Dementia: Understanding Mental Health - Article Example

Dementia: Understanding Mental Health Student name: Student number: Tutor: Date: Table of Contents Table of Contents 2 Introduction 3 Mental health and illness 3 Causes, course, and symptoms and functional difficulties 4 Causes of dementia 4 Dementia Course and Outcome 5 Stigma to Dementia individuals and care-givers 7 Stigmatisation of individual with dementia and their care-givers 7 Effects on life choices and decisions 9 Types of support 10 Conclusion 13 References 14 Introduction In Manderscheid’s et al (2010) view, the definition of wellness and illness has shifted from the mid-20th century to the modern-day, being diagnosis-focused into being person-focused description of mental illness as well as from the absence-of-disease perspective into one that emphasises positive mental psychological functioning for mental health. Stein et al (2010) and Manderscheid et al (2010) view wellness as the extent to which an individual feels both positive and enthusiastic regarding one-self and life, while illness describes the presence of disease. In this regards, the concept of wellness applies to the physical and mental state. A common example of mental illness among the elderly is dementia. Based on this background, this paper explores what is meant by mental health and illness. It further discusses the causes, course, and symptoms and functional difficulties associated with dementia. Next, it examines the experience and effects social stigma on life choices and decisions of individuals with dementia and their caregivers. Lastly, it explores the important types of support for individuals with dementia. Mental health and illness As explained by Ruggeri et al (2000), mental illness is a health condition that interferes with an individual’s thinking, mood, feeling, as well as capacity to associate with others. Like a range of other concepts, the concept of mental disorder lacks a consistent operational definition covering all situations. Mental disorders can be defined based on various perspectives such as dyscontrol, disability, distress, etiology, inflexibility, disadvantage, syndromal pattern, and inflexibility. Each of these is a significant indicator for disorder although none relates to the concept of mental disorder (Stein et al 2010). Manderscheid et al (2010) defines mental illness as the set of conditions or condition that affect an individual’s behaviour, cognition and emotion. According to Seignourel et al (2008), mental illnesses may include autism, depression, borderline personality disorder, dementia, bipolar disorder, panic disorder, depression, and posttraumatic stress disorder (PTSD). Dementia is one example of mental illness (Alzheimer’s Association 2013). Causes, course, and symptoms and functional difficulties Dementia refers to a set of symptoms such as diminished intellectual functioning that disrupts an individual’s normal life functions. World Health Organisation (2012) adds that dementia may as well be used to refer to individuals who exhibit multiple major life functions impaired, including lost perception, memory, reasoning, language and judgement. In most cases, dementia affects individuals aged 65 years and beyond, with only 2 percent of the case noted to start before the age (Alzheimer’s Association 2013). World Health Organisation (2012) suggests that dementia may be caused by the disease of the brain, which is progressive and chronic in nature, where there is a disruption of a range of higher cortical functions such as orientation, thinking, calculation, judgement, learning capacity and language. Causes of dementia Many underlying causes of dementia exist. There is a general consensus among researcher that Alzheimer’s disease (AD), which is characterised by neurofi brillary tangles and cortical amyloid plaques, is the most common cause of the mental illness, taking up between 50 and 75 percent of the cases (World Health Organisation 2012; Manderscheid et al 2010). Another common cause is Vascular dementia (VaD), which occurs when the brain’s supply of oxygenated blood is continually upset by blood vessel complications or strokes, which may damage brain tissue and function. For later onset dementia, World Health Organisation (2012) suggests that genetic factors are also critical risk factors. Indeed, a common genetic polymorphism, the apolipoprotein E (apoE) gene e4 allele, substantially heightens the risk of dementia. Evidence from case-control studies and cross-section studies show a link between head injury, limited education and Alzheimer’s disease to cause dementia (Boyd et al 2005). Depression is an additional cause, although it is also regarded as early symptom of the mental illness (Bierman et al 2007). Dementia Course and Outcome Dementia is a progressive mental illness that can be cured once the reversible condition is diagnosed as a cause and is then treated. The disease affects individuals differently. Its impacts are, however, dependent on what lifestyle, personality, and mental and physical health conditions the people with the disease had before the disease (Wilkins et al 2005). Concerning the course of the disease, World Health Organisation (2012) suggests that the problems associated with dementia could be effectively