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Dementia United aims to improve and standardise the Greater Manchester offer of support and services for people living with dementia, their carers and those at risk of developing dementia who might benefit from a brain healthy lifestyle. To learn more about our pathway and how to use it click 'read more'

Overview and how to use the pathway

We anticipate that this resource will contain information which will be beneficial for members of the public, people affected by dementia, health and social care staff, provider organisations and commissioners.

Who it's for

The Pathway contains 75 recommendations and quality standards drawn from existing services, national guidelines and the things people living with dementia and their care partners believe have a positive impact on their health, wellbeing and ability to live well with dementia.

Recommendations are available to search by stages of the NHS England 'Dementia Well Pathway'. Each recommendations includes:
<ul>
 	<li>A priority status, these are:
<ul>
 	<li>Required to provide: These recommendations are requirements according to United Kingdom guidelines and all localities should provision for these.</li>
 	<li>Should be provided: Although United Kingdom guidelines do not list these recommendations as being a requirement, sufficient evidence exists to suggest that these recommendations should be provisioned.</li>
 	<li>Ambition: Emerging evidence suggests that these recommendations will benefit those living with dementia, their care partners or those at risk of developing dementia.</li>
</ul>
</li>
 	<li>a narrative, with an explanation of what the recommendation may mean for people affected by dementia</li>
 	<li>Local, Regional (Greater Manchester-wide) and National services which address this recommendation (see below for more information on local service offers)</li>
 	<li>Evidence we've gathered which backs up the recommendation</li>
 	<li>Best practice examples of how this recommendation has been actioned to support people living with dementia and those who care for them</li>
</ul>
These recommendations are designed to be fluid, meaning that recommendations may be added or updated as new evidence becomes available.

What the Pathway contains

Recommendations and local service offers are presented here under the pillars of the NHS England ‘Dementia Well Pathway’:

<ul>
 	<li dir="ltr">
Preventing well: Ground-breaking research suggests that 40% of cases of dementia can be prevented or delayed by implementing changes in the way we live our lives. Therefore people should be made aware of and have access to services which can support their brain health. You can find more information on brain health here: <a href="https://brain.health/" target="_blank" rel="noopener" data-saferedirecturl="https://www.google.com/url?q=https://brain.health/&amp;source=gmail&amp;ust=1643962506882000&amp;usg=AOvVaw1n4Y2xm0NjhwRt6vmxKcxv">https://brain.health/</a>
</li>
</ul>
<ul>
 	<li dir="ltr">
Diagnosing well: It is important that those presenting with a cognitive impairment receive a timely and accurate diagnosis alongside tailored advice and signposting to post diagnostic support.
</li>
</ul>
<ul>
 	<li dir="ltr">
Supporting well: From the time of diagnosis, people diagnosed with dementia and their care partners should be provided with access to safe high-quality health and social care.
</li>
</ul>
<ul>
 	<li dir="ltr">
Living well: People with a dementia diagnosis can live well within a safe and accepting community, sharing their strengths, and receiving support to keep doing the things that they love.
</li>
</ul>
<ul>
 	<li dir="ltr">
Dying well: People living with dementia are supported to die with dignity in a place of their choosing.
</li>
</ul>
Each pillar contains a number of quality standards and recommendations, alongside a narrative explaining what this means for people affected by dementia, evidence and best practice resources and service offers from Greater Manchester’s Localities (where these are available).

What are the pillars of the NHS England ‘Dementia Well Pathway’

We have worked with service providers and commissioners in the 10 boroughs of Greater Manchester to provide a list of local services linked to these recommendations.
Most boroughs have provided local services linked to all ‘Required to provide’ recommendations. We are still working with commissioners and service providers, in order to establish available services and support offers with regards to the ‘Should be provided’ and ‘Ambition to provide’ recommendations.
Locality offers and recommendations will be reviewed and updated regularly by a panel with representation from all 10 boroughs of Greater Manchester, key stakeholders and partners including people with lived experience of dementia.

What is available in the area where you live?

