Dr Emma Wolverson
Research Lead at Dementia UK and Senior Lecturer in Ageing and Dementia,
The University of Hull, UK
Dr Karen Harrison Dening
Head of Research and Publications, Dementia UK
In the UK, there are an estimated 700,000 unpaid carers of people with dementia.3 Dementia is a progressive condition and can have a significant impact on the health and wellbeing of family members.
The importance of interventions after diagnosis
Families affected by dementia often require support from a complex matrix of health and social care services.2 For many families, concerns arise very early on when they notice that ‘something is not right’ before a diagnosis of dementia is given.
Once a diagnosis has been made, family-centred approaches can help to clarify issues and provide a structure to unite families, while still recognising the individuality of the person with dementia.
Case management in dementia care
Such relationship-centred approaches are best delivered through case management.2 Case management is a collaborative process led by a case manager to both deliver care and coordinate care from others, such as a district nurse or social worker. It involves triage, assessment, planning and review of care.
Case management has a long and successful history of supporting people with long-term conditions, such as severe mental illness and brain injury. In dementia care, case management is a relatively new concept by comparison and can provide consistency of specialist services and support to a family affected by dementia to reduce the fragmentation of services often experienced to enable receipt of the right care at the right time.2
Admiral Nursing aims to work with more complex cases and with high-level needs.
In a Cochrane Review, additional benefits were found to adopting a case management approach in dementia. These include reducing inappropriate admission to hospital, delaying a transition to care homes, reducing the length of stay in hospital and reduction in behaviour disturbance.4
A case management approach may increase the use of community services initially; however, it has demonstrated cost savings within the first year.5
Specialist nurse case management model
The Admiral Nursing case management model was established in the UK to uniquely join the different parts of the health and social care system and enable the needs of family carers and people with dementia to be addressed in a coordinated way.6
While Admiral Nurses (specialist dementia nurses) work across a variety of NHS organisations (primary, secondary, acute and community care) as well as in social care, care homes and hospice settings. Case management is central to their role.
Impact of specialist dementia nurses
Admiral Nursing aims to work with more complex cases and with high-level needs. They are required to engage with all local services and agencies to ensure families with less complex needs receive an appropriate level of care. Admiral Nurse case management ensures families affected have access to support across the life course of the condition. Evaluations of Admiral Nursing services show clear benefits and outcomes to both families affected by dementia and to health and social care organisations.
 Source: Luengo-Fernandez, R. & Landeiro, F. (in preparation). The Economic Burden of Dementia in the UK.
 Harrison Dening, K., Aldridge, Z., Pepper, A. & Hodgkison, C. (2017) Admiral Nursing: Case management for families affected by dementia. Nursing Standard. 31(24): 42-50.
 Lewis,F., Karlsberg Schaffer, S., Sussex, J. et al. (2014) The Trajectory of Dementia in the UK- Making a difference. Available from: https://www.alzheimersresearchuk.org/wp-content/uploads/2015/01/OHE-report-Full.pdf [Accessed: 2 February 2023].
 Reilly, S., Miranda Castillo, C., Malouf, R. (2015) Case management approaches to home support for people with dementia. Cochrane Library. Available from: https://www.cochrane.org/CD008345/DEMENTIA_casemanagement-approacheshome-support-peopledementia [Accessed: 2 February 2023].
 Vroomen, J.M., Van Mierlo, L.D., van de Ven, P.M. et al. (2012) Comparing Dutch Case Management care models for people with dementia and their caregivers: The design of the COMPAS study. BMC Health Services Research. 12:132. http://www.biomedcentral.com/1472-6963/12/132
 Rahman S, Dening KH. The need for specialist nurses in dementia care. Nurs Times. 2016 Apr 20-26;112(16):14-7