Mental Health Services for Elderly with Dementia

This dissertation examines the mental health services provided to elderly people suffering from dementia in the UK. It analyzes the challenges faced by patients and caregivers, explores existing services, and identifies knowledge gaps in dementia care. The research utilizes a systematic review methodology to provide a comprehensive understanding of the topic and offers recommendations for improving dementia care in the future.

Mental health services for the elderly suffering with dementia

ABSTRACT
Dementia is said to be a prominent disorder of elderly people. At the age of 75,
prevalence rate is said to be approximately 10 % (Wall & Duffy 2010, p.113). The prevalence
doubles every five years of increasing age along with an increase in the total population with
40% over the age of 85 years which will likely get affected. Evidence shows that risk of
developing dementia begins beyond the age of 90 years (Mordoch et al. 2013, p.20). Dementia
appears to be a major disease or problem in the United Kingdom. It is referred to terrible stigma
of elderly people who are suffering from dementia. According to statistics presented by
Department of Health UK, approximately 750,000 people living in the UK are suffering from
dementia disease while it is expected that these numbers will be doubled in next 30 years of
tenure and create a big problem for people in future (Sampson et al. 2010, p.174). There is a need
to provide best and appropriate mental health services to elderly people who have been suffering
from dementia disease. This research will guide mental health services provided to elderly
people suffering from dementia and issues faced by caregivers and patients related to
interventions and mental health services.

Contents
ABSTRACT....................................................................................................................................................2
CHAPTER I: INTRODUCTION.........................................................................................................................4
Background..............................................................................................................................................4
Research Questions.................................................................................................................................5
The research questions are......................................................................................................................5
Aims and Objectives................................................................................................................................5
Significance of Research..........................................................................................................................5
Outline of chapters..................................................................................................................................6
CHAPTER II: LITERATURE REVIEW................................................................................................................8
Mental health problems with elderly people..........................................................................................8
Issues with Existing Services for Dementia............................................................................................10
Mental Health Services .........................................................................................................................11
Knowledge gaps of care givers...............................................................................................................12
CHAPTER III: METHODOLOGY....................................................................................................................15
Research Design....................................................................................................................................15
Research Method..................................................................................................................................16
CHAPTER IV: ANALYSIS AND DISCUSSION..................................................................................................19
Results...................................................................................................................................................25
CHAPTER V: CONCLUSION.........................................................................................................................27
References.................................................................................................................................................31
Appendix....................................................................................................................................................35
Systematic Reviews...............................................................................................................................35
PRISMA chart.........................................................................................................................................37

CHAPTER I: INTRODUCTION
Background
The causes of dementia are progressive neuro-degeneration that is leading to memory
impairment, language comprehension and speech, executive function and ability in activities of
day to day living. There have been cognitive impairments, that most of the patients develop
changes in personality and "behavioural and psychological symptoms of dementia (BPSD)" like
psychotic symptoms (delusions and hallucinations), agitation and wandering as well as
purposeless activity or the aggression in the older people. Dementia is caused by the range of
underlying processes of neuropathology which is the commonest form of being the disease of In
recent decades, approximately 600,000 people in the UK are affected with dementia which is
10% of people that are above the 65 years old but it has been estimated that by end of 2026 ,
range will be approached to 840,000 while rising to more than 1.2 million by end of 2050 (Dong
2010, p.15). All over the world, prevalence figures are all set to increase steeply, which is
currently estimated at 24.3 million of people all over world suffering from dementia but this
number might be affected, and it will be doubled after every 20 years to approximately 81.1
million in the year 2040. However, it has been seen that there are number of people who died due
to dementia is increasing day by day (Esbensen 2010, p.107). According to estimation from the
project of UK MRC-CFAS, huge multi-centre study is looking towards functionality of health
and social care of approximately 13000 older people. Moreover, it suggests that people who died
between the ages 65-69-year-old have a high risk of suffering from dementia while rising to
approximately 58% risk of the people who died with dementia in those above the age of 9 years.
In the United Kingdom, one in the three people is above the age of 65 that will die while they are
suffering from dementia (Friedman, Tanouye & Joseph 2011, p.417). According to current
English National Dementia Strategy, it has been highly focused on the detection as well as

treatment of dementia at early ages with the cholinesterase inhibitors or social and psychological
interventions. Hence, there has been no evidence that such type of interventions will prolong the
life in the people suffering from dementia and as per recent interest in how the palliative care
approach will provide benefits to the people with advanced dementia (French 2014, p.618).
Research Questions
The research questions are
What are current practices of mental health services for dementia patient?
What are the problems faced by elderly patients in accessing mental health services in UK?
Aims and Objectives
The study aims to critically analyse main issues that have been faced by elderly people
with dementia services. Moreover, the aim is to identify gaps in current mental health services in
the UK for dementia treatment of elderly people. The study will provide existing mental health
services provided to dementia patient.
The main objectives of the study are
 To explore current practice of mental health services for dementia patient in older adults
 To identify existing mental health services provided related to dementia in the UK
 To identify issues related to healthcare and support by the caregivers to elderly people.
Significance of Research
The significance of research is that it will help to overcome issues faced by elderly
people for using mental health services or treatment. There have been certain on-going current
treatment that have been used to provide support to older adults suffering with dementia. This
research helps to evaluate the effectiveness of services such as family care, robot therapy,

