Windows of opportunity: prevention and early intervention in dementia

Transition points

What are transition points?

There are many potential transition points along someone’s journey with dementia. The first point is usually when someone’s cognitive functioning is worrying enough for them to consider seeking help. Research (Chrisp & Thomas, 2009) suggests that the gap between someone beginning to notice problems with their memory and actually mentioning this to someone close to them may be as long as a year.

Transition points occur where there is an intensification of perceived or actual risk to a person’s independence, health or wellbeing, or that of their carers.

A transition point need not be an inexorable shift to a greater level of dependence. It is an opportunity to reassert an individual’s overall independence. It is true that once a person’s needs for support become substantial or critical it is likely to represent increased care costs to them or to the social care community.

If the right kind of support is offered at the right time, shifts to substantial levels of need may be delayed or prevented. This needs to be underpinned by a fundamental person-centred approach that offers individual choice and control.

As well as offering the right support at the right time, it needs to be offered in a way that encourages people to seek help when they need it, and to plan for their future needs.

Where transitions occur in relation to a sudden change in a person’s health or their carer’s situation, perhaps through a fall or through physical illness, this should be regarded as a temporary state of affairs and efforts should focus on helping the person to return to their desired situation as soon as possible.

Questions for transition points

• Transitions from awareness to identificationOpen

  • Will being given a diagnosis help this person right now?
  • Will it help their family or carers?
  • What impact will it have on the wider health and social care community?
  • What can we do to encourage people to seek help at the right time?
  • How can we support this person in the assessment and possible diagnosis of dementia?

• Transitions at diagnosisOpen

  • Is this person ready to receive support?
  • How can we make it easy for them to ask for support when they are ready?
  • How can we encourage this person and their carers to start planning for the future now?
  • Does this person need support to manage their care?

• Transitions where the need for some support begins to emergeOpen

  • Are there any barriers that are preventing this person from accessing universal services?
  • How do we ensure that a lack of help at an earlier point does not create a greater level of need at a later time?
  • What abilities or inner strengths can we help this person to draw on?
  • What targeted interventions can we offer to maintain this person's current level of independence?

• Transitions where the level of need may changeOpen

  • Are there any barriers that are preventing this person from accessing universal services?
  • What targeted interventions can we offer to maintain this person's current level of independence?
  • How do we ensure that irreversible decisions are a last resort rather than a first choice?
  • Is this person getting the right amount of support to plan and manage their care?
  • Does this person know how to get help in a crisis?

• Transitions where more substantial needs ariseOpen

  • What abilities or inner strengths can we help this person to draw on?
  • Is there some kind of short term support that we can offer to help them to regain their level of independence?
  • Are there any barriers that are preventing this person from receiving targeted interventions?
  • What risks to their independence do we need to minimise?
  • How do we ensure that we arrange for the least intrusive or institutional ongoing intervention that is able to meet their needs?

• Transitions and the end of lifeOpen

  • What can we do to encourage people to state their wishes about end of life care while they are able to?
  • How do we support carers and families through and beyond the point at which delivering care ends?