There Is No Point in Providing Rehabilitation for Elderly Patients with Senile Dementia - Essay Example

You're e-mail phone fax There is no point in providing rehabilitation for elderly patients with senile dementia: the resources could be used more effectively elsewhere in the healthcare system. You're Name: According to the Alzheimer's Society (2005), dementia is an ever increasing concern among the aging population living in the UK. This is well based in light of the fact that current documentation shows that every one out of twenty elderly over the age of 65 and every one in five past the age of 80 are affected by some form of dementia (Newcombe 2003). One thing that needs to be addressed in regards to dementia is the fact that the term itself does not just represent one mental illness. In fact it includes a group of brain disorders. What this research will focus on is, 'Senile Dementia' in particular and how those diagnosed with it are affected. The theories of how health care should be considered and substantiated will be discussed as well as the costs of caring for those with senile dementia. Other relative issues that this report plains to explain and include are: physiotherapy and its therapeutic qualities, whether specific rehabilitation treatments are necessary and why, and also a more personal look into the carer's who provide health and supportive services for the aging in the early stages of dementia but living independently. This report will share both sides of the argument in regards to rehabilitative services and whether or not these same resources could be better served outside of mental care facilities. Also, there will be exploration into the many types of rehabilitative services there are such as: cognitive therapies, aromatherapies, music and dance therapy, occupational therapies, psychotherapies, massage therapies, and physiotherapies (British Geriatrics' Society 2005). Senile Dementia is a medical disease that afflicts an estimated amount of nearly 700,000 elderly people who have current residency in Britain, with the leading form of Dementia being 'Alzheimer's (BBC News Worldwide, 2003). This is a median percentage of the elderly population and it poses innumerable questions as to why older citizen's mental competency is diminishing in so many, within the older generation. Also, since the 40's era there has been a marked concern that due to the rising percentile of the aging showing signs of mental incompetence (Hilton 2005), the mental health care facilities might become overwhelmed because of the increasing need for specialized healthcare services. Therefore, great minds such as 'David K. Henderson and Aubrey Lewis' decided it would be best to implement a health care strategy not solely for the elderly with dementia already in mental homes but for those within the communities as well. It was attempted to maintain an equal balance and prevent or slow the progression of dementia by meeting the needs of those that still presented with an average sound mind and the ability to care for themselves in a normal environment (Hilton, 2005). This stabilization method has proved very effective in controlling any overflow of mental illness within the hospital environment by offering preliminary treatment in the earliest onset of the disease. There is no question that Senile Dementia is one of the leading factors in regards to the degenerative changes within the cognitive processes of the brain (Bupa Health Information Team 2002). The rate with which the disease progresses depends on multiple factors but the two primary ones seem to be the type and amount of support the elderly patient receives' and that persons individual physical and emotional well being at a specific time (Alzheimer's Society 2005). Directly relating to this statement, is the proven theory that, by incorporating various tested and studied cognition techniques, utilizing the cognitive side of the mind, brain exercise can prove extremely beneficial in providing validation that exercising this major muscle can actually protect it's short term memory and even slow down the symptoms experienced from senile dementia ( BBC News Worldwide 2003). One example offering confirmation on this idea is one which involves a scientific study facilitated by Dr. Joe Verhese and his other colleagues who assisted in the observation. This experimental situation involved 469 seniors over the age of 75, none of which presented with any signs of senile dementia in the beginning stages of the study. Also, none were residing in nursing homes at the time either. This exercise involved the monitoring of each individual's life style habits over a period of 5 years. While some of the participants involved themselves in leisure activities solely for the physical aspects of well being the other participators were involved with activities that exercised the brain itself such as board games like: scrabble, and monopoly and also leisure activities such as word puzzles, art activities, reading, music and dance, all of these involved direct use of exercising the brain muscle. At the conclusion of this 5 year study over 25 percent of the participants were presenting symptoms of early stage senile dementia while the other percentile that had been associated with activities involving cognitive thinking showed no mental in-balance whatsoever. In fact there was improvement in their short term memory capabilities and logical reasoning skills. (BBC News Worldwide 2003). So, Dr. Verhese's theory provides factual data that if more cognitive therapy is implemented into therapeutic programs for the elderly suffering with an early onset of dementia, there lie's a good probability that the disease's degenerative qualities can be slowed or prevented all together. What must be kept in the forefront of the mind though is that before there can be an absolute certainty on what technique works best, the needs of the individual have to be taken under consideration. Any form of rehabilitation calls for a unique mixture of clinical, therapeutic and also, social awareness assessments that will need to be implemented in order to address all of the relevant issues relating to the patient's physical, mental and social care (Patterson 2004). The question of rehabilitative care for older people afflicted with senile dementia has been a point debated for a number of years now (Lawton & Rubinstein & Springer, p. xiii). There tends to be a tentative agreement within the health care system regarding the elderly with advanced stages of dementia and the validity of whether or not rehabilitative treatments and complementary therapies are really useful or even necessary. (Lawton, et al, p.xiii). Despite a percentage of some views against rehabilitation intervention therapies, the tide is turning in favor for those who feel there is enough substantiated evidence to justify the funding