Problem 11/12: Choice of dementia Tx and support for carers Flashcards
Explain the rationale for prescribing donepezil? Could any other agents have been considered? Who can initiate treatment
Specialist drug treatments for cognitive symptoms of dementia should always be initiated by a specialist.
Acetylcholinesterase (AChE) inhibitors (donepezil, galantamine, and rivastigmine)
These drugs can be used for mild to moderate Alzheimer’s disease but must only be prescribed by healthcare professionals with expertise in this area (including psychiatrists, elderly care physicians, neurologists, or other healthcare professionals [such as GPs, nurse consultants, and advanced nurse practitioners with specialist expertise in diagnosing and treating Alzheimer’s disease]).
(ACh inhibitors not suitable in vascular dementia or in mild cognitive impairment).
Donepezil (Aricept, Eisai/Pfizer) is an AChE inhibitor, which works by increasing the concentration of acetylcholine at sites of neurotransmission. Donepezil has a marketing authorisation in the UK for the symptomatic treatment of mild to moderately severe Alzheimer’s dementia. It is given initially at 5 mg once daily at bedtime. After 1 month the treatment should be assessed, and the dose can be increased to a maximum of 10 mg once daily if necessary.
Side effects: diarrhoea, muscle cramps, fatigue, nausea, vomiting and insomnia.
Critically comment on the epidemiology and disease burden of dementia, and the impact of dementia on society
With 850,000 people living with dementia in the UK by 2015, dementia represents a major public health challenge here and worldwide. dementia costs the UK £26 billion a year.
Two thirds of the cost of dementia (£17.4 billion) is paid by people with dementia and their families, either in unpaid care (11.6 billion) or in paying for private social care.
Large economic burden: disabling nature, chronic duration and high prevalence in older segments of an aging population. Inclusion of the value of caregiver time is a major driver in attempts to determine cost-effectiveness. Some studies have shown that over 5 years cost of care for dementia patients is higher that the costs for those who died from heart disease and cancer. (average total per person).
Summarise the aims and treatment goals for managing dementia
The aims of treatment are to promote independence, maintain function and treat symptoms
No cure to dementia at present but medications available that can temporarily reduce symptoms or slow down progression of the disease. Acetylcholinesterase inhibitors (donepezil, rivastigmine (preferred in hallucinations) and galantamine)
Medications can also treat associated conditions such as stroke, cardio-conditions, diabetes, HBP and cholesterol, CKD and depression.
Medication can also treat challenging behaviour such as agitation, anxiety, aggression, delusions and hallucinations
Cognitive stimulation therapy aims to improve memory, PBL, language abilitiyetc
Reminiscence and life story work: compiling photos notes and keepsakes, reminiscence means talking about things and events from your past. Often the two are combined.
Explain the common side effects of donepezil, and the management for these? e.g nausea
Side effects: diarrhoea, muscle cramps, fatigue, nausea, vomiting, headache (very common) and insomnia.
Nausea management: stick to simple foods - avoid fatty or spicy meals.
Change in medication
Consider what monitoring and follow up should the patient recieve
Monitor physical and mental health and functional ability
Discuss driving - inform DVLA when diagnosed with dementia
Monitor response to, ADR to dementia treatments and the progression of dementia
Ask about behavioral and psychological symptoms of dementia (BPSD).
Monitor mental and physical health of the care giver; regularly reviewed care plan. Clear follow-up arrangements
Recommend any support and resources available for the patient and carers
NICE public chapter, The RPS fact sheet on dementia, NHS Choices, The Alzheimer’s Society, Alzheimer’s Research, The Lewy Body Society, Carers UK, Dementia Pathfinders
Demonstrate an appreciation for the demands of a caring role. How does caring for a dementia patient impact on their life and their job
Carers Allowance: for people caring for atleast 35 hours a week. £62.70 per week
Symptoms of caregivers stress: denial, anger, social withdrawal, anxiety, depression, exhaustion, sleeplessness, irritability, lack of concentration and general health problems.
Health and social care managers should ensure that the rights of carers to receive an assessment of needs, as set out in the Carers and Disabled Children Act 2000 and the Carers (Equal Opportunities) Act 2004
Those carrying out carers’ assessment should seek to identify any psychological distress and the psychosocial impact on the carer. This should be an ongoing process and should include any period after the person with dementia has entered residential care.
individual or group psychoeducation
peer‑support groups with other carers, tailored to the needs of individuals depending on the stage of dementia of the person being cared for and other characteristics
support and information by telephone and through the internet
training courses about dementia, services and benefits, and communication and problem solving in the care of people with dementia
involvement of other family members as well as the primary carer in family meetings
Discuss any emotional and physical issues Mrs Li may encounter whilst caring for her husband. Consider Mrs Li’s own health and what can be done to help her
Mrs Li’s rheumatoid arthritis - debilitating and disabling disease in itself. Affecting mental health as well as carers role.
Movement reduced in Mr and Mrs Li significantly (occupational therapy and health assessments needed)
Pain and movement management for Mrs Li as needs to lead an active life is a full time carer
Discuss the role of admiral nurses in dementia care
Admiral Nurses are registered nurses with experience in dementia care who work collaboratively with families and with other dementia care providers, sharing their expertise and giving them the support and skills they need to be effective.
in the community, in hospitals, in care homes and in hospices, and they maintain the highest level of practice, supported by Dementia UK.
Admiral Nurses work alongside people with dementia and their families giving them one-to-one support, expert guidance and practical solutions.
