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[null,"Baseline assessment tool for dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset (NICE guideline NG16)"]
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[null,"This baseline assessment tool can be used to evaluate whether practice is in line with the recommendations in Dementia, disability and frailty in later life – mid life approaches to delay or prevent onset.  It can also help to plan activity to meet the recommendations."]
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[null,"The tool can be used by individual services or organisations. Alternatively, an assessment completed with the involvement of all relevant services or organisations would help to develop a picture of activity in the local area."]
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[null,"It should be used in conjunction with Dementia, disability and frailty in later life – mid life approaches to delay or prevent onset (NICE guideline NG16)."]
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[null,"In the first instance, consider whether the guideline is relevant and record the conclusion in the box below."]
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[null,"Is the guideline relevant?"]
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[null,"The data sheet contains the recommendations from the guideline. Information can be entered about current activity relevant to the recommendation, actions needed to meet the recommendation, deadlines and the names of the responsible leads.  Useful documents can be added as hyperlinks."]
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[null,"The table can be adapted to include any other local information that is thought to be useful."]
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[null,"If it would be helpful to group the recommendations, for example those that are key priorities for implementation or by deadline, use the filter function in the data menu. "]
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[null,"Tools and resources to help put the guidance into practice are available on the NICE website. "]
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[null,"National Institute for Health and Care Excellence\nLevel 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT; www.nice.org.uk\n\nCopyright\n© NICE 2019. All rights reserved. Subject to Notice of rights.\n"]

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[null,"Baseline assessment tool for dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset (NICE guideline NG16)"]
[]
[null,null,null,null,"Number of relevant recommendations",{"$f":"COUNTIF(D8:D985,\"Yes\")","v":0}]
[null,null,null,null,"Number of recommendations met",{"$f":"COUNTIF(F8:F985,\"Yes\")","v":0}]
[null,null,null,null,"Percentage of recommendations met",{"$f":"IF(ISERROR(F4/F3),\"\",F4/F3)","v":""}]
[]
[null,"NICE recommendation","Guideline reference","Is the recommendation relevant?","Current activity/evidence","Recommendation met?","Actions needed to implement recommendation","Is there a risk associated with not implementing this recommendation?","Is there a cost or saving?","Deadline","Lead"]
[null,"Promoting healthy lifestyles"]
[null,"Encouraging healthy behaviours "]
[null,"National organisations and local government departments that influence public health should continue to:",1]
[null,"•\tDevelop and support population-level initiatives to reduce the risk of dementia, disability and frailty by making it easier for people to: \n-\tstop smoking\n-\tbe more physically active\n-\treduce their alcohol consumption\n-\tadopt a healthy diet\n-\tachieve and/or maintain a healthy weight.",1]
[null,"•\tUse the local regulatory options and legal powers available to encourage increased adoption of healthy behaviours, and risk reduction. For example, as outlined on websites such as Healthy Places.",1]
[null,"•\tMake physical activity, adopting a healthy diet and achieving and maintaining a healthy weight as accessible, affordable and acceptable as possible. ",1]
[null,"Integrating dementia risk reduction prevention policies\n"]
[null,"Public Health England, NHS England, relevant national third sector organisations and health and social care commissioners should:",2]
[null,"•\tInclude dementia in strategy documents aimed at preventing other non communicable chronic conditions (for example cardiovascular disease, type 2 diabetes, stroke and chronic obstructive pulmonary disease) see NICE’s guideline on preventing type 2 diabetes: population and community-level interventions",2]
[null,"•\tMake it clear that some common unhealthy behaviours can increase the risk of dementia and that addressing those behaviours will reduce the likelihood of developing dementia and other non communicable chronic conditions. ",2]
[null,"•\tEnsure interventions and programmes to prevent non communicable chronic conditions state that the risk of dementia can be reduced by encouraging healthy behaviours (see recommendation 1), including reducing loneliness, by leading a physically and mentally active life.",2]
[null,"Raising awareness of risk of dementia, disability and frailty"]
[null,"Public Health England, Health Education England and NHS England should:",3]
[null,"•\tCommission national, regional and local campaigns aimed at the public and health and social care professionals to show how the risk of dementia, disability and frailty can be reduced and to promote the concept of keeping mentally and physically healthy. Campaigns should use a range of media and formats to reach as many people as possible. See NICE’s pathway on preventing type 2 diabetes: population and community interventions.",3]