You will be able to search the pathway in a number of ways.
You can search our entire list of 75 recommendations in the following ways:

<ol>
 	<li dir="ltr">
If you are searching for information on something specific, for example you may be looking for singing for the brain community groups, or help with receiving a diagnosis, you can type a word into the search bar (i.e. ‘singing’ or diagnosis’). Then, by clicking ‘search,’ the website will show you a list of all the recommendations related to your search word.
</li>
 	<li dir="ltr">If you would like to view several recommendations which are relevant to your specific situation (for example all recommendations relevant for someone who has recently received a dementia diagnosis), you can use our survey. To do this simply click the 'click here' button next to the box which says: "Use our questionnaire to get recommendations". This will guide you through a small number of questions about you and your circumstances which will then direct you to the relevant recommendations.</li>
 	<li dir="ltr">
You can also search our recommendations by the stages of the NHS England ‘Dementia Well Pathway’ by clicking the ‘Preventing well’, ‘Diagnosing well’, ‘Supporting well’, ‘Living well’ and ‘Dying well’ icons below the map. This will display all recommendations linked with the stage of the pathway you have selected.
</li>
</ol>
Searching in any of these ways will highlight the recommendations related to your specific search. All our recommendations include information and evidence relevant to the individual recommendation, they also include links to national and GM-wide support related to that recommendation.
It is our ambition to work with all 10 Greater Manchester boroughs to help them provide offers of support for each of our recommendations, however, currently not all recommendations will have local support offers.
If you would like to search specifically for support available in your borough, you can search our recommendations in one of the following ways:

<ol>
 	<li dir="ltr">
Enter your postcode in the box which reads "Search by postcode", the website will then suggest what borough you should be searching in, click the borough name when it appears, then click ‘search’. This will take you to recommendations specific to your borough.
</li>
 	<li dir="ltr">
If you would rather select your borough from a map of Greater Manchester, scroll down to the image of the Greater Manchester Map and click on the borough you wish to view. This will take you to recommendations specific to your borough.
</li>
</ol>
You can return to the main search page at any time by clicking the text which says 'Return to search' in the top left-hand corner of the website.

How to use the pathway

Research suggests that looking after your brain can lower your risk of developing brain diseases such as dementia—meaning it may be possible for you to delay or even prevent the onset of dementia.
There's good evidence that a healthy lifestyle can help reduce your risk of developing dementia when you're older.
A healthy lifestyle can also help prevent cardiovascular diseases, such as <a href="https://www.nhs.uk/conditions/stroke/">stroke</a> and <a href="https://www.nhs.uk/conditions/heart-attack/">heart attacks</a>, which are themselves risk factors for <a href="https://www.nhs.uk/conditions/alzheimers-disease/">Alzheimer's disease</a> and <a href="https://www.nhs.uk/conditions/vascular-dementia/">vascular dementia</a> (the 2 most common types of dementia).
People who have dementia caused by stroke may be able to prevent future declines by lowering their risk of heart disease and stroke. Even if you don't have these known risks, your overall health can benefit from these strategies:
<ul>
<li>Don't smoke.</li>
<li>Stay at a healthy weight.</li>
<li>Get plenty of exercise.</li>
<li>Eat healthy food.</li>
<li>Manage health problems including diabetes, high blood pressure, and high cholesterol.</li>
<li>Stay mentally alert by learning new hobbies, reading, or solving crossword puzzles.</li>
<li>Stay involved socially. Attend community activities, church, or support groups.</li>
<li>If your doctor recommends it, take aspirin.</li>
</ul>

Prevention interventions to reduce cognitive decline

Prevention interventions to reduce your risk of developing Mild Cognitive Impairment dementia

