Practitioners situate dementia in a family context but do not yet use a disablement model of dementia which might reduce tensions about early diagnosis and the disclosure of the diagnosis. The term diagnosis could usefully be replaced by recognition, to aid this shift in model. Service gaps may emerge or widen if earlier diagnosis of dementia is pursued as a policy objective.
While CMHNs may have a key role in responding effectively to the newly identified needs of people with early dementia, other nurses working in the community are likely to encounter people with early dementia. In the context of a policy objective to identify people with dementia earlier, all community-based nurses should be able to recognize the possibility of dementia and support those undergoing referral or assessment. Their confidence in doing so should be enhanced by continued professional development. Training in dementia recognition, involvement in and membership of primary care teams supporting people with dementia should not be confined to CMHNs. Nurses who regularly encounter the general population of older people may be well placed to provide continuity of support for those who may, or may not, have cause to suspect that they or their relatives have early dementia.
In health and social care in the UK there is increasing emphasis on the need to recognize mental health problems as early as possible, particularly among older people. Both research and policy have identified the difficulties caused by delayed or late awareness of dementia and depression, and the potential benefits of their recognition at earlier stages. This article draws on the output from a series of multidisciplinary dementia workshops to explore the implications of such a shift in practice for interprofessional working. At a time when core specialist mental health teams have been identified as a way forward for dementia care in the UK, this discussion sets out four key bipolar categories derived from the workshops which may be useful in planning, implementing and reviewing the development of services and the drawing of professional responsibilities. These categories are opportunistic recognition versus population screening; referral and responsibility; key working and team working; generalist versus specialist roles. From this discussion we note a further four determinants which in our view need to be addressed in order to promote positive developments in dementia services: learning processes, resource implications, professional capacity and confidence and the impact of new teams on broader systems.
The present article explores professional attitudes to family members supporting an older person newly diagnosed with dementia. It draws on professional perspectives derived from a series of 24 multidisciplinary workshops held in the UK, analysed using a typology developed by Twigg in 1989. The primary care workers' understanding of carers' needs and circumstances fitted best with Twigg's models of carers as resources and co-workers, but showed limited awareness of carers' responses and attitudes to caring. It is argued that professional assumptions about family members' roles when dementia is recently recognised among older people expand definitions of carers, but still confirm their instrumental role.
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