cognitive and psychology therapy that can be used for palliative care for dementia treatment. The
research will increase knowledge of care givers in treatment of dementia for elderly people.
Outline of chapters
The dissertation is divided into five chapters that are based on intrinsic requirements for
achieving the research objective. The content covered in these chapters are explained below:
CHAPTER 1: INTRODUCTION
The first chapter will be linked with the introduction which defines the overall structure
and aims and objectives of the research. This will include significance of research, developing
research questions and background of research. This will help users to understand the importance
of research that will be undertaken and it will highlight relevant issues within research.
Moreover, the first chapter will include determining appropriate direction within research that
need to be done.
CHAPTER 2: LITERATURE REVIEW
The second chapter will provide the extensive review of the past literature and
appropriate and best fit research studies that have been conducted previously related to subject
which is under consideration. This will help to develop comprehension of relevant theoretical
and conceptual framework within the research study so that proper information can be provided
to readers that aid in improving their knowledge.
CHAPTER 3: RESERACH METHODOLOGY
The third chapter will go through research methodology that will be undertaken with
result and findings in the next chapter. The research methodology proposed for completion of
this study by performing systematic review established through PRISMA model. This will
enable assessment of relevant literature intrinsically associated with overall aim and objectives of
the study. Moreover, the systematic review will also enable assessment of various qualitative as

well as quantitative studies related to the subject. Hence augmenting findings of study through
evaluation of empirical as well as qualitative data related to the notion has been performed under
research. Hence, the selection of appropriate literature is mandatory for development of effective
and extensive research findings and attainment of the overall research objectives. The third
chapter will also include relevant ethical considerations of study as well. The ethical
considerations related to study will be associated with moral and legal regulations along with the
proper utilisation of secondary research studies. In addition to limitations of the study will also
be enumerated in order to assert negative consequence that can be experienced throughout the
study.
CHAPTER 4: FINDINGS AND ANALYSIS
The fourth chapter will be related to enumeration of findings and results of the study. In
this section all the information collected throughout the investigation of secondary sources will
be evaluated and analysed in order to extract the proper finding that can address or help
researcher to accomplish its investigation objectives.
CHAPTER 5: CONCLUSION
Final fifth chapter will assert conclusive remarks related to findings of dementia patient
services that has been developed in the previous chapter and assert relevant recommendations in
relation to the findings. In addition to this it also includes limitation that has been found by the
researcher throughout the investigation along with the quality of study that has been reviewed by
the investigator.

CHAPTER II: LITERATURE REVIEW
Mental health problems with elderly people
Dementia is said to be an umbrella which usually defines the syndromes and organic
disorder where the changes to the physical structure of the brand is the main causes of illness
which includes the death of brain cells or damages in the brain parts that will deal with thought
processes. This will lead to the decline in the mental ability which might affects the memory,
problem-solving, thinking, perception and concentration (Friedman, Tanouye & Joseph, 2011,
p.422).
According to Wall and Duffy (2010), older people suffering from dementia started to
forget about their daily activities as well as personal hygiene, and they face difficulty in coping
with the problems associated with their daily life (p.108). Mental health problems are said to be
common in older people as compared to younger adults, and they are associated with suicide,
individual suffering, use of health and social care services as well as poorer outcomes or results
from physical illness. Though symptoms of mental health in elderly people are more or less to be
volunteered, identified or they have been treated. Specifically, very few studies such as Prince et
al. (2013) have been presented that shows about complaints regarding dementia issues by elderly
people as it is said to be a common issue of memory loss due to age factor (p.63). The
presentation of mental illness is related to physical illness as compared to emotional symptoms.
According to Sampson et.al (2010) dementia decreases mental ability of a person, causes
mental disorder, functional or cognitive impairment, intellectual deficit that represent actual
diseases that occur within older aged patients for which most of doctors, family as well as entire
society must have the knowledge, compassion and they can take care of patient effectively
(p.159).
Many people used to lead a long and prosper life without any issues related to mental
health and despite of all the relevant image of elderly people for being slow and forgetful,

dementia, whereas dementia is not an inevitable development as the current age where there is a
need for new development in interventions (Dong 2010,p.15).
There consists of many reasons of why the mental health issues are in increasing rate
along with age whereas it is from biological changes which can interfere with the ability of brain
for providing processed information to social changes like children leaving the place or
retirement which can lead to the feelings of isolation or the worthlessness (Esbensen 2010,
p.107). There have been many underlying diseases like the stroke or Parkinson's that are most
commonly developed, and it is often considered as important for the contributory factors. Many
mental health problems can have a serious impact on ability of older aged people for carrying out
the basic and day to day activities in living. The impact of mental health problems on the life of
people even if there are only a few minor symptoms it is needed to get it checked so that it will
not be changed into a huge problem in future (Collins et al. 2011, p.27).
Some problems will go untreated and undiagnosed as per low mood that might be ended
as the unavoidable outcome of decline from the chronic diseases that might often develop in late
years while odd behaviour might be the attribute that has been seen frequently to eccentricity.
Many older aged people are struggling without any right help, or they don't need any other help
from anyone (Friedman, Tanouye & Joseph, 2011, p.417).
Understanding the needs of dementia patient as why psychiatric illness have been
developed and way elderly people get affected is said to be vital in providing help to the people
for managing problems easily and effectively as possible and it helps to reduce the risk which
can have serious harm to the people (Esbensen, 2010, p.126).
The experience of person who is suffering with dementia is said to be unique. Early onset
dementia is referred to as term that can be used for the dementia patient whose diagnosis has
been received just before the person is at the age of 65. It has been estimated that approximately
40,000 people have been diagnosed with dementia all over the United Kingdom. The subtyping

