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PO15. Inter/National dementia strategies

Detailed programme, abstracts and poster presentations

PO15.1. Anti-stigma training reduces stereotypes and increases GP’s confidence in managing neurocognitive diosorders

CARTZ PIVER Leslie1, MAILLET Audrey2, CALVET Benjamin3, DUMOITIER Nathalie4, RAYCHEVA Margarita5, REJDAK Konrad6, CLEMENT Jean Pierre3, LEPERRE- DESPLANQUES Armelle2, KROLAK-SALMON Pierre2

1Clinical and Research Memory Centre, Limoges University Hospital, Inserm UMR-S 1094, Limoges University, Limoges, France, 2Clinical and Research Memory Centre, Lyon Institute for Elderly, Hospices Civils de Lyon, Lyon University Hospital, Inserm UMR1028, CNRS UMR 5292, Lyon University, Lyon, France, 3Clinical and Research Memory Centre, Department of Psychiatry, Esquirol Hospital, Inserm UMR-S 1094, Limoges University, Limoges, France, 4General Medicine Department, Limoges University Hospital, Limoges, France, 5Clinic of Neurology, UH “Alexandrovska”, Medical University, Sofia, Bulgaria, 6Department of Neurology, Medical University , Lublin, Poland

Objectives: Neurocognitive Disorders (NCD) affect approximately 9 million people in Europe (ADI World Report, 2015). Detection and diagnosis of NCD remain a challenge, especially in primary care. Negative stereotypes and lack of knowledge about the benefits of timely diagnosis and of post-diagnosis care can result in delayed diagnosis and poor management. This pilot studied the impact of an “Antistigma” training to empower GPs to diagnose and act on NCDs.

Methods: In the context of the “Act On Dementia” European Joint Action, four medical universities (Limoges and Lyon, France; Sofia, Bulgaria, and Lublin, Poland) invited GPs and residents to an “Antistigma” training based on an ethical approaches and case studies. Pre- and post-questionnaires were performed to explore GPs’ and residents’ stereotypes about NCD and their self-confidence in NCD management, before and after the training.

Results: In 2018, 8 sessions of the “Antistigma” training were held in Limoges, France (3), in Lyon, France (1), in Bulgaria (2) and in Poland (2). 192 GPs and residents participated. Before training, participants expressed particularly high stereotype levels about disclosure of NCD. After training, the global level of stereotypes was reduced significantly (p < 0.001), and more specifically the stereotypes about NCD disclosure (p < 0.001). Participants’ confidence increased significantly in general and also for each step of the pathway:  initiating diagnosis, disclosure of NCD, managing care and anticipating needs (p < 0.001). There were no significant differences between the training centers, or between residents and GPs.

Conclusion: During the European Joint Action “Act On Dementia”, “Antistigma” training proved its positive impact on GPs’ and residents’ attitudes and practices towards NCDs. By sustaining this training and implementing it in other countries, practices can be reinforced and harmonized across Europe.

PO15.2. Could telemedicine improve neurocognitive disorders detection and diagnosis in nursing homes?

KROLAK-SALMON Pierre1, LEPERRRE- DESPLANQUES Armelle1, HAUGER Isabelle2, MAILLET Audrey1, POLITIS Antonis3, MEHRABIAN Shima4, GAULIER Sylvain1

1Clinical and Research Memory Centre of Lyon, Lyon Institute for Elderly, Hospices Civils de Lyon, Lyon University Hospital, Inserm UMR1028, CNRS UMR 5292, Lyon University, Lyon, France, 2Résidence Talanssa, Talence, France, 3National and Kapodistrian University of Athens, Athens, Greece, 4Clinic of Neurology, UH “Alexandrovska”, Medical University, Sofia, Bulgaria

Background: In Europe there is a lack of detection of neurocognitive disorders (NCD) in primary care, particularly in nursing homes (NH). Obstacles in NH include general practitioner’s (GP) limited time, unawareness of diagnosis guidelines and tools, and difficulties to refer disabled patients to NCD specialist doctors. Telemedicine (TLM) could improve access to specialist doctors and increase NCD diagnosis.

Methods: In the context of the “Act On Dementia” European Joint Action, three countries (Bulgaria, France, and Greece) tested TLM for NCD detection/diagnosis in six NH (1 in Bulgaria; 3 in Greece; 2 in France). NCD detection tools for patients were shared as well as satisfaction and dementia attitude questionnaires for NH staffs. The experiments were planned from April to June 2018.

Results: The six NH were faced with legal, ethical and practical requirements before TLM could be implemented. Results at 3-months varied. In Greece, the NH staff was trained about NCD by a 30 hour teleeducational program. In France, despite altered MMSE scores and current TLM for behavioral disorders (BPSD), there were few requests for NCD diagnosis, due to unawareness of benefits of diagnosis for NH residents. In Bulgaria, NH staff training and 17 teleconsultations for NCD diagnosis took place. Despite the challenges, all the NH teams were satisfied of TLM. The dementia attitude scale results were similar between the different NH, between the countries, and between health professionals and other NH professionals.

