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CLINICAL: OLDER PEOPLE


support and meet the needs of the person with dementia, but also the family carer. Whilst it may be assumed that there is a wealth of research-based evidence available to primary care workers to support carers of people with dementia living in the community, the reality is a little different. However, two references drawn from major reviews of the literature stand out as they highlight best practice. The first was conducted by Brodaty et al.4


who reported that


combined approaches, ie, interventions tailored to help both the individual person with Alzheimer’s disease and their family carer conducted at the same time, have the best chance of sustained success. What this means in practice is that if a time-limited community-based reminiscence programme was being planned to take place in a local resource centre, for example, then it would be best if both the person with dementia and the carer were invited to take part in the group. In this way, benefits of participation would be mutually reinforced and any improvements in quality of life and communication between the couple continued over time. The second piece of work was reported by Selwood et al.5


who found


that interventions tailored solely for carers of people with Alzhei- mer’s disease are seen to be most effective if they are practised through six or more sessions of individual behavioural management therapy, with the focus centred on the behaviour of the person with dementia that was causing most concern, such as excessive walking. This more specialist intervention can help to lessen the stress on family carers and construct a more positive and effective coping response.


LOOKING TO THE FUTURE What future opportunities and challenges currently exist in primary care and dementia? Here, two topic areas immediately spring to mind. Firstly, primary care staff may benefit from training in case finding, the use of cognitive screening tools and understanding further ‘what is dementia’. Some of our own work in this area found that the greatest benefits were obtained when members of the primary care team were trained together (such as during the space available at weekly team meetings), followed a structured dementia


64 Nursing in Practice March/April 2012


education programme and regularly delivered.6


Secondly, the place


of lifestyle interventions (ie, improved diet, exercise and so on) is becoming seen as an increasingly important role in the prevention of dementia. This is because lifestyle interventions can improve vascular health. If instigated in primary care, a lifestyle intervention programme should be targeted at the over 50s who are the population most ‘at risk’ of acquiring a dementia in the future, yet can still modify their behaviour to good effect. Whilst there may still be no cure for dementia, this does not


mean there is no hope. There is much that can be done to improve quality of life and care, with primary care staff ideally placed to undertake this work and forge new paths into the future.


REFERENCES 1. Alzheimer’s Society. Dementia UK Report. London: Alzheimer’s Society; 2007. Available at: http://alzheimers.org.uk/site/scripts/download_info. php?fileID=2


2. Alzheimer Europe. Value of Knowing. Luxembourg: Alzheimer Europe; 2011. Available at: www.alzheimer-europe.org/Research/Value-of- knowing


3. National Institute for Health and Clinical Excellence. Alzheimer’s disease - donepezil, galantamine, rivastigmine and memantine (TA217). London: NICE; 2011. Available at: www.nice.org.uk/guidance/index. jsp?action=byID&o=13419;


4. Brodaty H, Green A and Koschera A. Meta-Analysis of Psychosocial Interventions for Caregivers of People with Dementia. Journal of the American Geriatric Society 2003;51:1–8.


5. Selwood A, Johnston K, Katona C, Lyketsos C and Livingston G. Systematic review of the effect of psychological interventions on family caregivers of people with dementia. Journal of Affective Disorders 2007;101:75-89.


6. Downs M, Turner S, Bryans M, Wilcock J, Keady J, Levin E, O’Carroll R, Howie K and Iliffe S. Effectiveness of educational interventions in improving detection and management of dementia in primary care: cluster randomised controlled study. British Medical Journal, 2006;332: 692-696.


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