well good afternoon everyone and welcome to today’s RC SLT webinar on dementia and the role of the speech and language therapist thank you very much for doing this my name is going on and I’m the director of policy and public affairs it was RC SLT I’ll be turning the webinar today I’m joined today by two experts Mary heritage who’s a speech language therapist and is based in Derbyshire and Sasha Wade who until very recently was service improvement lead for dementia at the Kingston Hospital NHS Trust it’s been us keeping you can hopefully see in the right hand of your screen I think some called chat please make use of that to send in chat messages never be on the subject of SLT in demand pepper if you want to use it for the chat there’s nothing you can do and also to send in any questions you have using the Q and a button we have a number of questions in advance and we’ll build as many of those as we can but please do send us in any further questions this sir you know that the event is being recorded and you can see the web address there to seat recordings of previous webinars Vicki Harris is a colleague of mine here at the world College you won’t hear her today but Vicki is very important because she is running the show technically and if you’ve got an issue with hearing or seeing or anything else then you can email so you can chat with us directly and she will help you out okay what are we going to cover today well we’re going to be talking about the pivotal role there’s a beach and language therapists to play in the dementia care pathway we’re going to be look at the type of outcomes that commissioners for those of you you have thurmond decision-makers in other parts of the UK what outcomes they want around dementia we discuss key points from the new RC SLT dementia Edition paper we’ll look at how we hit into the multidisciplinary team delivering care and support to those living with dementia and finally we will mention Asus please giving voice for people with dementia campaign so I’d now like to hand over for an overview with particular reference to our CEO selfies dementia position paper to marry heritage Mary thank you first of all I have to start with some facts and figures about dementia and its context in the UK this slide shows the number of people that are currently affected by dementia and the figure at the bottom or England should read 5,000 you’ve got the numbers for the current number of people affected by dementia and then we see that that number is expected to rise from current 800,000 in the UK to a million in just seven years so this is something that affect all of us professional and for most of us ourselves or our families in the future not just a problem for older people we know that there are at least 17,000 people under the age of 65 who are affected by dementia and that’s considered to be likely to be a significant under estimate and the incidence of dementia in adults with learning difficulties is quite significantly higher than in older people in our general population so what is dementia well it’s not a single disease process or umbrella calm and it’s always a progressive condition we’re talking about a set of symptoms that includes when we lost mood changes and problems with communication and reasoning and these symptoms occur when the brain is affected by didn’t using- diseases one and changes caused by vascular disorders is another we need to remember that each person is unique I have any they have a unique brain and so dementia will affect them in a unique way and our care needs to be tailored to reflect that there are over a hundred different forms of dementia Alzheimer’s disease is probably probably the most well known followed by vascular dementia and each of those or a combination of the two account although 90% of all dementia the speech and language therapist may have a higher proportion of the rarer forms of dementia associated with Lewy body disease frontotemporal dementia semantic dementia primary progressive dementia picks disease and so on these rarer forms often present initially as a language impairment and so you may find more of those on your speech americantale slopes and then other professionals all now going to look at what the decision-makers in each of our four nations are focusing on they’re understandably concerned about

the challenges that the England’s Wombles are people affected by dementia presents with observation first slide shows the position from the Department of Health in England and the focus on outcomes that were looking at about early diagnosis and intervention about improved quality of care for people who are in our inpatient beds in hospital there are very high number of people who are the dementia in our care homes and the sort of quality of life that we’re able to provide for them and the real challenge around reducing the use of antipsychotic medications for people with dementia looking briefly at the Scotland’s dementia strategy if have some similarities but also have an increased focus on and dementia friendly communities of participation and involvement of people with dementia and their families and carers all the nations have their own strategies and we’ve just shown the tune of all for today so how can a speech-language therapy is to help people with dementia and their familes raqqa little speech and Irish therapist is producing native dementia position paper to address these issues and on this side you can see there’s a link to read the position paper in full in summary the areas that the position paper focuses on is the speech and language therapy service which should be adequately rewards provide quality care for people dementia the communication of swallowing ultimately the whole pool the specific role of the speech and language wall this is empowerment and education as well as providing a directness intervention where appropriate and early access to people is crucial so that people that have met with dementia and their families can have their needs met in the most home wall in a multidisciplinary team each language therapists are really well placed to deliver outcomes for people with dementia all of those now firstly around diagnosis with skilled at providing specialist assessment to identify the language disorders and in order to inform the diagnosis for people where their earliest preventing symptoms are around language and communication we can provide specialist assessment or eating drinking or swallowing problems that occur at a particular emphasis on the environment in which people are eating and drinking and we may be involved in helping to assess the person’s capacity to consent to treatment and care on to care we may be providing individual programs what’s my function and that might give any stage