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AimsThis audit aimed to assess to what extent patients being referred for assessment of memory problems were receiving appropriate screening for reversible causes. We considered the blood tests recommended by the National Institute for Clinical Excellence (NICE).BackgroundResearch into ‘reversible dementias’ identified numerous common underlying causes. As a result of this NICE complied comprehensive guidance on investigations which should be performed in the initial stages of assessing patients with memory problems, ideally at a primary care level. These investigations are also crucial at the point of secondary care assessment in order to make a confident diagnosis.MethodDetails of patients referred by their GP to the Older Adult CMHT with memory problems over a one month period were collected. We then used the local laboratory database to note whether each of the eight recommended blood tests had been performed in the preceding 6 months. We measured this against an agreed standard of 95%.After the first cycle of data collection we prepared business-card sized ‘aide memoirs’ for GPs that could serve as a quick reminder. These were sent out to all GPs in the area along with a letter outlining the audit findings.ResultOverall 31 patients were included in the first cycle. 15 patients had all 8 dementia blood screens (48%), 13 (42%) had some of the recommended tests and 3 patients had no screening tests at all (10%). On average patients had 76.6% of the recommended bloods completed. The most commonly completed tests were Full Blood Count (FBC) and Urea & Electrolytes (U&Es), with blood Glucose being the most frequently omitted.In cycle 2, 20 patients were included. Of these patients, 10 had the full complement of screening bloods (50%); 8 had some tests completed (40%) and 2 patients had no screening tests complete (10%). On average 76% of tests were completed. There was an improvement in the rate of completion of both Glucose and Liver Function Tests from cycle1.ConclusionThis audit demonstrated that current practice does not meet the national standard in general. Our intervention produced a modest improvement in the proportion of patients who received a full complement of dementia screening tests, as well as increasing the rate of patients receiving a blood glucose as part of their screening. It would likely be beneficial to consider further intervention and a 3rd audit cycle in due course.

tackles not just one patient group but deals with community care as a whole, aiming to give guidance to a large variety of practitioners, from managers and health care to social workers and the voluntary sector. The early chapters dealing with broad themes are the most useful for most audiences. They are easy to understand and can comfortably be read as many of the points covered discuss best practice and common scenarios which many readers will be able to identify with. Later chapters are a more difficult read, not least because of the complexity of the subject matter. These deal both with the legislation itself and also case law, the latter of which gives a refreshing real world dimension which can be more stimulating to read.Of particular interest to readers with an interest in dementia is the new section in this edition examining the Mental Capacity Act 2005. This is thoughtfully written with good case vignettes, complemented with concise definitions and clear explanations of powers and roles.Overall the volume succeeds in being both an introduction and solid reference to guide practice in a very wide range of scenarios. I would recommend this as a reference text for policy makers of local authorities and NHS, but also for those who deal with complex issues in the community both in the social work and the NHS. Unfortunately, the later chapters are only of interest rather than practical use to those outside England as specific legislation elsewhere (including the rest of the UK) is not covered.

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This is an exceptionally important book that celebrates the interdependency of human beings, the virtues of the education of carers and the positive treatment of people with dementia. One might not glean this much merely from the title and the seeming purpose of the book as 'a guide to good practice', but one cannot judge a book by its cover. Let me explain.In describing in exquisite and profound, but necessary, detail how to create and re-create a wonderfully sensitive approach to caring for people with dementia, the authors have conveyed some of the most important research findings of the past twenty years in the context of a programme to support the strengths and well-being of people with dementia. At the same time, the programme they describe serves to educate carers to support and revel in demonstrations of their loved ones' strengths.The 'Remembering Yesterday, Caring Today' (RYCT) programme is a group-based effort that has been used successfully in many countries, involves the use of many different senses and a variety of means, to trigger long-term memories in the lives of people with dementia. The goal is to aid them in communicating aspects of their lives and experience that have been and are meaningful to them. In the process, small groups of people with dementia come to know and enjoy the company of one another at a time in their lives that would otherwise feature a rapidly shrinking social world.Psychologist Erik Erikson recognized that old age is a time when people re-evaluate the meaning of their lives and face a crisis that he described as 'integrity vs. despair'. Most otherwise healthy people face this crisis and engage in this retrospective by telling stories about their lives to younger relatives, but people with dementia are rarely afforded this opportunity due to their own word-finding problems and the less than supportive social environments in which they often live. The RYCT programme is a wonderful solution to this problem in that it uses reminiscence to engage people with dementia to tell aspects of their life stories, going back to childhood and progressing to old age. In the process, they and their carers learn a great deal and are enlivened tremendously as attested to by quoted reactions of those involved. This is a book that can add greatly to the lives of all concerned and I recommend it highly.