dementia is said to be important for guidance regarding the treatment and prescription of the
decisions. The Alzheimer’s disease is said to be most common type of dementia that have been
diagnosed among 60% of the people who are degenerative and the causes of Alzheimer are still
unknown (Friedman, Tanouye & Joseph, 2011, p.417).
Issues with Existing Services for Dementia
Currently, there is no uniform model of mental health services for dementia patients
across England. Majority of the people that are suffering from dementia are looked after more in
primary care as compared to the old age psychiatry services given to the patient at the time of
their mental health issues (Schoenmakers, Buntinx & DeLepeleire, 2010, pp.44-45). The reason
behind is that most of people diagnosed with dementia have been provided with the care at home
and it is supported by families, neighbours and mainstream services. In the year 2011, World
Alzheimer Report has been presented that shows the need for the early intervention within
dementia, and it has been suggested for the collaborative care as the available means for
improving the quality of care and cost-effectiveness within the community care. The
collaborative care comprises the care as the case manager who will coordinate the care between
the professionals that lie between the secondary and primary care and utilise the pathways of
evidence-based care to address psychosocial and physical needs of people. It has been found out
that it is said to be effective in such conditions such as a person in depression. While the earlier
trails of interventions that have found out there are many benefits for people suffering from
dementia and family caregivers. According to recent year systematic reviews, it has been found
out that little clinical, as well as cost-effective evidence, has been used to support the widespread
implementation of case management beyond the benefits of quality of life (French, 2014, p.618).
Approximately two third of people suffering from dementia living in England usually live
at home, and they have been supported by the family members, health and social care

practitioners as well as dementia services like Admiral Nurses. There have been many concerns
regarding quality and increasing the cost of the dementia interventions and care that have led to
the calls for cost-effective and integrated approaches. In the United Kingdom, the care
management has been provided through health and social care community for the mental health
services but it is usually reactive and time-limited interventions (Esbensen, 2010, p.107).
Mental Health Services
According to National Collaborating Centre for Mental Health (2007) and National
Institute for Health and Clinical Excellence (NICE, 2006) in the UK, there are guidelines for
evidence-based care related to the way that needs to be done for patients suffering from
dementia. There are still some issues regarding the knowledge and training of nurses in acute
hospitals for the treatment and care of elderly people suffering from dementia.
Modorch (2013) identified that capability of the older adults to changing conditions is
said to be limited, and people usually wait for using appropriate services. Similarly, the family
used to tied up to continue to be an important form of instrumental and emotional support for
older patients (p.14).
According to 2011 Alzheimer's Society survey, it has been found that approximately 50%
of the caregivers, as well as people with dementia disease living in home, stated that person
suffering from dementia was not getting the proper support as well as care in order to meet the
needs of the elder people with dementia. These have been serious repercussions which include
avoidable admissions to hospitals and the early entry to long-term care (Livingston eta.al 2010,
p.41).
The majority of care workers have surveyed and demonstrated that being able to provide
care for same elderly people over a long time will help in providing support to elderly people to
stay at home. Mordoch et al. (2013) conducted study while showing National Service

Framework developed for the older aged people and the problems that elderly people faced while
having access to the framework and the effective diagnosis process that most of healthcare
service provider lacks to provide to elderly people (p.15).
The behavioural changes within dementia patient that leads relatives to seek help from
health care service provided by the government to elderly people. People with dementia have
many behavioural changes such as discomfort from constipation, agitation, sleep disturbance,
aggressive, incontinence, difficulties in communication and sexual inheriting.
Some of the mental health services covered by Maudsley and South London NHS
Foundation Trust have managed to play a significant role in the development of services for
mental health care for older people with dementia in the UK.
Olazaran et.al (2010) stated that in the year 2012, Maudsley and South London first
dedicated the Clinical Academic Group (CAG) for the elderly people has been created which
aims to provide high-quality specialist in mental health care to older adults over the age of 65
years and have complex and severe needs related to mental health and for support of dementia
patient (p.161-162).
Knowledge gaps of care givers
The cognitive dysfunction and psychiatric symptoms characteristic of Alzheimer's
disease deeply plague home caregivers without relevant professional knowledge. Analysis of the
influencing factors of the caregiver's psychological problems and the adoption of reasonable and
personalised psychological crisis interventions can alleviate psychological pressure of the elderly
dementia caregivers and effectively improve their mental health. Caregivers have good mood to
provide services for Alzheimer's patients and improve quality of life of patients with Alzheimer's
disease. Resilience is an active adaptation of individuals to difficulties. It is the ability to
maintain or restore mental health after frustration. With the development of positive psychology,

psychological flexibility has become a hot topic for scholars at home and abroad as a new
perspective, and has been widely used in the fields of psychology and education.
Some scholars such as Livingston et.al (2010) think that education can develop brain
intelligence, increase "brain reserve", and cause law (origami, painting). According to the
patient's physical condition and hobbies, it is appropriate to protect against dementia. The
activities, which play a positive role in promoting the patient's feelings and actions, can be used
to improve the characteristics of brain care of main caregivers, which is conducive to the
rehabilitation of the disease. The main caregivers are mainly women, mainly spouses and
children. This may be related to my investigation and found that the main caregivers attach great
importance to the development of health education (p.141). The traditional customs of the vast
majority are related.
It is found that the majority of the current caregivers live with the patients; the process of
on-the-job and retirees is influenced by many factors. In general, a person's knowledge change is
more common. Easy, and attitude changes are more difficult than knowledge changes. As for the
change of behaviour, the mental state of the main caregivers is more difficult and time-
consuming than the two. In this survey, there were only three subjects in this survey before and
after health education: 36.56% of people with different degrees of depression, of which, although
in many behaviours, the main caregivers have not changed, the family caregivers are welcome.
Cognitive and supportive psychotherapy:
It work toward developing understanding regarding common sense and nature of disease,
correctly treating development of disease, changing the misconceptions and expected goals of
the caregiver and patient, thereby improving unreasonable mood of caregiver; often contacting
caregiver. Let caregiver have a way to vent their emotions and obtain psychological support
(Friedman, Tanouye & Joseph, 2011, p. 417). The above measures ultimately reduce the number
of times the caregiver's psychological load occurs. At the same time, this study shows that the

