Mental Health Illness: a Closer Look at Dementia - Essay Example

?A Closer Look at Dementia Introduction The latter part of the 20th century has witnessed the rise of exceptional knowledge and understanding of health care. A large number of illnesses that led to gradual and agonising death in earlier times are currently made more endurable by medications or surgical procedures, whilst several can be treated to the point that their progress is delayed or stopped, and some can be cured nowadays (Habell 2010, 110). With a rapidly aging population all over the world, there emerges a widely known illness that has been given modest attention and for which roots remain unclear. These are the set of symptoms that impinge on the brain’s nerve cells, changing their systems in such a manner that they cannot function normally anymore (Ferri 2009, 118). Since impaired neurons are not capable of reproducing or renewing, the changes are irreversible, and any outcomes they produce are often irreversible (p. 118). Generally, it is not possible to halt the progression of the illness, because no cure is available. Hence the condition could affect other nerve cells, slowly but unavoidably resulting in the behavioural disorders and incapacities called ‘dementia’ (Esiri & Trojanowski 2004, 1-2). The outcomes could be illustrated as an organised deterioration of the mind through which the individual becomes more and more helpless, insecure, difficult, unaware, and inadequate. With an aging population that is drastically enlarging, there is the likelihood that dementia will become massively prevalent in the 21st century. Dementia: An Overview Dementia is defined by the World Health Organisation as (Curran & Wattis 2004, 10): A syndrome due to 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. Consciousness is not clouded. The cognitive impairments are commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour, or motivation. Hence this illness has implications for the capacity of individuals to deal with facets of their everyday lives to their prior capabilities. Commonplace tasks like taking a bath, dressing, going to work, leisure, and building and maintaining relationships become more and more taxing. If the individual endures dementia for a long time it could become painfully difficult for him/her to perform such tasks by themselves or to communicate or express needs clearly and intelligibly (Judd 2011, 89). The nature of dementia is that it is an accelerating condition; signs become more evident and impinge on the person’s life on a greater extent, sooner or later spreading through all parts. Signs and Symptoms Loss of memory is dementia’s most common symptom. There are those who fail to remember the names, or even faces, of people they have been acquainted to for a long time, or lose their way in long known places. There are those who have obsessed or paranoid delusions about the people around them (Esiri & Trojanowski 2004, 3). Numerous have abrupt, unhealthy loss of weight. When such diagnoses do not disable function or ability, mild cognitive impairment (MCI) is detected (Esiri & Trojanowski 2004, 3). According to Levine (2006, 29), roughly 20% of individuals with MCI progress to dementia as these cognitive disorders affect everyday activities and function. Psychiatric signs and symptoms (e.g. depression, psychosis) were identified as major features of dementia since 1907. In spite of this finding, emphasis during the earlier decades has usually focused exclusively on memory deficits and other cognitive areas that have been drawn on to identify dementia’s clinical symptoms (Budson & Kowall 2011, 113). The scientific value and extensive prevalence of other mental disorders in dementia are currently the focus of numerous specialists and researchers. According to some findings, the pervasiveness of neuropsychiatric symptoms in dementia is between 60 to 80 per cent (Budson & Kowall 2011, 113). According to Prasher (2005), neuropsychiatric symptoms, besides inflicting pain and misery to the patient, are associated with the growth of distress and depression among carers and boost the institutionalisation rate of individuals with dementia. As enumerated by Hughes (2011), other signs and symptoms of dementia are changes in behaviour (e.g. apathy, frustration), temper (e.g. irritability, severe anger), and personality (e.g. fearful, paranoid, self-absorbed), weakened judgment and efficiency, reduced abstract thinking abilities, damaged recognition, reduced communication skills, blunted language, diminished productivity and performance on everyday tasks, poor memory, and disorientation. Epidemiology The number of individuals with dementia is increasing as populations all over the world age. Drawing on the UK as a case in point, whilst in 2007 it appeared sensible to project that there would be roughly 600,000 individuals with dementia in the region by 2010, by 