Dementia Pathway

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Dementia Framework

Here you will find information about dementia and the services provided. In addition you can view the Dementia Framework 2017 on this page.

  •  What is dementia?

    • The term dementia can be a confusing and frightening one for many people. It is considered to be the condition that people aged over 55 years are most frightened of developing.
    • Dementia is not a single disease; it is an umbrella term used to describe a group of diseases that affect the brain and which cause cognitive decline. The condition is progressive which means the symptoms gradually get worse over time. The duration of the condition varies depending on various factors including the type of dementia, the age of onset and the person's co-existing health conditions. It is important to remember that dementia should not be considered to be a normal part of ageing.

  • Tell me about the symptoms of dementia

    • The symptoms of dementia are numerous and include:
    • Memory loss (recent memories affected more than older memories).
    • Difficulty finding the right word when speaking.
    • Difficulty understanding what is being said.
    • Difficulty interpreting written language.
    • Difficulty recognising or naming people.
    • Having problems with concentration (the person may struggle with reading a book).
    • Difficulty planning and completing tasks like cooking, personal care, managing money, paying bills, driving etc.
    • Disorientation in time (the person may feel they are in a different time in their life. They may believe their parents are still alive or that their children are still very young).
    • Disorientation in place (the person may not recognise familiar environments or even their own home).
    • Managing fine motor skills like doing buttons or tying shoes may become difficult.
    • Changes in mood (the person may become worried, anxious or frightened).
    • Behaviour changes (the person may act differently as they try to make sense of what is happening. They may get suspicious or possessive of the person closest to them).
    • Continence issues (the person may have difficulty remaining independent with toileting or in later stages may not recognise the need to do so).
    • In some forms of dementia the person may experience hallucinations. These visions can arise as a result of changes in the brain or eyesight and can sometimes be frightening for the person.  
    • It is important to remember that dementia is a progressive condition and many of the symptoms listed above may only occur at certain stages of the illness. Dementia is not a specific term so not everybody with dementia will experience every symptom on the list.
    • We must be careful not to focus too much on symptoms and risk forgetting about the person. Everybody is different and therefore their own personality and life experiences will affect how the condition presents.

  • What is Alzheimer's disease?

    • Alzheimer's disease is the most common type of dementia and accounts for around 60% of all dementia cases.
    • The term Alzheimer's disease is named after the German neurologist Alois Alzheimer who, in 1906, found particular changes occurring within the brains of the person, causing the formation of neurofibrillary tangles and amyloid plaque deposits. The build-up of these plaques and tangles impairs the ability of the neurons to relay messages. Over time the brain cells die and brain size decreases in size and weight.
    • The main risk factor associated with Alzheimer's disease is age. After the age of 65 years the likelihood of developing dementia roughly doubles every five years. By the age of 80 years the risk of a person having dementia is about 1 in 5. The likelihood of developing the disease may increase if there is a strong family history of Alzheimer's (e.g. if both parents had the disease, or if many members of one side of the family developed the condition).

  • What is vascular dementia?

    • The second most common cause of dementia is vascular dementia, accounting for about 20% of all the dementia's. This type of dementia occurs as a result of problems with blood supply to the brain: either the supply is blocked, or there are tiny bleeds as a result of mini strokes or TIA's. Studies have shown that up to half of dementia's can be a mixture of both Alzheimer's and vascular types. 

  • How can I reduce the risk of vascular dementia?

    • There is good evidence to suggest that healthy lifestyles may help reduce the incidence of vascular dementia. Risk factors for vascular dementia are the same as those for strokes. The Alzheimer's Society has published guidelines which state "What's good for the heart is good for the head" There are steps we can take to reduce the risks such as:
    • Monitoring blood pressure: get your blood pressure checked when you visit your GP and follow medical advice to keep it under control.
    • Monitoring cholesterol: evidence shows that high cholesterol levels in mid-life can increase your risk of dementia later on. Your GP may be able to give you advice on reducing levels if high.
    • Avoiding obesity: obesity can increase the risk of high blood pressure and diabetes which can increase the risk of dementia. Eating a healthy diet and reducing excess sugar and saturated fats is recommended.
    • Regular exercise: Try to be physically active for at least 30 minutes, five times a week, with a moderate intensity activity such as brisk walking or cycling. You should be working hard enough to raise your heart rate and break a sweat.
    • Stopping smoking: smoking has an extremely harmful effect on the heart, lungs and blood vessels, including the blood vessels in the brain. Research shows that smokers have a 50 per cent greater chance of developing dementia than those who have never smoked, but this risk can be significantly reduced by quitting the habit.
    • Avoiding excess alcohol: drinking more than the recommended levels of alcohol increases the risk of developing various forms of dementia, such as Korsakoff's disease and vascular dementia. However, research suggests that light to moderate amounts of alcohol may protect the brain against dementia and keep the heart and vascular system healthy.
    • Mental activity: it is thought that mental activity increases the brain's ability to cope with, and compensate for, physical damage. This would mean a person who often takes part in these activities will be able to tolerate a greater level of damage before symptoms of dementia are detected. Taking up new hobbies or learning new skills are great ways to challenge your brain and keep it active. Social activity is also a very good way of keeping the brain active.