understood in three key stages: Early stage, Middle stage and Late stage. Johns Hopkins University (2013) comments that during the early stage, the symptoms are often overlooked as family and friends would view it as the normal process of aging. What complicates the process further is that the onset of the disease is mostly gradual. Additionally, knowing when the disease begins is difficult. In most case however, Vollicer (2005) suggests that individuals will tend to have a problem communication or talking properly. Signs of memory loss, especially for things that have just occurred, or forgetting the time of the day or the day of the week may also be an indicator of the disease. This is, however, combined with the tendency to get lost in familiar places or complexities in making decisions, become inactive, experience mood swings, anxiety, and depression (Waite et al 2004). According to Wilkins et al (2005), individuals with dementia during the early stage also tend to react angrily at petty issues. Occasionally, they may show loss of interest in activities and hobbies. In the middle stage, an individual’s limitations become more obvious and restricting. People with dementia may have trouble in performing day-to-day duties. Instances of forgetfulness are also common, particularity of recent events or the names of people they know. They therefore cannot be able to live independently without someone who can clean, cook or do their shopping. Hence, they become dependent on friends, family, and caregivers. They also tend to ask repeatedly the same questions and experiencing disturbed sleeping. Instances of hallucinations may also be common (Wilkins et al 2005). During the late stage, individuals with dementia become very dependent on caregivers. They also become inactive, and will tend to experiences severe memory disruptions. At this stage, the physical implications of the disease on an individual become obvious (World health Organisation 2012). Therefore, an individual with the disease has difficulty in eating and communication. The individual may also fail to recognise the familiar faces of relatives and friends. They also lack insight regarding what goes on around them, or to find their ways home. According to Gallo et al (2008), individuals with dementia may also have trouble in swallowing and walking, as well as instances of bowel and bladder movements causing involuntary defecation and urination. Ultimately, the individuals would become more confined to bed or the wheel chair. An overall implication, according to World Health Organisation (2012), is that the disease reduces the individual’s lifespan. In the high-income countries or developed nations, people with dementia can expect to live for nearly 5 to 7 years. In middle- and low-income countries, diagnosis may be much delayed, which also means that the lifespan may be shorter. Still, some researchers have also argued that variation between individuals is also possible, meaning that while some individuals may live longer while others may live for a shorter time depending on how they interact or handle the symptoms. Stigma to Dementia individuals and care-givers Stigmatisation of individual with dementia and their care-givers The social stigma and stereotyping, in Batsch & Mittelman (2012) view, exists and potentially undermine or mislead the interventions. The World Health Organisation’s (2012) findings suggest that in developed nations that have comprehensive social and health care systems, the crucial caring role of the families as well as their need for support is in most case overlooked. This is especially true in the United Kingdom where in spite of the nuclear family structures, there is an established tradition prevailing for the local children to provide support to the parents with dementia. On the other hand, in developing countries, the extent of family care is usually overestimated. This implies that mythologizing the role of family has inherent risks of perpetuating complacency. As established by Burgener et al (2013), social stigma can be cause in the event that normal people are aware that a person has dementia. The researched added that stigma could be viewed as a behaviour, attribute and reputation that is socially discrediting in a specific way. It therefore causes an individual to be mentally classified by other individuals in undesirable manner. This hints to the concept of stereotyping (Reingold & Krishnan). Within the perspective of sociology, Riley (2012) suggests that the term stigma is often applied in describing the manner in which the society regards those to be viewed as being mentally ill. Essentially therefore, it has a powerful impact on individuals due to the emotional response it leads to in the stigmatized persons and the carers. These impacts can be explained using the Modified Labeling Theory (MLT), which was posits that when individuals are labelled or stereotyped due to mental illness, they become exposed to negative societal conceptions. According to the theory, the responses of others make the persons with dementia to internalise the perceptions and attitudes of the society, making it difficult for the victims to participate constructively in the society (Riley 2012). For instance, carrying the stigma of