2010 the number was in fact 700,000 individuals (Great Britain: National Audit Office 2007, 14). After two decades there will be sizeably more individuals with dementia and thus, since the pervasiveness of dementia heightens with age, there will be enlarging populations of individuals with dementia. Nevertheless, it is important to note that there are approximately 15,000 individuals in the UK aged below 65 years and yet suffer from dementia. It should be noted, as well, that a large number of individuals with Down’s syndrome acquire dementia much earlier than others (Hughes, Lloyd-Williams, & Sachs 2010, 14). For example, it has been reported that an individual with Down’s syndrome normally acquire dementia at the age of 55, which means that a large number of individuals with Down’s syndrome will be aged below 55 years when dementia arises. Finally, it should be noted as well that individuals with Down’s syndrome are reaching very old age, which implies that there is a higher likelihood that they will sooner or later develop dementia (Hughes et al. 2010, 14). According to the 2009 report of Alzheimer’s Disease International (ADI), the commonness of dementia differs to some extent between countries. General prevalence statistics are moderated by the lower rates of prevalence in sub-Saharan Africa, though this perhaps shows the scarcities of studies in this area, which implies that the figures are somewhat unreliable compared to regions where there have been numerous studies (e.g. United Kingdom) (Hughes 2011, 4). Dementia is a global issue for it is forcefully created by biology, which is aging. Prevalence The number of individuals with dementia in the European Union (EU) in 2006 was approximated to be 7.3 million (OECD 2010, 54). The highest rates of prevalence were discovered in Germany, Switzerland, Italy, and Sweden. The standard prevalence rate of dementia for the EU nations was 1.4 per cent. The identified primary risk factor for dementia is age. Even though premature dementia may appear sooner than the age of 65 years, rates of prevalence rise progressively after the age of 65 years, to arrive at 16 per cent of females and 15 per cent of males at ages between 80 and 84 years (OECD 2010, 54). In European countries, it has been found that there is a significant positive correlation between the number of individuals aged 65 years and the pervasiveness of dementia (p. 54). Figure 1. Prevalence of dementia, population aged 30 years and over, 2006 *graph taken from OECD (2010, 55) Figure 2. Prevalence of dementia in EU countries, 2006 *graph taken from OECD (2010, 55) Co-Morbidity Numerous individuals with dementia experience other psychiatric and medical conditions. Furthermore, individuals with dementia are highly susceptible to diseases. The larger the number of co-morbidities they have the more severe their problems in functioning and cognition. The reason for such remains unknown but may perhaps be related to the fact that dementia exhibit prevalent illness of the brain (Rabins, Lyketsos, & Steele 2006, 7). To some extent, this is because of the relationship between chronic diseases (e.g. diabetes, arthritis) and old age, but it most likely develops from the fact that disorders of the brain heighten susceptibility to symptoms (p. 7). An old person with dementia, for instance, has greater capacity to deal with a fever than an old person with dementia. In addition, individuals with dementia are more prone to experience side effects from prescription treatments. The application of medications to manage other illnesses and the growth of co-morbid medical diseases usually lead to a further deterioration of dementia’s cognitive condition, the occurrence of disorientation, heightened cognitive deterioration, and the development of noncognitive neuropsychiatric conditions (Gilliard et al. 2005, 575). The delivery of appropriate psychiatric, gynecologic, surgical, and medical care to patients with dementia is integral in reducing the impacts of co-morbidity (p. 575). Prognosis The prognosis of dementia has repercussion not just for the individual with the illness, but also for support or assistances in relation to the cost of the disease and the requirement for added institutional care. The mortality rate and medical process for dementia are highly identified by the form of dementia that develops. For instance, dementia linked to Creutzfeldt-Jakob Disease (CJD)--a brain disorder—may be fatal within several weeks of the diagnosis of the first sign of illness (Prasher 2005, 25). Nevertheless, individuals with Dementia in Alzheimer’s Disease (DAD) have been found out to survive up to two decades after detection of the first symptom. Life expectancy for people with Down Syndrome (DS) who have DAD seems to be not that very different from that of the majority (Prasher 2005, 25). Basically, the course for dementia is determined by the cause and may