  • Other less common types of dementia include:

    • Lewy Body dementia, fronto-temporal dementia and alcohol-related dementia's.

  • I'm worried about my memory

    • We must be careful to differentiate between normal forgetfulness and of symptoms of dementia.
    • We all forget things from time to time. Nowadays we are bombarded with information from various sources. Many people feel naked if they leave the house without their phone which enables instant connection to friends, family, work, social media, news headlines, their calendar, music, sport etc. Our head space is often full of 'spinning plates' right up until we go to sleep at night. There is little time to process, encode and file all of this information and it is easy to become distracted. Short-term memory is just that (in and out). To make something stick we have to recognise it as being important and we must put some effort into remembering. If we have not concentrated in the first place it does not get stored.
    • There are many other reasons why memory problems may occur. Depression can affect all age groups and can present with symptoms similar to dementia (slowness of thought, lethargy, diminished interest, concentration problems). Depression can be quite treatable with a combination of therapy, lifestyle adjustments and medication.
    • Other medical conditions that can affect memory include low thyroid function, anaemia, infection (especially in the elderly) electrolyte imbalance and vitamin deficiency. Such conditions are also very treatable and memory problems can resolve once addressed.
    • It is fairly common therefore to occasionally forget things. It's not unusual to walk upstairs and forget why we are there or to stand blankly looking into the fridge. It's certainly frustrating but most of us manage to recall what we've forgotten shortly afterwards or we can find ways to prompt ourselves by re-tracing our steps. Getting older in itself also causes a degree of decline in memory, as the brain, like any other organ, becomes less effective.

  • What should I do if I am worried about my memory?

    • It is only when the shortfalls in memory are occurring regularly or if they are interfering with your ability to manage your day-to-day life that they should be explored further. If your memory is causing you to struggle with things you once did well such as: 
      • Finding the right words
      • Managing money
      • Keeping appointments
      • Shopping
      • Cooking
      • Managing household chores
      • Keeping on top of bills
      • Getting lost
      • Driving
    • Then you should go and speak to your GP. It may also be helpful to ask a family member or friend to go along with you for support

  • Memory tips

    • Life can be very busy so here are some tips that can help you improve and organise your memory:

      • Keep socially active: Human beings are essentially social animals and social activity gives the brain a thorough workout. During contact with others one needs to be receptive, not just to what people are saying but also to body language, gestures and tone of voice. We then have to process this information and communicate back to them. All of this happens very quickly, often with a dash of humour and within accepted social norms which also gives the frontal lobe of the brain a challenge. Social activity can also lift our spirits, increase wellbeing and counteract loneliness all of which can affect memory.
      • Minimise distractions: Focus on one task at a time. Finish one before moving on. Multitasking merely means the brain has to very quickly switch between one task and another, thus doing neither very well. Try to minimise clutter in the house or workplace as this is another cause for distraction.
      • Pay attention: If we don't receive information correctly we can't expect to make sense of it and store it. If you tend to struggle with memory or concentration ask for information to be repeated. Repeating it back to the person may help with clarification. Make sure that your hearing and eyesight are tested regularly and that any visual or hearing aids are worn to ensure that communication is maximised.
      • Focus: Our brains can only remember a certain amount of information. Try to filter out unhelpful information and focus on the key messages you need to remember. Make notes if required.
      • Make associations: Try to make mental pictures if you need to store information. Visual memory is more easily recalled than words alone. If for example you are introduced to somebody called Mark, perhaps think of him with a mark on his face. Molly could be pictured as Molly Malone wheeling her barrow, through streets broad and narrow. You don't have to tell them how you remember them.
      • Keep a diary: Whilst phones and electronic tablets can be a distraction they can also help us remain organised. Set up a shared calendar with a family member to give you reminders of what is happening that week. If you don't use electronic devices a diary works just as well. Get into the habit of writing appointments and reminders in it and keep it with you. The act of writing something down will help in itself. Perhaps keep a monthly planner by your home telephone so you can write messages down whilst on the phone.
      • Make a list: If you have many tasks to achieve make a list and cross things off as you undertake them. Most people depend on a shopping list.
      • Keep to routines: It's frustrating to lose items around the house. Try to get into the habit of placing important items in the same place. Hang keys on a hook after coming in. Consider using a cord to keep glasses around your neck, especially if you use more than one pair. Try to charge your phone in the same place every day which will reduce the amount of places it gets placed. Helpful routines can be developed such as taking your medication with your first cup of tea in the morning.
      • Sleep: It is difficult to function if we don't get enough sleep. If we are tired we will miss out on important information and memory will be affected. Don't fight sleep, go to bed when feeling tired and avoid using electronic devices whilst in bed. Avoid caffeine for several hours before going to bed. Adults should be aiming to get 7-8 hours' sleep every night.
      • Stay hydrated: Drink plenty of water throughout the day. Your brain is 75% water and it takes only 2% dehydration to shrink brain tissue and cause a temporary loss of concentration and memory.
      • Diet: You wouldn't use cheap fuel in a fine sports car, so don't feed your brain with junk food.
      • Keep active: It is easy to get bogged down in day to day life to the point where we can't think clearly. Having a walk or some exercise is good for our circulation and gets the blood flowing to the brain. Having a walk is also calming and allows us a chance to relax, clear our mind, take in nature and generally improve wellbeing.
      • Look after your health: Keeping generally healthy can impact positively on memory. Physical health issues should not be ignored but should be investigated and treated by your GP.
      • Alcohol: Whilst alcohol in moderation can help us relax we should remember that alcohol is a depressant and it can impact negatively on memory. In excess it can cause long-standing memory problems. Some studies have shown that an occasional glass of red wine can be beneficial but we should still aim to have 3-4 days every week where we don't have any alcohol.

