The Interface between Old Age Psychiatry & Learning

DisabilitySusan M Benbow

Wolverhampton City PCT & Staffordshire University

Norwich November 13th 2008

ACKNOWLEDGEMENTS

Dr S. BhaumikDr S. BlackDr K. DoddsMembers of the Interface Group

CONTEXT

KEY POLICY DOCUMENTS

Valuing people NSF for Mental Health NSF for Older People

Apply to ALL people

OLDER PEOPLE’S MENTAL HEALTH

Standard 2 NSF-OP:Person-centred care

NHS and social care services treat older people as individuals and enable them to make choices about their own care

VALUING PEOPLE

Based on people having

Their rights as citizens

Inclusion in local communities

Choice in daily lifeReal chances to be

independent

EVERYBODY’S BUSINESS

1.2m people with mild/ moderate LD

210,000 People with severe LD in England

25,000 aged 60+

EB CONT.

Most psychiatric disorders more common in people with LD

High risk of dementia in people with Down’s 55% at age 60-69 Life expectancy increasing

KEY ELEMENTS 1

Cognitive assessments in adulthood for people with Down’s

Better information & signposting of services Support for family carers & others Involve people in planning, monitoring &

delivery of services Special consideration for people from BME

groups Joined up working Joint training

KEY ELEMENTS 2

Consider joint teams Joint protocols Better collaboration

between Primary Care OPMH LD services

Consider in Transport Aids & adaptations Access to routine

medical investigations

‘NOTHING ABOUT US WITHOUT US’

DH Strategy User Group ‘All services should include people with learning

difficulties properly in everything they do … not just one person as a token but several people who can support each other’.

National Dementia Strategy

Consultation doc 2008

COLLEGE WORK

4 MAIN AREAS OF WORK:

Joint protocol for people with Downs syndrome + dementia in partnership with BPS & others

Training Days/ CPD events Psychiatrists Other staff working in both specialist areas

College publication Survey of LD & OA psychiatrists

DRAFT 7 – 22nd September 2008 Dementia and People with Learning

Disabilities:  Guidance on the assessment, treatment

and support of people with learning disabilities who develop dementia

AIMS OF JOINT PROTOCOL

To collate evidence-based practice, clinical opinion & experience

to provide a framework for good practice to promote assessment, treatment and support for

PWD, their staff & carers guidance for service developers & commissioners to provide a set of standards of good practice to promote service development to provide a training framework to guide future service development

COMPARATIVE RATES OF DEMENTIA - DOWN’S SYNDROME, LEARNING DISABILITIES, GENERAL POPULATION

Cooper, personal communication

DS

LD

GP

Key points: assess every adult with Down’s syndrome at age 30

to establish a baseline against which to compare future suspected changes in functioning.

consider screening all adults with Down’s syndrome over 40 regularly because of increased risk of dementia prevalence of undetected treatable illnesses.

Sharing the information with the person with learning disabilities:

Steps should be taken to share the information with the person with learning disabilities at all stages ……. This process should be undertaken as good practice irrespective of the mental capacity of the person concerned.

consider the person’s happiness, comfort and security. The focus of care should move away from targets to quality of life.

Key Points: Wherever possible, people with learning disabilities

and dementia should remain in familiar environments.

Environments can be adapted to make them dementia friendly and enable the person with dementia to make sense of where they are living.

‘Dying in place’ where the person can stay where they are currently living with appropriate supports adapted and provided. This means that the person stays with what is familiar in their long term memory.

4 MAIN AREAS OF WORK:

Joint protocol for people with Downs syndrome + dementia in partnership with BPS & others

Training Days/ CPD events Psychiatrists Other staff working in both specialist areas

College publication Survey of LD & OA psychiatrists