and resources needed to offer specialized treatments to the elderly with senile dementia, no matter what progressive stage of the illness they might be in. Some of the most reputable of these therapies happen to be: cognition treatment for one, and the use of aromatherapies in massage treatment (Lawton, et al, p.xiii). Aromatherapy and massage therapy treatments involve a variety of oils that have been obtained from certain plants, thoroughly mixed together and then applied directly to the skin using a massage motion that is relaxing to the older patient. Some of the oils are heated to provide a smell that is pleasant to the sensory elements of the treatment. The Mental Health Foundation (2000) provided funds to allow for more research regarding what oils seemed to promote the most prominent positive effects in sensory and cognition patterns with regard to patients with dementia and found one in particular that seemed to provide the most viable results. It was duly noted that the specific use of the oil, "Melissa officinalis" otherwise known as, "lemon balm" proved to be the most beneficial in prevention of the loss of the brain chemical "acetylcholine". This oil seems to be a factor in deterring the loss of acetylcholine, and because of these healing qualities and positive benefits, it's very likely that this "lemon balm" might actually be able to slow down the degenerative process or halt it altogether (International Federation of Aromatherapists, 2000). Furthermore, Alistair Burns (2002) wrote his own findings in the British Medical Journal, providing affirmation that aromatherapy along with massage therapy, seems to allow much more than just relaxation and could be substantial in providing an alternative form of treatment than solely neuroleptic drugs. Even though more research needs to be done with this technique and the one particularly essential oil, the argument is now notably marked that there is reasonable justification to allow resources for aromatherapy and massage therapy to be utilized in treating the old with dementia due to the evidence that has been obtained from studying this treatment ( General Council for Massage Therapy, 2005). Although gradual changes are occurring for the older people with progressed stages of dementia there are still roadblocks. The NHS (2005) in the UK, has pinpointed some of the issues preventing the pathway for access to total rehabilitative treatments for the aged citizens with neurodegenerative illness. At times Health Resources can be limited and therefore there is a certain process the medical system goes through in deciding where funds are better served and a critical analysis determines where those funds are needed the most (Nuffield Institute for Health, 2002). Unfortunately, this sometimes leaves the elderly suffering with progressive dementia out of the loop to allow for other elderly patients within the community to receive rehabilitative care themselves (Nuffield Institute for Health, 2002). In order to satisfy the need for these critical services elsewhere in the medical environment there has been more of a focus placed on short-term rehabilitation procedures that are more cost effective in intermediate care. They also concentrate solely on physical illness which again, excludes those with dementia (Nuffield Institute for Health, 2002). One of the main reasons this occurrence has been taking place is due to the idea that those with dementia are going to take up beds longer in the general hospital ward awaiting discharge to a long term care facility. This causes a strain for the medical establishments due to the fact that beds taken up lead to a need for more beds which ultimately creates more higher costs for the health care system as a whole so, those elderly who are considered already past the point of intervention, with regards to special services; are over-looked (Nuffield Institute for Health, 2002). However, if a more effective care planning objective was put in place, involving good coordination of services then there would not be delays in the discharge of the elderly with mental illness because their assessments would go a lot quicker thereby eliminating the need for more beds and then allowing for care to be given to other's in need of the medical assistance (Monahan, 1993). Also, if these improvements are implemented in then there would be less of a need for admittance into the hospital for those with dementia because instead they could be assessed and supported whenever possible in their own homes (Monahan, 1993). If new approaches and links between other services are incorporated then they could drastically reduce admissions to the long-term care facilities and offer more effective and proficient utilization of other existing resources for other elderly patients presenting with illnesses such as : flu, pneumonia, bronchitis, emphysema and early stages of mental illness (Am Fam Physician, 2005). Further, the addition of new services would make a gradual difference as well in choices that older people in the earlier stages of dementia make in regards to their independence and health care habits. With the National Health Service's assistance (2005) along with Britain's Geriatric Society (2005) , and the Department of Health, there has been lobbying for support to make it quite clear to general practitioners that there needs to be recognition for the frail population with dementia or otherwise their health needs will continue to be over looked. What is required is appropriate training and case management systems put in place in medical establishments so that a high standard of continuing care can be obtained for those who can not speak for themselves (British Geriatrics' Society 2005). Also, in regards to funding and limited resources in healthcare, it must be expressed that the elderly whom have a higher social stature, are more privy to extended services and many times have the opportunity to reside in their own home for longer periods (Department of Health, 2001). This is due to the fact that they have the funding necessary to facilitate their care outside of an institution before becoming impaired and also have set up their legal affairs to allow for this type of care, instead of holding concern of being institutionalized. The nurses and the personal carer assigned come to see them and they don't have to go to the medical facility unless in an emergency (Kohn & McKehnie, 1999, p.27). They also have better alternatives in the way of nursing facilities when the time comes to move into a structured living environment (Kohn & McKehnie, 1999, p.27). Although this might hold some significant truth, the NHS (2005) has been working extremely hard to devise better means of caring for all of those who might need the specialized care without having to worry about whether their medical needs will be met completely, such as with the