Train/ educate/ sensitize healthcare professionals on dementia and care realities
The Dementia India Report 2010 admits that awareness of dementia is low even amongst the medical community and support providers; some excerpts:
…there is no special emphasis on dementia diagnosis and management in the training of healthcare professionals
There is no structured training on the recognition and management of dementia at any level of the health service
Health care services remain insensitive to and do not provide the much needed information and support for carers and family members
In a list identifying “Barriers to dementia care in India” (Figure 4.2) the report includes “Poor awareness even within the medical fraternity”
Clearly, improving dementia awareness and sensitivity to caregivers in health care professionals and support staff can help in many ways, such as improving chances of early diagnosis, ensuring doctors spend enough time and provide more information to families in addition to prescribing medication, and health care facilities better handling interactions and support of persons with dementia.
There are two levels of awareness and sensitization required (1) what all health care professionals need to know and (2) what specialists need to know.
All health care professionals–doctors, nurses, technicians, other staff–may be interacting with someone who has the symptoms, whether or not there is a diagnosis. The person may have come or been brought for some other medical problem, and the person’s dementia may be affecting how well the person communicates the problems, or understands the doctors/ nurses/ technicians, or how uncomfortable the person feels in an institutional setting. All health care professionals therefore need to know enough to have effective interactions with the person and also use the family to get additional data. They need to know enough to be able to suspect dementia based on symptoms/ behavior and refer the person to a specialist if necessary. As most patients have more than one medical condition, doctors need to factor in the person’s dementia when treating for other medical conditions or suggesting interventions or hospitalization.
Specialists, of course, need more detailed and up-to-date knowledge to provide correct diagnosis and treatment and suggest appropriate interventions.
All health care professionals (including specialists) need to understand what dementia care involves, and appreciate possible caregiver stress etc., and ensure their advice is practical. Most families may not look for volunteer bodies or caregiving advice unless their doctor tells them they may need it. If doctors have been sensitized to care difficulties and how important care is for the quality of life of the person, they will appreciate care work and fulfill their role in directing families to possible support and resources for non-pharmacological interventions.
Note that while many professional bodies associated with dementia are informed about effective interventions and approaches, many doctors do not get enough professional re-training and updates and so may not know about the advances in the domain unless specifically trained/ sensitized for these.
Some key points (not intended to be a complete list)
- Suitable information packages to convey the information to the target health care audience . These could be in the form of DVD courses, online courses, material for seminars and workshops, booklets, etc. pamphlets on dementia, addresses of support organizations (Necessary)
- Identification of target audiences (examples: nursing and medical colleges, medical facilities, nursing associations, doctors’ associations, professional associations of occupational therapists, physical therapists, etc.) (Necessary)
- Modalities to reach across various segments and attract them to undergo such training (could use schemes like continuing medical education credits, or could be part of a curriculum (Necessary)
- Specialists/ instructors to prepare material, conduct training programs, resolve queries, create usable examples and case studies, etc. (Necessary)
- Specialists, reputed educationists and experts to see how to include dementia in the curriculum used for training and educating various types of healthcare professions (one of the possible actions in this action area)
- Specialists to create guidelines on how healthcare professionals should interact with persons with dementia and their families (one of the possible actions in this action area)
- Volunteers to do various administrative tasks and to distribute material (needed for information booklets that can be left at nursing homes, hospitals, etc.)(Necessary)
- Funds for the above (fees, material preparation and production costs, honorariums and travel reimbursements, other costs) (Necessary)
- Suitable databases that contain information to locate persons to be trained/ sensitized ((highly desirable)
- Suitable systems for streamlining record capture and follow-ups (highly desirable)
- Suitable systems to gather data for analysis/ research to assess reach/ effectiveness of the program (nice to have; may also be useful to get funding)
Training and sensitizing healthcare professionals for dementia and care may require effort and connections, and is a high-skill activity. But it will yield great benefits. It is a worthwhile area for contributors who have the required expertise, resources, and networking connections. Contributors can take on this type of project for a single target audience or for a wider section of healthcare professionals. (A general discussion on how potential contributors can select projects and contribute can be seen at: Action Areas to Contribute to, and Possible Approaches )
- It can be difficult to persuade medical professionals in India to pick up new medical knowledge, especially smaller doctors who have a private practice. It may be useful to give them informative brochures they can hand out to families.
- Families in India depend heavily on doctors for information around medical conditions. They often assume that if there is a medical condition, a doctor should prescribe medicines. Doctors are often under pressure to give medicines even if there are no effective medicines available. Material should include suggestions on how doctors can support families and satisfy them without giving ineffective medicines, and how doctors can introduce counseling about non-pharmacological interventions as part of their consultation.
- Culturally in India, the role of a “caregiver” is not seen as anything different from normal living with an ageing person. The systems of caregiver support are not established. Doctors often assume families will know what to do. Or they feel that their role is giving medicines and they should not offer any advice on caregiving. The training and sensitization they undergo should help them realize how important caregiving is in medical conditions like dementia, which cannot be slowed or stopped by medicines, and also realize that they have a role to play.
- A team of specialists can support doctors who are unsure how to handle families demanding solutions and medicines.
Some more discussion on this topic from my blog: About doctors, hospitals, healthcare, and a dementia care support wishlist. An excerpt:
There should be clear guidelines for clinics, nursing homes, path labs, hospitals, etc., on how to support dementia patients. For example, family members should be allowed to be present with the patient, the patient should not be harried for answers, and the family member’s input should not be discarded.
Given the widely acknowledged fact of under-diagnosis of dementia, medical associations and other concerned bodies should encourage family doctors and hospitals offering “health checkups” to include preliminary dementia scanning as part of geriatric checkups. Inclusion of such preliminary checking for dementia in normal checkups of elders(just like BP and fasting blood sugar is) will increase early diagnosis and also improve awareness and alertness towards dementia; patients/ family members may then spot the symptoms themselves and approach doctors in time.
More discussion on the current state of awareness in health staff and the need for this can be seen in: Dementia India Report 2010.
Pages in this section:
- Understand dementia and care in the Indian context
- Action Areas to Contribute to, and Possible Approaches
- Community-level work: A Dementia-Friendly India
- Focus: Improve Dementia Awareness
- Focus: Create Dementia Services and Products, Facilitate Support Forums
- Project ideas for students, artists, and others