Nurse Practitioners for Older People

Many drivers with dementia are good drivers and can navigate the roads safely.  Drivers with dementia are advised to stop when their ability to drive safely is affected; read leaflet entitled: When to Stop Driving.   It is good practice to make some journeys by taxi and public transport before changes are noticed, to make the transition easier once no longer driving.

Safer for Longer Workshop (Wirral Borough Council):

The Road Safety Team offers a free Safer for Longer Workshop to raise awareness of Road Safety for people over 60 years.  In Casualty Statistics, this age group is increasingly over-represented as drivers, passengers and pedestrians.   The Workshop is informal and includes discussions and sharing experiences.  A Road Safety Officer will provide information and advice to help keep people safer for longer when driving, travelling as a passenger, walking, riding including:

• Driving Assessments, Eyesight, Lifestyle, Medication, Public Transport

Drive Safely for Longer Assessment:

This is a 2‐hour session for drivers aged 60+ and costs £20.  Launched in 2016, it is a Merseyside Road Safety Partnership-funded scheme that has proved very popular and, as at ………nearly 2,500 assessments completed.   This initiative is designed to help Senior Drivers improve their skills and address any concerns they may have so that they can drive safely for longer.

For more information:

Telephone 0151 606 2143; Email: [email protected]

Driver Mobility Assessment:

People with dementia or their Families may decide that a Driving Assessment would be beneficial to determine safety to continue driving; this may be requested by the DVLA.  At a cost of approximately £94, Driver Mobility Assessment Centres provide advice and assessments (that may include evaluating: physical ability, eyesight, cognitive ability, practical driving assessment) for drivers with a medical condition or disability that affects their driving or who may require adaptations to their vehicle and also for carers who need to drive patients with restricted mobility.

For further details, contact:

Chester DriveAbility, Chester

01745 584858; [email protected]; www.wmdas.co.uk

(Can be booked for driving assessment on Wirral at Age UK using this number)

The North-West Driving Assessment Service, St Helens

01942 483713; [email protected]

www.bridgewater.nhs.uk/northwestwide/northwestdrivingassessmentservice

Regional Driver Assessment Centre, Manchester

0300 300 2240; [email protected]; https://www.rdac.co.uk/services/

Dementia can affect a range of skills and it is important to recognise warning signs that driving is becoming unsafe, for example:

• Getting lost on familiar routes
• Feeling less confident or irritable when driving
• Problems with spatial awareness, for example hitting kerbs
• Difficulty parking
• Driving safely past cars
• Finding bumps or scratches on your car
• Accidents or near misses
• Uncertainty with diversions and roadworks
• Problems identifying the right lane
• Misjudging speed

If any of the above is happening, it is important to stop driving.

Confidence can be affected, and some people will make the decision to stop driving when they realise they are no longer safe to drive.

Please Note: It is illegal to continue driving if your Doctor or Consultant has advised you to stop.

Your Driving Licence:

You must return your licence to the DVLA if any of the following apply:

• You do not meet the required standards for driving because of your medical condition.
• A doctor has told you to stop driving because of your medical condition.

Stopping Driving:

No one wants to stop driving as it’s part of our independence; making this decision can be very difficult, especially if you’re told to do so by someone else.  You may require support to help you adjust to not driving.

Refusal to Stop Driving:

Dementia can create problems with reasoning and judgement and often leads to people living with dementia and their Carers/Healthcare professionals seeing the world differently.  Sometimes, people with dementia may not understand or accept the need to stop driving and, against advice, may continue to drive and forget or refuse to notify the DVLA.   If someone with dementia continues to drive, the Doctor and/or family should take every reasonable step to persuade them to stop.  If you do not persuade the Patient to stop driving or discover they are continuing to drive against your advice, you should consider if the patient’s refusal leaves others exposed to a risk of death or serious harm.  If you believe that, you should contact the DVLA promptly and disclose, in confidence, any relevant medical information:

The Medical Adviser (GMC 2022):

• DVLA, Swansea SA99 1TU
• DVLA Drivers Medical Enquires:  0300 790 6806

If you are diagnosed with dementia, you must:

• Let the Driver and Vehicle Licensing Authority (DVLA) know about your diagnosis or you could be fined up to £1,000; if you were involved in an accident, you could be prosecuted.
• Let your Car Insurance Company know; if not, your Insurance Policy would be invalid.

After telling the DVLA:

They will make a decision about your driving.  They may need to ask for further information from a Healthcare Professional. They will let you know of their decision in a letter.

