Dementia as a syndrome resulting from disease of the brain - Essay Example

Introduction The World Health Organization defines dementia as a syndrome resulting from disease of the brain, usually of a chronic or progressive nature, in which there is impairment of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgment (Practice Nurse). The three main forms of dementia, which attack people are Alzheimers disease, vascular dementia and Lewy body dementia. The first symptoms that can be perceived are forgetfulness, confusion, risk of fall and instability. Under the circumstances, it becomes imperative that they are under the right care and guidance as there is no cure for dementia. This essay will discuss the effect various factors have on overall health, particularly dementia and how such patients are being cared for in UK. Physical, mental and emotional health The overall well-being of a person includes the physical, mental and the emotional health. Physical well-being means the vital organs of the human body function normally. According to WHO there is no official definition of mental health and the absence of a recognized mental disorder is not necessarily an indicator of mental health (Wikepedia). Merriam-Webster defines mental health as "A state of emotional and psychological well-being in which an individual is able to use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life." When a defined pathology can be found in the brain tissue, there is likelihood of a mental disease. These diseases are neurological in nature and the two most commonly found diseases are Parkinson’s disaese and Alzheimer. As per these definitions, a person suffering from dementia is by no means a healthy person. UK has about 750,200 people suffering from dementia and this figure is expected to reach 1 million by 2026 as the life span of people has increased. As this disease generally comes with age, the older people need to have integrated mental health. Most people are cared for at home by friends or relatives. They enter institutional care only when their disability reaches a particular level. Since there is no cure for this disease, support and care is the only way these patients can cope with it. Effect of personal behavior, environment factors, and political influences on the health The Social Cognitive Theory defines human behavior as a triadic, dynamic, and reciprocal interaction of personal factors, behavior, and the environment (Bandura, cited by Brown, 1999). The theory has its basis on the discipline of psychology. It explains why people behave as they do. According to John Watson, behavior could be explained in terms of observable acts that could be described by stimulus-response sequences (Brown 1999). Farley & Cohen argue that the environment is a powerful force in influencing human behavior, although changing and redesigning the environment to promote health is not necessarily a "new approach" (Healthscaping, 2005). The environment can include the home, family, society, the Care Home, or the hospital setting, the landscape, in short anything that supports the achievement of an optimum health, safety, comfort and well-being of an individual. The environment has a direct effect on the dementia patient. They reel under emotional trauma and need special care. At the same time, the carers are also at a high risk of depression. Various global issues and politics affect the individual health. For instance, poorer nations did not have access to generic drugs or it was too costly for them but the recent WTO strategy allowed the poorer nations easier access to these drugs. Poverty and war between nations also affect the health. Usually epidemics like SARS could affect the treatment due to political influence but dementia being a very common problem globally, specially as age advances, is not likely to be affected. Thus, personal behavior as seen above is a direct response to the stimulus and environment is an important stimulus for those suffering from dementia while politics has practically no influence on the dementia patients. Alzheimers Society, the leading care and research charity for people with dementia, emphasizes that people with dementia need to be tackled with respect and understanding. It is important for the carers to understand why dementia patients behave as they do. This is half the battle won. Patience and support is all they need. Carers can help put their talent and skills to the best use. They need regular encouragement and reassurance. Initially it starts with memory loss, gradually they repeat incidents or ask the same questions over and over again. Personality changes occur and the changed personality may be entirely opposite of the previous personality. The intellect does not function properly; they may speak irrelevant things. They are even unable to perform the routine tasks like combing their hair. Emotionally it is very disturbing for them as they cry for no reason. Suddenly they may even become hostile or start laughing. Under the circumstances it is very important that their life and lifestyle is kept as simple as possible. They should be allowed to do only what they can. They should not be forced to do anything that can lead to frustration or anger. The environment in which they live has to be familiar. Shifting dementia patients to alien surrounding can be dangerous. They feel lost in new surroundings. A sensitive and thoughtful person becomes preoccupied only with his/her own needs when afflicted with dementia. It is often overlooked that dementia patients can have other physical problems also. If neglected, these can make dementia worse. On the other hand paying attention to simple needs like the right glasses or hearing aids can make huge difference. When the physical health problems are