Reviewing a Patient with Dementia
The quality of care provided to patients with dementia can be improved by focusing on the following 6 key areas at this regular review. This applies both to patients in the community and nursing home residents.
1. Medication Review
- Is the patient on an antipsychotic? Is it necessary? Is it monitored? Can it be reduced or withdrawn?
- Further information on antipsychotic use in dementia, including monitoring and withdrawing antipsychotics, is provided on our post diagnostic care and support page.
- Is the patient on a medication such as an anticholinergic that could worsen cognition?
- Visit our post diagnostic care and support page for a list of medications that can contribute to impaired cognition
- Is the patient on an acetylcholinesterase inhibitor (e.g Donepezil)? If yes, is the dose therapeutic? Are there any side effects?
- Visit our post diagnostic care and support page for information on acetylcholinesterase inhibitors & memantine
- Does the patient have adequate pain relief?
- Is the patient experiencing any medication side effects?
A tool for monitoring antipsychotic prescribing can be accessed here.
2. Mental Health
- Is there evidence of depression? Depression is often difficult to detect in people with dementia. If uncertain consider using a depression screening tool such as:
- The Geriatric Depression Scale - this is a relatively short 15-item questionnaire and has been validated for use in mild dementia, however, is not as suitable in more advanced dementia as the patient may lack the ability to comprehend the questions.
- The Cornell Scale for Depression in Dementia - this tool is dementia specific but can take up to 20 mins to perform.
3. Physical Factors
- Hearing, vision, nutrition, bowel, bladder
- Mobility/falls risk and bone health
- Is the home environment suitable/adaptable to meet patient's evolving needs?
- Advise dental review
4. Risk Assessment
- Inadvertent self-harm e.g kitchen accidents, medication mistakes
- Financial/social vulnerability
- Risk to others e.g. driving, aggression
- Evidence of elder abuse
- Deliberate self-harm
5. Assessment of Carers Needs
- Consider caregiver burden: Does the carer regularly get time to themselves? Do they have adequate support? Are they themselves feeling down/anxious/irritable?
- Consider using a scale to formally measure caregiver burden, however, these are often quite lengthy.
An assessment scale for caregivers stress can be accessed below.
If appropriate consider directing carers to online resources designed to support carers:
- Visit link to our 'information resource for carers' for more information on places to direct carers and relatives to.
6. Social Supports Review
- Are there social supports in place? Does the carer, or person with dementia, access any support groups, go to Alzheimer cafes, avail of day care or respite services?
- Visit our service directory for information on services & supports in your area.
- Has advance care planning taken place? More information about advance care planning and advance healthcare directives here.
- Are there supports in place for assisted decision making, if required? More information on the Assisted Decision Making (Capacity) Act here.