IRCST Logo Official

The Daisy Risk Assessment Celeste Bond Dementia Advisor . RN. Upper Hunter Dementia Advisory Service Upper Hunter Community Health Centre NSW 25.05.09

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Upper Hunter Dementia Advisory Service The acronym “DAISY” stands for

D - Dementia A - Advice & I - Information S - Service for Y - You 3

Over view • Statistics & Dementia Advisory Role • The Funding • The Idea & The Aims • Format • DRA

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Statistics • Estimated the Hunter region will experience larger increases in dementia prevalence & incidence. • The Hunter population over 65 years was 14.4% in 2001 • Projected growth to 26% by 2021.

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• The NSW Action Plan on Dementia estimates that that 51% of people with moderate to severe dementia are living at home. 2

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Service provides • Information provision. • Advice. • Support. • Assessment of clients. • Behavioural / care management. • Case management & care coordination.

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Service provides continued • Knowledge of local services & referral pathways. • Facilitation of service introduction. • Education for families /carers, community & professional groups. • Facilitation of support groups. • Community awareness events.

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Funding • Thanks to NSW Institute of Rural Clinical Services & Teaching. • http://www.ircst.health.nsw.gov.au/ IRCST Logo Official

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The idea for the DRA… • What clients say ……….. isn't necessarily what is happening! • Anosognosia • Speaking to families & care workers about safety concerns.

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• Wanting to develop a way to inform people of the risks for a person with dementia living at home. 9

The idea• How can we inform people how ‘memory loss’ effects a persons day to day functioning? • At times family members don’t relate a loss of function to the illness - & may think the person has simply chosen not to do something any more. • Wanted a way to inform people of what can happen, what to monitor for, ……………… & that the needs of people with dementia can be vastly different . 10

Aims • Development of a risk assessment for clients with dementia living in the rural community. • One that enables identification of risk factors, in particular, for those clients living alone. • One that includes management strategies for identified risk factors. • Management strategies become part of a person-centred plan of care.

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Aims continued • To increase service providers/carers & families awareness of dementia specific risk factors.

(Evaluation shows that even when care workers considered they had knowledge of risks, after reviewing DRA, 71.5% reported they were much more aware.)

• To provide families with information to assist them in proactive decision making. • Produce a document that is user friendly.

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Areas identified 1.Personal circumstance 7. Personal safety ( Cognition, MMSE)

2. Physical limitation

8. Telephone (Hearing)

( Physical activity, falls, vision )

9. Heating/cooling

3. Social & mental wellbeing (Affect, alcohol)

10. Driving

4. Medication

11. Money

5. Health

12. The Shed

(Co morbidity, self rated health, smoking )

6. Nutrition 13

Format • Easy language • No scoring • Yes / No answers • Shaded answers indicate risk • Includes -Questions / Risks / Management options

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Questions

Risks

Management options

other strategies 15

7. Personal Safety 1. Does the person have doors locked while in their house? 2. Does the person lose the house keys? 3. Can the person lock himself or herself in? 4. Does the person barricade themselves in the house? e.g. use furniture to block doorways, jam locks or chock doors. 5. Is the person able to hear if someone comes to the door?

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Personal safety continued 6. Are they able to follow traffic rules? 7. Does the person leave their house at inappropriate times? 8. Is the person able to regulate hot water when showering? Can they manage to turn taps & check water temperature? 9. Would the person be prepared for /able to manage in a power failure? 10. Would the person be able to manage during a natural disaster? 17

Risks Access to intruders. Client becomes locked in home. Access blocked for emergency services/ care workers. Client not able to hear someone at the door. Becoming lost, injury due to an accident. Heat exhaustion, sunburn, hypothermia. 18

Management options 1. Ensure locks are able to be opened from the outside. 2. Install loud doorbell. 3. Regular support service visits. 4. Have copies of a current photo on hand. 5. Reduce temperature of hot water system. 6. Emergency kit .

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11. Money 1. Do they take large amounts of money out of the bank? 2. Do they carry large amounts of money? 3. Do they hoard money? 4. Do they open their purse for shopkeepers to access money? 5. Would they give money to collectors if they came to their door?

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Risks Financial exploitation Robbery/assault Loss of funds Failure to pay bills Fines, no insurance

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Management options 1. Bills redirected to family for payment. 2. Direct Debit 3. Introduce support staff to assist with shopping & bill paying. 4. Recycle hoarded monies. 5. Enduring Power of Attorney. 6. Seek advice from guardianship tribunal.

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The Shed •

Does the client have tools they still use?



Does the person wear appropriate safety gear ?



Does the person have access to chemicals & fuel?



Has the person ever confused chemicals or fuel?



Does the client have any machinery they use? 23

The Shed continued. • Has there been regular servicing of vehicles & equipment? • Does the person attend servicing of vehicles & equipment? • Does the person have access to any guns? • Does the person have access to pumps or electric fences? 24

Risks Risk of injury to self or others. Damage to tools, equipment & vehicles. Poor/ incorrect /or no maintenance of equipment /vehicles. Incorrect use of chemicals. Person may have a reduced sense of worth not being able to do previous work & activities Depression 25

Management options 1. Removal of guns. 2. Remove or secure access to tools / chain saw. 3. Remove keys, disable vehicles, sell vehicles. 4. Securing of pumps, chemicals, sheds.