[null,"•\tUse the campaigns to provide messages such as: \n-\tSustained ill health in old age is not inevitable. The risk of developing dementia, disability and frailty may be reduced and, for some, onset can be delayed and the severity of the conditions reduced.\n-\tSmoking, lack of physical activity, alcohol consumption, poor diet, being overweight or obese and loneliness are all avoidable risk factors for dementia, disability and frailty.\n-\tThe earlier in life that healthy changes are made, the greater the likelihood of reducing the risk of dementia, disability and frailty.\n-\tThere are health gains that can be made by changing behaviours even in mid life.\n-\tHealthy behaviours are more likely to be maintained if they are built into everyday life.",3]
[null,"•\tEnsure messages do not stigmatise people by suggesting that people who develop dementia, disability or frailty are at fault. Tell people that although some important risks can be reduced, there may be others such as genetic susceptibility that cannot be changed. It is still worth reducing risks where possible, even if there are unmodifiable risks, as this can increase the years spent in good health. ",3]
[null,"Producing information on reducing the risks of dementia, disability and frailty"]
[null,"Public Health England and NHS England should produce detailed information to promote specific behaviours that can improve someone’s health and discourage those that can lead to poor health in later life. For example, it should:",4]
[null,"•\tEncourage smokers to quit or use harm reduction measures by highlighting the immediate and long term benefits. In particular, make it clear that there is a link between smoking and dementia, disability and frailty. ",4]
[null,"•\tShow how a wide range of domestic, leisure and work activities can help people to be physically active and explain how even modest increases in physical activity, at any age, can be beneficial. Include information on how physical activity:\n-\treduces the risk of illness in both the short and long term, preserves memory and cognitive ability, reduces risk of falls and leads to a healthier old age, improving wellbeing and quality of life\n-\tis enjoyable and can have social benefits\n-\tshould be a part of everyday life for a person’s whole life course.",4]
[null,"•\tExplain that alcohol consumption can increase the risk of dementia, disability and frailty and encourage people to reduce the amount they drink as much as possible.",4]
[null,"•\tExplain that regularly consuming meals, snacks and beverages high in salt, fats and sugars is bad for health.",4]
[null,"•\tExplain that a diet mainly based on vegetables, fruits, beans and pulses, wholegrains and fish, is likely to improve their health (see NICE’s pathway on diet).",4]
[null,"•\tAdvise people to aim to maintain a healthy body weight (see NICE’s pathway on overweight and obese adults – lifestyle weight management).",4]
[null,"Preventing tobacco use "]
[null,"Local government, Public Health England, NHS England and the National Trading Standards Board should continue to develop, deliver and enforce comprehensive local tobacco control strategies, in line with current policy. They should:",5]
[null,"•\tMake smoking tobacco less accessible, affordable and acceptable.",5]
[null,"•\tContinue to work to prevent illegal tobacco sales.",5]
[null,"•\tEnforce smoke‑free laws and tobacco display provisions.",5]
[null,"•\tExtend smoke‑free policies into a wider range of public places, for example, public parks, open‑air markets and sports grounds.",5]
[null,"•\tPromote, and support people to establish and maintain, smoke‑free homes and cars.",5]
[null,"•\tMake all health and social care services smoke free (see NICE's guideline on tobacco: preventing uptake, promoting quitting and treating dependence).",5]
[null,"Local authorities and clinical commissioning groups should continue to commission smoking cessation services (see recommendations on policy, commissioning and training in NICE's guideline on tobacco) and promote quitting as the best way to reduce the risks from tobacco. Services should include strategies to encourage smokers who may not be able to quit, or who do not want to quit, to switch to less harmful sources of nicotine (see the section on harm reduction in NICE's guideline on tobacco).",5]
[null,"Improving the environment to promote physical activity"]
[null,"Local government, local enterprise partnerships, transport professionals and other organisations involved with the built and natural environment or with road safety (see who should take action?), should improve environments where people live and work to encourage and enable everyone to build physical activity into their daily lives. This should include:",6]
[null,"•\tUsing new and existing traffic management and highway schemes to make walking and cycling safe and attractive options (see NICE’s pathways on physical activity and the environment and walking and cycling).",6]
[null,"•\tImproving the existing built environment, and designing new developments, to promote physical activity (see NICE’s pathway on physical activity and the environment).",6]
[null,"Reducing alcohol‑related risk "]
[null,"Local government, Public Health England, the National Trading Standards Board and licensing authorities should continue to develop and implement guidance and policies to reduce alcohol consumption across the population. They could include:",7]
