Local Services - Health

Introduction

The NHS is a huge organisation, with many different parts. In most instances your GP will be your first point of contact, and will refer you to other professionals within the health service as required. This page aims to give an overview of the health professionals you are most likely to encounter in relation to dementia.

GPs and Surgeries

As well as referring the person with dementia to specialists, e.g. the Memory Clinic (see below), the GP will of course continue to deal with day to day health problems and illnesses.

It is important to address health concerns as soon as possible when someone has dementia. Some problems (such as chest or urinary infections), can increase confusion. Admission to a general hospital ward is often unsettling for the person with dementia: early treatment may sometimes be able to prevent this.

The health care team based at the GP surgery is also likely to include District Nurses, Practice Nurses, and Health Visitors. The GP can also arrange services such as community physiotherapy, chiropody, supervision for taking medication at home, and sometimes alternative / complementary therapies.

For more information see Alzheimer's Society factsheet How the GP can help.

Memory Clinics

Becoming forgetful does not necessarily mean that a person has dementia so it is worth discussing concerns with your G.P.

Making a diagnosis of dementia is often difficult, particularly in the early stages, so G.P.'s will often refer to a Memory Clinic for assessment. See Getting a Diagnosis for more information.

Memory Clinics operate throughout the county at main community locations and offer assessment, support, information and advice to those with memory problems and their carers.

How to get an appointment

Referral for an appointment is normally via a GP so that preliminary screening can be carried out. It is important that the doctor investigates and treats any underlying physical illness and is able to assess the features of the memory problem. If mobility or travelling difficulties are a problem, your GP can request that a specialist visits at home, rather than you having to attend an appointment at the Memory Clinic.

Aims of the Memory Clinic

• Early identification of memory problems and any related disorders.
• Comprehensive assessment and diagnosis.
• Support and advice for patient, relatives or friends.
• To consider a trial of medication.
• Make available information about other service providers.

What happens at the Memory Clinic?

The first appointment may take between 1 and 2 hours. It is difficult to be precise about timing as all cases and circumstances are different and may need varying amounts of time.

This appointment involves a doctor or nurse talking with the patient and a relative (or close friend), who is able to explain the difficulties or problems being experienced and their effect on daily living. The team will carry out some tests to find out the strengths and weaknesses of memory, so it is important to take along reading glasses or hearing aids if these are used. It also involves gathering detailed information about the patient’s background, past medical history, any current medical problems and medications currently being taken.

By the end of the appointment the clinic team aim to have completed an assessment, discussed the results and helped plan any future treatment or care. Details of other services which may be helpful will also be made available.

What happens next?

A follow-up appointment will usually be made after three months to undertake a progress review. This appointment takes about half an hour and is an opportunity to discuss any concerns and assess the benefits of any advice or medication that has been given.

Further information about Memory Clinics

Old Age Psychiatry and Inpatient Units

In Oxfordshire the "Old Age Psychiatrists" are also the specialists in dementia care. If you are a Younger Person with dementia it may seem strange to be referred to older adult specialists, but this is because they have the most experience in the field of dementia care.

The Old Age Psychiatry doctors in Oxfordshire (including 11 Consultants), work with colleagues across the In-Patient Units, Day Hospital Assessment Units, Memory Clinics, and Community Mental Health Teams. However each of these areas has its own nursing team.

For more information, including travel information for the In-Patient Units, visit the Oxfordshire Mental Healthcare NHS Trust website.

CPNs and Community Mental Health Teams

If you have dementia you are likely to receive regular support from a Community Psychiatric Nurse (CPN). The CPNs are key members of the Community Mental Health Teams, which may also include occupational therapists. They visit people with mental health problems and dementia in their own homes to carry out assessments, and provide treatment, care and support. They can advise people with dementia and their carers on ways of coping, and of improving their health and quality of life.

A community mental health team for people over 65, but including younger people with a dementia type illness covers South East Oxfordshire. There are 3 bases: Thame, Abingdon and Henley. A fully multi-disciplinary team, that can provide, assessment, treatment and care via home visits, memory clinics, and day service outreach, via groups in the local community. Referral usually via GP but referrals can be accepted from other sources if GP aware and happy to provide supporting information.
Contact details: S.E. Community Mental Health Team
Abingdon Mental Health Centre
Abingdon Hospital Site
Marcham Road
Abingdon
Oxon OX14 1AG
Telephone number: 01235 205420
Fax number: 01235 205473

Age Concern Flexible Care

Time-limited therapeutic home based service for older people with any mental health need.