differ by person. Medications may delay the speed of deterioration for a number of individuals with Alzheimer’s disease. Nevertheless, in numerous instances, the illness progressively becomes worse. Treatment/Intervention Useful treatment preparation for individuals with dementia must take into account characteristics of the patient (e.g. manifestation of problematic behaviour, cognitive performance level), the vigorous interaction of the environment and the patient as the illness develops, and the assistance given by the physical and social environments. The patient’s needy condition or dependent relationship on others requires that treatment preparation consider as well as institutional and emotional assistance for caregivers (Lliffe et al. 2008, 169). Studies have reliably shown that caregivers of people with dementia are exposed to considerable risks on their physical and psychological condition. Assistance to strengthen the condition of the caregiver will definitely bring benefits to the individual with dementia. The treatment of dementia has a variety of features: dealing with the caregivers’ needs, managing the core dysfunction that is bringing about cognitive deterioration, mitigating behavioural disorders, and alleviating the cognitive problem in certain patients with Alzheimer’s disease. It is vital to diagnose and remedy any curable aspects producing or reinforcing cognitive disorder. Treating of core endocrine and metabolic disorders, drug toxicity, and depression could lead to cognitive progress (Giannakopoulos & Hoff 2009, 96). As further stated by Giannakopoulos and Hof (2009, 96), the course of vascular dementia could be hampered by smoking inhibition, curing of atrial fibrillation, aspirin treatment, and antihypertensive treatment. Cognitive performance could recover after treatment of coexisting non-dementing disease. Key Policies that Influence Interventions In the United Kingdom and globally, a number of interventions have tried to enhance care for people with dementia. Yet, the evidence base on how delivery of such care may be enhanced is rather inadequate, specifically when evaluated against studies for cancer-afflicted individuals. Effective person-based care needs a circular process and several multifaceted interventions and directions have been formulated. Palliative care applies a team model and is not merely given by professionals; it may be provided in any care environment (Thune-Boyle et al. 2010, 259-260). In Australia, for instance, growing professional medical assistance to ‘Hospital at Home Schemes’ (Keady, Clarke, & Adams 2003, xix) and nursing homes have been reported to be related to significant degrees of carer and patient satisfaction, have substantial cost reductions, and lessen fatalities in the acute hospital. Community mental health nursing started in the United Kingdom during the 1950s. Its development was one of the several programmes focused on transferring patients of mental hospitals to community settings. At the outset, community psychiatric nurses (CPNs) served an array of individuals with mental health disorders. Their primary responsibility was to handle and examine continuous intramuscular medications on individuals with chronic illnesses like schizophrenia (Keady et al. 2003, xix). This sustained the traditional reliance of mental health nursing on specialists, for it was to them that community psychiatric nurses disclosed the decline or improvement of patients. Drawing on the practice cases presented in the original paper of Greene (1968), Keady and Adams (2001) proposed that for the community psychiatric nurses serving individuals with dementia and their families their original tasks included (Keady et al. 2003, xix): the value of experience in working with people with dementia and their families; a knowledge of dementia and its likely course; attention to the personal care needs of people with dementia; information-sharing with families; promotion of autonomy for people with dementia; maintaining regular visits and contact; establishing trust with both the person with dementia and their family; service coordination Institutional care, since the advent of the 1980s, has lost its popularity and has been substituted by person-based principles and community care, as lately shown in England by the presentation of the National Service Framework for Older People (Keady et al. 2003, xix-xx). In health care, the inter-agency and multi-disciplinary approach is currently the rolling object of UK public policy with a number of recent accounts supporting this as the ideal approach for a contemporary social care and health service (Keady et al. 2003, xx). Such aspiration towards stronger organisation and professional partnership has been integrated into The New NHS—a UK government White Paper—with its stress on collective responsibility, agency teamwork, and programmes like health development initiatives (p. xx). The National Service Frameworks for Mental Health and for Older People work up this institution of social services and health care acting as a team, and restate that service provision, assessment, and care development must be a multi-agency venture. For that reason, the mental health system is mandated to deliver the array of interventions and consolidation all over professional services (Keady et al. 2003, xx). The emerging assumption that successful planning and delivery of care in any environment depends on solid, concerted effort is advocated by the National Health Service Executive (1993) which looks at nursing in primary care and states (Keady et al. 2003, xx): The best and most effective outcomes for patients and clients are achieved when professionals work together, learn together, engage in clinical audit of outcomes together and generate innovation to ensure progress in practice and service. While the primary care setting for individuals with dementia and their families is in their residences, two major perspectives have emerged to deal with this demand. The first perspective places importance on the caregivers’ needs as they nurse or take care of individuals with dementia (Innes & Manthorpe 2012, 1). The perspective is supported by a large number of social and health policy papers, specifically the Caring about Carers and 1995 Carers Act (Keady et al. 2003, xx). In dementia care, consequently, a variety of models have emerged that mainly focus on family caregivers. These involve definite intervention approaches and evaluations that focus on strengthening the coping abilities and bases of security of caregivers. On the other hand, another perspective of analysing the course of dementia emerged during the 1990s. This perspective concentrated on the individual with dementia instead of their caregivers. This perspective placed importance on the characteristics of the individuals with dementia and their capacity to choose what kinds of services they want to obtain (Gilliard et al. 2005, 578). Supporting the individuality of individuals with dementia was another aspect of the ‘new culture of dementia care’ (Keady et al. 2003, xx), and these principles have gained a permanent recognition in social policy via their incorporation into the NSF for Older People. Each of these perspectives is seen as upholding their own assumptions and goals, connected to their own interpretation of realities. The value of an integrated model is that it distances dementia care from dividing, bifurcated, and stagnant outlooks about either the caregiver or the individual with dementia and recreates dementia care in the form of a system of mutual relationships between individuals who are involved in distinctive manners. The Effects of Dementia on Individual Service User, Carer, and Families The effect of dementia on the individuals themselves, their caregivers and their families can be overwhelming. The major developments in social and health care delivery, structure, and values can be seen as generating comparable reactions in care and nursing personnel. Maybe these similar experiences of acquired vulnerability will have favourable consequences for everyone. The difficulties and demands of dementia will unavoidably weigh down on the individual having the illness, their caregivers, and their families. As the individual with dementia exhibits more and more dependence and decline, the burden on the family is severe. There are accounts of physical fatigue, due to the inadequacy of sleep, along with need for reprieve, scarcity of resources, and feelings of disorientation. Psychological fatigue (e.g. bad temper, anxiety) is also prone to arise. These circumstances involve signs of depression (Lliffe et al. 2008). The need for reprieve and assistance cannot be blatant or exaggerated if the carer is to manage successfully. Nevertheless, the studies of families constantly show that most families look after the individual with dementia. Because dementia damages the brain, the capacity to communicate and to behave rationally, the carer fails to sustain the established relationship. All the same, almost all carers are able to cope so long as they can. Death, disease, depression, or exhaustion is normally what pushes families to look for outside support. Furthermore, not all have the physical and emotional assets needed to handle this major adjustment (Jones 2007, 182). However, studies of families continually emphasise the strong points and ingenuity of families and their capacity to adapt to their new situation and collaborate with service providers. Communication Skills Involved Decline in an individual’s ability to communicate and understand as the dementia develops could be somewhat counteracted in a number of means. Examples involve the application of images and gestures, positioning at a similar eye level as the individual, maintaining a low pitch of one’s