[null,"•\tMaking alcohol less accessible, affordable and acceptable (see also NICE’s guideline on alcohol-use disorders: prevention).",7]
[null,"•\tContinuing to work to prevent illicit alcohol sales (see also recommendation 3 in NICE’s guideline on alcohol‑use disorders: prevention).",7]
[null,"•\tMaking best use of local information such as alcohol‑related injuries and crime, to develop the local alcohol strategy. For example, use early morning restriction orders, the late night levy, designated public place orders and the cumulative impact policy as necessary to reduce alcohol related harm (see also recommendation 2 in NICE’s guideline on alcohol‑use disorders: prevention).",7]
[null,"•\tEnsuring plans include screening and brief interventions for people at risk of an alcohol‑related harm, hazardous drinkers (increasing risk drinkers) and harmful drinkers (high-risk drinkers; see NICE’s guideline on alcohol‑use disorders: prevention).",7]
[null,"Supporting people to eat healthily"]
[null,"Local government, Public Health England and NHS England should help and support people to eat healthily by:",8]
[null,"•\tReducing availability and promotion of foods that can contribute to an unhealthy diet. For example, by reducing or limiting the number of food outlets in a given area selling foods high in salt, saturated fat, artificial trans fats and free sugars. (See recommendation 23 in NICE’s guideline on prevention of cardiovascular disease, and NICE’s pathway on preventing type 2 diabetes: population and community interventions.)",8]
[null,"•\tHelping people to understand what constitutes a healthy diet. (See NICE’s pathways on prevention of cardiovascular disease and preventing type 2 diabetes: population and community interventions.)",8]
[null,"•\tImproving access to affordable fruit and vegetables and information on how to prepare them.",8]
[null,"•\tEncouraging supermarkets and other retailers to offer promotions, such as 2‑for‑1 deals, on fruit and vegetables.",8]
[null,"Service organisation and delivery"]
[null,"Delivering services to promote behaviour change "]
[null,"Public Health England, commissioners, local authorities, providers of NHS services, NHS Health Checks and other providers of behaviour change programmes should:",9]
[null,"•\tEnsure programmes to prevent non‑communicable chronic diseases share resources and expertise nationally and locally to maximise coverage and impact (see NICE’s pathways on preventing type 2 diabetes: population and community interventions and behaviour change: individual approaches).",9]
[null,"•\tWork together to deliver services that address the needs of people with multiple risk factors as well as for those with single risk factors.",9]
[null,"•\tEmphasise the need for, and help people to maintain, healthy behaviours throughout life (such as stopping smoking, being physically active, drinking less alcohol, eating healthily and being a healthy weight).",9]
[null,"•\tHelp people identify and address their personal barriers that prevent them from making changes to improve their health.",9]
[null,"•\tMake information and services available to all (see the Equality Act 2010). Additionally, target these towards those with the greatest need whenever possible.",9]
[null,"•\tDevelop the NHS Health Check programme to promote opportunities in mid life to reduce the behavioural risk factors for dementia, disability and frailty by:\n-\ttailoring the advice component of the NHS Health Check programme for different age groups\n-\tadding dementia prevention advice to all health checks.",9]
[null,"•\tUse audit to help improve the effectiveness of services.",9]
[null,"Providing accessible services"]
[null,"Commissioners and providers of local services should:",10]
[null,"•\tWork with local communities to understand the range of services that they need to reduce the risks of dementia, disability and frailty.",10]
[null,"•\tProvide services at convenient times and in easily accessible places. They should offer some outside office hours, and some in workplaces and community settings (for example, community and faith centres).",10]
[null,"•\tProvide digital services to complement traditional services when appropriate.",10]
[null,"•\tProvide information in a range of languages and culturally acceptable styles, and offer translation and interpretation facilities if appropriate.",10]
[null,"Providing advice on reducing the risks of dementia, disability and frailty at every appropriate opportunity"]
[null,"Public and third sector providers (such as local authorities, leisure services, emergency services and health and social care providers) should:",11]
[null,"•\tUse routine appointments and contacts to identify people at risk of dementia, disability and frailty (for example, appointments with a GP or practice nurse, when attending leisure centre classes, or visiting a community pharmacy).",11]
[null,"•\tTake advantage of times in people’s lives when substantial change occurs. (Examples include: retirement, when children leave home, when starting to care for older relatives or grandchildren, or during the menopause.) These are times when people may consider adopting new healthy behaviours, or may be at risk of adopting unhealthy ones.",11]
[null,"•\tWhenever the opportunity arises give people advice on how to reduce the risk factors for dementia, disability and frailty or refer them to specialist services when necessary (see recommendation 9 in NICE’s guideline on behaviour change: individual approaches).",11]
[null,"Providing physical activity opportunities"]
