Dementia And The Elderly: Clinical And Social Implications For The Future - Term Paper Example

?Dementia and the elderly: clinical and social implications for the future. Introduction This paper considers the prevalence of late-onset dementia affecting elderly people in the world. It outlines the key features of this serious disease and examines the world’s prospects for dealing with its clinical and social impact. It takes account of medical advances that are currently in the pipeline, and of the many volunteers and unpaid carers who devote so much time to looking after the emotional and physical needs of elderly dementia sufferers. Finally it considers also the currently inadequate financial planning for the future in this area, and concludes that prospects for dementia sufferers and their carers are uncertain, both in advanced economies and in the developing world. Technical details The term “dementia” refers to a range of conditions in which the memory function is impaired, resulting in difficulty for patients in reasoning, in communication with others, and as time progresses, increasing difficulty in coping with the demands of everyday life (Banerjee & Wittenberg, 2009). Alzheimer’s disease accounts for the majority of late onset dementia (defined as dementia diagnosed at age 65 or over), but there are other forms of dementia including vascular types and some forms related to other diseases. It is difficult to draw a clear line between these various types of dementia, since the symptoms are similar and exact diagnosis is only possible through post mortem examination of the brain. There is also a form of dementia that occurs early, and there are further types of dementia caused by preventable causes such as head trauma, alcohol abuse and HIV (McMurtray et al, 2006). In developed countries the prevalence of dementia is about 1.5% among 65 year olds and this rises with age so that among 80 year olds the prevalence is about 30% (Gotz et al, 2006). Early symptoms include forgetfulness and emotional or personality changes that are often mistaken for normal ageing and many sufferers go undiagnosed for years until more obvious symptoms like severe memory problems or difficulty with language prompt sufferers or their families to seek medical help. In recent years there has been more awareness of the early signs of dementia, with a diagnosis of Mild Cognitive Impairment (MC1) now often being seen as a precursor to Alzheimer-type dementia (Lyketsos et al., 2002). Impact on society Dementia renders a person incapable of carrying out his or her normal work and impacts severely on that person’s relationships with others. There is therefore an immediate economic cost to the sufferer and his or her family. As the majority of the sufferers of dementia are elderly, the burden of care often falls on their own elderly spouse, or on adult children, particularly women, many of whom have to care for their own teenage children while at the same time looking after elderly parents suffering from dementia. This adds a considerable emotional and financial burden, affecting the quality of life of caregivers who have been called “the invisible second patients” (Brodaty and Donkin, 2009, p. 217). Positive views on future prospects In a study which analyses the trends in England, Banerjee and Wittenberg (2009) developed a model to trace what the costs and benefits would be of increasing early dementia diagnosis and interventions systems. They found that if even 10% of dementia patients could be diverted from residential care then there would be a net gain in the costs associated with treating this condition, since the burden on the health service of treating such people at home is much less than the full time care costs. According to Banerjee and Wittenberg (2008, p. 748) these kinds of improvements “seem very likely to be achievable” since good support for family carers can delay admission to residential care for several years. This early intervention approach also brings a better quality of life for dementia patients, and so there are sound social reasons for pursuing such a policy. In many cases, and particularly in the early stages of dementia, many individuals live relatively contented lives thanks to the support of their families, and various community services including mental health nurse support, day-care, respite care and membership of voluntary organisations who set up community based activities for dementia sufferers and carers. Carers who are motivated by traditional family values and care for elderly relatives out of love will often resist the offer of residential care for their relative, preferring to keep the family together and this can strengthen family bonds and shared values in some cultural groups (Brodaty and Donkin, 2009). As scientific understanding of the pathogenic mechanisms which underlie dementia begins to grow, there are some scientists who are hopeful that in the next decade or so it may be possible one or more of the many drug treatments currently in trials will prove to be successful in treating at least some types of dementia. For