voice, or making use of glasses or hearing aids to lessen further sensory disabilities (Thune-Boyle et al. 2010, 268). These methods will require adjustment during the various phases of dementia as the capacity of the individual to understand what is uttered or to communicate declines. Common procedures for each phase of dementia are along the following lines. For the early phase, it is important to employ an easy to understand language. Be accommodating or helpful and restate essential messages (Chrisp et al. 2011, 562). For the middle phase, it is vital to talk when one is clearly visible to the individual, draw on facial expressions, repetition, and emphasising to take full advantage of communication. Wait for the individual to answer or react, again putting messages in another way instead of continuously restating, and where likely consistently draw on brief or simple sentences (Prasher 2005, 92). For the late phase, it is important to exercise calm, reassuring pitch of voice, talking unhurriedly, audibly, and understandably. Use gestures and touch for non-verbal expressions. Continue speaking although there is no clear response but avoid talking as though the individual is not present (Prasher 2005, 92). Conclusions Dementia is a major issue confronted by old people, their caregivers, and their families who look after them. While the cultural wealth of the UK enlarges, scholars and professionals have to gain further knowledge of traditional practices and acquire a clear and accurate understanding of how a variety of principles influence health care and values associated with dementia. Having more knowledge about individuals with dementia and their families can help service providers and health care institutions enhance the success of their strategies and of the settings or environments within which they function. References Books Budson, A. & Kowall, N. (2011) The Handbook of Alzheimer’s Disease and Other Dementias. UK: John Wiley & Sons. Curran, S. & Wattis, J. (2004) Practical Management of Dementia: A Multi-Professional Approach. UK: Radcliffe Publishing. Esiri, M. & Trojanowski, J.Q. (2004) The Neuropathology of Dementia. Cambridge: Cambridge University Press. Giannakopoulos, P. & Hof, P. (2009) Dementia in Clinical Practice. UK: Karger Publishers. Hughes, J. (2011) Alzheimer’s and Other Dementias. England: Oxford University Press. Hughes, J., Lloyd-Williams, M., & Sachs, G.A. (2010) Supportive Care for the Persons with Dementia. UK: Oxford University Press. Keady, J., Clarke, C., & Adams, T. (2003) Community Mental Health Nursing and Dementia Care: Practice Perspectives. England: McGraw-Hill International. Levine, R. (2006) Defying Dementia: Understanding and Preventing Alzheimer’s and Related Disorders. Westport, CT: Greenwood Publishing Group. Prasher, V. (2005) Alzheimer’s Disease and Dementia in Down Syndrome and Intellectual Disabilities. UK: Radcliffe Publishing. Rabins, P., Lyketsos, C., & Steele, C. (2006) Practical Dementia Care. England: Oxford University Press. Journal Articles Chrisp, T. et al. (2011) “Dementia timeline: Journeys, delays and decisions on the pathway to an early diagnosis” Dementia, 10(4), 555-570. Ferri, C. (2009) “Global prevalence of dementia” Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 5(4), 118. Gilliard, J. et al. (2005) “Dementia care in England and the social model of disability: Lessons and issues” Dementia, 4(4), 571-586. Great Britain: National Audit Office (2007) Improving services and support for people with dementia. London: The Stationery Office. Greene, J. (1968) “The psychiatric nurse in the community nursing service” International Journal of Nursing Studies, 5, 175-184. Habell, M. (2010) “The Dementia Care Building Crisis” Perspectives in Public Health, 130(3), 110. Innes, A. & Manthorpe, J. (2012) “Developing theoretical understandings of dementia and their application to dementia care policy in the UK” Dementia, 1+ Jones, R. (2007) “Commentary on ‘Health economics and the value of therapy in Alzheimer’s disease’” Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 3(3), 180-185. Judd, K. (2011) “Understanding the support needs of young-onset dementias: experience from a UK tertiary referral clinic” Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 7(4), 89+ Keady, J. & Adams, T. (2001) “Community mental health nursing and dementia care” Journal of Dementia Care, 9(1), 35-38. Lliffe, S. et al. (2008) “Making progress in psychosocial research in dementia” Dementia, 7(2), 167-174. National Health Service Executive (1993) Nursing in Primary Care—New World, New Opportunities. London: The Stationery Office. Organisation for Economic Co-Operation and Development (OECD) (2010) Health at a Glance: Europe 2010. UK: OECD Publishing. Thune-Boyle, I. et al. (2010) “Challenges to improving end of life care of people with advanced dementia in the UK” Dementia, 9(2), 259-284. Read More