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Management options continued 5. Focus on & facilitate activities the person is still able to do. 6. “Shed time” is supervised by family or by carers. (With sensitivity)

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Potential uses of the DRA • Assessment can be repeated, to indicate decline /changes in the client – review care plan. • Service providers, could use to identify to families that a client has declined, & that home based management options are no longer adequate. • Provide a list of local service providers. • Have a page for routine monitoring i.e. weight . 29

References 1.

Boustani M. (2004) ‘The interface of Depression& Dementia’. Psychiatric Times Vol 21, No 3 .

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Brodaty H, ‘Gp’s Diagnosing & managing dementia ‘ Dementia Collaborative Research Centre. Assessment & Better Care Outcomes , Sydney NSW.

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Derouesne C, Thibault S, Lagha- Pierucci S , Baudouin-Madec V , Ancri D, & Lacomblez L. (1999), ‘Decreased Awareness of Cognitive Deficits in Patients with Mild Dementia of the Alzheimer's Type.’ International Journal of Geriatric Psychiatry, Vol 14, pp 1019-1030

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Donald I.P. (1997) ‘Development of a modified Winchester disability scale – the elderly at risk rating scale’ Journal of Epidemiology & Community Health Vol 51pp 558-563.

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Hallberg I. R., Kristensson J (2004) ‘Preventative home care of frail older people: a review of recent case management studies’ International Journal of Older People nursing Vol 13, 6b, pp 112-120.

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Han B . (2002) ‘Depressive Symptoms and Self Rated Health in Community Dwelling Older Adults: A Longitudinal Study’. Journal of American Geriatrics Society, Vol 50 pp 1549 – 1556.

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Hebert R, Robichaud L, Roy P.M, Bravo G, Voyer L. (2001). ‘Efficacy of a nurse led multidimensional preventative programme for older people at risk of functional decline. A randomized controlled trial’. Age & Ageing Vol 30 , pp 147-153

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8. Hunter New England Health. ‘Hunter Dementia Care in the Community Strategic Plan-2006-2010’ p 6 -9.

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Kotler-Cope S,& Camp C.J. ( 1995) “Anosognosia in Alzheimer's Disease’. Alzheimer's Disease & Associated Disorders, Vol 9, No-1 pp 52-56.

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Martin C.T, Kayser-Jones J, Stotts N. A , Porter C, Froelicher E. S,( 2007’) Risk for Low weight in Community Dwelling Older Adults’. Clinical Nurse Specialist , Vol 21, No 4 pp 203-211.

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McDaniel K.D, Edland S.D, Heyman A, ( 1995) ‘Relationship Between Level of Insight & Severity of Dementia in Alzheimer's Disease’. Alzheimer's Disease & Associated Disorders, Vol 9, No-2 pp 101-104 30

References continued 12.

NSW Health ‘The NSW Action Plan on Dementia’

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Poulin de Courval L , Gelinas I , Gauther S, Gayton D , Lui L, Rossignol M, Sampalis J, Dastoor D. (2006). ‘Reliability and validity of the Safety Assessment Scale for people with dementia living at home’. Canadian Journal of Occupational Therapy. Vol 73 Number 2 pp 67-65.

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Soini H, Routasalo P ,Lagstrom H.( 2005). ‘Nutritional Status in Cognitively Intact Older people Receiving Home Care Services – A Pilot Study’. The Journal of Nutrition, Health & Ageing, Vol9, No-4, pp 249-253

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Stuck A.E , Walthert J.M, Nikolaus T, Bula C.J, Hohmann C, .Beck J.C. (1999.) ‘Risk Factors for functional status decline in community living elderly: a systematic literature review.’ Social Science & Medicine 48, pp 445-469.

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Snow A.L, Norris M.P, Doody R, Molinari V.A., Orengo C.A, & Kunik M.E. ( 2004) ‘Dementia Deficits Scale Rating Self- Awareness of Deficits’ . Alzheimer's Disease & Associated Disorders, Vol 18, No 1 pp 22-31.

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Salmon E, Perani D, Collette F, Feyers D, Kable E, Holthoff V, Sorbi S, & Herholz K.( 2007) ‘A comparison of unawareness in frontotemporal dementia & Alzheimer’s Disease’. Journal of Neurology , Neurosurgery & Psychiatry, Vol 79, pp 176-179.

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Tierney M.C., Charles J, Naglie G , Jaglal S, Kiss A , & Fisher R.H .( 2004) ‘Risk factors for Harm in Cognitively Impaired Seniors Who Live Alone : A Prospective Study’. Journal of American Geriatrics Society, Vol 52, No 9. pp 1435-1441.

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Thank you! Celeste Bond [email protected]. au IRCST Logo Official

Phone – 65422707 Mobile – 04 282 666 33 Upper Hunter Dementia Advisory Service PO BOX 120 Muswellbrook NSW 2333 32

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