I wrote up some reflections and thoughts about my time at the Rally and March on Saturday for Community Care and my piece can be read here.
I also wanted to comment about the proposal that the Alzheimer’s Society suggested that everyone over 75 is screened by their GP for dementia. I can see where they are coming from – there certainly needs to be a greater awareness but honestly, I’m not sure if this is the answer.
The idea of the screening is for the GP to offer a type of MMSE (mini mental state examination) test and to have a discussion with a family member/friend in conjunction with this.
Whilst I agree that awareness and early identification of dementias can and must be promoted, I’m not sure that general screening would be of as much use as the Alzheimer’s society do.
I believe it would probably be the people who are more reluctant to go to their doctors who might need the tests the most. There need to be a way of thinking through better targeting of information about dementia and what can be done for people who are diagnosed early in terms of drug therapies and lifestyle changes.
Perhaps if doctors surgeries make contact with people in that age group with whom they have had little contact for months or even years. My concern is the general screening will focus time and resources on those who are most likely to access the services in any case.
The problem with this is that GPs surgeries are now routinely ‘deregistering’ patients if they don’t attend and don’t send back letters which ask them to confirm their address/registration with a particular surgery. This has frequently been a problem I’ve seen at work as older people who might be more forgetful or just less engaged with responding to correspondence end up without any GP at all. I expect it happens less in smaller towns and villages where GPs know their patients better but in large cities and inner cities, it is a big problem.
It doesn’t need to be a doctor that carries out the screening tests and conversations either – perhaps there is scope to use wider ranges of professionals – not to make diagnoses but to refer for more extensive discussions with doctors. Perhaps you know, even social workers in adult care settings could be involved in identifying some of those people who might be better targeted or leaving information or even adding a few questions about memory and any concerns about it with the people as they call or are requested to call for assistance .
Day centre staff (where they still exist) could have some information to distribute.
General hospitals could also share information and have discussions (this could be a discrete post rather than adding further burdens on currently stressed staff).
It’s useful to look at the prevalence rates for dementia in England and Wales and it is possible to see how it increases after 75 and why this age is the point at which the tests are being proposed. Perhaps even more useful is looking at the incidence figures (new diagnoses) after 75. It seems that if there is some type of screening it should be repeated at regular intervals rather than a one-off screening at 75.
Maybe it is the way to go. After all, the Alzheimer’s Society has much more expertise in this area than I. I just see so many people whom I know would not go to a doctor’s surgery for a test and I wonder how engaging the process could be.
Often diagnoses are arrived at by family members discussing concerns with GPs in the first place but how to ‘catch’ the diagnosis earlier? Engage those who are likely to see this section of the population and disseminate information.
Information and awareness have to be the key – get the message out that a diagnosis is the start and not the end of help.
I know there was also some discussion about whether someone would want to know if they had a diagnosis of dementia.
Would I want to know if I had a dementia diagnosis? Absolutely and without doubt yes.
I would want to be able to make plans. I would want to be able to benefit from assistance available.
I don’t think general screening is bad. I think there needs to be more thought in how it could be implemented and ultimately, any discussion about dementia on television is a good discussion.