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 GPs 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.
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.
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.
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.
Further information is available on the The Bladder and Bowel Foundation website. Or you can call them on 01536 533255, or email them on info@bladderandbowelfoundation.org
Health Advice and Keeping Healthy
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.
