The challenge and strategy tools

This challenge and strategy tool is designed for social prescribers supporting GP surgeries & local authorities… or anyone new to dementia.

We have created this tool using the knowledge of a co-creative group of Social Prescribers we have worked with across this study. The strategies we list have been recommended by those working as social prescribers.

At the time of publishing social prescribing services are by no means consistent across the UK but we have included advice from social prescribing practitioners and dementia research teams to help as many people as possible.

If you have any suggestions or additions for this tool please do get in touch. To contact the UK research team, please email: [email protected] 

Prioritise referrals in a matter of urgency. Urgency could be risk of homelessness, no food, no gas and electric.
High priority could be struggling financially (because of lack of attendance in place). Moderate could be an interest in social groups or activities

You may want to explore whether legal arrangements are in place, such as lasting power of attorney or who gave consent in the referral process. This will clarify who you will be having discussions with and most importantly who will have a final say in any course of action.

Social prescribers often report feeling “Jack of all trades, masters of none”. You may want to consider signing up to newsletter and mailing lists of different/relevant organisations such as the National Academy for Social Prescribing.

Getting in touch at intervals with organisations, to see if there is anything new that you have missed, is also helpful.

You may want to consider posting a letter via regular mail. Not only are older generations more familiar with regular mail than e-mail, but also it is best for people living with dementia to have a physical/readily available reminder about the appointment.

Whilst operating in a person-centred approach is key to social prescribing, it is equally important not to overlook the carer and how their health and wellbeing also affects the person living with dementia

At the same time, it is very hard, especially when people reach a certain age, to know what normal forgetfulness or normal changes in behaviour is and what is actually a dementia concern.

It is advised to refer the patient for a memory assessment, to initiate the process of getting a diagnosis, because that is the starting point to make them eligible for further support. Remember, no diagnosis equals no adequate support in place

Sometimes, it might be helpful to use terminology a little bit differently to kind of fit the person’s needs, to kind of ease them in. For example, a patient may say that all they need is a cleaner. So instead of presenting yourself as a social prescriber, try to say you are there for the purposes of cleaning (https://www.alzheimers.org.uk/blog/lying-to-someone-with-dementia). Ultimately, an initial “no” may not be definitive, so do not close the referral at first rejection, but try a couple of times more

You may want to go back to the person who originally referred the patient (e.g., GP) to double check.

Sometimes, they might even be unaware or unaccepting of underlying needs, especially when it comes to mental health. It is important to remember that people with dementia (and their families) experience anxiety, depression and suicidal thoughts/ideation much more frequently that people without dementia. These symptoms (and subsequent support need) might be trickier to identify than physical health and social needs. 

There are strategies to check these things without being intrusive, for example, by asking for a cup of tea and checking the quality of milk or glancing inside the fridge when opened

It might be helpful to invite them to tell their background story, what has been happening for the past six months. Something important will come up. Some social prescribers find a technique called motivational interviewing helpful: https://motivationalinterviewing.org/understanding-motivational-interviewing

You may find something exciting and new yourself. Establishing links with people in the community will facilitate future referrals too.

Remember to look for evidence on scientific/reliable sources. For example, on https://scholar.google.com/ , you can input the main words such as “exercise” and “dementia” to identify published literature in this area

Common barriers include mobility/transport, finance, and bereavement. If you know the barriers, you can work to address them. In some instances, e.g., if the patient lacks confidence to make that first step in joining an activity, If you have capacity, you may want to consider accompanying the person during their first session

Questions like “how long ago did you try? What’s different now? Would you be against trying that again?” can help you explore their preparedness. Suggestions like “Let’s have a little look at amending that, adapting it, adapting it slightly” can win their cooperation. Alternatives like “you can’t do XY you said, but could you do a B&C. What does that look like? Let’s have a look and try” can challenge their resistance.

For example, a person living with dementia from an ethnic minority might revert back to a time where mixing with other cultures was not appropriate/common, so they might be resistant to engage in a dementia café where most attendees are not from their community. Consider demographic factors and gender roles as well.

Social prescribers report that men from older generations may be hesitant to ask for help. Some people do not consider themselves to be carers. Ideally, you may want to address culture by asking your patient about religion/ethnicity/gender identity.

Just be aware that these may be sensitive topics. It is also important not to assume that all people from a specific community will want to attend culture-specific activities/groups, and prefer mixing with others

This will act as a reminder but also prompt action planning. To safeguard you, it may be also helpful to check with them ongoingly that you have their consent and to record in writing whether the patient has declined anything

On the contrary, control is taken away from the person if things are left unaddressed and something has to be put in place as an emergency. Some strategies that work to make patients empowered are asking them how they would like you to communicate with them, giving them options (e.g., three links to activities), asking them to check which one they would like to engage with versus referring them directly

These are all viable venues where to present cases to reflect on practice and to find support on those type of cases that might be difficult.  It is important to have a system in place to support you emotionally, as social prescribers have often reported getting upset, in particular with difficult cases and when they work in isolation from home

Include contacts from this organisation in the patient’s plan. Share with the organisation the plan that you have created with the patient, client’s information and everything that you have done (with their consent).

Let the organisation take over. Agree with the organisation that if the patient needs further social prescribing, they could get in touch with you directly and you could just step back in. This strategy should reduce your and your patient’s anxiety about discharge

Some elements of trainings that social prescribers have found helpful are what dementia looks like, how it is potentially going to progress depending on type, what to do if a person with dementia goes missing (https://www.scotland.police.uk/what-s-happening/missing-persons/the-herbert-protocol/), and strategies to work around memory impairment (e.g., have memory books, have things photographed, write key things/reminders on post it notes, try not to move things around in the home)

Social prescribers have reported that in the current status of services, it is difficult to embed specialism in social prescribing, as social prescribers are required to support a diverse range of populations. However, if you have a special interest in dementia and want to invest in professional development, you may want to consider courses/programmes that give you accreditation (diplomas, certificates) to boost your CV and open up new horizons