dementia may cause the victims to experience difficulty in finding work, life-term partner, or housing, which increase their vulnerability lapse (Graham et al 2003). Stigma negatively impact the ability of a person with dementia to fit in with other individuals viewed to be normal or to relate with individuals perceived to be normal. This lead to a discriminatory behaviour towards the stigmatised individual and therefore, reduces their capacity to integrate into their society fully (Sayce 1998). Beattie et al (2014), elaborates that when the individual who has been stigmatised reacts defensively by blaming the stigmatised patients for their mental illness. Effects on life choices and decisions Burgener et al (2013) also found that social stigma or rejection may cause anxiety, depression as wlel as trigger behavioural symptoms. The researchers examined the effects of social stigma on life choices using linear mixed model and established that internalised shame due to social stigma is a major cause for depression, low self esteem, effective understanding of social support and personal control. Hence, from Burgener’s et al (2013) findings, the intricacy of the relationships between the quality of life and perceived stigma is apparent. Hence, when the society becomes aware of the diagnosis of dementia to an individual, it often considers the individual as lacking in cognitive skills, social contribution, and independence. As highlighted by Scholl and Sabat (2008), the society has placed great emphasis on such labels when an individual with dementia is unable to take personal care leading to feelings of rejection. Such labels may begin at childhood where the children are the carers and may become reinforced into adulthood resulting to negative self-stereotyping. According to Clare (2002), the media has also significantly contributed to stereotyping, when has made people to internalise such stereotypes, leading to mental anguish for individuals with dementia. Schol and Sabat (2008) explained that the older individuals are underrepresented by the media and are often portrayed as being impaired, weak, helpless and vulnerable to dementia. These influence societal attitudes of the disease and aged individuals, hence contributing to greater feeling of rejection (Waite et al 2004). At the same time, individuals diagnosed with early-stage dementia become increasingly aware of the societal attitudes and views or the stereotypes, which make them to become concerned regarding the responses of their family, peers, and general society. Batsch & Mittelman (2012) adds that such individuals may become embarrassed of their diagnosis and seek to cover up the symptoms or withdraw from social groups. Riley (2012) explains that individuals with dementia are susceptible to internalising societal attitudes since they aware of their inadequacies and respond to the responses with depression, angers, frustration and sadness. They may also refrain from situations that may expose their inadequacies, leading to low self-esteem. Types of support The World Health Organisation (2012) suggests that early diagnosis is vital as it facilitates better understanding, what to expect from the disease as well as what social support to anticipate. Therefore, diagnosis is a vital step towards planning for social support. This perspective is supported by Riley (2012), who suggests that in recommending social support for the disease, a preliminary step should be to identify and treat the cause of dementia, which may be environmental, psychological, or physical in nature. While there is no treatment that cures dementia, Repper and Carter (2011) points out that drugs such as cholinesterase inhibitors shortly decelerate cognitive decline, as well as further neurodegenerative dementia. For psychosocial symptoms, Vollicer (2005) argues that evidence-based therapies exist for symptoms such as depression, hallucinations, anxiety, delusions and agitation. However, Lachman (2012) explains that it is significant to recognise non-drug interventions, which should also be a priority in managing behaviour problems ethically. This signals the important support such as informal social supports as well as those offered by healthcare services. In fact, psychosocial interventions, especially provision of support, has been found to reduce the symptoms of dementia. Therefore, the relationship between healthcare and social support, as well as improved quality of life and functioning is well supported by research literature (McCorkle et al 2007). Franz-Hoyt (2014) argues that delivery of support by the family is the keystone for care of individuals with dementia who have lost the capacity for independent care. Robinson et al (2005) found that care giving often centres on social support and patient satisfaction as the principle predictors of strain. The aged persons with dementia and their caregivers may utilise numerous types of support services designed to sustain community independence, such as in-home respite, adult day-care, support groups and meal services. Based on this backdrop, support services should be available fits the particular needs of individuals with dementia, such as adapting the existing services or establishing new services. As stated by Batsch & Mittelman (2012), dementia care coordinator should be appointed in healthcare settings for each individual with dementia. In home care services, personnel specialised in home care services should be encourage to engage individuals with dementia in daily activities to enable them to maintain their functional capacities. This option reflects Kilik’s et al (2008) opinion that in providing care and support to individuals with dementia, emphasis should be placed on social interaction. From the above description, different types of support and care services can be used. These include home help and personal assistance, palliative care and night time care. When it comes to personal assistance, Gallagher (2011) argues that the patients should be provided with supervision when it comes to taking medicine whenever necessary. This should however be for not only the medicine related to dementia treatment but as well as for comorbid conditions (Millisen 2006). Additionally, there is a need to provide a joint curative and preventive approach to skin care and incontinence such as medical and non-medical elements of such care or provision of suitable and satisfactory continence equipment or pads. Activities to assist them with drinking or eating or service of meals should as well be provided to particular needs of individuals with dementia. At the same time, family care should integrate assistance with mobility, laundry, housework, shopping and transport (Gottlieb 2013). Home-based night-time support and care service should be made available to individuals with dementia who stay alone. Alzheimer-Europe (2014) suggests that mobile night services should be made available or carers should be provided to supervise and attend to the people with dementia. For palliative care, a palliative care coordinator should be appointed for each elderly people who need palliative care (Anon 2005). However, as the disease progresses and the individual with dementia experience deteriorated communication skills, Alzheimer-Europe (2014) suggests that providing care services and support should be interchanged with those that promotion their emotional and psychosocial well-being. Therefore, counselling and support for individuals with dementia should also be provided. Individuals with dementia need to have access to group and individual counselling, support as well as psycho-education through the entire course of the disease. These can also overcome the negative psychological impacts of social stigma due to dementia. Additionally, their social contact should be boosted through holidays and social activities (Vollicer 2005). The significance of social contact, physical exercise, and meaningful social and leisure activities for promoting the well-being of individuals with dementia is emphasised by Hendryx et al (2009). In his view, such activities promote the preservation of these individuals’ remaining capacity and in re-asserting their roles whether at home or residential care settings. Hence, there is a need to create opportunities for individuals with dementia to socialise together. This may be through excursions and Alzheimer cafes. Measures should as well be taken to allow the individuals with dementia and their carers to have holiday periodically. Conclusion Dementia is an example of mental illness characterised by symptoms such as diminished intellectual functioning that disrupts an individual’s normal life functions. Dementia may as well be used to refer to individuals who exhibit multiple major life functions impaired, including lost perception, memory, reasoning, language and judgement. The disease affects individuals differently. Its impacts are therefore dependent on what lifestyle, personality, and mental and physical health conditions the people with the disease had before the disease. Dementia has far-reaching social impacts Based on Modified Labeling Theory (MLT), individuals may be labelled or stereotyped due to the mental illness. Accordingly, the responses of others make the persons with dementia to internalise the perceptions and attitudes of the society, making it difficult for the victims to participate constructively in the society While there is no treatment that cures dementia, drugs such as cholinesterase inhibitors momentarily decelerate cognitive decline as well as further neurodegenerative dementia. For psychosocial symptoms, evidence-based therapies exist for symptoms such as depression, hallucinations, anxiety, delusions and agitation. It is significant to recognise non-drug interventions, which should also be a priority in managing behaviour problems ethically. This signals the important support such as informal social supports as well as those offered by healthcare services. In fact, psychosocial interventions, especially provision of support, has been found to reduce the symptoms of dementia. References Alzheimer’s Association 2013, “Alzheimer’s Disease Facts and Figures,” Alzheimer’s & Dementia, vol 9 no 2, viewed 29 Nov 2014, Alzheimer-Europe 2014, Specific services and support, viewed 30 Nov 2014, Anon 2005, “Treatment of Dementia and Agitation: A Guide for Families and Caregivers.” A Postgraduate Medicine Special Report, viewed 29 Nov 2014, Batsch, N & Mittelman, M 2012, "Overcoming the stigma of dementia," Alzheimer’s Disease