Dementia Report: Addressing Dementia in New Zealand Healthcare System

This report examines dementia within the context of the New Zealand healthcare system, addressing various aspects including aetiology, diagnostic criteria, and treatment approaches. It explores the impact of dementia across the lifespan, considering psychological distress, social isolation, and econ...Read More

Running head: DEMENTIA
DEMENTIA
Name of the student:
Name of the university:
Author note:

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Introduction:
In the recent era, Dementia has been framed as a neurodegenerative condition highly
associated with ageing, especially amongst those over 80 years of age. Dyall (2014), suggested
that For Maori inhabits in New Zealand dementia is not fundamentally associated with age but is
individual histories within this country, and the social determinants of health for populations
from A recent report Alzheimer new Zealand suggested that Dementia affected more than
70000 individuals and expected to increase triple by 2050. The recent report of dementia
suggested that the prevalence of dementia in the population of New Zealand was approximately
62,287 individuals in 2016, accounting for almost 1.3% of the total population of New Zealand.
This data suggested that dementia has increased by 29% over 5 years from 2011 where
population living with dementia include 48, 182 individuals (Payman, Yates & Cullum, 2018).
The purpose of this essay to demonstrate a range of principles and environment that support the
recovery of the individuals of New Zealand, including Whanua and discuss the therapeutic
approaches to reduce the mental health issues of the individuals. This paper will discuss
aetiology, diagnosis criteria and treatment in task 1, the potential impact on the lifespan in task 2,
principles that support recovery in task 3, two strategies that support recovery in task 4 and
therapeutic nursing intervention in task 5 in following paragraphs.
Discussion:
Task 1:
For this task, the chosen health condition is dementia. Martinez-Ruiz et al. (2016), suggested
dementia is a collecting term for describing a range of symptoms such as cognitive declined,
limited social skills confusion, poor concentration and difficulties in remembering specific recent

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events. Considering the aetiology of dementia, dementia can be caused by the death of brain cells
or neurodegenerative diseases as seen in dementia. Other aetiologies of dementia include head
injury, stroke, traumatic brain injury, brain and brain tumour, HIV infection and other viral
infection, depression, vitamin deficiency, thyroid abnormalities and Creutzfeldt-Jakob disease
(Russ et al., 2016). Hvidsten et al. (2018`), suggested that there are several types of dementia
such as Alzheimer’s disease, huntinging disease, dementia with Lewy bodies , Parkinson’s
disease and mixed dementia. The early signs of dementia are changes in the short term memory,
changes in the mood, apathy, being repetitive, trouble completing the daily activities, poor sense
of direction, difficulties in adjusting changes and confusion. The demographic risk factors for the
disease include increased age (usually80 years), gender (women are at high risk of developing
dementia), different ethnicity and race (high prevalence has been highlighted in American and
Latino population), smoking, heavy consumption of alcohol and genetic factors (APOE *4 is
associated with high risk of dementia) (Russ et al., 2016). In this case, the protective factor is the
capacity and integrity of brain such as brain mass, preserved large neuron.
While early diagnosis of dementia is acknowledged by a range of literature, there are still
high rates of undetected dementia internationally. In the majority of the cases, dementia is
undetected which resulted in high mortality rate and sudden death. DSM V replaces the term
dementia with a major neurocognitive disorder as well as mild neurocognitive disorder than less
on more impairment and focuses on the decline in the speech and language usage ability (Alpass
et al., 2017). Hence, patients with dementia must exhibit a range of deficient in one or cognitive
domain such as speech, judgement, memory, visuospatial and behaviours that usually interferes
with daily activities. The individuals with a history of drug abuse, medication or other medical
histories, poor decision making, responses to feedback, recognition of emotion, selective

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attention and processing speed are required to subject to the dementia treatment (Fekete, Szabo,
tephens & Alpass, 2019). Dementia can be diagnosed with the assistance of the Dementia
Rating Scale that focuses on the five subscales such as construction, initiation, conceptualization,
memory and attention.
The common treatment of dementia includes medication such as donepezil, Dopamine
blocking agents, tacrin and Cholinesterase inhibitors, rehabilitation and occupational therapy.
On the other hand, a range of therapies can improve the cognitive function of the patients
through rehabilitation, cognitive stimulation therapy, reminiscence therapy and Butterfly Scheme
for dementia where professionals must provide culturally competent support to the patients
(Swain, 2018).
Task 2:
Impact of dementia across the lifespan:
As discussed by Cheung Appleton, Boyd Cullum (2019), Neurocognitive disorders,
predominantly major neurocognitive disorders such as dementia have extreme consequences for
individuals with dementia, their family members, the healthcare system as well as the economy.
O’Sullivan, Hocking and Spence (2014), suggested that experience of patients living with
dementia differs according to individual circumstances, especially social determinants. The
researchers suggested that the early stages patients and family members of many families usually
manage the symptoms, but as the syndrome progresses, they subject to high-level psychological
distress such as anxiety, depression and trauma that impact the recovery and quality of life of the
family unit. Cations, Withall and Draper (2019), suggested that individuals with dementia likely
to experience emotions such as grief, loss, anger, fear, disbelief and even relief which may result

