11:30 12:40. Younger people with demen1a. Karen East, Head of Care and Quality, Dukeries Healthcare

Transcription

1 11:30 12:40 Younger people with demen1a No Brainer: A care pathway for people with alcohol related brain injury Karen East, Head of Care and Quality, Dukeries Healthcare

2 Towards a care pathway for people with Korsakoffs syndrome Karen East RMN, BSc

3 Dukeries Healthcare Based in Nottinghamshire Residential, rehabilitative care for people with alcohol related brain damage/ injury established 2006

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5 A cluster of syndromes including: Korsakoffs syndrome Wernickes encephalopathy Often erroneously referred to/ treated as: Alcohol dementia

6 First described by Carl Wernicke in 1881 Caused by a lack of thiamine (vitamin B1) Fatal in around 20% of cases 85% of survivors go on to develop Korsakoff syndrome Affects people in their 30 s, 40 s and 50 s as well as older people

7 Most sufferers are chronic alcohol abusers Males tend to drink over a more sustained period Wernickes encephalopathy precedes KS in most cases 85% of those who survive W.E develop KS Affects short term memory, mobility and ability to function on a day to day basis, especially in relation to planning/ executive symptoms Alcohol can be overlooked as the cause due to similarities with dementia symptoms

8 Carers/ families of people with Korsakoffs syndrome Clients own experiences Our own experience Research Best practice

9 Being passed from pillar to post between services before and after diagnosis Lack of information about their illness A perception by health professionals that the illness is self inflicted and therefore not worthy of an empathic approach A general view that recovery is not possible Limited options for care- mostly due to lack of knowledge and lack of funding Spending too much time in hospital waiting for placement ARBI is stigmatised; self inflicted, low priority Double jeopardy: dementia and alcohol dependency

10 Lack of professional responsibility and commissioning of care of people with Korsakoffs syndrome Brain injury team? Elderly care team? Dementia team? Alcohol team? Young physically disabled team? Mental health team? No national guidelines for the management of ARBD

11 Approximately 2% of alcohol abusers develop the syndrome Alzheimers Society % of population of W.A.D In Scotland (2000) 9% of patients in long stay mental health hospitals had K.S In Australia (similar incidence to Scotland) in 2010, 20% of W.A.D population had K.S 25% of the population drink to harmful levels (2011)

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13 Usually patients are admitted for falling/ RTA/assault/detox in hospital. Develops W/K/S symptoms. Discharge delayed Difficult to manage for staff on a busy medical ward Delays affect clients ability to recover Most stay in hospital between 2 to 6 months whilst placement is sought Average cost of NHS bed for 2 month stay = 30,000

14 25% of delayed discharge patients in an Irish acute general hospital were patients with alcohol related brain disorders the average stay in hospital was 84 days due to the absence of care pathways (Popoola et al 2008)

15 One in four acute male admissions is alcohol related Alcohol costs the NHS up to 3 billion a year (Royal College of Physicians) 8 out of 10 people attending A and E at peak times receive treatment for alcohol related injuries compared to 1 in 6 during normal hours 21% of psychiatric admissions are alcohol related ( CMO 2001)

16 Admitted to hospital July 2011 with collapse Treated for Wernickes Developed K.S August 2011 assessed by our service Very confused, confabulating, incontinent, unable to self care Spent 6 months in hospital Went home with care package as no funding Readmitted to hospital within 2 months

17 Most improvement occurs during the first three months Occular Mobility Cognitive takes longer Apathy on ward Lack of mental and physical stimulation Lack of opportunity to practice ADLs De-skilling Eventual rehabilitation may be longer

18 Patient admitted repeatedly with various injuries, varices, infections, confusion, wandering the streets, drunken states Fluctuating capacity can make it difficult to assess levels of functioning No funding for specialist placements Lack of knowledge about the potential of people with Korsakoffs syndrome

19 Forensic history of gangs and violence Drug abuse and alcohol abuse Developed K.S Constantly in and out of hospital as refusing intervention Often prescribed heavy tranquillisers on wards due to behaviours Agreed to rehabilitation Funding ran out after 6 months Mr S had improved dramatically but not ready for discharge Sent to cheaper care home Began drinking alcohol Continued cycle of repeated admissions to hospital Died 1 year later

20 No rehabilitation CHEAPER in short term No peers to relate to Access to alcohol Very often dementia care Not age appropriate Can result in placement breakdown Limited knowledge of KS Cost (based upon 30 years in care home)= 2 million

21 65 Years old Admitted to hospital for collapse and alcohol withdrawal Developed K.S Placed in elderly care home Improved physically Got bored Increased negative behaviourssafeguarding Admitted to rehab unit

22 Specialist care Short term solution Activities help redevelop cognitive skills Prevents behavioural deterioration Nutritional education Dry environment Cost 35k per year Average stay 1 year

23 HOSPITAL ASSESSMENT/ SPECIALISED SERVICE PRESENTS WITH SYMPTOMS OF WERNICKES 80% DEVELOP K.S DISCHARGE WITH/WITHOUT SUPPORT PACKAGE PRESENTS WITH SYMPTOMS OF KORSAKOFFS LONG TERM CARE (AGE AND CONDITION APPROPRIATE) REHAB LONG TERM CARE USUALLY ELDERLY CARE HOMES Key = Needed = Current

24 1. ARBI is an acquired brain injury engendered through excessive alcohol ingestion. Its management has some similarities to that of other acquired brain injury as well as dementia care. 2. Currently there are no national guidelines for the management of ARBD 3. There is no ownership or commissioning of ARBD 4. Services are available, however these are not capable of addressing the multiple needs of people with ARBD in isolation. 5. Many services do not have the training or expertise to deal with clients who have ARBD 6. Clients require significant psycho-social care (high mortality and morbidity). 7. Therapeutic services are likely to be cost neutral or potentially cost efficient