problems in the control group are getting more and more serious, which does not indicate that
health education is useless, and may be related to the poor effect of health education and the
faster development of the disease without intervention. There was no statistically significant
difference in the psychological load between male caregivers and female caregivers, which may
be related to the small number of samples and short intervention time (Stokes,2017) . Further
research is needed.
Based on the situation of Haining, this study is a tentative study on service forms and
specific contents of Alzheimer's caregivers in the community (Friedman, Tanouye & Joseph
2011, p. 422). The purpose is to provide a basis for the establishment of social service networks
and support institutions suitable for the services of Alzheimer's patients and caregivers in
community. In this study, the number of patients in each group was reduced, all of which were
death cases, which may be related to the age of patients enrolled.

CHAPTER III: METHODOLOGY
Research Design
Research design refers to the type of method which is used to collect information
regarding the present research topic. These research design are of two type such as primary
research design and secondary research design. Primary Research is said to be designed in order
to meet the unique and specific needs of the people as it focuses toward collecting the fresh and
relevant information (Schoenmakers, Buntinx and DeLepeleire, 2010). This fundamental and
important research has been conducted by the people if there has been people on the tight budget
or through the research firm that hire the people for the specific project usually the organisation
that comes up with the recommendation by the colleague. The research can be used to include
surveys, focus groups, observations and interviews.
On the other side, secondary research is a type of design which focuses toward gathering
the information from sources or research which has already been performed by some another
person over similar topic. Hence secondary data collection method is the one in which
information used which is collected or published previous and now help on another research by
forming up a base for further research. Sources of secondary data collection are books,
magazines, journals, portals and many more (Schoenmakers, Buntinx and DeLepeleire, 2010).
For collecting secondary data it is very essential for a researcher to set up a specific criteria
because this will plays a crucial role in enhancing the quality of research in term of reliability
and validity. Some of the major consideration which a researcher must focus is generally
includes reliability of sources, date of publication, depth of analysis, nature of data collection and
many more.
In order to conduct this research secondary data collection method will be used which
help in analysing several issues that are being experienced by the people in term of dementia and

other mental health related issues. In addition to this it also help in determining the causes as
well as measures to overcome these health related issues to avoid major risks to the life of people
who are affected by these sort of diseases (Sampson, 2010).
Research Method
“Quantitative method is a process of statistically inferring empirical data (including experimental
data and observation data) to test theoretical hypotheses to serve positivist research. The positivist study
recognises the separation of the object from the subject, and is mainly analytical, aiming to discover the
objective world. The positivism of positivism differs from the ontology and epistemology in the
"interpretation" or "criticism" tradition in social science research. As a kind of empirical research, the
methods and ideas of quantitative research are not applicable to interpretive and critical research.
However, quantitative research is only one type of positivist research. As long as it is acknowledging that
the purpose of research is to understand the objective world phenomenon rather than to interpret and
criticise the phenomenon in a normative sense.
To correctly understand the role of quantitative methods in scientific research, it is necessary to
further explain scientific research. “Deduction and falsification are the two decisive features of scientific
methods. The theory is not entirely derived from the induction of reality. Observations based on many
more events are unlikely to rise to universal theories. The theory must be the result of deduction, and the
source of the theory is the real world or some mysterious inspiration. The scientific methodology tends
not to be discussed. The deductive nature of scientific research theory determines that quantitative
methods are not used for theoretical creation. This may sound frustrating for the advocates of quantitative
methods. However, scientific research is a cyclical process. When quantitative methods discover facts
that are contrary to theory (or falsification), researchers must rethink and correct theory. But the revision
of the theory still has to go through a process of re-deduction, not based on the empirical results of
quantitative analysis that is, based on the induction of reality” (Larson, Yaffe and Langa, 2013).
Quantitative methods are one of the ways to conduct theoretical tests in logical research. The
main features of the logical approach are many well-defined strategies, based mainly on the enhancement

of explanatory and deductive hypothetical speculations and the use of observational evidence to test
hypothesis theory. The quantitative method is only a test hypothesis, which is a prerequisite for the
deductive property of the logical hypothesis. This fully recognises the logical study of quantitative
methods and mining surveys of measurable information. A large number of information age methods
have induced some researchers to begin with information and to find the necessary connections most
likely to be expected, causal enlightenment remains the true quest for sociology, including global
relationships. Judging the judgement and tampering and misrepresentation in scientific and
methodological rationality has long been discussed (Karel, Gatz and Smyer, 2012).
In particular, quantitative methods begin with speculation to be attempted, which is about the
reasonable causal relationship between ideas, which is usually probability and not certainty. From the
point of view of conceptualisation theory, quantitative methods need to interpret "thoughts" as "factors",
thus interpreting hypothetical questions as factual problems. When an idea becomes a variable, it can be
estimated and the preconditions are estimated to be organised and institutionalised. After deciding the
method of estimation, the scientist observes the truth and collects the data in the frame information, which
is called confirmation of the variable. The factors can be quantitative or subjective, but in quantitative
tests they use a digital structure. Estimates of subjective variables are not numerically important, only
classification or disposition of meaning (Jakobsen and Sørlie, 2010). The type of information is
determined by a number of factors, and respect is generated by a clear structure of estimates. The
scientists of the time carried out a measurable investigation of the information. If it is unpredictable or
basic, the reason and the end result are theory tests and decide if they reject speculation depending on
predetermined criteria.
In order to conduct this research secondary method has been used which because it help
in providing the information from the secondary sources in which information is gathered by the
professionals who are expertise in this field. This will help in providing more adequate and
reliable information to the readers who are referring this research and also support practitioners
to develop their knowledge regarding dementia. In order to collect this information google has

