SCIE media releases 2006
NICE SCIE guideline to improve care of people with dementia
22 November 2006
The National Institute for Health and Clinical Excellence (NICE) and the Social Care Institute for Excellence (SCIE) today (22 November) issue joint guidance on the treatment and care of people with dementia in health and social care. The guideline covers the identification, treatment and care of people with dementia and the support that should be provided for carers within primary and secondary healthcare, and social care. For the first time, healthcare professionals working within the NHS will be following the same guidelines as social workers and care workers in nursing homes.
Dementia is a progressive and largely irreversible clinical syndrome that is characterised by a widespread impairment of mental function. As the condition progresses, people with dementia can present carers and social care staff with complex problems including aggressive behaviour, restlessness and wandering, eating problems, incontinence, delusions and hallucinations, and mobility difficulties. It is estimated that there are 700,000 cases of dementia in the UK and approximately one million people caring for them.
Key recommendations include:
- There should be a coordinated and integrated approach between health and social care to treat and care for people with dementia and their carers.
- The needs of carers should be assessed by health and social care professionals and support should be offered as part of a coordinated care plan.
- Memory assessment services should be the single point of referral for all people with a possible diagnosis of dementia.
- People with dementia should not be excluded from any recommended services because of their diagnosis, age (whether designated too young or too old) or coexisting learning disability.
The dementia guideline recommends cognitive stimulation programmes for the treatment of symptoms affecting thinking and memory (cognitive symptoms) in all types of mild and moderate dementia. The guideline incorporates the Institute's recommendation that donepezil, galantamine and rivastigmine should only be prescribed for people with moderate Alzheimer's disease when managing these symptoms. It also contains supplementary advice for clinicians on how to accurately diagnose which stage of Alzheimer's disease an individual has reached, for example, if they have a learning disability or if the patient has language difficulties because they have had a stroke.
The guideline goes on to set out a range of recommendations on pharmacological and non-pharmacological treatments for symptoms affecting mood and behaviour (non-cognitive symptoms). It recommends that donepezil, galantamine and rivastigmine may be offered to a small number of patients with dementia with Lewy bodies if these symptoms are causing severe distress, and a small number of patients with Alzheimer's disease if these symptoms are causing significant distress and other treatments have not worked or are not suitable. Some patients with mild Alzheimer's disease will display these symptoms.
Andrew Dillon, NICE Chief Executive and executive lead for this guideline said: "This is a very important guideline not only for people with dementia but also their carers. This is the first time that a clinical guideline has been produced in conjunction with SCIE, demonstrating the real importance of health and social care professionals working closely to drive forward improved standards of care for people with dementia. The clinical guideline incorporates our appraisal guidance on the use of drugs for people with Alzheimer's disease, but it also sets wider standards for the care of people with all types of dementia which clinicians and commissioners alike in the NHS are expected to implement."
Bill Kilgallon, SCIE Chief Executive said "Supporting a person with dementia requires an understanding of both their unique social circumstances and their medical condition. It is therefore vital that all services for people with dementia are aware of the most appropriate treatment and support available. This guideline helps social care and health professionals work together with people with dementia and their carers to plan coordinated, person-centred care packages that effectively meet needs and lead to better outcomes."
Dr Andrew Fairbairn, Guideline Chair and Consultant in Old Age Psychiatry, said: "Dementia costs the health and social care economy more than cancer, heart disease and stroke put together. This is a unique opportunity to raise standards in the health and social care of people with dementia and their carers and families. The guidelines make recommendations ranging from the education and training of care staff in homes, through acute hospital care for physically ill people with dementia to end of life issues."
Dr Tim Kendall, Joint Director National Collaborating Centre for Mental Health, said: "This has been a very exciting guideline to write for NICE and the Social Care Institute for Excellence. The guideline, which has been developed by mental health and social care professionals and academics working alongside service users and carers, covers the full range of social, medical and psychological treatment and care for people with dementia and their carers, from early detection through to end of life. I think this guideline is a real asset to both SCIE and NICE and will lead to huge improvements in dementia care throughout England and Wales. The guideline group should be proud of this achievement."
Steve Iliffe, Reader in General Practice and member of the guideline development group, said: "These guidelines outline the package of medical and social care that should be available for people with dementia and there families. They give a clear signal to PCTs and practice based commissioners about the kinds of services that are needed and to practice teams about the training they will need to optimise the care of people with dementia. The guidelines on medication use are particularly helpful because they emphasise the importance of clinical judgement about impairment and counsel against a mechanistic reliance of test scores."
Click here to access the guideline on SCIE's website.
Media contact
Annie Goss | Media and Communications Officer | T: 020 7089 7117 | M: 07739 458 192 | Email: annie.goss@scie.org.uk
Notes to Editors
About the dementia guideline and technology appraisal guidance
- The NICE-SCIE dementia guideline is available on the NICE website at www.nice.org.uk/CG042 and the SCIE website at http://www.scie.org.uk/.
- The NICE-SCIE guideline on dementia includes recommendations derived from the NICE technology appraisal of donepezil, rivastigmine, galantamine and memantine for the treatment of Alzheimer's disease. They have been incorporated into the guideline in accordance with the NICE process. More details on this appraisal are available from www.nice.org.uk/TA111.
About NICE
The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.
NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS
- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
About SCIE
The Social Care Institute for Excellence (SCIE) was launched in October 2001 as part of the Government's drive to improve social care. It is an independent registered charity, governed by a board of trustees. Its role is to promote and advance knowledge about good practice in social care across England, Wales and Northern Ireland . For more information about SCIE visit www.scie.org.uk.
SCIE has produced the following related guides:
- Practice guide 02: Assessing the mental health needs of older people: This online practice guide offers quick and easy access to practice knowledge about assessing the mental health needs of older people. It includes key research findings; ideas from practice; details of relevant legislation, guidance and standards; and links to further information. Revised and updated April 2006.
- Practice guide 05: Implementing the Carers Equal Opportunities Act 2004: This online practice guide offers quick and easy access to practice knowledge about implementing the Carers (Equal Opportunities) Act 2004. It includes key research findings; ideas from practice; details of relevant legislation, guidance and standards; and links to further information.
- Practice guide 09: Dignity in care: An online guide to help older people, their carers and those working in older people's services to understand what is meant by dignity and how it can be embedded into practice. Published November 2006.
