Case Study: Improving Health Outcomes

Our client

Sidney had advanced Lewy Body type dementia and was living at home with domiciliary care. Repeat episodes of absconding the house and behavioural challenges had resulted in numerous 999 call outs, A&E visits and admissions. Several domiciliary care agencies had withdrawn service and social services were considering DOLS and care home referral against the wishes of Sidney and his daughter. Sidney was prescribed quetiapine 10mg BD and was also experiencing frequent falls which put further pressure on NHS and community services.

Sidney was enrolled onto The Good Care Group dementia care pathway which includes a robust assessment of need and the provision of a highly skilled consistent dementia care team. Telecare was explored as a way of enabling safe freedom of movement for Sidney. The highly individualised plan of care focussed on:

• Communication
• Stimulation
• Behavioural analysis
• Life history work
• Appropriate use of validation therapy

Medications management was provided as part of the service and a full medications review was initiated including a review of the quetiapine prescription as quetiapine was identified as a possible cause of falls and was proving ineffective in managing behaviour.

Improved outcomes

The following outcomes for Sidney were achieved over the next 12 months:

Health and wellbeing:

• Reduced incidences of behaviour that challenges
• Improved wellbeing and quality of life
• No requirement for DOLS – client able to remain own home in accordance with his wishes and mental capacity act (least restrictive option)
• Improved compliance with medications schedule
• 66% reduction in falls – falls are a major symptom of DLB and not always avoidable

Pressure on health services:

• No 999 calls due to behaviour
• No 999 call outs due to absconding
• Elimination of antipsychotic prescription
• Only two 999 calls outs
• No admissions