Guidance for nurses on dementia care

From the Nursing Times

Guidance for nurses on dementia care package assessment

21 May, 2015 | By Steve Ford

A guide on evaluating the emotional and psychological needs of dementia patients has been published for clinicians involved in assessment for NHS-funded nursing care packages.

The Alzheimer’s Society guidance, published today, is designed to help NHS continuing healthcare assessors evaluate the emotional and psychological needs of people with dementia.

NHS continuing healthcare is a free package of care covering nursing and personal care needs. The assessment for it can be carried out by healthcare professionals trained to do so. 

Evaluating the needs of someone in the later stages of dementia can be very difficult, particularly if the assessor has not known the person over a prolonged period, noted the charity.  

“We hope to see this guidance used by professionals across health and social care”

George McNamara

For example, it is likely the patient will not be able to give a first-hand account of their needs, may be unable to communicate verbally or have the capacity to understand and agree to the assessment.

The guidance, written by researchers from the University of Worcester, is intended to provide clear advice on determining whether the patient is experiencing hallucinations, depressed mood, anxiety or distress.

It underlines the importance of involving family members and professional care staff – particularly those who have spent a significant amount of time with the person with dementia – in the assessment process.

Non-verbal communication such as body language and facial expressions should be assessed, particularly if the person is unable to communicate using language, it adds, reminding assessors to ensure their own non-verbal communication conveys warmth and consideration.

“This is a really useful publication which brings to the fore the essential and complex nature of assessing the inner needs of people living with dementia”

Dawne Garrett

In addition, the guidance highlights that emotional distress may be communicated as behavioural disturbance, with around 90% of dementia patients experiencing symptoms such as withdrawal, aggression and agitation.

Many with advanced dementia may also become withdrawn or disengaged in response to distress, and thus withdrawal could be a key sign that someone is experiencing depression or anxiety, the guidance added.

It reinforces that depression is common in dementia and can occur for the first time at any age.

George McNamara, head of policy and public affairs at the Alzheimer’s Society, noted that the financial support provided by NHS continuing healthcare was a “lifeline” for many people.

“It is therefore essential that the assessment process is thorough and robust, particularly to ensure those who cannot communicate their needs verbally are not unfairly penalised,” he said. “We hope to see this guidance used by professionals across health and social care to ensure people with dementia have a fair assessment of their needs.”

Professor Dawn Brooker, director of the Association for Dementia Studies at Worcester University, said: “There are a lot of misunderstandings, even among experienced professionals, about how to assess the health and well-being of people with advanced dementia.

“Our aim in writing this guidance is to ensure that professionals feel confident to assess needs thoroughly and to provide evidence of their decision making,” she said.

Dawne Garrett, professional lead for older people and dementia care at the Royal College of Nursing, added: “This is a really useful publication which brings to the fore the essential and complex nature of assessing the inner needs of people living with dementia.”