  • What will my doctor do if I go to see them?

    • Your GP may ask you some questions about your memory and if this is affecting your daily life. The doctor may also ask you to undertake a brief memory test.
    • Your doctor will want to undertake some basic blood tests. This is to find out if there are any treatable conditions that might be affecting your memory. You will probably be asked to have an ECG to check your heart rhythm. You may also be referred for a CT scan to see if there are any changes occurring in the brain that may be affecting your memory.
    • Your doctor should also ask you some brief questions about your mood. Depression can have symptoms very similar to dementia. It can slow up your thinking, cause you to forget things and affect your concentration. This may be quite treatable.
    • Once your doctor has received all the test results he/she may want to treat any medical causes that may be affecting your memory. The GP may then refer you for a more specialised assessment at the Memory Clinic. The doctor will ask your permission for this to occur.

  •  What happens at the Memory Clinic?

    • Within about 4 weeks, a member of the Memory Clinic team will arrange to come and see you at home. With your permission they will gather some background information about you and ask you about your daily activities and how your memory is affecting your daily life.
    • Once the team have got an overview of your concerns you will be invited to come along to the Memory Clinic at the hospital, usually with a family member. There you will have a more in-depth assessment of your memory. With your permission your family member will also be able to contribute to the discussion.
    • Once all the assessment is complete you will be offered an appointment to see a specialist doctor at the Princess Elizabeth Hospital who will aim to explain the probable cause of your memory problem. They may make a diagnosis and prescribe some medication to help your memory. If the diagnosis is not clear they usually ask to see you again in about 6 months to monitor your situation.
    • If you receive a diagnosis of dementia you will have the opportunity to discuss with the doctor what this means and the implications it may have for you in the future. They usually try to include your family member in these discussions so that they can offer you support and ask any questions they may have.
    • If you receive a diagnosis a team member will visit you at home about 2 weeks afterwards. You may have questions you want to ask. You will be provided with information about your diagnosis and offered advice about support groups and practical help if needed. You will be seen again after about 6 and 12 weeks. After 12 weeks you may be discharged from the clinic or offered ongoing support if required.
    • Your GP will be provided with all the information from the Memory Clinic and if you are prescribed medication it will eventually be added to your normal prescription which you collect from the GP practice.

  • What help can I get after diagnosis?

    • After you have been diagnosed and given all the information about your condition you or your carer may be advised to attend some support groups run via the voluntary sector and Adult Community Services.
    • If you need ongoing support you may be allocated a member of the Older People's Adult Community Mental Health Team (OPACMHT) or a Social worker.
    • Organisations such as the Alzheimer's Society and Guernsey Alzheimer's Association provide some support for people with dementia and carers through peer support groups, music groups and can sometimes provide financial help to people in a caring role. You can also contact Guernsey Alzheimer's Association through Facebook.
    • There are other smaller organisations that should be recognised such as café and church groups who provide social engagement for people with dementia for example Caritas.

  • What is the dementia care pathway?

    • The Dementia Care Pathway Journey Provides the person with dementia with an explanation for their symptoms and allows them time to come to terms with it. it enables timely access to anti-dementia medication and enables the person and carers to access community support (occupational therapy, home care, day centres, specialist nurses, respite etc.). For more information go to  Dementia Care Pathway - Dementia Friendly Guernsey 

  • Tell me about services available at the hospital?