been used which has a link of various website as well as articles that can be used to gather
information in this regard. The collected information is more valid and reliable as it is gathered
from the authenticated sources which is approved by some of the best known health care
institutions such as NHS.

CHAPTER IV: ANALYSIS AND DISCUSSION
Data analysis refer to process of evaluating, cleansing and improving the data with an
aim to gather useful information so that proper finding as well as conclusion could be extract to
achieve the desired outcome of research objective. In order to properly gather information
related to concern area of research several articles and Transcript has been analysed using the
quantitative method of data collection. In addition to this, inventory analysis will also be used fro
determining the nurses' empirical significance while the care and treatment of Dementia (Berg,
2001). After conducting analysis over these sources there are number of area determine in which
a nurse have their knowledge and understanding to cure its patients much effectively. These area
of dementia are :
1) Social/Psychological treatments for dementia – From tkhe data analysis over several
imnformation sources it has been analysed that the patient of dementia are also required
some socialised based treatment despite of medication. This help in improving their
health much more quickly. For this patients must be provided with socio-psychological
treatment and one of the best example for this is person-centred care or personhood. This
treatment was first adopted by Tom Kitwood and experienced a more better result then
medication (Chan and et. al., 2010). This approach consider dignity, humanity and moral
ethics while providing treatment to patients. In addition to this individuals are also
supported and enabled to involve in decision making regarding their treatment procedure,
provided with equality in communication and mutual respect.
2) Early onset Dementia and iapproches used in clinc to manage obesityts impact on
peoples' lives:- Early onset Dementia is a sort of mental disesase which is basically
found in young age people i.e. Younger then teh age of 65 which is very essential to cure
quickly. As this may worsen the case if not properly cure or treated on time. There are

number of aproachjes used in clinics to treta this which are GP Counselling, talking
therapy which help people in getting rid of depression, anxiety, ampathy etc. In addition
to this cognitive simulation ia also used as a non-drug approach in order to improve the
behavioural cahnges within the patients (Collins and et. al., 2011).
3) Dementia and Public Health - Government strategies related to minimising Risk
of Dementia in later life:- The health issues related to Dementia are increasing day by
day and as a result of which government and other health care institutions has worked
toward forming certain plans and strategies to provide better cure and treatment to such
diseases in order to improve the health or living of people (National dementia plans.
2019). Alzheimer's Disease International supports in creating a high level plan against the
growing impact of dementia worldwide, in this around 27 WHO State member are also
involve. From this integration a national dementia plan has been formed which are
capable of addressing the disease in a manner which are tailored as per the culture and
demographic of each country (Dong and et. al., 2010). In addition to this there are also
certain comprehensive governmental plan for addressing and curing this diseases which
includes increasing public awareness, improving the quality of health care, long term care
support and service for patients of dementia etc.
4) Dementia and Co-morbidity with other Mental Health conditions:- The analses and
treatment of psychiatric symptom in person having cognitive dysfunction are becoming
increasingly more improtant as it is increasing very frequently. It has been assumed that
around 5% people having their age of 71 to 79 year and approx 25% to 50% are upto 90
or above who are suffering from dementia and also having psychiatric co-morbidities
(Comorbidity: Psychiatric Comorbidity in Persons With Dementia, 2019). So these
patients must be treated accordingly as dementia is not merely a problem with memory
rather the presence of one or more additional cognitive disturbance are required

diagnosis. This is because it affect both patient as well as care giver because of memory
deficit and quality of life.
5) Pharmacological treatments for Dementia:- There are number of pharmacological
therapy for the cognitive symptom related with the dimentia disease are Cholinesterase
Inhibitors, Risperidone and memantine. These all medication help in assist with these
issues which help in imroving the quality of life for teh people who are suffering from
this disease (French and et. al., 2014). But before providing treatment to this it is very
essential for the care homes to communicate it with the patient as well as their families
regarding the expected modest benefit of medication and facts that are required to
continue despite the medication provided.
From the above mentioned literature review it has been found that a general theme was
subsequently identified, including a comprehensive understanding of the nurse's experience.
Theme 1: Current practice of mental health services for dementia patient in older adults
From the above performed literature review it has been analyzed that Dementia can be
consider as an umbrella that usually defines organic disorder and syndromes where changes
happens in physical body part of a person causes illness. This may includes part of brain get
damaged or death of brain cells which support a human being in their thinking process. These
issues are mainly found in old age people because of age factor or some other major illness in
other part of body. The elders who are suffering from dementia started forgetting about things
which they perform in their daily routine. These issues are generally common in older people
which are associated with use of health and social care services, poor outcome from physical
illness. It has been also determined that there is increase in such sort of issues among people
when they get older because of age factor and the presence of mental illness is directly
connected with physical illness despite of emotional or other sort of issues.