Conclusion: Each country identified facilitators to improve NCD diagnosis in NH, e.g. a shared tool explaining the benefits of NCD etiological diagnosis for patients in NH to be included in the educational program on NCD for NH staff and GPs. The first request for TLM for NCD in NH was for BPSD; NCD detection and diagnosis in NH could be improved by TLM when combined with BPSD evaluation. 

PO15.3. Learning from each other - The experiences of the INDEED project in the Danube Region

EGERVÁRI Agnes, VAJDA Norbert

Social Cluster, Budapest, Hungary

Continuous international cooperation is essential for improvement in dementia related services, no matter if a country has approved national dementia plan or not. This is an important conclusion of the year-long cooperation within the framework of the INDEED project. The Social Cluster Association (Hungary) is one of the 10 Partners representing different countries of the Danube Region. As part of this heterogeneous group, after several meetings and discussions, we conclude that in complex world of dementia care every nation can learn from the others.

The INDEED educational program which simultaneously addresses healthcare professionals and entrepreneurs is a significant contribution to the development and implementation of national dementia plans. To match these plans and to ensure uptake, dissemination and sustainability of the intervention, policy makers are involved in the design of the three INDEED modules from the beginning:

·         CAMPUS - Information and skill-building

·         CONNECT - A set of networking tools

·         COACH - Business consultancy.

The project provides a catalogue of recommendations featuring contents and formats that are most appropriate to step up the qualification of the workforce, effective strategies for enhancing the integration and coordination of services, and tools for stimulating the creation of innovative services. The policy recommendation catalogue also includes an account of costs and risks associated with the educational program.

The lNDEED project has a great potential to support policy makers. Its unique approach to co-educate and co-qualify all professional groups involved in dementia care while also promoting social innovation and entrepreneurial activity is a significant and economical way to improve the quality of life of people with dementia and their carers.

In this presentation we are planning to share our experiences. We do hope that participants will get new ideas, which they will be able to use immediately in their dementia related services.

PO15.4. Taipei is the first city to launch the “Dementia Action Plan of Taipei”

LIN Hui-Ya1, LIU Wei-Hsien2, WANG Suh-Chin2, HUANG Shier-Chieg2, LEE Pi-Hui2, ZHENG Xuan-Miao2, LIU Chien-Liang2

1Department of Health, Taipei City Government, Taipei, Taiwan, Province of China, 2Taipei, Taiwan, Province of China

In March 2019, the senior population in Taipei reached 464,030 (17.42%), which is above the national average. The population of people with dementia in Taipei is estimated around 38,990.  The Taipei City has taken the lead in launching the “Dementia Action Plan of Taipei.” This develops a variety of dementia care services in Taipei, as well as provides comprehensive support to people with dementia and their family caregivers. Residents in Taipei can choose between different dementia care services according to their individual needs.

According to the Ministry of Health and Welfare’s “Taiwan Dementia Plan” announced at the end of 2017, the Taipei City Government devised the “Dementia Action Plan of Taipei” in March 2019, which outlines the seven strategies. With 15 action plans and 27 work projects, this plan is the first one to integrate internal and external resources.

Internally, it establishes network platforms across different departments, including the Departments of Health, Social Welfare, Education, Transportation, Labor, and the Fire Department. Externally, dementia screening is provided through communities, hospitals, and 12 District Health Center, Taipei City. The number of Integrated Dementia Care Center (IDCC) was expanded from 2 in 2018 to 5 in 2019.

 A community platform for dementia care was constructed, through which 84 dementia promotion activities were held with 4,755 participants, 1,343 cases of dementia were referred and tracked, and 19 dementia care training sessions were held with 2,309 participants. In communities, the number of Support Center for People with Dementia and their Families (SPDF) increased from 11 in 2018 to 24 in 2019 to provide people with dementia and their family caregivers with support services like cognitive promotion, dementia alleviation, family support groups, and family care programs. These services offer a comprehensive dementia care network to people with dementia and their family caregivers in the community.

PO15.5. General practitioner and nurse cooperation for timely detection of neurocognitive disorders in primary care

FOUGERE Bertrand1, MAILLET Audrey2, LEPERRE-DESPLANQUES Armelle2, VANACORE Nicola3, TRAYKOV Latchezar4, KROLAK-SALMON Pierre2

1Division of Geriatric Medicine, Tours University Hospital, Tours, France, 2Clinical and Research Memory Center of Lyon, Lyon Institute for Elderly, Hospices Civils de Lyon, Lyon University Hospital, Inserm UMR1028, CNRS UMR 5292, Lyon, France, 3National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy, 4Clinic of Neurology, UH Alexandrovska, Medical University, Sofia, Bulgaria

Background: In Europe, there is a lack of detection of Neurocognitive disorders (NCD) by General Practitioners (GP), due to time constraints and unawareness of current assessment guidelines and tools. Collaboration between GPs and nurses may improve management of NCD in clinical practice.

