Dementia: A Long-Term Condition, Its Impact, and Current UK Policies

Desklib provides past papers and solved assignments for students. This report analyzes dementia in the UK.

Contents
INTRODUCTION.......................................................................................................................................1
DISCUSSION.............................................................................................................................................1
CONCLUSION...........................................................................................................................................8
REFERENCES............................................................................................................................................9
1

INTRODUCTION
Dementia is a neurogenerative disorder that is characterized by the symptoms of
decline in cognitive functioning and loss of memory. It is mainly associated with disease
such as Alzheimer’s (Wu, Fratiglioni and Brayne, 2016). The main cause of dementia is
unknown to date, it is known to be due to damage to brain cells that affect cognitive
functioning and cause degeneration of the cells in the brain. Some psychotic diseases
are the main cause of dementia and it also has other risk factors such as age and
stress. Dementia is a broad term used for a group of thinking and social symptoms that
disable the individual mentally. In this assignment, the aim is to study dementia as a
2

long term condition as it cannot be cured and only can be handled by medication and
care throughout life. The impact of dementia on the life of the individual, its impact on
the economy and culture of the nation as well as its rising prevalence is been
discussed. The policy that is introduced to provide better care for dementia patient that
is the Five Year Forward View by NHS is discussed and criticized for its effectiveness
as well as its efficiency. Later part of the assignment will also highlight the role of nurses
in health promotion and services for the disorder.
DISCUSSION
Dementia is considered a long term condition. A long term condition is defined as a
condition or disease that is chronic in nature and stays for the long term of life that
cannot be cured permanently and can only be controlled by means of medication and
scientific interventions. Dementia is considered as one because of its chronic nature as
well as it is incurable. It can be controlled by medication and requires a person to seek
support from external sources to lead a normal life or at least do the daily tasks. Another
reason why dementia is considered as long term condition is that its aetiology is yet
unknown and thus cure is not present. It is seen that this disease is so prevalent in the
world that every year around 10 million cases are diagnosed globally. The main areas of
brain affected are cognitive functioning, memory, language, orientation, thinking,
decision making, concentration ability etc. people suffering from dementia are prone to
have declined conversation skills they find it difficult to recall right words to fit in their
statements and find is difficult to communicate and make an eye contact as a tool of
nonverbal communication (Giebel, Sutcliffe, and Challis, 2015). The orientation and
concentration ability of the individual are also reduced due to damage to brain cells, a
person has lowered decision making power and also problem-solving ability gets
deteriorate. Dementia patients usually find it difficult to recall events and forget day to
day routine tasks even and they become weak in geographic orientation and can get
easily lost in nearby surrounding also. Some of the functions like sleeping using the
toilet, eating are not lost but others like bathing, grooming, etc. are not focused on or
are forgotten easily by the patient suffering from dementia. There are four basic stages
3

of the disease, as outlined below. 1. Mild cognitive this stage is characterized by
general forgetfulness, which affects many people as they grow older. 2. Mild stage this
involves people having a mild experience of cognitive impairments that impact on them
occasionally. 3. Moderate stage this means that daily life becomes more challenging for
people. 4. Severe dementia this is when symptoms worsen considerably. It has been
discovered that its signs increase over time and everyone faces the changes at different
speeds (Tewary, Cook and McCurry, 2018).
Dementia has moderate to severe impact on the lives of the individual suffering from it
as well as on the lives of the carer and family members of the individual suffering from
dementia. The impact of this condition on the patient is both psychological emotional
and social. It declines one’s ability to lead an independent life whereas it also is
responsible for dragging an individual towards social isolation and loneliness. These
factors help in the development of other mental issues such as depression and anxiety
disorder. The individual also faces difficulty in continuing social engagement and
managing work that cuts him down from his social circle and makes him more
vulnerable to depression. Society plays an important role in possessing an impact on
dementia as the social stigma portrays dementia as a subject to discrimination and
abuse. Dementia population widely suffers from abuse and harm from external
environment due to their forgetful nature. The life of family members and carer of
dementia patient becomes highly occupied with managing work, family and disabled
individual. They hardly are left with any time for themselves that makes their quality of
life suffer to great extent. The critical point at which carers of dementia patients are
greatly impacted in terms of frustration and effective caring for the patient include the
time when dementia is diagnosed, the patient capacity begin to decline, when the care
requires emotional support or a break from caring; when the dementia patient suffers
poor mobility, coping with challenging behaviour or when the carers’ circumstances
change and when the dementia patient becomes incontinent (Gridley, Aspinal and Van
Den Berg, 2018). Economically in UK dementia cost about £26 billion every year. It is
similar to the cost of electricity for every household for a year in this region.
4