Dementia is a major issue in elder people which decreases the mental ability of people
and also cause cognitive impairment and mental disorder whose symptoms must be known by
the family as well as society in order to deal with major risk that may arises and affect people
badly who are suffering from dementia. But from the study it has been found that it is a
biological change within a person that affect the ability of a brain regarding information
processing for social changes which develops the feeling of isolation among people.
In addition to this, dementia give birth to several mental health issues which have a
serious impact over the ability of old age people in term of their day to day activities. As this
leads to decline in perception, thinking, memory weakening and concentration. These issues can
also found in people before they get over the age of 65 which is known as early onset dementia.
There are around 40000 people within UK who are suffering from dementia and this data has
been found from the diagnosis.
Theme 2: Existing mental health services related with dementia in the UK
From the above analyzed authors view it has been identified that at present no uniform
model related with mental health care services is present in England for dementia patients and
patients are usually looked after in primary care despite of any old age psychiatric services. Main
cause behind this is that it believes from so long that people suffering from dementia must be
taken care at home with the support of families, neighbors and mainstream services, patients get
able to recover much earlier. From the analyses of World Alzheimer Report regarding the early
intervention of dementia it can suggested that collaborative care is a mean to improve the quality
of care provided by community care. These collaborative care generally lies between primary as
well as secondary care in order to utilize the evidence based care pathway to provide a physical
as well as psychological need of people. In England around two third people are suffering from
dementia which are being supported by their family members, admiral nurse for dementia
services and health & social care practitioners. Hence, the social care and other practitioners who

are providing treatment regarding dementia mainly focuses toward providing them home-based
services despite of keeping them at clinics. Apart from this in United Kingdom, care related with
dementia is usually managed by the health and social care community but it has time-limited
intervention and reactive.
Theme 3: Issues related to healthcare and support by the caregivers to elderly people.
From the above analysis it has been concluded that incompetent care is the reason for a
mentally ill person early transfer to mental hospital. Without the proper care, person's health
become more distorting everyday. It has been observed that it happens because of unavailability
of proper care available. A person with mental illness require more care from their family,
friends, neighbours, but, these special care required by a mentally ill person suffering from
dementia or Alzheimer is yet not available in England. It happens because still people with
Alzheimer are treated in regular primary care than that of special psychiatry ward. It has been
stated in many reports that these patients require special collaborative care. The Collaborative
care refers to a collaboration by a middle men between psychiatrist and the needs of patients. If
an early detection of dementia is treated with collaborative care, then, there is a huge chance that
the person's health will be back to normal within some time.
Many a times, it has been seen that a person suffering from mental illness in England,
usually lives in home, and is supported by family and care practitioners and, thus, they lack the
care they actually require which will only be provided to them by the specialists and
collaborative care is one such step towards it. In United Kingdom, the care management is
provided by social and health care community which is time bounded and it is not enough for a
mental ill patient. Many a times, it is also observed that the services availed by a mentally ill is
quite expensive and can't be afforded by many people and thus they lack right treatment.
Collaborative care can be one solution to many problems of mentally ill patients.

The first author and the second author conducted a content analysis and read all texts,
including Swedish and English. A transcripts was presented to interpretive phenomenological
analysis (IPA) for producing a model to explain participants' subjective experience in
descriptions of topics and hospital care with the life of dementia. IPA is rooted in the
philosophical tradition of phenomenology and doctrine symbolic interaction, to explore life
experience and individuals understand how they experienced (Smith, Jarman, & Osborn, 1997;
Smith), focusing on the significant internal psychological meaning of its description & Osborn,
2004). "IPA" refers to the descriptive, aims to identify individuals form a credible explanation of
the concept and subjective experience, but also has a clear explanatory, the recognition of any
statement also contain elements explain the researchers. Therefore, the IPA is based on the
descriptive and hermeneutic traditions of phenomenology.
We performed a review process with QSR International's NVivo 2.0 software for
computer-assisted data analysis (QSR International, Doncaster, Victoria, Australia). The analysis
was performed as follows (see Quinn & Clare, 2008; Smith, Osborn, & Jarman, 1999). First, we
analyse each transcript separately. Familiar with the transcripts, reading and rereading, we
identify the key points through the detailed coding line by line. Then we list all the key points
and assemble them into groups that reflect the initial emerging topics and rewrite the transcripts
based on these topics. After analysing all the transcripts in this way, we performed a group-level
analysis. We compiled a list of all emerging topics in all transcripts, and grouped them by
similarity and overlap. In addition, we refine the resulting clusters in a process to identify the top
topics, each containing many subtopics. We mark topics and subtopics as much as possible by
selecting representative quotes and using participants' own words. We then re-encode all
transcripts by topic and subtopic list and list all relevant excerpts in each topic title. This forms
the basis of the thematic account presented here, which describes the four main themes identified
in the analysis.