 DVLA might:

• Contact your Doctor or Consultant and request a report or an examination for you.
• Request you take a Driving Assessment.
• Request that you have your eyes tested.

You are usually allowed to drive whilst the DVLA considers your application, however if a doctor has advised you not to drive you cannot drive from that point.

DVLA Decision:

After assessment of your Medical Condition, the DVLA will decide if:

• you can keep your license. They may renew the driving license for a shorter time period than usual (licenses are normally renewed every 3 years after you are 70).
• you must stop driving and return your Driving Licence.

Stopping Driving:

If there’s a medical reason to stop driving, you will be told in writing.  If you disagree with the decision, you can write to the DVLA, but you must provide relevant information that was not included in the original assessment and give:

• Reference number from the Decision Letter.
• Proof that you meet the required standards for Driving as explained in the DVLA’s letter.

DM Business Support
D7 DVLA, SA99 1ZZ

You can appeal the decision by contacting your local Magistrate’s Court within six months.  You may need legal advice before you appeal, and you might qualify for Legal Aid.  You must notify the DVLA in writing if you choose to appeal:

Driver and Vehicle Licensing Agency
Drivers Medical Group
Swansea, SA99 1DF

Home

• Remove clutter – Clutter can make it difficult for people to see the items they need, so removing unnecessary items makes it easier to find what is needed.
• Use of contrasting colours with a minimum of pattern can help patients find useful objects; for example: a red plate on a white placemat; different colour toilet seat to toilet (for example black); painting the bathroom door a different colour to other doors. Too many patterns can have the opposite effect and create visual confusion making items more difficult to see; clashing patterns can cause agitation because of too much visual stimulation.
• Leave doors open and/or add simple signs. People with dementia may not remember the rooms in their home so it’s important to leave interior doors open; if the inside of rooms is visible, it’s easier to navigate the house.  If they are frequently getting lost, consider putting up one-word signs (Food, Kitchen, etc) or pictures of a toilet or a bed with an arrow pointing the way.  If there are rooms that they shouldn’t visit, keep those doors closed and avoid calling attention to them.
• Orientate to time: In the room where they spend most time – and on bedside table, etc, place a clock that clearly shows the time, whether it’s morning, afternoon, evening, day, and date. This information in one place can make a difference.  Consider a large print calendar.  These details can support cognitive function.
• Include photos and keepsakes that evoke positive memories and encourages reminiscing and creates a pleasant environment.

Bathroom

With shiny surfaces in a small space and a variety of tasks to complete, the bathroom can be challenging so:

• Contrasting toilet seat – black, red, blue or yellow – as white toilets often blend with the floor and walls so aren’t as noticeable.
• A raised toilet seat – with or without arms, will make it easier to sit and stand independently.
• Toilet target aids – when passing urine, older men with dementia and/or poor vision may find it difficult to keep the toilet area tidy. Adding a highly visible target inside the bowl indicates where they should be aiming.
• Clearly label hot and cold taps regardless of type, separate, mixer etc.

Kitchen

In most kitchens, items are hidden behind doors or inside drawers which explains why people with dementia will open and close many doors and drawers as they can’t remember where to find items.  Keep kitchen surfaces clutter-free and put the larger regularly used items at the front.  To find smaller items like cups and utensils, use a sign or a photo on the outside of the cabinet door or drawer or change to glass doors.

• Hide items not required as someone with dementia can become overly focused on something and, for example, constantly feed a pet. Telling them that the pet has already been fed won’t work so hide these items as “out of sight, out of mind” can sometimes work.
• Adapt frequently-used items. As conditions like arthritis, stroke or dementia can make it difficult to grip and use cups or other utensils.  If someone is struggling with these items, consider adaptive utensils, dishware or use foam tubing to expand grips.
• Make mealtimes easier and more pleasant as they can become a challenge and reduce appetite and willingness to eat. Simple steps can make mealtimes easier and more pleasant and, hopefully, improve appetites; for example, limit distractions, noise or TV, use plates that make food visible and adapt to food preferences.

For more information and support on dementia and eating / drinking, visit:

• Dementia UK
• Alzheimer’s Society

Remember the person

• Their likes and dislikes.
• Provide photos, pictures and momentos to help remember.
• Talk about special occasions.

Smile

The person will notice:

• Your emotional state
• Your body language
• Tone of voice

Slow down

• Provide care in a relaxed manner.
• It’s ok for the person to do things for themselves.
• Keep it simple.

