverse reactions to medication
- Staff are able to administer and record medications and understand how to obtain consent and what to do if consent is not given
- Staff understand the ethical issues around drug treatments in the care of people living with dementia
- Staff understand the range of medication to address common physical health problems of people with dementia, including the risks associated with how these drugs may interact with cognitive enhancers and drugs prescribed to address behavioural and psychological issues
- Staff are able to incorporate assistive technology to support self-care and meaningful activity
- Staff are able to develop strategies to reduce the struggle with unfamiliar environments including understanding perceptual distortions and their impact
- Staff are aware of ways to adapt the physical environment to promote independence, privacy, orientation and safety (e.g. to reduce risk of falls)
- Staff understand how to use a care plan to ensure someone is fully supported and are understand the importance co-production
- Staff understand how a diagnosis of dementia can affect friends and families of the individual and understand how to help where possible (i.e. offering advice and reassurance)
Intermediate
For staff responsible for planning the care of people living with frailty.
- Staff know the action to take in response to identification of fatigue and falls
- Staff know where to find evidence-based information and resources and when to refer for more specialist advice from a registered dietitian/registered nutritionist on nutrition or other health care professional e.g. speech and language therapist for textured modified foods
- Staff understand the principles, processes and options for self-directed support
Advanced
For staff responsible for planning interventions for people living with frailty and dementia or MCI.
- Staff are aware of new and emerging knowledge of psycho-social approaches that can be used to enhance the well-being of people with dementia
- Staff are able to assess the need for review of medication safely and appropriately in consultation with people affected by dementia where appropriate
- Staff understand the range of drugs to manage behavioural and psychological symptoms of dementia and when such drugs should or should not be used
- Staff are able to provide dementia specific advice and guidance on adapting the physical and social environment to ensure physical safety and emotional security and can use this to create a risk assessment
- Staff understand how to co-produce a personalised care plan for someone diagnosed with dementia (including new diagnoses) with families and carers
Clinical
For clinicians.
- Staff understand processes for assessing and prescribing cognitive enhancers
- Staff can assess for depression and loneliness (UCLA) during annual review and understand the effects of these
Mental Health, Delirium and Mild Cognitive Impairment
Understanding, and responding to, triggers will allow for the best care and treatment plans to be created. It is thought that staff only need to be trained to intermediate level to manage Mental Health, Delirium and Mild Cognitive Impairment effectively, in this context.
Awareness
For staff providing care to people living with frailty.
- Staff understand the impact of delirium, depression and social stressors
- Staff understand common triggers and responses to stressed or distressed behaviours as well as specific triggers for the individual. Staff understand the best way to learn these are to write the care plan with the individual and ask their triggers and how they can respond to these
- Staff understand that MCI has similar symptoms to dementia and can sometimes be early indicators of dementia progression
- Staff understand MCI may have a cause such as medication, poor sleep hygiene, poor nutrition etc. and can review risk factors
- Staff understand risk factors contributing to delirium and can recognise when an individual is delirious
Intermediate
For staff responsible for planning care of people living with frailty.
- Staff know the main risks and benefits of using anti-psychotics, anti-depressants, anxiolytics, anticonvulsants, and cognitive enhancers and be aware of the impact drugs may have on daily living,
- Staff can review an individual’s delirium and make changes to support and reduce this (i.e. treating pain/fever/dehydration/UTI)
Education Resources and Case Studies
City University of London run a Dementia and Frailty course suitable for any health or social care professional with previous level 6 study. You can find more information about cost and how to enrol here.
Alzheimer’s Society Teaching resources
Supporting Case Studies – Coming Soon