elderly in latter stages of dementia. The estimated cost for caring with the elderly who have severe dementia today, in the United Kingdom, is approximated to be around 6bn[pounds sterling] and ($9 bn) a year, an amount that also allows for the combined services of health and social care (British Medical Journal, 2001). One of the key essentials that are included in this cost is the establishment of memory clinics. These clinics improve the quality of life, quite sufficiently for those who care for the people of dementia due to the medical advice they offer and treatment presented in assisted care (British Medical Journal, 2001). Because of these memory clinics and much earlier diagnosis of dementia in the 20th century, choices and decisions are more easily made by the patient, on their own instead of it being made for them. This allows for the best possible treatment arrangements and also maximizes on cost-effectiveness in the fact that a health care plan is being structured and devised before the patient's cognitive abilities prevent it from being taken care of (British Medical Journal, 2001). This aids in keeping beds open because the establishment of care has been decided so therefore there would be no need to be placed in a general hospital ward for care (British Medical Journal, 2001). Also, a plan to include a carer to take care of the older patient has been thought out so that there would be no need to rush into a nursing home environment if the patients' mental stability declined sooner than expected. This would keep necessary resources open for other elderly patients as well because it would allow for the patient to be taken care of in their own home for as long as possible which is what the aging patient normally wants (Timely Topics In Medicine, 2005). Carer's make up an essential part of the support network for the patient with senile dementia in regards to being available to assist in hospital admission procedures to caring for the patient after discharge back into community living (Alzheimer Fact Sheet 528, 2000). Dementia patients are often admitted to the hospital in order to perform specific medical tests or possibly a surgical procedure or due to some form of illness. Sometimes this type of situation can pose legal and ethical dilemma's due to the patients possible incoherence (if dementia is progressed) and also relating to their individual care and treatment including the inability to fill out forms required before medical intervention can be given (Alzheimer's Fact Sheet 528, 2000). This is where carer services are crucial in the necessary implementation of the medical procedures. A carer can provide all the pertinent information necessary about the patient if they are unable to do so themselves which takes care of the legality of the situation since normally the carer has a written authorization allowing him or her to make decisions for the elderly individual (Jones & Lester, 1994). The basic information they provide assists nurses and doctors in providing the best care possible for the elderly patient and even goes so far as to list their favorite foods, TV shows they might like to watch, items that keep them in a relaxed state, what type of medications that they might be currently taking, etc (Alzheimer Fact Sheet 528). Carer's can even provide the cultural and religious observations observed by the patient so the hospital staff will be aware of their preferences in case of an emergency in regards to life and death. Many Carers' often feel that the burden of caring for the patient with dementia is placed heavily on their shoulders. This can be seen in the view of how early hospital's discharge patients with dementia (Jones & Lester, 1994). Current policies on length of stays cause there to be a lack of rehabilitative care for the elderly who are recovering from acute illness but suffer from dementia as well. This leads to them being released back into the care of the Carer when in actuality they aren't really prepared to be back in the community at all (Jones & Lester, 1994). This places a weight on the Carer to insure that there is an adequate amount of home support available to provide proper care for the older patient. The hospitals discharge planning is not immediately influenced on the well being of the patient but more on the need to have a bed available for the next admission (Alzheimer's Fact Sheet 528, 2000). On the other hand, to shed light on the hospital administrations view on this, their point is the fact that they are overwhelmed with such an increasing rate of older patients being admitted into the hospital due from minor to acute illnesses that they just don't have the space to keep the dementia patient in the needed beds for extended periods of time when those are resources needed for other elderly patients having better chances of rehabilitative therapy for complete recovery (Age and Ageing, 2004). The rate of admissions into the hospital for elderly patients is at such a high amount, that the question of their quality of life needs to be addressed. Assessing the quality of life of an elderly patient, presenting with dementia is not just done by one individual and their sole judgment any longer (Institute of Psychiatry, 2005). Recently, in order to achieve a more accurate scientific measurement of necessities in care and comfort, there has been implementation and utilization of a methodology known as, "Demqol" which is based on the soundest of "psychometric developments" (Institute of Psychiatry, 2005). This technology considers all aspects of care in order to provide a clear and concise picture on what steps might need to be taken to establish more appropriate medical services with regard to improved structured living in old age (Institute of Psychiatry, 2005). One program that strives to bring quality living back into the elderly with severe dementia happens to be an organization that has been established since the early 1940's. Methodist Homes whole point for the aged is to emanate care policies specifically for the aged with dementia so that they might have the opportunities to: remain in their personal home longer, acquire improved supportive services, sustain from isolation by developing more social interactions, and have a direct concern for individual patient care in regards to the long term holistic needs of each person centered treatment (Bruce & Surr & Tibbs, 2003). In conclusion, its imperative to recognize that the elderly patient with dementia is just as important to the commitment of the medical world as the elderly patient needing treatment for the flu is. A mutual sharing of resources is not inconceivable and through study and research it has been learned that if proper procedures are followed and new programs implemented when available then the shortage on services can be corrected. 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