January 2014. Following the independent review of the use of the Liverpool Care Pathway (LCP) for the dying patient and the subsequent announcement of the phasing out of the LCP, reference to the LCP has been removed from the health and social care professionals' audience description for statement 9.
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.
This quality standard covers 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. It should be read alongside the NICE supporting people to live well with dementia quality standard (QS30), which applies to all social care settings and services working with and caring for people with dementia. The NICE dementia pathway presents the information from both quality standards in an integrated format (see the section how this quality standard fits into the NICE Pathway for details of how the statements fit into the pathway).
The quality standard for dementia requires that dementia services should be 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.