Flexible carers work to meet specific mental health needs with agreed outcomes for clients. They engage in a range of therapeutic activities which aim to:

• Improve clients mental health well-being
• Build relationships and reduce social isolation
• Help clients gain confidence so that they are able to benefit from other available services e.g. Day Care and Respite Care
• Where possible prevent further deterioration of mental health functioning and maintain current levels of functioning
• Maintain and maximise residual abilities through individual pursuits and interests
• Provide support to carers/families
• Help clients to continue to enjoy interests and hobbies where these enhance mental well-being
• Support clients to continue to live as independently as possible in their own homes.

In 2001 the Flexible Care Team won a prestigious Department of Health Award under the category of "Improving the lives of people who are older". The service has become an integral part of the mental health services for older people in Oxfordshire working in collaboration with Health and Social Services.

Most referrals come from staff of the Psychiatry for Older Adults Services or Social & Community Services. Most users are over 65yrs but clients may be accepted at a younger age if they have early onset of a dementing illness.

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Continence Care

As dementia progresses people may experience continence problems with bladder or bowels. This may be because they are unable to find their way to the toilet anymore: in which case leaving the toilet door open, and measures such as a highly visible red toilet seat may help for a time. The Alzheimer's Society factsheet Incontinence has more information.

Urinary incontinence is more common, and pads are usually used to manage this when someone has dementia. This is because measures such as urinary catheters are unfamiliar, and therefore a foreign object to the person with dementia, who may well pull the catheter out, causing themselves considerable pain and possibly physical damage. However if the person with dementia is already used to having a urinary catheter this may continue to be tolerated. A small clip is available to prevent inappropriate emptying of the leg bag (e.g. the Bard Urilock).

Continence assessment and care is provided through the District Nurses. Everyone is entitled to free continence care on the NHS, including provision of pads if required. In Oxfordshire there is a policy to promote washable, rather than disposable, continence products. If the use of washable products is difficult for you talk to the District Nurse who in "exceptional circumstances" is able to make other products available to you.

If you are willing to purchase continence products yourself there is a wide range available to meet the full spectrum of needs, including pull on disposable pants that incorporate high absorbency: these are ideal if the person with dementia sees a pad as a foreign object to be removed from their underwear. Such products can be ordered through Boots (own brand is Staydry), or independent chemists (e.g. TENA products). You can also order through a number of mail order companies online, e.g. youreableshop.co.uk.

If even after consulting the District Nurse more advice is required, or you feel a full specialist continence assessment would be useful, you can contact the Oxfordshire Community Continence Advisory Service:

Further information is available on the The Continence Foundation website.

OPTIMA

OPTIMA (Oxford Project To Investigate Memory & Ageing), is an Oxford University Research Project for people with memory problems, those with a diagnosis of dementia (e.g. Alzheimer's), and volunteer "controls" who are interested in contributing to research. Generally participants are aged 60+ years old. Support is provided to all participants and their carers, but medical management is retained by GPs/Consultants.

Referral may be via Consultants, GPs, CPNs, Memory Clinics, or self-referral.

Health Advice

For most health concerns your GP will be your first point of contact. In emergencies you can of course ring 999 for an ambulance. If the person with dementia has a minor injury, such as a cut that you think may require stitching, it may be better to seek your GP's advice initially rather than attend A&E, as casualty departments may involve long waits in a potentially confusing environment. If the person with dementia does need to attend A&E make sure that staff are made aware of the dementia diagnosis.

NHS Direct

If you are unsure about whether something needs medical attention, or would like general health advice, you may find it useful to visit the NHS Direct website.

The NHS Direct website is part of the National Health Service, and aims to provide high quality health information and advice.

If you are feeling unwell you can telephone NHS Direct on 0845 4647 for individual advice and information, given by nurses, 24 hours a day.

Further Information

You may find the Alzheimer's Society factsheet How health professionals can help of interest.

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