We try to maximise the credibility and credibility of our accounts in three main ways
(Elliott, Fischer, & Rennie, 1999; Yardley, 2000). First, an independent researcher analyzed 15%
of the transcripts and then discussed them so we could resolve any differences by consensus.
Second, we seek answers to the results of relevant groups. We conducted focus groups for home
caregivers, home care workers for dementia patients, and dementia care professionals, and we
discussed them individually with people with dementia precocious. Finally, in presenting the
results, we used a section to illustrate our report to prove that the results were based on data
(Whitemore, Chase, & Mandle, 2001). In addition, although IPA studies generally do not report
quantitative data, they can make an important contribution to the interpretation of meaning in
qualitative reports (Sandelowski, 2001). We attempted to illustrate our analysis by presenting the
frequency of occurrences for each topic and sub-theme, the number of participants involved and
the average number of participant dialogue statements associated with this topic. We also
considered the relationship between the number of topics represented in the individual account of
the participant and the level of cognitive function of the participants, as indicated by the MMSE
score.
Results
In many discussions, the experience of private consideration of dementia has been successfully
passed down. A total of 80 participants, 71 (MMSE score, M = 10.54, SD = 6.45; Territory = 0-
20, module score 0; see Figure 1), a total of 283 discussions (per participant, M = 3.99; Territory
= 1- 8) Talk about their abstraction, part of the psychological experience, and provide data for
the subject check in this way. Of the 71 participants, 34 lived in real estate with families
considering dementia, 20 of whom lived in homes that considered more celebrities, including
designated departments specifically considering dementia patients, 17 I lived at home to cook a
mixed passenger meeting for dementia. The remaining nine participants did not discuss their

emotional experience. When dissecting their transcripts, we could not find any material that
could explain the problem.
Next, we will describe each topic and support our depictions with illustrative excerpts.
Nothing is the feeling conveyed by this theme now that the psychological experience of
participants is largely portrayed by pain, and painful expressions focus on vulnerability,
misfortune, apartheid and depression, fear and useless emotions. In any case, participants are not
sure why they are at home, what might happen at home, and how long the course of action is. As
one participant said, “Well, I don’t have the most vague idea, they will do something to me here,
but hey, they didn’t say what they are doing, [and] I have no clue why they put me
Here...''(BG06). Another person said, ''I didn't realise if I was trapped here because of my life or
what really happened'' (GR03). Participants seem without any feeling of being advised or
educated, these excerpts indicate that they are powerless to apply any order to their situation.

CHAPTER V: CONCLUSION
Conclusion:-
Above given report is about the increasing mental sickness among the people such as
Dementia, Alzheimer and many more. It is mainly found in elder people as after passing up a
certain age people started getting affected by weakness in their other physical part and also get
affected by several other disease due to weakening of their immune system. These all diseases
and health issues have an direct impact over the memorising or thinking capability of brain
which in turn leads to increasing in mental stroma, feeling of loneliness and emotion swing such
as anger. It all leads to get suffered from diseases like dementia in which people find it difficulty
while performing their day to day activities.
From this investigation it has been found that around 71 people are suffering from
moderate to extreme dementia represented, these people live in private homes and distinguish
between an understanding of this experience Structures can be useful for experts and strategic
producers, as well as researchers.It has also been determined while working together with the
social management department, as well as with management departments that are not separated
by age, whether or not maintaining mature psychiatric management. Each of these associations
has conquered some of the problems that some see as unbelievable obstacles.
Despite this, most regions have a common strategy of social and health considerations,
there appears to be modest progress in establishing a comprehensive administrative model on the
part of authorities or suppliers. The world-class commissioning program of the Ministry of
Health has been designed to convey a gradual, critical and long-term approach to the
commissioning of the Health Management and Social Considerations Committee and clearly
highlights the best health outcomes.22 The next phase review the NHS also highlighted Clinical

Associations and Leadership. The administrative advancement of the Ministry of Health controls
everyone's business 1 and the real psychiatrist's improvement criteria23 present a picture of
management style and practice. The National Strategy for Dementia, the Network's Health
Response and Social Considerations to the Equality Act, and a New Vision for Mental Health
(which will provide the NSF with essential courses on emotional health) provide incredible
potential for emotional health management for the elderly Without coordination efforts, centers
and leaders, they will not communicate changes.
Limitation of research:-
While conducting this research there remains a number of limitations as well as issues
which have been experienced throughout this investigation. This is because number of people
who doesn't want to share proper information regarding their patients due to their norms as well
as rule of their health care centres. In addition to this, researcher also find it difficult to collect
information from several sources like internet or other articles as the concept is very much in
trend. Because of it information is available at very border manner which make it difficult for the
research to extract the information which is required to address the objective of presented
research.
But in order to provide high quality of information to the reader the information
regarding this research topic has been gathered from authenticated websites which do not mis-
lead people who are reading the information. In addition to this information related to the
symptoms of dementia are also gathered from the professional expertise which provide an in
depth knowledge in this regard.
Implication:-
For Participants' reports are inspired by unstructured discussions aimed at presenting
insignificant requirements to participants while providing them with a space to share their
thoughts and emotions. Not all participants referred their emotional and psychological

experiences to the discussion, but most participants did so, and it should be noted that we are a
particularly broad example of IPA considerations. In this account quantitative data including the
common theme in the accounts of the participants and the contributions of the sub-themes as
well as between the participants and the degree of dimensions disability convey the problems
associated with illustrious people with cognitive characterised by the score MMSE Relationship.
from the point of view of the inspection structure, notices should be taken when attempting to
translate quantitative data.
The completion of this examination adds another metric to our understanding, conveying
a thematic description of the abstract psychological experience of moderate to extreme dementia
from the perspective of patients with dementia in particular considerations.
Recommendations
From the above given information and analysis it can recommend that Dementia is
generally occur due to physical illness and age factor which is harder to avoid. Hence such
patients must be treated at the place where they are comfortable and likely to be treated.
Therefore, patients must be provided with home care treatment as when they get treated over
their familiar place outcomes would be more positive. In addition to this it also help in avoiding
the major risk or harm that can be cause of the patient of dementia not get treated earlier.
Recommendations to future research
The investigation over current topic has been performed using secondary data collection
method which support in gathering information from the previously performed or published
research. But major disadvantage of using this data collection method is that information
sometimes can be outdated. Hence it is recommended that a researcher must focuses toward
gathering the information through primary sources also so that the report could be more accurate
and current. This support a researcher to provide information regarding the particular research

data in more ethical manner as inefficient or outdated information may miss-guide the people
who are reading this available content.