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in depression and anxiety in some people. They often experience physical abuse, neglect,
stigma and withdrawal of support from the family members, peers and community. Individuals
may have less control over the feeling, fearful or agitated, poor self-esteem and low self-
confidence. In this context, in New Zealand, individuals with dementia often experience
personal decimation and social isolation. A range of indigenous individuals of New Zealand,
Maori individuals experience severe discrimination and stigma due to the presence of dementia
(Oliver, Wilson & Malpas, 2017). The family members of dementia also experience
helplessness, financial crisis, lack of resources, and lack of employment, high hospital
admission, stigma and social exclusion due to dementia (Payman, Yates & Cullum, 2018). The
economic impact of dementia on across the lifespan is severe since in New Zealand the cost of
dementia is increasing gradually. Dementia Economic Impact Report suggested that the costs
related to dementia have increased by 75% from $955 million in 2011 to $1,676 million in 2016
(Mentalhealth.inquiry.govt.nz., 2020). Consequently, individuals from the low socioeconomic
area tend to experience a severe financial crisis, unemployment and limited access to health care
when they develop dementia.
Task 3:
The principle that supports the recovery of individuals:
In New Zealand, mental health is considered as the capacity to think as well as in a way
that increases the enjoyment of life and enable individuals to overcome life. This concept of
mental health is similar to the Maori concept of holistic health called Hauora where approaches

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to the disease consider social, psychological, emotional, biological and environmental factors
(Payman, Yates & Cullum, 2018). Generally, principles that support the recovery of individuals
include the uniqueness of the individuals, attitude and rights, choices of the individuals, dignity
and respect, partnership and communication and evaluating recovery. Ministry of health new
Zealand suggested that individuals with mental illness is termed as Tangata whai ora ( a person
is seeking help) who are subjected to assessment care and treatment of mental health. The
recovery-oriented approaches for Tangata whai ora usually consider the perspective to
consumers since wellness of Tangata whai ora include supportive relationships (principle of 1).
In this context, partnership with Tangata whai ora, family members and mental health
professionals are likely to provide the best result in the process of recovery. The second
principle suggested that families are entitled to access the information, training and support for
enhancing their understanding and provide care to their Tangata whai ora. The third principle
suggested that families are entitled to seek other opinions regarding the assessment, care and
treatment of the Tangata whai ora (Wharewera‐Mika et al., 2016). In this context, primary care
nurses are required to involve the family members to support the individuals in their recovery.
The individuals often feel neglected and dissatisfied with the health care services which can be
mitigated through principles of recovery that incorporate Tangata whai ora. The fourth principle
suggested that families are allowed to access to Tangata whai ora during the assessment and care
(Wharewera‐Mika et al., 2016). The fifth principle suggested that Tangata whai ora with a
capacity to make decisions are allowed to refuse to have contact with their family and withhold
their personal information from their family (Isogai & Stanley-Clarke, 2017). When Tangata
whai or is incapable of deciding on behalf of them, the common practice for mental health staff
to makes contact with the family members of the patients to seek the involvement in care.

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Task 4:
Discuss strategy that supports dementia:
. Cations, Withall and Draper (2019), In 2011, approximately 48,000 population in
New Zealand had dementia where Maori population also impacted severely due to stigma and
discrimination along with financial loss. By 2026, it is assessed that approximately 78,000 New
Zealanders will have dementia which is accounting for over 60 % of New Zealand. In this
context, the most comprehensive strategy is the New Zealand Framework for Dementia Care by
the ministry of health of New Zealand that aims to provide the care and support to the
individuals with dementia from the diagnosis to end of life stage ((Shannon, Bail & Neville,
2019). It encourages different health care providers and social services to work in collaboration
for integrating care. The framework emphasizes on the services which consider the choices and
desires of the individuals and cultural preferences and life, especially to support Tangata whai
ora to receive culturally competent services. In this context, overarching factors for the
framework include education and training for the individuals with dementia and their family as
well as whanau, education and training, family and Whanau support, governance, culturally
appropriate services and monitoring as well as evaluation along with the advocacy. The key
elements of the framework include awareness of the population and risk reduction of the
individuals who are at high risk of developing diseases, assessment, early intervention and
continuous support to the individuals (New Zealand Framework for Dementia Care, 2020). Apart
from these key elements of the framework, living well through the support of families and
whanau is also part of the framework that provides a sense of purpose and confidence by
maximizing the independence and culturally competent care. The framework also supports the
end of life care. Draft New Zealand Dementia strategy 2020 to 2023 is one such initiative taken