taken care of, depression rates are lower (Alzheimers Society). Dementia patients also become suspicious of everything and everyone around them. They should not be left alone at home without supervision. The patient loses all social abilities and this becomes a testing time for the family concerned. The family is as affected as the patient himself is. Primary, secondary and tertiary health promotion: Under the circumstances, dementia patients need not just primary health care but secondary and tertiary support also. Primary health care includes the provision of primary health promotion. According to WHO (1998) it can be defined as the first level contact with people taking action to improve health in a community. Local doctors and general physicians are the primary health care ports where anyone in need would turn to. This primary care in case of dementia patients needs to be multidisciplinary as most patients are old and may have other complications apart from dementia. Primary care is the first point of contact with dementia (Practice Nurse, 2005). Secondary health promotion is provided by hospitals, which serve as an important bridge in accessing and utilizing secondary care services (AH&MRC, 1999). Both patients and carers benefit from an early diagnosis because it helps both to plan the future course of action. A study conducted by the British Geriatrics Society (2004) to understand the general practitioners knowledge of dementia diagnosis and management, revealed that one third of general practitioners expressed limited confidence in their diagnostic skills, whilst two-thirds lacked confidence in management of behavior and other problems in dementia. The general physicians lacked time and social service support. They had difficulty in talking with patients and firmly believe that dementia patients require special attention. Hence, the need for multidisciplinary team at the primary level. This multidisciplinary approach or the specialist care, constitute the tertiary health promotion, which include medical specialists and allied health professionals. Care of dementia patients requires interaction between the primary and secondary care and by the voluntary and statutory agencies. For symptomatic relief to be effective, early detection is necessary. Nurses and carers develop a relationship with the patient and can immediately detect any change in behavior or deterioration. The role of primary care is to help in identifying and diagnosing, careful planning, and involvement of different agencies including carers. Multidisciplinary team is essential. Interrelationship between knowledge, attitude and behavior Alzheimer Research Trust (2005), dedicated to the cause of dementia, funded research to study the interrelationship between knowledge, attitude and behavior of mentally impaired patients. One such study revealed that such patients suffering from amnesia retain a sense of the self. Across a variety of measures, they were as accurate as control participants in knowing their personality. Attitudes, while guiding human behavior are also important as they provide meaning and structure to an individuals social world. Further research revealed that people with memory loss could retain their attitudes and opinions. With time, the stability reduced, though, signifying that their attitudes are prone to change. The need of the community/individual While there is no cure that can reverse the progress of dementia, some therapies can help tackle the disease to some extent. The environment should be familiar and safe. Thought should be given to simple things like large signs at the toilets, can help the dementia patients to maintain their dignity and independence. Care should be taken never to make them feel humiliated; their self-respect has to be maintained. They should be helped to keep in touch with who they are. Majority of the dementia patients know that there is a problem with their memory but they do not know what it is or how to handle it. Most of them are not being told what they illness it. Communication is essential for survival and to maintain the quality of life. It also helps to preserve the sense of identity. The patients are encouraged to express their views through the non-formal means of communication. The carers are trained to understand this language through practice. The family or the community too needs support and guidance. Their physical, social, emotional, and intellectual needs too have to be taken care of. They have to constantly deal with aggression and anxiety. The family experiences bouts of depression (CNADC). Even otherwise healthy spouses get agitated or irritated at the slightest provocation. This may lead to guilt in them. Their roles change overnight. A spouse takes the role of a parent. They need the support of the physicians, the social care workers, the psychiatric or psychologist. The carers need time for leisure - breaks or respite from the usual routine so as not to stress and to be able to cope with the patient better. These are healthy needs and help the family to re-energize themselves. Those closest to the patient may experience strong mixture of feelings as they see the changes in the patient. It helps to talk to a professional for support. Besides, at such time the family should draw close for mutual benefit. The family reels under dilemma whether to inform the family and friends about this disease. The role of a carer is by no means an easy job. Physical and psychological illness amongst the carers is common. They tend to go into depression and depression affects the ability to concentrate and solve problems. This can ultimately affect the life of both the carer and the patient. Various tools have been introduced as assistive instruments intended to help dementia patients