Methods: In the context of the “Act on Dementia” European Joint Action, GP-Nurse collaborations were implemented in France (Lyon), Italy (Modena) and Bulgaria (Sofia). GPs and nurses were trained in detection and management of cognitive impairment. Common detection tools were used in Bulgaria and France (DLA, DLA-I, MMSE, Mini-GDS and NPI); GP-COG was also used in Italy and France. In Bulgaria, 19 subjects were assessed by GPs alone and 12 subjects by a GP-nurse team. In Italy, 16 subjects were assessed by six nurses and 9 of them were also assessed independently by GPs. In France, 1 nurse assessed 15 subjects referred by 14 GPs.

Results - Assessed patients (n = 62) did not differ in age (p = 0.08). The main reason for detection was a cognitive complaint since less than 2 years (n = 26) or for 2-5 years (n = 24), with reduced daily-life activities in 40 patients. Results of multidimensional evaluation showed significant differences of scores of DLA (p = 0.03), Mini-GDS (p = 0.015) and NPI (p = 0.001). There were no significant differences in GP-COG scores between France and Italy, nor in GP-COG scores collected by nurses and GPs. Half of the patients assessed (n = 31) were referred for additional testing. The patients were generally satisfied with this management model.

Conclusion: This pilot showed the feasibility of the GP/nurse cooperation to detect and manage cognitive impairment in daily clinical practice. The involvement of all primary care health professionals is essential to provide early/timely NCD management.

PO15.6. The puzzle of dementia in Memorabel

VAN ASSELDONK Gerdie, SCHOLTEN Marjolein, VAN DEN OEVER Marlies, TENG Roy, DURRANI Abida, DEKKER Erlinde, SIPS Inge, MELCHERS Maaike, BOEKESTIJN Dionne, TEUBEN-MIEDEMA Boukje, VAN GASTEL Willemijn

ZonMw, Den Haag, Netherlands

The national ZonMw research and innovation program Memorabel, started in 2014, aims to improve the quality of life of people with dementia and the provided care and support, through groundbreaking research in a national or international context. This is to understand and prevent the development of dementia, and to find starting points for diagnosis and treatment. Memorabel also focuses on the development and application of effective and efficient instruments, interventions, care models and innovations. It is one of the three pillars of the Netherlands Delta Plan for Dementia.

The program distinguishes 4 themes, each looking for answers on specific questions through research:

(1) origin and mechanism of the disease:

·         What happens in and between the cells in the brain?

·         What is the influence of, for example, nutrition, stress and smoking on the development of dementia?

·         What are protective factors for dementia and how do they offer protection?

(2) diagnostics:

·         What are the best predictors of the development of dementia?

·         How can dementia be detected earlier?

·         What kind of assessment tests and procedures are available? How to best apply them considering patient’s preference?

·         What is the best approach to discuss the results of tests with people with dementia and their loved ones?

(3) prevention and treatment:

·         Which interventions can reduce the risk of dementia?

·         Which interventions improve quality of life and well-being of people with dementia and their loved ones?

·         Which drug treatments are effective?

(4) effective care and support:

·         What is cost-effective care for people with dementia?

·         What is the optimal organization of care?

·         How can people with dementia live at home longer?

With the results of the interim evaluation of Memorabel (summer 2019) we will illustrate to what extent the above questions have been answered.

PO15.7. Dementia Competence Centre of Estonia

TUUR Miret

Dementia Competence Centre, Tallinn, Estonia

Based on solid scientific evidence and international guidelines and best practices, through the cooperation with patients and their families as well as service providers, both in the medical and social sector, the Ministry of Social Affairs along with its’ partners founded the Dementia Competence Center (DCC) in September 2018.

DCC is State-financed, established September 2018 and is a collaboration of 4 strategic partners:

·         NGO Living with Dementia

·         Viljandi Hospital (general healthcare provider)

·         Tallinn Diocese Hospital (formal caregiving, nursing care and hospice/end-of-life care provider)

·         Tartu Health Care College (tertiary education provider/academic institution).

The focus areas of DCC:

(1) The integration of care services

  a. Healthcare

•Early diagnosis

•Secondary prevention (targeting people at risk of developing dementia)

•Dissemination of evidence-based best practices

  b. Social care

•  Growth of competence in dementia in all factions of society via a national network of care professionals and informed dementia-friendly communities and institutions

•  Training of service providers

•  Creating and developing dementia-friendly quality label/standard for the care-homes    

(2) People with dementia and their families

•  national network of support groups

•  information helpline (telephone)

•  training, life-long development

•  protection of human rights of people with dementia and their families 

(3) Coordinating academic research regarding dementia-related topics

(4) Communication – Building awareness towards a dementia-friendly nation.

The DCC is focused on strategic goal achievement and it will be financed by the state until 31.12.2021. Financial sustainability after 31.12.2021 is a priority and will be discussed during the project period.

The poster presentation will be designed with DCC new visual identity (worked out April 2019), poster includes text and graphics and provides an overview of the topics described above with keywords.

 

 

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Last Updated: Thursday 07 November 2019

 

 
  • Acknowledgements

    The 29th AE Conference in The Hague received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe and Alzheimer Nederlands gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche
 
 

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