Alzheimer’s disease in particular it is thought that tailored drug treatments may soon be able to at least slow down the progress of the disease, even though they may not be able to cure it or reverse damage which has already occurred (Gotz et al., 2006). Negative views on future prospects There have been some studies which attempt to predict the future cost of dementia disorders and these have produced some rather alarming figures. According to Wimo et al. (2006) the global cost of dementia disorders in 2003 was in the order of 156 billion US dollars, with a worldwide prevalence of around 27.7 million sufferers. Most of these costs are in advanced economies, but the predicted increases in longevity across the globe mean that over time other economies will also be affected, creating a great and increasing challenge for industrialised and developing countries alike. Demographic trends have been evident for many years now, but there are no signs that either advanced or developing economies are equipped to deal with the scale of investment necessary to ensure that dementia sufferers and their families are supported to an adequate level. A Canadian study by Hux et al. (1998) noted that the cost of caring for patients with Alzheimer’s disease increased with disease severity, with unpaid carers in families bearing the main cost in early stages but as the disease progresses institutionalisation is very common, and represents the largest, but not the only cost component. Dementia patients who live in a care home still make use of General Practitioner services and they have hospital admissions and on-going health needs alongside the dementia. Altogether, the societal cost of dementia is very considerable and set to rise. One early American study by Hay and Ernst (1987) estimated that the total net cost to American society for the diagnosis, treatment and long term care of Alzheimer’s disease sufferers amounted to between 27.9 and 31.2 billion US dollars. This takes account of indirect costs such as care provided by families or volunteers, and shows just how high the impact of the disease is on society as a whole as well as on sufferers themselves. These figures, coupled with rising demographic trends point to a situation that is fast becoming unsustainable. Even if treatments for the disease do emerge in the near future, the burden of paying for them on top of the costs of caring for the millions of people who already have dementia will cripple even the most buoyant economy. There is evidence, too, that many caregivers do not currently access services for people in their role, suggesting that there is still a long way to go before societal awareness of support needs reaches its peak (Brodaty et al, 2005). In fact the majority of people appear to be in denial about the reality of dementia and in the view of Brodaty et al (2005) there is still an unhelpful stigma attached to the disease which causes much suffering and prevents many people from seeking help that would improve their quality of life. All the signs point to a huge epidemic of dementia that will soon overwhelm the resources of National health systems across the world. Conclusion It is clear from this short analysis that dementia is a serious issue which is beginning to present very large challenges to individuals, communities and national administrators. On the research side there are promising signs that better treatments might be available in the near future, but there is a long way to go before drug trials are completed and new drugs are approved for use. Quite apart from this there is a burgeoning need for care and support both at home and in institutions and there is every sign that the economic impact of dementia is only just beginning to become apparent. As economic pressures affect families also, the likelihood is that more and more elderly dementia sufferers will require institutionalised care, and this will increase the financial burden all the more. Overall therefore, the prospect for the dementia sufferers of the world and their carers in the near future looks uncertain. It may be possible to sustain the level of care that is currently offered, but as the demographics change, and larger numbers of people become elderly and suffer dementia, it is by no means certain that governments will have the will and the financial ability to increase resources accordingly. References Banerjee, S. & Wittenberg, R (2009) Clinical and cost effectiveness of services for early diagnosis and intervention in dementia. International Journal of Geriatric Psychiatry 24(7), 748-754. doi: 10.1002/gps.2191. Brodaty, H., Thomson, Cathy, Thomson, Claire & Fine, M. (2005) Why caregivers of people with dementia and memory loss don’t use services. International Journal of Geriatric Psychiatry 20 (6), 537-546. Brodaty, H. & Donkin, M. (2009) Family caregivers of people with dementia. Dialogues in Clinical Neuroscience 11 (2), 217-228. Gotz, J., Mittner, L. & Schonrock, N. (2006) Alzheimer’s disease and frontotemporal dementia: prospects of a tailored therapy? 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