Caregiving and dementia/Topics/Diagnosing dementia

This NPA focuses on diagnosing dementia and planning for the future with people who have dementia.

Overview
In surveys conducted by the SA & NT Dementia Training Study Centre (Dementia Needs Analysis 2008 and Training Needs Analysis 2010), people with dementia have spoken of issues concerning gaining a timely diagnosis and information from their local general practitioner (GP). Research shows that GPs are often reluctant to diagnose dementia for a variety of reasons including a fear of damaging their relationship with the person and the belief that there is no curative treatment option yet available. This project will therefore address several issues: GP attitudes, diagnostic tools, time taken for diagnosis, effectiveness of drug treatments, symptoms of dementia, and issues concerning diagnosis of younger people.

Individuals who have concerns about their memory are likely to visit their GP (Quality Dementia Care: No time like the present: the importance of timely diagnosis, September 2010) and evidence from a variety of research indicates that most people who have concerns about their memory believe early intervention is necessary – particularly in order for them to properly plan their finances, lives and future care arrangements.

However successful early and timely diagnosis of dementia is more infrequent than it is common place.

In Australia, families first notice symptoms of dementia an average of 1.9 years before the first health professional consultation and there was an average of 3.1 years before a firm diagnosis was made, which was consistent with other overseas studies. The consequence of this delay is a lost opportunity for earlier medical and social interventions for those suffering dementia and their families (Quality Dementia Care: No time like the present: the importance of a timely dementia diagnosis)

A number of barriers to timely diagnosis have been identified; particularly by Paterson and Pond who proposed the following key barriers:
 * GPs lack confidence or training in diagnosing dementia. GPs were found to have difficulty in differentiating normal ageing from dementia and did not perceive a need to determine a specific diagnosis.
 * A scarcity of specialist diagnostic services, particularly in rural areas combined with the patient’s impaired ability which reduces the accuracy of patient history and a lack of a recognised quick-to-administer screening tool
 * Negative attitude to dementia. There is a stigma associated with dementia that also encompasses doubts about the patient’s ability to cope with a diagnosis and the efficacy of medications.

Furthermore, GPs perceptions of the barriers to a timely diagnosis of dementia have also been investigated by Paterson and Pond who highlighted that GP’s do rely upon patients to alert them to specific concerns or issues and this can delay diagnosis as people with dementia can lack insight into the problems they are experiencing. The research also indicated that GP’s may also become used to treating existing illnesses and are not always on the look out for emerging pathology.

Assessment of Dementia is more than Diagnosis
View this lecture here.… 22 November 2011 Professor Henry Brodaty University of New South Wales 1 hour 28 minutes 45 seconds

After Diagnosis, Planning Ahead
What is Advance Care Planning?

According to the Advance Care Directive Association Inc it means thinking about, discussing and writing down your wish for care or treatment if at a future time you are unable to speak for yourself because of illness or injury.

Advance Care Planning is not just for people with a diagnosis of dementia, it is useful for everyone. People with dementia or other chronic illness are especially well-served by making their wishes for treatment known to family or carers and formalising this with a Power of Attorney document and an Advance Health Directive. It is important to give attention to these matters before the person loses the capacity to make these decisions, as legally they cannot appoint an attorney after they lose capacity. There is some lively debate about the amount of decisional capacity a person retains well into the dementia journey, particularly if matters are explained carefully and they are able to demonstrate awareness of the consequences of their decision. At any rate, to reduce stress and conflicts, it is wise to settle these matters when a person is sound of mind.

An Enduring Power of Attorney is a legal document used to give permission to someone to conduct business or financial affairs on behalf of another person.

An Advance Health Directive is a legal document that enables an individual to give instructions about their healthcare, including special health matters, should they lose capacity to make their own decisions in these matters. Specific directions can be recorded about the care they would want and under what circumstances.

Advance Care Planning

 * 1) Advance Care Directive Association Inc. website http://www.advancecaredirectives.org.au/ accessed on 15 January 2013
 * 2) Queensland Health Advance Care Planning website http://apps.health.qld.gov.au/acp/HOME.aspx accessed on 15 January 2013