in the progress of dementia and providing advice on what is the optimum environment for the person to communicate in all threes and drinking and looking there what are their strengths what are their remaining abilities and what do they need living well we’ll be working very closely with the people that supports the person with dementia and the carers the family professional calls and perhaps adopting a conversation partners approach or an enabling approach as well as maybe acting as an advocate for the personal there can be no communication difficulty and supporting a person with dementia interactions in their community making sure we’re maximizing their participation and quality of life and then helping the person with dementia and their carers by providing support enables carriers to provide core but that won’t be maximizing more knowledge skills looking at their quality of life that the pressures that they’re under and reducing their and isolation and risk of mental health problems we’ll be looking at management strategies for people who it’s eating of swallowing difficulties and in this early pioneering stage of speech language therapists input into dementia care really important that we’re involved professionally in developing clinical networks in influencing policy development risk management complex ethical decision-making and audit and research the vision paper looks at what are the reason what providing speech and language therapy and there we look at the Greece quality of life and quality of relationships of that particular by communication breakdown delays in getting a good and early and accurate diagnosis in order to access the right care and are professionals making sure that we’re preventing increased dependence at to earlier launch and preventing people with dementia from being excluded from decision-making about their own care and decision-making about service planning and of course in relation to disabled we’re looking to prevent avoidable death from hospital admission might be in relation to

nutrition choking or aspiration pneumonia thank you very much Mary that’s an excellent overview these are particular questions around what Mary said hold those and we will deal with an en now I’m very pleased to introduce to you sasha Wade and Sasha’s going to talk to us about how speech and language therapists can help people living with dementia hi thanks very much for having me yeah so for the last 18 months I’ve seen the service improvement lead for dementia at Kingston hospital and for what the last six months is also being the therapeutic activities lead for patients with dementia at the hospital as well I’m gonna talk to you a little bit about some of the ways that I’ve helped people with dementia at the hospital Mary’s just gone over some of the points from the RCS LT dementia position statement just a review we helped to inform differential diagnosis optimize communication and swallow training and education and research and development so my experience primarily comes from an acute care context I’m going to provide you with a few examples of some of the ways that I’ve seen involved with the hospital dementia education promoting person-centered care supporting carers and advocacy so starting with dementia education I was involved in creating a dementia program at the hospital which aimed to deliver education program to improve care for people with dementia to members of staff throughout the hospital so we targeted departments that included clinical staff and non-clinical staff so our clinical staff included islet health professionals nurses junior doctors members of our MRI team non-clinical staffs an example included our receptionists our porters our hosts and hostesses who delivered food and drinks to patients at mealtimes so most of the dementia awareness education sessions were quite broad and they focused on teaching staff to recognize dementia to understand what it is the different causes of dementia how prevalent it is in the hospital approximately over half of our patients over the age of 75 had a confirmed or unconfirmed diagnosis of dementia and of course in these presentations there was a lot of emphasis on communication because good dementia cares about good communication and the training frequently also addressed how to manage behaviors that challenge or in other words behavioral and psychological symptoms of dementia and I found that it helped to provide specific examples of scenarios that a specific staff group might run into so for example if I was doing a presentation to our order sometimes it was helpful to do a roleplay and have someone pretend to have dementia someone who didn’t want to for example get in the wheelchair to be transported and just teach some of the communication approaches and strategies that that that staff group may find potentially useful dementia education also included a lot of on feeding swallowing in the offline promotion we had a dining companion program which was both for staff and for members of the community it was a volunteer program to assist patients with dementia to eat their meals so some some of these patients had dysphasia and some just needed assistance prompting a social partner during their mealtime so that was another program that I was heavily involved with developing and delivery and I also just wanted to point out that across all of the various dementia education sessions I always made sure to advocate for speech and language therapy profession I would started my presentation explaining that I was actually a speech and language therapist and a little bit about my background and why speech and language therapists have role to play in dementia care I also wanted to touch on person-centered care little bits as well so person-centered care focuses on the importance of the unique wishes and

