Dementia quality standard

9. People in the later stages of dementia are assessed by primary care teams to identify and plan their palliative care needs.
10. Carers of people with dementia have access to a comprehensive range of respite/short-break services that meet the needs of both the carer and the person with dementia.

This NICE quality standard defines a high standard of care within this topic area. It provides specific, concise quality statements, measures and audience descriptors to provide patients and the public, health and social care professionals, commissioners and service providers with definitions of high-quality care

Dementia is a progressive and largely irreversible clinical syndrome that is characterised by a widespread impairment of mental function. Although many people with dementia retain positive personality traits and personal attributes, as their condition progresses they can experience some or all of the following: memory loss, language impairment, disorientation, changes in personality, difficulties with activities of daily living, self-neglect, psychiatric symptoms (for example, apathy, depression or psychosis) and out-of-character behaviour (for example, aggression, sleep disturbance or disinhibited sexual behaviour, although the latter is not typically the presenting feature of dementia).

Dementia is associated with complex needs and, especially in the later stages, high levels of dependency and morbidity. These care needs often challenge the skills and capacity of carers and services. As the condition progresses, people with dementia can present carers and social care staff with complex problems including aggressive behaviour, restlessness and wandering, eating problems, incontinence, delusions and hallucinations, and mobility difficulties that can lead to falls and fractures. The impact of dementia on an individual may be compounded by personal circumstances such as changes in financial status and accommodation, or bereavement. This quality standard provides clinicians, managers and service users with a description of what a high-quality dementia service should look like.

Care provided by health and social care staff in direct contact with people with dementia in hospital, community, home-based, group care, residential or specialist care settings.

The quality standard for dementia is based on the understanding that dementia services are commissioned from and coordinated across all relevant agencies encompassing the whole dementia care pathway. An integrated approach to provision of services is fundamental to the delivery of high quality care to people with dementia.

• Dementia areas of care map: click here to see the quality statements mapped against the areas of dementia care

• National Audit Office, 'Improving dementia services in England: an Interim report‘ (2010).
• Department of Health, 'The use of antipsychotic medication for people with dementia: Time for action‘ (2009).
• Department of Health, 'Living well with dementia: a national dementia strategy' (2009).
• National Audit Office, 'Improving services and support for people with dementia‘ (2007).

National Institute for Health and Clinical Excellence (NICE) and the Social Care Institute for Excellence (SCIE) clinical guideline 42 ‘Dementia: Supporting people with dementia and their carers in health and social care' (2006; NHS Evidence accredited).

Director

Val Moore

Consultation and field testing of the dementia quality standard took place from 27 November 2009 to 15 January 2010. In total, 644 stakeholders were contacted during consultation and the NICE field team visited six provider organisations to discuss the draft standard in detail. All eligible comments were reviewed by the Topic Expert Group and Quality Standards Programme Board and the standard was updated accordingly.

• Dementia field testing and consultation report

Many organisations share NICE's commitment to improve quality by making it clear what quality care is for patients and the public, health and social care professionals, commissioners and service providers.

So that these standards reach the widest possible audience, some of the organisations who have been involved in the development process, and who endorse the dementia quality standard, have become partners in its publication.