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by the New Zealand government to support the patients with dementia (O'Connor, 2019). This
initiative aligned with New Zealand Framework for Dementia Care since the initiative provides
care to the new Zealander by providing equal access to the care services, provide education
training, timely diagnosis ( especially to the individuals living in the rural and remote areas)
(Isogai & Stanley-Clarke, 2017).. The initiatives also integrate the dementia action plan for
Maori for engaging Tangata whenua where Māori kaupapa support services are provided to the
population. The second initiative is Better Later Life He Oranga Kaumātua 2019 to 2034 that has
developed to initiate action to ensure that all New Zealanders recognize the potential of the older
population (Better Later Life, 2020). It creates an opportunity for everyone to participate as well
as contribute to support older individuals with dementia so that they can feel empowered and
safe. These initiatives can be implemented at the local level through collaborating with the health
care providers and culturally competent care workers.
Task 5:
Therapeutic nursing intervention:
Therapeutic nursing interventions are approaches carried out by the nurse to help the
patient cope with or manage their diseases. Individuals with dementia are at high risk of
developing distress, anxiety and depression due to the stigma and support from the community.
Before implementing therapies it is crucial to understand their stores, assess the risk of dementia
and building the therapeutic relationship. The indigenous population usually subjected high
psychological distress due to trauma which affected the mental health and increased the risk of
developing dementia. Therefore, in order to provide holistic and culturally competent care, it is
really crucial to understand the stories of the indigenous individuals (Shannon, Bail & Neville,
2019). The common practice in this area is to incorporate cultural values and beliefs in the care

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process. Nursing professionals can improve quality of care through incorporating cultural belief.
On the other hand, for understanding the impact of trauma that impact mental health, it is crucial
to listen to the survival narratives. Nursing professionals are require involve the patients into
therapeutic communication so that they can share their concerns. It will empower them to seek
the treatment for the dementia and reduce premature death. The survival narratives also provide
the idea of risk of developing the disease so that appropriate therapeutic interventions can be
given. The Dementia Risk Assessment (DRA) is one such online tool that contains questionnaire
regarding risk factors for dementia, memory test, and report of cognitive decline. This risk
assessment will provide the idea regarding the appropriate therapy that incorporate cultural
values. The common therapy by nurses includes reminiscence therapy, validation therapy and
multisensory therapy. Reminiscence Therapy is a treatment that uses all the senses such as sight,
touch and taste to individuals with dementia recall events, close individuals and places from the
past (Woods et al., 2018). The nursing professionals usually use objects in various activities to
enable individuals to recall of memories. Tangata whaiora usually believe to incorporate family
in the care process and prioritize family as a part of the therapy. In this context, nursing
professionals must involve family members in the care process for incorporating consumer
perspective in the care process. The second nursing intervention can be Multisensory stimulation
that aims to encourage the primary senses of the dementia patients to achieve a balance between
sensory-stimulating and sensory-calming activities such as creating soothing home environment
(Kale, Stupples & Kindon, 2019). The nursing professionals can implement this in the home
environment by family members in the care process such as collaborating with the family
members. The aromatherapy can be an effective therapy to regain the senses of the individual
with dementia since patients with dementia often have poor senses and smells. In this context, it

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is a holistic approach to treat patients where family members of the patient can incorporate
traditional plant extract to promote the health and wellbeing of the individuals (Press-Sandler et
al., 2016). Lastly, validation therapy is another effective and therapeutic nursing intervention to
approach individuals with empathy and understanding so that individuals feel comfortable and
reassurance people who are living with dementia. Its initiative involves communicating with
individuals, respecting and reflecting empathy so that they feel empowered and safe to seek
therapy. Tangata whaiora usually believe to incorporate family in the care process and therefore,
it is fundamental to build a relationship with the family. For building therapeutic relationship
with the family, the family members can be involved in each therapy. The shared decision
making is another common practice in the clinical setting that facilitate therapeutic relationship
with family. Family members of the patients usually subjected to high psychological distress or
experience helplessness because of the mental illness they are unaware (Lai, Hanton, Jury &
Tuason, 2019). The shared decisions making is one such way to develop therapeutic relationship
with family members. It will empower family members to support the recovery of the patient and
adhere to the treatment for living a purposeful life.
Conclusion:
On a concluding note, it can be said dementia is a collecting term for describing a range
of symptoms such as cognitive declined, limited social skills confusion, poor concentration and
difficulties in remembering specific recent events. The differential diagnosis of the patients
include patients with a range of deficient in one or cognitive domain such as speech, judgement,
memory, visuospatial and behaviours. The principles that support the recovery of the
individuals include attitude and rights, choices of the individuals, dignity and respect, partnership
and communication and evaluating recovery. New Zealand Framework for Dementia Care by

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ministry of health of New Zealand is one such recent strategy that supports Better Later Life He
Oranga Kaumātua 2019 to 2034 and Draft New Zealand Dementia Plan 2020 to 2023 are two
initiatives that support the dementia patients. The therapeutic interventions for supporting the
patients with dementia include reminiscence therapy, validation therapy and multisensory
therapy. In this case, individuals with dementia can be supported by nursing professionals
through the incorporation of family members in the care so that individuals can feel empower
and safe.

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