    • Tautenay Ward
    • This is an 8 bedded assessment and admission ward for older adults with mental health issues. It is based at the new Oberlands building (link). A high proportion of admissions are dementia related. Following a period of assessment service users may be able go back home with some added support or alternatively a long term care placement may be explored and arranged. 
    • Duchess of Kent House
    • The Duchess of Kent offers residential placements to cater for older adults with mental health conditions which may mean they need care and support for complex or challenging behaviour. This includes, but is not limited to, dementia. The service is not suitable for those with significant physical or mobility difficulties. There are 26 beds available, 2 of which are reserved for short-break care placements. This is where someone comes in temporarily to have a break from living at home, or to give the family or friend that cares for them a break, or both. This service is running close to capacity. Whilst the service is mostly funded by Health Social Care, residents pay a fee equivalent to the Long-term Care Insurance co-payment (further information about the operation of the Long-term Care Insurance Scheme is available below).
    • Hanois ward
    • This is a 19 bedded ward. This ward is specifically focused on supporting people with complex behaviour associated with mental health conditions (especially dementia).
    • Fougere ward
    • This is an 18 bedded ward providing support for people with more advanced dementia and associated nursing care needs.  Average occupancy for both these wards is high with the service usually running at or near capacity. Whilst the service is mostly funded by HSC, residents pay a fee equivalent to the Long-term Care Insurance co-payment. For further information please follow this link.

  • Tell me about the Older Adult Community Mental Health Team (OACMHT)

    • The OACMHT is a community team that deliver community mental health support to islanders aged over 65. The team tends to primarily support a people with dementia but also supports older people with other mental health issues. The team gives specialist advice on mental health issues and can offer support and advice regarding medications. This team also has responsibility for overseeing:
      • Training sessions to third sector and Institute of Health and Social care
      • Cognitive Stimulation Groups
      • Carer Support groups
      • Memory Clinic
      • There is no charge for the services the OACMHT provide. You can contact the team on telephone (01481) 220000. Ext 3515

  • The Willows (Community Day Centre)

    • The Willows is a Community Day Centre based at La Nouvelle Maraitaine providing occupational therapy and personal care services for people with dementia and people with ongoing physical conditions. The service also serves to provide essential respite for carers. Interventions include art projects, music, gardening, visits to local amenities and a bathing service. For more information please follow this link. 

  •  What other support is available in the Community?

    • Whilst not a specific dementia service, the community teams work closely with the Older Adult Community Mental Health Team to provide daily personal care and domestic help to many people with dementia in the community. Your needs may be assessed by the OACMHT or Memory Clinic whilst the daily care is delivered by the Community services teams.
    • For more information about the Community Teams please follow this link.
    • For more information about the Voluntary Car Service please follow this link.

  • What is Dementia Friendly Guernsey?

    • The role of Dementia Friendly Guernsey (DFG) is:
      • to raise awareness of dementia in Guernsey and to ensure we are inclusive of people with dementia and their carers to help improve individual's ability to remain independent and have choice and control over their lives.
      • to listen to those living with Dementia and seek to improve the Guernsey environment.
      • to support and encourage businesses and organisations in Guernsey to understand and deliver changes.
      • to create a Dementia Friendly Community to ensure people with dementia and their carer's are encouraged to seek help and support from the Community.
    • For more information about Dementia Friendly Guernsey please visit their website by following this link.

  • Tell me about support for Carers

    • For information about: short breaks, support groups, financial support and working and caring please follow this link.

  • Tell me about private care homes

    • There are currently 5 Residential (EMI) homes that are recognised as being better equipped to support people with dementia:
    • Coolderry House: 19 EMI residential beds. Manager Christine Lewis. For more information please telephone (01481) 722653.
    • Green Acres Residential Home: 47 EMI residential beds and 2 respite beds may be available. For more information please telephone (01481) 213640.
    • Highfield House: 19 EMI residential beds, 24 nursing beds. Manager Guy Mitchell. For more information please telephone (01481) 722667.
    • Le Platon Home: 25 EMI residential beds. Manager Sharon Williams. For more information please telephone (01481) 723640.
    • Maison De Quetteville: 29 EMI residential beds. Manager Hazel Robins. For more information please telephone (01481) 259935.
    • There is one further private home (Green Oaks) providing Nursing (EMI) care for people with more complex care needs. Green Oaks: 16 EMI Nursing beds. Manager Tony Tallon. For more information please telephone (01481) 267300.
    • For information around what to think about when choosing a care home for somebody with dementia please follow this link.
    • Residents with an EMI certificate attract a supplementary payment from the Social Security Department to help the home provide more support for people with dementia (activities, groups, outings, staffing etc.).