Presenting with early signs of changes

Preventing Well

It is important that those presenting with a cognitive impairment receive a timely and accurate diagnosis of dementia alongside tailored advice and signposting to post diagnostic support.
Dementia can be difficult to diagnose, especially if your symptoms are mild.
If the GP has been able to rule out other causes for your symptoms, they'll refer you to a healthcare professional who specialises in diagnosing dementia, such as:
<ul>
<li data-block-key="y7h16">a psychiatrist with experience of treating dementia (an old-age psychiatrist)</li>
<li data-block-key="b5q7b">a doctor specialising in elderly care (a geriatrician)</li>
<li data-block-key="3kjpc">a doctor specialising in the brain and nervous system (a neurologist)</li>
</ul>
The specialist may work in a memory clinic with other professionals who are experts in diagnosing, caring for, and advising people with dementia, and their families.
<h3 data-block-key="zb8z4">Help while waiting for your appointment</h3>
<div class="nhsuk-inset-text">
Find out more about memory assessments, how to get support and how to take care of your wellbeing while waiting for your appointment from the <a href="https://www.nextsteps.org.uk/">Next Steps website</a>.
</div>
Below are our recommendations for this stage of the dementia pathway.

Pre-diagnosis - how to proceed if you notice memory or thinking problems

Memory assessment services - what to expect from your visit

Receiving a dementia diagnosis

Receiving an MCI diagnosis

Diagnosing well

Post diagnostic support covers a range of services and information available to help those diagnosed with dementia and their carers, both immediately after diagnosis and onwards.  It must be on-going and flexible to adapt to the changing needs of the person, carer and family as the disease progresses.  For many carers, and for those with Young Onset Dementia, this can also include employer awareness and support.
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Post diagnostic support includes many different options in many different settings – in primary care, in memory assessment services, in the community and is provided by many different agencies within the NHS, Local Authorities, charities and voluntary agencies.  It includes things such as signposting to up to date and locally available services, medication and medication reviews, carer support, cognitive stimulation therapy, dementia friendly communities and so on – whatever helps those diagnosed with dementia and their carers to live as well as possible for as long as possible with their condition.
</div>
</div>
</div>
</div>
</div>
From the time of diagnosis, people diagnosed with dementia and their care partners should be provided with access to safe high-quality health and social care. Below are our recommendations for this stage of the dementia pathway.

Planning for your care

Getting support with home life, lifestyle and finances

Getting support with your health and wellbeing

Getting support in your community

Supporting Well

Dementia can affect all aspects of a person's life, as well as those around them. If you have been diagnosed with dementia, it's important to get the right support to help you living well with dementia. 
You need to remember that:
<ul>
<li data-block-key="fylbm">you're still you, even though you have problems with memory, concentration and planning</li>
<li data-block-key="35kal">everyone experiences dementia differently</li>
<li data-block-key="7uap9">focusing on the things you can still do and enjoy will help you to stay positive</li>
</ul>
With the right help and support when you need it, many people can, and do, live well with dementia for several years.
People with a dementia diagnosis can live well within a safe and accepting community. They can also share their strengths, and receive support to keep doing the things that they love. Below are our recommendations for this stage of the dementia pathway.

Getting post-diagnostic support if you are living with a Dementia diagnosis

Getting post-diagnostic support if you are caring for someone with a diagnosis of Dementia

Health and social support

Living Well

<a href="https://dementia-united.org.uk/">Dementia United</a> believes that people living with dementia need to receive the right support to die with dignity in a place of their choosing. Basically, a good death would involve being treated as an individual, with dignity and respect, without pain and other symptoms. It also involve being in familiar surroundings and in the company of close family and friends.
People with dementia should be involved in decisions about end of life care wherever possible. However, as dementia advances, in many cases, people living with dementia may loss capacity. With this purpose in mind, decisions need to be made on behalf of the person with dementia to the best of their interest.
Advanced planning for end of life care is vital. They let the family and healthcare professionals know the future wishes for the end of life care. At present, taboos about discussing death and poor understanding of dementia mean that these conversations do not take place between people with dementia, families, friends and health and social care professionals. Accordingly, people with dementia should be supported to use their rights, under the Mental Capacity Act in England and Wales.  They need to identify whom they want to make decisions and any treatments they would not want.
Below are our recommendations for this stage of the dementia pathway.

SEARCH

STAGES OF THE DEMENTIA CARE PATHWAY