[null,"Local authorities and third‑sector organisations with a responsibility for, or who support, public health services should:",12]
[null,"•\tEncourage both recreational activities and active travel (for example, walking, cycling) for local journeys.",12]
[null,"•\tProvide supervised activities and exercise classes and an infrastructure to support walking and cycling. They should also maintain parks and open green spaces. The aim is to help people in mid‑life to be physically active in different ways – and at different levels of intensity (see NICE’s pathways on physical activity and walking and cycling).",12]
[null,"•\tEnsure that venues provide easily accessible information for visitors using forms of active travel, such as cycle parking locations and links to local online journey planners and mapping (See NICE’s pathway on walking and cycling).",12]
[null,"•\tPublicise these opportunities, including where they can be found and who to contact for more information (see NICE’s pathways on physical activity: brief advice for adults in primary care, behaviour change: individual approaches and risk identification and interventions for individuals at high risk in NICE’s pathway on preventing type 2 diabetes).",12]
[null,"Provide training"]
[null,"Training commissioners and providers should:",13]
[null,"•\tCommission or provide training and continuing professional development programmes for local authority staff, all health and social care professionals, relevant third‑sector staff and community volunteers to help to reduce the risk factors for dementia, disability and frailty in later life. Training should include how to identify people at most risk and how to advise and support people to change behaviour (see NICE’s pathway on behaviour change: individual approaches).",13]
[null,"•\tTrain participants to provide brief advice and when and how to refer people to other services to address behaviour change.",13]
[null,"•\tHelp participants reduce their own health risks, if necessary, by changing their own behaviour (see recommendation 10 in NICE’s guideline on tobacco: harm‑reduction approaches to smoking and recommendation 13 in NICE’s guideline on smoking cessation in secondary care: acute, maternity and mental health services; also see NICE’s pathway on physical activity: brief advice for adults in primary care).",13]
[null,"Leading by example in the public sector"]
[null,"Public sector organisations should:",14]
[null,"•\tSet an example by ensuring their procurement, commissioning and other policies encourage and support healthy living. For example by: \n-\tspecifying the need to encourage a healthy diet in contracts for on site cafes and shops\n-\tby restricting foods high in salt, saturated fat, artificial trans fats and free sugars and drinks high in sugar\n-\tby providing resources and support to help employees make behavioural changes (see recommendation 15).",14]
[null,"Providing support in the workplace"]
[null,"All employers should:",15]
[null,"•\tDevelop policies and provide information and support in the workplace to help employees:\n-\tStop smoking (see NICE’s pathways on workplace interventions to promote smoking cessation, smoking cessation in secondary care: acute, maternity and mental health services, and tobacco: harm-reduction approaches to smoking).\n-\tBe more physically active (see NICE’s pathway on promoting physical activity in the workplace).\n-\tImprove their mental wellbeing (see NICE’s pathway on promoting mental wellbeing at work).\n-\tReturn to work after long term sick leave (see NICE’s pathway on managing long-term sickness and incapacity for work). \n-\tEat healthily (see recommendation 10 in NICE’s guideline on prevention of cardiovascular disease).\n-\tReduce alcohol consumption (see prevention and screening for alcohol use disorders in NICE’s pathway on alcohol use disorders).",15]

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["  ","Baseline assessment tool for dementia, disability and frailty in later life – mid life approaches to delay or prevent onset (NICE guideline NG16)"]
[]
[null,"Who should do what at a glance"]
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[null,"Who should take action","Recommendation"]
[null,"Architects, builders, developers and local authority planning and housing departments",6]
[null,"Commissioners of services","2,5,9,10,13"]
[null,"Directors of public health","1,2,3,4,5,6,7,8,9,10,11,12,13,14,15"]
[null,"Employers, occupational health services, human resource departments, trade unions, third and private sector organisations who support workplace health",15]
[null,"Health Education England","3,13,14,15"]
[null,"Local education and training boards, health and social care education providers, schools, colleges and universities, adult education providers",13]
[null,"Health and social care services, local authorities and strategic partnerships (including health and wellbeing boards)","9,10,11,12,13,14"]
[null,"Highway authorities, road safety partnerships, transport professionals",6]
[null,"Licensing authorities",7]
[null,"Local enterprise partnerships",6]
[null,"Local government officers","1,5,6,7,8,9,10,11,12,13,14,15"]
[null,"National Trading Standards Board","5,7"]
[null,"NHS England","2,3,4,5,8,13,14,15"]
[null,"NHS Health Check providers",9]
[null,"Organisations that coordinate or offer training, or that register and set standards for professionals",13]
[null,"Providers of social housing",6]
[null,"Public Health England","1,2,3,4,5,7,8,9,10,15,"]
[null,"Third‑sector organisations with a responsibility for or an interest in the health of the public","1,2,6,9,10,11,12,13,14"]