needs of the individuals care so we’re moving away from a medical model more towards the person-centered care model where the patient is at the center of care the english’s are important are the most important and if we’re unable to facilitate communication with patients we’re not providing person-centered care so just a few examples of some of the programs that I put in also us to promote person-centered care in the hospital first is the forget-me-nots scheme you’ll see a forget-me-not flower in the top right of your screen essentially we just used this flower to indicate whether or not someone had a confirmed or unkind confirmed diagnosis of dementia in hospital so the flower would go above their bed or on a patient summary board on the ward and this which just helps us to realize that they need to take a special brooch with that particular patient you’ll see also this is me this is another document that we promoted in the hospital this is an Alzheimer Society document and it’s probably the most widely recognized sort of person-centered person’s personal summary document that you probably see throughout the community and acute care and it summarizes the person’s communication methods their daily care plan you can indicate things that the person enjoys or think that agitate them it’s a really useful document and we suggest that all of our patients bring this into hospital and just updated as things change and make a photocopy to leave the hospital and out to their files another few examples are dementia champions environmental modifications therapeutic activities program ok so I’m going to give you a closer look at a few of these my last bullet point is a team effort I’m going to give you an example here oh and the picture showed up a little bit backwards here but you didn’t Knight yes so this is some of the signage that I worked with a group of multidisciplinary colleagues to update the signage for our toilets and showers on wards and so we had members of our estate team helping to find something that we could easily put up and take down if we chose to paint the doors to do a further environmental modification later on we had geriatricians you know looking at different options for signage and sort of voting on what they liked the best we had our occupational therapy department input on you know what color background will be easiest to see and what color font and how you know a red border could highlight the signage and then of course coming from a speech and language therapy perspective my suggestion with use of real pictures of the objects rather than sort of line drawings or diagrams with the easiest for patients with dementia to understand so that’s one project okay something else that we implemented at hospital which is very similar to the this document that I showed you a couple slides back which was the Alzheimer’s Society document and this one is called important things about me and this is just the front and back sides of the card that you’re seeing the tabletop card that folds in half and kind of sits next to the patient’s bed at their bedside and you can see from the couple slides that I’ve shared with you here you can indicate what that person likes to be called information about where they came from things that happened in their life lots of good information there to get a conversation going and establish rapport with the patient and and also on the back of the card things I need to help me to communicate and you’ll see there that communication aids with some tick boxes they’re listed there this is a really important document because it helps us to provide person-centered care it helps them understand what kind of approach they need to take with the person and how to connect with that person okay my third example here is the therapeutic activities program which is a relatively new program at the hospital which included an education component and it included daily one to one in group activities utilizing the help of both volunteers and staff members such as we have assistant health care assistants and we also had a therapeutic activities assistance as well and most of the activities were communication based and if you have an opportunity to get involved in a program like this I highly recommend it it it’s really a lot of fun and I think the patients get a lot out of participating in the program so we did things like reminiscence therapy

singing for the brain group reading finished outline and other familiar interests will function appropriate activities something else that I did for the programmers create how-to guides so that if someone was wanting to conduct an activity and they weren’t too sure how to go about doing it the how-to guide would provide suggestions depending on the person’s kind of cognitive communication level and Hollywood that that activity okay next a couple things I was involved with in supporting terrors so a person with dementia if there is or a packaging niche they’re going to help the person with dementia you’re you’re going to be helping the person who’s taking care of that person with dementia as well so a few examples of things that I did to help support carers while I was at Kingston Hall providing training to carers informally about compensatory strategies function appropriate activities for their family members in hospital education around behavior management communication support very often I would invite tears along to the therapeutic activities group so they could learn some strategies practically of course advanced care planning which is another example so providing information about the swallowing decline that’s associated with the progression of the disease you’ll see an example on the right there of a Paris passport that we use that basically said that carers can come to the Awards at any time to support staff in to support obviously the person with dementia in the hospital they know the person better than anyone else and visiting hours and mealtimes hours that kind of thing don’t apply actually what it means also assistance intention avocation support so just being aware of what kinds of programs are available in the community you’ll see a sort of the front cover of the information booklet that we would give to terrors of patients with dementia with a phone number there’s a big call to find out what kinds of services are available to them because we serve five different boroughs so it was quite tricky to know exactly what was available depending on where the person was from finally advocacy so these are a few of the different organizations and initiatives that I was involved with so I helped them creating a community dementia Action Alliance in Kingston I became a dementia champion which is for dementia friends and dementia friends is essentially a social movement to create dementia friendly communities Barbara story is a wonderful training program for staff that was commuted aizen st. thomas’s it’s a series of films about a person with dementia and their journey throughout sort of the end of life and then also dementia Awareness Week there’s a lot of different ways that you can become involved I delivered dementia friends session as part of dementia awareness week and also had the Alzheimer Society and H consenting and come into the hospital and display alongside me in the main entrance information about dementia okay thank you about this fascinating as I say we’ll come back to questions all of us yet just briefly now before we move on to questions just to link in the our society’s own demented campaign given voice for people with dementia we’ve been aware for a while as some of you will remember the work we did around promoting awareness of the role of