Help with orientation

• If they forget, remind them who you are.
• Remind of daily routine.
• Use cues – words, signs, pictures.

Communicate clearly

• One point at a time.
• Make sure glasses and hearing aids are clean and working.
• Take time to understand.

Step back

When the person is angry

• Keep yourself safe – have a safety plan.
• Try and work out why the behaviour happened.
• Try again later.

Reduce noise (if causes agitation)

• Stop and listen.
• Reduce conflicting noises – TV, radio, children.
• Avoid overstimulation – crowds, shopping centres.

Don’t argue (if possible)

• Go with the flow.
• Acknowledge and respect what the person is saying and doing.
• Telling them they are wrong may have a negative effect.

Engage and encourage

• Get the person started with a meaningful activity.
• Set activities up to succeed.
• Thank them for assisting you and themselves.

Distract

• Talk about their life.
• Give then something to do.
• Provide a relaxed environment.

Talk with others

• Develop support networks.
• Talk about what has worked and what hasn’t.
• Record what you did – journal or diary.

Be aware of sudden changes

• Look for a reason – pain, dehydration, infection, constipation.
• Contact your GP if you are concerned.

Your GP can offer advice, support and refer you to other health and care services to help manage and support dementia, including the Frailty Nurse Practitioners (FNPs).  FNPs are available to provide a full holistic assessment as well as support and advice for both the person living with dementia and their carer / family.  Please ask you GP to refer to the ICCT (Integrated Care Co-ordination Team) for an FNP assessment.

Social Service Central Advice and Duty Team (CADT) provide support and advice to people experiencing difficulties managing dementia. Call 0151 606 2006.

Talking Together Wirral provide free NHS counselling services that you can self-refer to. Visit www.talkingtogetherwirral.org Call 0151 649 1859 (Monday-Friday 9am-5pm).

NHS Cheshire & Wirral Partnership 24hr crisis helpline is available for deteriorating mental health or emotional conditions, including dementia, that require immediate advice or response, 24 hours a day, 7 days a week.  Call 0800 145 6485. It is not for general health conditions which should be referred to NHS 111 or your GP practice unless deemed to be life threatening then to 999 emergency service.

Alzheimer’s Society is a charity supporting people with dementia and carers. Visit www.alzheimers.org.uk or call 0300 222 11 22.

Alzheimer’s Society website and publications – Visit www.alzheimers.org.uk/get-support/publications-factsheets/full-list for a wide range of publications and information online to help people understand dementia and the support available.

Dementia UK is a charity that provides Admiral Nurses for families affected by dementia. Visit https://www.dementiauk.org or call 0800 888 6678.

National Dementia Helpline 0333 150 3456 Freephone number open seven days a week, providing instant access to advice and information for anyone affected by dementia.

Dementia Connect – A new personalised support service from Alzheimer’s Society to talk to you about what you need and connect you to the right support for you. Call 0333 150 3456; visit www.alzheimers.org.uk/dementiaconnect; or email [email protected]

Age UK Wirral offer a variety of support for people diagnosed with dementia and carers, including Admiral Nurses. Call 0151 482 3456 or visit www.ageuk.org.uk/wirral

WIRED are a local charity that provide support services for carers. Call 0151 670 0077 or visit www.wired.me.uk

Dementia Together Wirral organise memory cafés and activities across Wirral. Call 07511777126 or visit www.dementiatogetherwirral.org

Side by Side matches you with a volunteer from Alzheimer’s Society who will support you to keep doing the things you love. Call 0151 426 4433.

Talking Point is 24-hour online support and discussion for anyone affected by dementia.  You can ask questions and get practical advice and emotional support from other people who have a shared experience. www.alzheimers.org.uk/get-support/dementia-talking-point-our-online-community

Healthwatch Wirral have created a local health and care service directory. The directory can be accessed here: www.healthwatchwirral.co.uk/signposting

The Live Well Directory has information on care and support services, activities and information covering Wirral and Liverpool. Visit www.thelivewelldirectory.com

Alzheimer’s Society Dementia Directory – www.alzheimers.org.uk/find-support-near-you/dementia-directory-privacy-policy our dementia services directory with over 3,500 listings of local information, support, and services. Simply enter a postcode or location to find services nearby.

• Carers First pocket guide
• 16 Things I’d Want If I Got Dementia
• Detect and manage delirium wheel – are they different today?