FEATURE Diagnosing Dementia
With GPs reportedly avoiding diagnosing patients with dementia due to perceived pressure on support services, Judith Davison, professional support lawyer at insurance law specialist BLM, discusses the benefits of an early diagnosis.
There are currently around 850,000 people in the UK with dementia, a figure that is expected to rise to one million by 2021. However, diagnosis can be difficult and it is thought that as many as one third of those living with dementia have not been formally diagnosed.
With dementia care costing the economy £26.3 billion a year – around £31,000 per person – the Department of Health and NHS England have committed to improve the quality and rate of diagnosis. The Prime Minister’s challenge on dementia 2020 aims to provide people with an initial assessment of dementia within six weeks of GP referral and to double funding for dementia research by 2025.
What are the benefits of
early diagnosis? Early investigation and diagnosis can significantly impede the progression of dementia and preserve a patient’s level of function for a longer period. Some causes of dementia are treatable, and may be fully or partially reversible depending upon the nature of the problem. With that in mind, early diagnosis and access to treatment have to be the priorities.
Targeted medication can significantly affect day-to-day living, prolonging an individual’s independence and delaying the need for them to move into a care home. A diagnosis may also assist health and care professionals to appropriately manage concurrent medical problems – explaining things to patients in a way they can understand and adopting specific strategies to ensure medication is taken safely.
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In the care home setting, a diagnosis can enable appropriately trained members of staff to be allocated to the patient to meet their needs. Not only that, but being alert to a resident’s changing needs will enable better risk assessment and planning for future resources.
The CQC’s report Cracks in the Pathway highlighted concerns that around 29% of care homes demonstrated aspects of variable or poor care with regard to assessing patients’ needs. Some 34% of care homes demonstrated aspects of variable or poor care regarding how care met patients’ physical, mental, emotional and social needs.
The absence of a diagnosis could have risk implications. Where there is only a suspicion of dementia, appropriate risk assessments may not be triggered and staffing levels may not be allocated appropriately. If an adverse incident were then to arise, the care home could be criticised for failing to act upon their suspicions. In the event of a legal claim, the care home would need to demonstrate that it had fulfilled its duty of care to a particular resident.
It is evident that a dementia diagnosis does not transform a person from having no care needs to one having complex needs. The symptoms suffered will not suddenly worsen because a label has been attached to them. However, recognition of the cause could, or should, enable the person to access the appropriate care and support services, making it easier to plan for their increasing needs over time.
What hinders early diagnosis? The nature of dementia makes diagnosis difficult – as it has an
insidious onset with variable symptoms and can be difficult to distinguish from the normal ageing process. By the time symptoms have developed to a point where assistance is sought from a GP, a patient’s ability to function independently may already be significantly compromised.
Where there is only a suspicion of dementia, appropriate risk assessments may not be triggered and staffing levels may not be allocated appropriately.
However, even having reached that point, a recent survey by the Alzheimer’s Society revealed that GPs are concerned about the patchy level of services available in some areas to patients following diagnosis.
What can be done? As is often the case, increased funding would enable better support and services following diagnosis and further training to assist GPs in making early diagnoses.
However, helping people to stay independent for as long as possible by providing early diagnosis and streamlined treatment in the community could ease the pressure on care homes and reduce the strain on state funding.
www.blmlaw.com
www.tomorrowscare.co.uk
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