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Appendix
Systematic Reviews
Authors Year Title Research Aim /
Problem Statement
Summarising the
Evidence
Wei Qiao Qiu
MD, Michael
Timothy Liu,
Linda George,
Margery
Gann ,Joshua
Cohen &
Martha L.
Bruce
2010 Physical and
Mental Health
of Homebound
Older Adults:
An Overlooked
Population
The aim of paper is to
examine specific
psychiatric, and
physical factors that are
mostly responsible for
older adults have been
suffered from remaining
in the home. The
homebound cause them
serious illness. The age
population is an
important aspect in
elderly people that
mostly suffered from
dementia disease.
According to Qui et al.
(2010) conducted
study that shows there
are currently
approximately 38.9
million of the people
who are aged about 65
years old in the U.S.
More than 3.6 million
of the people that have
been housebound and
they are in need of
home-based care.
Although, status of
home-based is not be
defined particularly
along with the wide
range of disability
level that has been
evident that most of
the people who have
been suffered from
homebound from the
medical and the
psychiatric illness.
Greg A. Sachs ,
Catherine A.
Alder ,
Stephanie
Munger , Cathy
C. Schubert ,
Mary Guerriero
Austrom , Ann
M. Hake ,
Frederick W.
Unverzagt ,
Martin Farlow ,
Brandy R.
Matthews ,
Anthony J.
Perkins , Robin
A. Beck &
2011 Implementing
innovative
models of
dementia care:
The Healthy
Aging Brain
Center
The aim of the research
is to implement
sustainable and
collaborative dementia
care program in public
care system within the
county
The study investigates
use and
implementation of
tools that have been
used within dementia
care for the healthy,
and it can be utilised
to translate health care
model of delivery that
has been developed in
research laboratory to
operation, practical
and health care
delivery program in
the country.

Christopher M.
Callahan
Shibata T.
Wada K.
2011 Robot Therapy:
A New
Approach for
Mental
Healthcare of
the Elderly – A
Mini-Review
The aim of the research
is to critically examine
literature that addresses
the use of any treatment
that has been offered by
the government for
treatment of elderly
people who have been
suffering from dementia
issues.
According to Shibata
T. Wada K. (2011)
The mental health care
of the elderly people is
said to be the common
problem in advanced
countries. Currently,
the high technology
has been developed
the robots for use only
in factories but also
for the living
environment. The
paper has been used
the robot therapy for
the substitution of the
patients who have
been suffering from
the dementia patient
and any mental health
issues. It has been
analysed that this will
help to know the
problem of health
issues faced by the
people.
Livingston, G.,
Leavey, G.,
Manela, M.,
Livingston, D.,
Rait, G.,
Sampson, E.,
Bavishi, S.,
Shahriyarmolki,
K. and Cooper
2010 Making
decisions for
people with
dementia who
lack capacity:
qualitative
study of family
carers in UK
The study aims to
identify the common
difficulty in making
decisions by family
caregivers on behalf of
the people who are
suffering with dementia
and different barriers
and facilitators of the
decisions which is
helpful to produce
information regarding
family carers related
overcoming barriers in
future.
It has been concluded
by the author that
Family carers
identified the give
main problematic
areas related to
decision making
process which is
accessing health and
social services
regarding dementia
disease, legal and
financial matters, care
homes, non-dementia
related health care and
making significant
plans for the person
who have been
suffering with
dementia disease and

if the carer will be too
ill to provide the best
care to them there will
be issues and
problems faced by
them. Families have
been devised
strategies in order to
gain the agreement to
ensure that it is to
retain dignity for the
person suffering with
dementia.
Sarah E.
Goldberg
Kathy H.
Whittamore
Rowan H.
Harwood Lucy
E. Bradshaw
John R. F.
Gladman Rob
G. Jones
2012 The prevalence
of mental
health problems
among older
adults admitted
as an
emergency to a
general hospital
This study aims to
provide description
regarding current
prevalence of the
problems among people
who are at the age of 70
years and they have
been admitted to the
hospitals as an
emergency in order to
help the ward staffing
level and the skill mix
planning.
It has been concluded
that there is a high
prevalence of the
mental health
problems among
elderly people who are
admitted to the general
hospitals. These
patients have a high
level of psychological
and behaviour
problems and different
level of functional
dependency that have
implications of how
interventions have
been catered and how
elderly people have
been cared for.
Dementia services that
has identify problems
and offer therapeutic
intervention must be
evaluated.
PRISMA chart
ID
Citation identified through
the database search (n=
2000)
Unique Studies after
removing Duplications
(n=1200)

Screening
Screened Studies (n= 1200) Excluded Based on title (n=
900)
Abstracts retrieved (n=310) Excluded based on abstract
(n=200)
Full text articles retrieved
(n=110)
Full text articles excluded
(n=43)
Quality Assessment Studies assessed for quality
(n=7)
Identified
Studies included (n=5) Excluded based on quality
(n=0)
Excellent (n=3)
Good (n=2)
Fair (n=0)