SL team come with us this will example and we where the dementia is a similar area which is important is growing but there perhaps isn’t as much awareness out there as the role of the speech and language therapist and with dementia being but politically and socially very important we thought the time was right to raise awareness about our role so the key objectives we have linking in obviously to the preceding paper around budget holders reviewing provision of SLT around care services and also the care home set for thinking about communication that’s alcohol working with different peripherals and staff to understand the impact communication and making other people are able to identify the early signs around eating drinking and swallow London campaigns at different times you will be wearing voice and some of you will also know about the international campaign although we have in the audience I think the dimension campaign we are particular cursed on our professionals and the awareness of other people in the health and care field around the SLT role there’s a role for everyone I mean taken to meet you in person

combined this afterwards but we’re taking the three Emmys you can assist with around diagnosis around this failure around communication and we’ve talked about different ways that we can focus awareness nosing in campaigning and the things we want to do in the whole quest about this is welcome back to clearly those of you directly involved in domestic services or involved in adult services more government will be closer into this but actually there are things that all SLC’s and students can do created where we’ll come back to that in the questioned campaign resources available you’ll find on giving voice website a menu of campaign ideas the different people to do elicit that you can use in awareness rating stores for example in your hospital or whatever but also a slightly longer briefing but if you were to meet with the MP or you to meet with the executive although ever it might be along the briefing that you can leave behind for them and we also have a specific awareness postal bill from the seven signs around the communication signs that can be wrong and dementia so we hope we’ll make use of all of those there are links and then this goes up online you’ll be able to find all the players let’s move on to questions as I mentioned we had quite a number of questions that have already come in and so I’m going to begin with a couple of rows which were around the area of access to services I would say this will somebody asked whether people have working in areas where he starts Lee speech and language therapy was only involved with dementia and dysphagia and secondly an allied quest one around traditional English therapy services not accepting the phone for people with dementia and that might even constitute discrimination now if you have any thoughts on that first of all I think it’s really good that services who only in the past work with people with dementia and aphasia and now starting to be able to offer support to people who are also affected by communication difficulties of communication professionals it’s really important that we can use all of our skills to meet all of the needs that people with dementia are experiencing I my experiences and start to provides them advice and support and assessment and inputs to people around their communication as well as their swallowing multidisciplinary team will find that imports useful and will start to refer more patients but from the start people won’t understand what and what the full role of the speech language therapist is in quite now and then you also asked about whether this is discrimination we’re only offering support for people who have one source of brain organic brain disease with warm or stroke or a head injury versus people who have another source of brain disorder as in dementia and I think yes I’m comfortable with that okay thank you very much for that we also had several questions related to dementia and learning disability reminding us that people with Down syndrome may develop dementia at a younger age and asking how we ensure that their interest is make musical adjustments we don’t get service users asking also about community learning disability services and great so when you are providing services to someone with learning disability who has a new diagnosed with dementia I would say that you provide sort of the same kind of approaches and strategies that you would with someone without learning different disabilities and and and who has dementia usually someone with learning disabilities will often have communication strategies in place and they already have some support in place in their environment but it’s really important to find out how they were communicating before their dementia and really working with using those strategies and methods that work for the person sort of throughout their life until the dementia so some of the things that you can do which are some of this you know similar to ideas that you can use with people who have just dementia on its own are ensuring that you’re establishing routines and sticking to those routines keeping a calm environment calming activities to reduce agitation carrying out activities that the person enjoys especially if their memories impacted like reminiscence therapy and of course implementing clear communication strategies as well okay

thank you very much for that sir I can see a couple of questions now coming in live and we’ll move to those in a moment which I was ask you which was around the mix how can we manage that the mix of people with dementia on boards with and the support in inverted commas functional patients I need any comments on that yeah that’s something that actually people bring up a lot with me you know having worked in a dementia rollin in a hospital and in a hospital with a large proportion of our patients with dementia we had patients with dementia on every ward so for orthopedics for a knee to surgery the medical wards there’s patients with dementia intermixed with patients without dementia throughout the hospital and that’s through one of the realities in the hospital so some of the things that we can do in the hospital is we can adapt to the environment for patients with dementia and we can implement programs such as forget-me-nots skiing that kind of thing in the hospital we can place patients in wards so that they can view the toilet so that they can view clot and you know place them your the nursing station have got livable ensure that they have lots of activities during the day to ensure that they have qualms nights and essentially good dementia care is just good patient care so if you’re implementing these strategies throughout your hospital