cope with daily life. Phones with large buttons, reminder messages to lock the door, or not to go out at night are some of the gadgets. Sensors can be place around the house which can detect if the taps have been left running are the gas has not been turned off. Provision of services to meet the needs of the community/individual Ramsay & Coid (1994) observe that the health and social care needs of people suffering from dementia increases with age until death occurs. Most of such patients are under the care of their family or friends, in association with statutory or voluntary organizations. The support from external agencies is of utmost importance and when this is reduced, there is strain on the informal carers who have no experience in this area. As age increases, chances of people with dementia entering hospitals become higher. The responsibility of supporting people with dementia lies primarily with the informal carers even though many nursing homes have come up. The local authorities are expected to assess the needs of such people and plan their health program in association with the local communities. This is required as per the National Health Service (NHS) and the Community Care Act. Professionals from different fields working together as a team can offer different perspectives in handling such patients. While UK has plenty of care homes, most are suffering financial losses. The families of residents of a particular Care went to the court of law against the closure of the care home, saying that such closures is a breach of the European Convention on Human Rights (Community Care, 2003) which has been refuted by the court. Dementia patients are in no position to bear the trauma of shifting homes every now and then. It requires time and strain, especially on the part of the carers to help them get accustomed to the new surroundings. Local authorities merely act as planners while voluntary organizations are being encouraged to act as service providers (1996). The relationship between the local authorities and voluntary organizations is becoming complex as the latter now provides consultation, policy formation, and provision of service. They have trouble in the process. They have to subsidize the service while there are not enough resources to meet the expenses. Certain local authorities who were maintaining good practice found that they do not have the skills to monitor the quality and value for money of the services outsourced to voluntary organizations. Effectiveness of health social and voluntary provision in the community care and recommendations Various organizations like Dementia Voice, Mental Health Foundation, and Alzheimers Society have been doing benevolent work in this field. They conduct regular researches; they provide consultancy and guidance but there is a lot of further research required in this field. Alzheimers Society (2003) information sheet suggests that a healthy lifestyle and diet may protect against dementia but there is fail-safe method of avoiding dementia. Apart from genetic inheritance, people with Downs syndrome are also likely to get dementia at an early age. Severe head injuries also increase the risk of dementia at a later stage. What people do in their spare time can have an effect on the chances of developing dementia. Those who watch television excessively are at a high risk while those indulging in mental activities, sports have less chance of developing dementia. Research suggests the risk of developing dementia depends on a combination of genetic and environmental factors. Risk factors have different effects on different people. Some are more sensitive than others are. Despite diet and other suggestions to reduce the risk factor, Alzheimers Society feels research into treatment and cure is necessary. Research on the impact of community care has revealed, while services have improved with community care, there is still ample scope for improvement. Conclusion Dementia is a disease, which affects a large percentage of people in UK. Various factors, especially the environment influences to what extent treatment is possible. Several agencies are dedicated to the cause of dementia but the area is vast as number keeps increasing every year. The local authorities and voluntary organizations have to work cohesively towards a common cause. Private agencies have to support the government. The patients have to be treated taking care of their emotional and intellectual needs but at the same time, care of the carers is of equal importance. Since there is no cure yet for dementia, for the overall well-being of such patients, an integrated health care system is essential where primary, secondary and tertiary health promotion agencies have to work together. Most importantly, their lifestyle has to be kept simple and they should not be shifted away from familiar surroundings. References: AH&MRC (1999), 25 MARCH 2006 Alzheimer Research Trust (2005), Memory, Attitudes and Opinions, Bristol University, 20 March 2006 ALZHEIMERS SOCIETY INFORMATION SHEET · JULY 2003, Mind Your Head, 21 March 2006 British Geriatrics Society (2004), General practitioners knowledge, confidence and attitudes in the diagnosis and management of dementia, Age and Ageing 2004 33(5):461-467, Oxford Journals, 20 March 2006 Brown K M (1999), Social Cognitive Theory, University of South Florida, 25 March 2006 CNADC (2002), The Familys Response, 21 March 2006 Findings (1996), The relationship between local government and voluntary organizations, 21 March 2006 Ramsay D & Coid D R (1994), Assessment of the Structures and Functions of Fife Core Dementia Teams, Journal of Management in Medicine Volume 8 Number 2 1994 pp. 65-71 Wikipedia, Mental Health, 25 March 2006 WHO (1998), European Observatory, 25 March 2006 Read More