Dementia is a progressive and debilitating neurodegenerative condition leading to a negative impact on older people’s quality of life and daily activities. Recently, there is interest in the bidirectional association between dementia and poor oral health. Research suggests higher incidence of gingivitis, plaque, periodontitis, mucosal lesions, reduced salivary flow and tooth loss in patients with dementia. Maintaining good oral health is visionary with disease progression and challenging behaviors. Good oral health could be achieved through appropriate oral care advice and education to carers/families with regular professional dental care. Standards of living are improving with increased life expectancy leading to an ageing population (1) which constitutes a risk factor for dementia, with a huge economic and social burden. Family members are negatively impacted, especially with disease progression and behavioral changes (2). Dementia is characterized by progressive cognitive impairment. Patients suffering from dementia usually present with dental conditions influenced by their impaired self-care, polypharmacy, co-existing morbidity, malnutrition, xerostomia, dysphasia, and dysphagia (2). Recent research suggested that dementia patients have higher incidence of caries, retained roots, and orofacial pain (3). There is increased risk of plaque, gingival bleeding, periodontal pockets, xerostomia, reduced salivary flow, stomatitis and oral lesions (3).

Aim: Improve staff's confidence and abilities to care for patients on end-of-life (EOL) pathways. This project ran across Stanley and Pembleton the acute dementia wards. During reflective meetings, staff identified a need around improving confidence in working with people at end of life (EOL). Staff voiced wanting to feel they had done the right thing, despite not being a specialist EOL ward. Staff’s views regarding what they needed to help improve their confidence in working with people at end of life were used to develop training, information and support around the following topics: -Increasing Knowledge and Skills around EOL -MDT Working and a ‘joined up approach’. Providing an appropriate environment and tools to guide interventions (i.e. SOP, pain identification). Tools Used: Staff discussions and feedback. Questionnaires with quantitative and qualitative responses. QI Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf. Staff report feeling more confident in their abilities to care for patients at end of life (EOL). Service level agreement in place: Mary Ann Evans hospice to offer rapid response to support ward with EOL concerns. Staff report feeling better able to access support from services during/following identifying a patient as approaching EOL. Importance of the need for a SOP identified and development has begun.

Aims By way of Quality Improvement, this project aims to identify awareness levels, deliver a brief training and thus increasing the confidence of Memory Assessment Clinicians in detecting delirium. Background People with dementia are at greater risk of delirium, and the acute confusion associated with delirium may be mistaken as part of their dementia. Despite having an estimated prevalence in care homes of 14.2% in the UK, delirium is under-recognised. Memory Assessment Clinicians may have low confidence in identifying and have low awareness of delirium despite being tasked with a triage and diagnostic role in dementia assessment. NICE has recently updated the guidelines on Delirium in March 2019 with recommendations on prevention and treatment of Delirium. Method We delivered a survey pertaining: Awareness of Delirium NICE Guidelines Confidence in spotting Delirium We used convenience sample of Memory Assessment Clinicians in Coventry. Overall, this survey was uptake by 17 clinicians. The pre training survey was done in early October 2019 and the post training survey was done shortly after the training, at the end of October 2019. A brief training comprising NICE Guidelines and using Confusion Assessment Method (CAM) was delivered. The survey is repeated post training and differences in result of level of confidence is done to measure changes. The survey assessed knowledge, beliefs, practices and confidence level regarding delirium detection. Result Pre training: 17 clinicians took part in the survey. 59% was aware that there is a delirium NICE guidelines. 12% felt strongly agree, 41% agree and 47% felt neutral in their confidence of detecting delirium. Post training: 10 clinicians took part in the survey. 50% felt strongly agree and 50% agree that they are confident in detecting delirium. Overall, the mean difference is 2 and the p value is 0.92034. we used Mann- Whitney Test to measure the difference in pre and post training which showed not significant at p < 0.05. Participants felt that the training was useful and relevant to practice. Conclusion This study showed our clinicians have a good basic knowledge in detecting delirium. As a result of this study, we have created ‘Delirium checklist’ and Confusion Assessment Method (CAM) to be used during duty work. We also feel that the majority of delirium cases referred to us comes from the community base, thus our next step of the project will be to involve educational work with the community care home.

In 2019 there were an estimated 50 million people living with dementia globally [1]. There is a strong need for therapies and interventions that ameliorate symptoms and improve quality of life for individuals living with dementia. Whilst there is evidence for the effectiveness of music interventions in long-term care settings, such as nursing homes, less research has been conducted into their effectiveness in acute settings. It is important to build up an evidence base of effective interventions in acute settings specifically, which often see the most challenging cases of symptoms associated with dementia. This systematic review represents a novel examination of the literature on music as an intervention for dementia patients in acute settings. A database search identified 204 papers, of which 10 studies satisfied criteria and were reviewed. A quality assessment framework was applied, with the majority of studies scoring highly (above 80%). The review identified 4 areas where music interventions have been utilized to improve outcomes for dementia patients in acute settings: mood and wellbeing, behavioral and psychological symptoms of dementia, and use of inpatient resources. The most reliable evidence is currently within mood and behavior domains reflecting positive change following music intervention for inpatients. Limitations, clinical implications and recommendations for future research are discussed.