all patients are going to benefit from from the strategies okay thank you very much questions are coming in online there’s a particular one around numbers that are specialty provide guidance on ratios and SOP for patient population this is a question that comes up a great deal in different times the service provision I think what I’m going to be the person who’s asked this and isn’t going to contact you answer on this one if the answers quite complex and possibly not amenable to to a quick reply here so we’ll get back in touch with you after the webinar on that those come in and my colleagues will take a little look but I noted that we’ve had warning around keeping Commission is not currently commissioning sufficient services in a number of SLT air means what happens is the dementia is getting or will the exhibition television now obviously an animal whether we have colleagues on from Scotland and places we’re commissioning it’s not an issue in the same way yes it’s true and yes a lot of what we’re trying to do for example with the awareness campaign is say here’s why this is important but ultimately it’s going to be about business wants and it’s going to be about evidence of meat what we do know of course is that from the prime minister down we’re being told that dementia is apparel ordinary it’s one of the few areas of commonality amongst the different political parties and hopefully that can help to provide the context for making a case of who enhance provision but there’s no doubt that there isn’t enough don’t be in the direction field right now and that’s why the awareness-raising work we do along with the evidence events it’s so important just wanted to check with Mary and Sasha the question around picture sets of boards if you’ve got a particular example so the question was Russia I know any picture sets or boards that can be used to enable service users in dementia I’m just straightforward question you know I would say that it really depends on the person who you are some people find that having a picture there to sort of help with the context of the question is quite helpful and quite reassuring I would say using picture sets or boards in combination was just really good communication strategies where you’re implementing really great total communication you know from from the words that you’re choosing the rate of speech your your body language your facial expressions and a mode of communication that the person is quite familiar with in conjunction with you know maybe trying using some pictures of support might be a useful strategy thank you and thank you for those of you who have been commenting already that they found some of the ideas that then very put forward to be helpful and when you’re dealing with particular ideas Sasha there was one other question that had come in quite specific but around cognitive stimulation therapy and outcome measures and I know you had one of his performance yeah so positive stimulation therapy is basically just

psychosocial therapy and our therapeutic activities program for patients with dementia I would say as a form of cognitive stimulation therapy now as people with dementia a lot of emphasis is being placed on reality orientation was part of cognitive stimulation therapy and that was a part of our program but I would say a lot of the sort of cognitive communication and that we did were you know would also via considered a form of CSG like reminiscence therapy singing for the brain finish that line those kinds of activities and the outcome measure that we use was a mood and well-being sort of like Hertz scale type of questionnaire where the person conducting the activity whether you know a member of staff or a volunteer what rate the person’s mood before the activity as well as their own and then after the activity also rates the patient’s mood as well as their own mood and we found that that was quite a simple way of tracking participation in activities but also tracking how the activity or how the therapy impacted how the patient was feeling okay thank you very much and the last question that I got at the moment and there’s people coming quick it has their own campaigning around giving ones and the question was how can this visual language therapists who don’t work adults support and promote the importance of our role in dementia care and I think that is important clearly those of you who work directly with in with dementia or in adult services are going to be closer in and warlike thing to organize things like visits for dignitaries or events specifically around our own dementia but there’s definitely a wider role for those of you involved in giving voice and campaign for example social media and promotion around Twitter and Facebook for example if you’re doing general giving voices awareness events like the one I’m going to very soon in Sheffield which will focus on all of our current priorities there’s a role down at the moment for making sure dementia is part of that general pitch and thirdly we’re quite soon going to be asking you to approach all of the candidates in the general election come one to talk about the importance of speech and language therapy and we’ll want you to include our role in dementia as part of that now questions are just coming quickly and I don’t don’t we’ve been reading this line the team is looking at the how counselors specialize in working with people who collect another new way is there any evidence of the benefits of this our wider scale interesting one on which we will return to you the last one is much simpler which is will the size of event what have you half of this presentation and the answer is yes they will they’ll be going up along with a full recording of the event I can also see that someone said could we have a reading yes if possible and then I’m getting a nod back so I think some result is already available on the web start so we’re coming to a conclusion here’s some more facts justice on you on with thanks to Derbyshire the chance of developing dementia increases relate but here’s what’s interesting one in six people over eighty has dementia walk on amongst women than men but here’s an interesting one particularly if you’re making politician dementia cost the economy twenty three billion a year more than cancer stroke heart disease combined so we hope that you have found today a useful introduction to this area we hope that you’ll engage with what the royal college is doing in terms of evidence in terms of practice and in terms of campaigning I’d like to thank Maori heritage and Tasha wait for their timing for their expert input I’d like to thank all of you for being on the webinar and participating we look forward to join you joining us on another webinar see thank you good afternoon