International World Alzheimer Report 2012 Beattie, E, Horner, B, Wellman, D, Burgener, S & Moyle, W 2014, Dementia, stigma, health and wellbeing - are there connections?, viewed 30 Nov 2014, Bierman, E, Comijs, H, Jonker, C, & Beekman, A 2007, “Symptoms of anxiety and depression in the course of cognitive decline,” Dementia and Geriatric Cognitive Disorders, vol 24 no3, 213-219 Boyd, M, Garand, L, Gerdner, L, Wakefield, B, & Buckwalter, K 2005, Delirium, dementias, and related disorders. In M. Boyd (Ed.), [Psychiatric Nursing: Contemporary Practice] (3rd ed., pp. 671-708), Lippincott Williams & Wilkins, PA Buckwalter, K, Perkhounkova, Y & Lui, M 2013, “The effects of perceived stigma on quality of life outcomes in persons with early-stage dementia: Longitudinal findings: Part 2,” Sage Journals Chancellorm B, Duncan, A & Chatterjee, A 2014, "Art Therapy for Alzheimer’s Disease and Other Dementias," Journal of Alzheimer’s Disease vol 39, 1–11 Gallagher A 2011, “Ethical issues in patient restraint,” Nursing Times, vol 107 no 9, pp18-20 Gottlieb, L 2013, Strengths-Based Nursing Care: Health and Healing for Person and Family, Springer Publishing Company, New York Franz-Hoyt, H 2014, “The Use of Social Support by Spouses of Alzheimer’s Patients to Improve Communication Master’s Thesis," Alzheimers.net, viewed 29 Nov 2014, Gallo, J, Schmidt, K, & Libon, D 2008, “Behavioral and psychological symptoms, neurocognitive performance, and functional independence in mild dementia. Dementia: The International Journal of Social Research and Practice, vol 7 no3, pp.397-413 Graham, N, Lindesay, J, Catona, C, Bertolote, J, Camus, V, Copeland, J & Wancata, J 2003, “Reducing stigma and discrimation against older people with mental disorders: a technical consensus statement,” International Journal of Geriatric Psychiatry, vol 18, pp.670-678 Hendryx, M, Green, C & Perrin, N 2009, "Social Support, Activities, and Recovery from Serious Mental Illness: STARS Study Findings," Journal Behavior Health Services Research vol 36 no 3, pp.320-329 Johns Hopkins University 2013, Early-Onset Alzheimer’s Disease, Early-Onset Alzheimer’s Disease, viewed 30 Nov 2014, Kilik, L, Hopkins, R, Day, D, Prince, C. R., Prince, P. N., & Rows, C 2008, “The progression of behavior in dementia: An in-office guide for clinicians,” American Journal of Alzheimer’s Disease and Other Dementias, vol 23 no 3, pp.242-249 Lachman, V 2012, “Applying the Ethics of Care to Your Nursing Practice,” Medsurg Nursing 21(2), 112-114 Manderscheid, R, Ryff, C, Freeman, E, McKnight-Eily, L & Strine, T 2010, "Evolving Definitions of Mental Illness and Wellness," Prev Chronic Dis, vol 7 no 1, A19 McCorkle, B, Rogers, S, Dunne, E & Wan, Y 2007, "Increasing Social Support for Individuals with Serious Mental Illness: Evaluating the Compeer Model of Intentional Friendship," Community Mental Health Journal, pp.11-12 Millisen, C 2006, “Use of physical restraint in nursing homes: clinical‐ethical considerations. Journal of Medical Ethics vol 32 no 3, pp148-152 Repper, J & Carter, T 2011, "A review of the literature on peer support in mental health services," Journal of Mental Health vol 20 no 4, pp.392-411 Reingold, A, & Krishnan, S 2001, The study of potentially stigmatizing conditions: An epidemiologic perspective. Bethesda, MD: Paper presented at the National Institutes of Health International Stigma Conference. Riley, R 2012,"Perceived stigma in persons with early stage dementia and its impact on anxiety levels," PhD (Doctor of Philosophy) thesis, University of Iowa, 2012. Robinson, K & Buckwalter, K & Reed, D 2005, "Predictors of Use of Services Among Dementia Caregivers," Western Journal of Nursing Research, vol 27 no 2, pp.126-140 Ruggeri, M, Leese, M & Thornicroft, G 2000, "Definition and prevalence of severe and persistent mental illness," The British Journal of Psychiatry vol 177, pp.149-155 Savvam G, Matthews, F, Davidons, J, & McKeith, I 2009, "Prevalence, correlates and course of behavioural and psychological symptoms of dementia in the population†," The British Journal of Psychiatry vol 194, pp.212-219 Sayce, L 1998, “Stigma, discrimination and social exclusion: What's in a word?” Journal of Mental Health, vol 7 no 4, 331-343 Scholl, J, & Sabat, S 2008, “Stereotypes, stereotype threat and ageing: Implications for the understanding and treatment of people with Alzheimer’s disease,” Ageing & Society, vol 28 no.1, pp103-130 Seignourel, P, Kunik, M, Snow, L., Wilson, N, & Stanley, M 2008, “Anxiety in dementia: A critical review,” Psychological Medicine vol 28 no 7, pp.1071-1082 Stein, D, Phillips, K, Bolton, D & Kendler, K 2010, "What is a Mental/Psychiatric Disorder? From DSM-IV to DSM-V," Psychological Medicine vol 40 no 11, pp.1759–1765. Vollicer, 2005, End-of-life Care for People with Dementia in Residential Care Settings, University of South Florida, Tampa Waite A, Bebbington P, Skelton-Robinson M, Orrell M 2004, "Life events, depression and social support in dementia," Br J Clin Psychol. Vol 43 no 3, pp313-24. Wilkins, C, Moylan, K & Carr, D 2005, “Diagnosis and Management of Dementia in Long-Term Care.” Annals of Long-Term Care vol 13 no11, pp17-24 World Health Organisation (WHO) 2012, neurological disorders a public health approach, pp.41-109, viewed 29 Nov 2014, Read More