Supporting brain health in people with Parkinson's and frailty


By Dr Christine McCarthy, Specialist Registrar in Geriatric Medicine, Galway Integrated Care for Older People Group (GICOP)

A quality improvement project conducted as part of the Dementia Academy 'Mild cognitive impairment virtual course' which ran from March-September 2021.

Background

Older people, as a demographic, can be more vulnerable, frail and more likely to experience memory problems, including mild cognitive impairment (MCI) or subjective memory impairment. However, they are rarely monitored for or given consistent advice and support regarding brain health and how to reduce the burden and impact on their cognitive abilities.

Clinical Deficit

The Galway Integrated Care for Older People Group (GICOP) supports a wide range of people with differing needs; however, there is no framework or process in place to support brain health monitoring or support.

Aims of intervention

To assess how well the GICOP supported its patients regarding brain health-related monitoring and assessment, and provision of information, advice, and lifestyle interventions.

Methodology

A review of patient case notes, where a cognitive complaint was recorded. The review will assess how well patients' brain health is supported (in terms of what has been documented), specifically in relation to:

  • Medication assessments and recommendations

  • Smoking cessation

  • Lifestyle interventions -

  • Sleep disturbances

  • Hearing impairment

Interim results were as follows:

  • Medication assessments and recommendations were consistently performed well

  • Smoking cessation was well supported

  • In 70 % of cases lifestyle interventions were not documented as having been offered to those with cognitive complaints.

  • 50% of cases were screened for sleep disturbances, however, further support in the form of medication review or sleep hygiene advice was not consistently provided.

  • Hearing impairment was screened for and found present in 20% of cases but advice and support subsequent to this was not documented.

To understand why there was inconsistency in support and follow up around these areas, a further detailed team review of 30 patients who presented with memory complaints or MCI was conducted.

It was found that:

  • the frailty of the patient population makes generic lifestyle advice complex:
    • 40% required assistance or an aid to be mobile, making exercise advice complex

    • 23% had moderate or high risk of malnutrition making generic nutritional advice more complex

  • The sleep screening tool being used was not practical

  • There is not a good map of audiology services and knowledge of how to initiate appropriate referrals or obtain access to hearing aids for patients was poor within the team.

Outcomes

  • Development of a range of dedicated brain health literature which caters for the potential barriers that older and frail people may have in implementing lifestyle advice

  • Change in sleep screening tool from RU-SATED to a self-designed and validated tool with practical questions to assist lifestyle changes

  • Developed a map of current audiology services in the area and developed clear information around funding and access

  • Ongoing staff education sessions are planned.

  • Future audits are planned to monitor changes and ensure improvements.

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