Conclusions and Recommendations

The number of cases of dementia in South Lakeland is likely to rise significantly over the next decade in line with local population trends. Increased levels of activism and expectation amongst future generations of older people, along with migration into the area and changes in family structure, will lead to increased demands for formal service intervention in dementia care. Current labour intensive, community care strategies are unlikely to be sufficient to meet this increased demand.

Informal carers provide the bulk of dementia care in the community. Dementia care makes special demands on carers many of who are older and at higher risk of ill health. Family support networks are likely to be more difficult to maintain in isolated rural communities especially amongst those people who have moved to the area from elsewhere. Maintaining large numbers of stable informal care arrangements is essential if care services are to be expected to provide adequate and appropriate institutional support for people in the later stages of dementia.

Counselling, information giving and training strategies has been shown to be the most effective means of supporting informal carers and helping people with dementia to remain in the community. Research findings show that training programmes for informal carers focusing on personal coping strategies and basic care skills have been especially valuable in reducing self reported stress among carers. Assistive technologies and particularly telematics can provide effective, efficient and accessible support for carers and people with mild or early stage dementia. These can be of significant value in rural areas where travel and other resource costs reduce the level of available support.

The vulnerability of people with dementia stems from the cognitive impairment that impedes autonomy. Good practice in dementia care requires carers and professionals to be constantly aware of this vulnerability and to act in such a way as to support and enhance autonomy in people with dementia. Service provision should be flexible and responsive to the needs of people with dementia and their carers. The development of assistive technologies and telematics provide important opportunities for improving existing provision especially in relation to reducing isolation, personal safety and access to information and advice services.

Recommendations

Counselling and advice giving

Existing provision of counselling and advice for carers in the area would be enhanced by development of telematic systems. The society should consider the following actions:

1. Continued development of the information resources contained in the demonstration Alzheimer’s Web/CD ROM
2. Provision of a ‘touch screen’ information resource in the reception area of Stricklandgate House.
3. Maintenance of an email support service to enhancethe existing telephone service.
4. Distribution of a CD ROM based advice package to GP surgeries, social services, community health teams etc.

Training

Provision or purchase of training for carers and dementia care staff in the following areas.

1. Carers

• Personal coping strategies (e.g. the Sense of Coherence Model)
• Basic caring skills
• Coping with emergencies
• Accessing formal services
• Internet and email skills

1. Staff

• Personal coping strategies
• Counselling skills
• Internet and email skills

Community Action

The society already plays an active role in campaigning on behalf of people with dementia and their carers. Future lobbying of statutory providers and community representatives needs to focus attention on the issues raised in this report. The society should consider campaigning on the following issues:

1. Provision of a district or county wide telecare service for people with dementia and their carers.
   This could involve local primary care groups, general practitioners, health promotion, social services and voluntary agencies.
2. Enrolment of carers on counselling and training programmes as a therapeutic strategy following diagnosis.
3. Provision of Internet and email facilities for carers to reduce social isolation.
   Local businesses could be asked to donate equipment, web space or technical support. Collaboration between voluntary groups in the district would greatly reduce costs and improve facilities for all groups.