In UK dementia is so prevalent that it is estimated that about 850,000 people currently
are suffering from this disorder. It is estimated that the rising number of dementia
patients in the UK will rise to 1 million by the end of 2025. In 2017 the records indicated
that dementia was most prevalent in the age group of 65 years and above. The data
from 2018 suggested that the hospital admissions of patient aged 75 and above in
emergencies were majority cases of dementia with a ratio of 86.7%. The World
Alzheimer's report indicates an urgent need for sustainable funding in the field of
dementia (Prince et al, 2013). One in 14 people over the age of 65 is diagnosed with
this condition and it influences one in six people over 80-years-old.
The policy that was introduced in 2014 by the NHS England for better services of long
term condition including dementia was Five Year Forward View (England, N.H.S.,
2014). This policy was introduced to discuss the practices that are currently being
provided for the health and social care in the UK as well as the need and requirement
for a change in the system. The plan shows how the changes can be implemented,
what it will look like and what impact will it have on the system. This policy covers areas
of primary and preventive care. The aim of NHS was to submit a plan that will enable
the health care system to deliver services with lowering differences between primary
and secondary care, physical and mental care as well as private and public care. The
Five Year Forward View has received high governmental support that is essential for its
success (Livingston et al, 2017). The view is to have integrated and improved services
until the year 2019. The collaboration of service user and service provider is another
area of concern for the success of this plan. The report also identified the work done by
NHS in the field since the last decades where the prevalence of some of the chronic
diseases was reduced to 40%. Other than this one more strategy implemented by Prime
Minister under the name Challenges of Dementia 2020 is also subject to discussion.
This policy is similar to the Five Year Forward View in a manner that both the policies
are introduced to improve the services for the long term conditions like dementia
(England, N.H.S., 2014). The strategy discussed various challenges faced by the
patient, family members and carer as well as health care staff while providing services
for dementia. The programme introduced a plan where it was stated that the UK
government would fund around euro 300 million on the research and study for dementia
5

and trials. This will provide better evidence-based practices with the new breakthroughs
in the field of precaution and care of dementia (Luengo‐Fernandez, Leal and Gray,
2012). The view is to make England the best place for the dementia population to live in
and to provide improved services to reduce its prevalence and mortality due to it. It was
identified in both the reports that the long hospital stays, staffing and resources were a
major issue that hold back the improved services for dementia in the UK. The strategies
plan to overcome all these issues and provide better primary and emergency care for
dementia as well as accommodate community care plan for the dementia patients.
Challenges dementia also announced the initiation of an International dementia institute
by 2020 in England. This will provide the UK with a chance to be the leading nation in
research and study for dementia. One major similarity between both the policies is they
tend to work on the efficiency, wellbeing, quality and funding of the services. The Five
Year Forward View by NHS also initiated a programme of shared budgets from which
1.4million unpaid carer in the UK would be benefitted (Chenoweth et al, 2014).
Ageing is the process that cannot be controlled and advanced medical interventions
have improved life expectancy but are ineffective in reducing the prevalence of
associated long term diseases that makes the ageing process unhealthy. Rather than
successful ageing that is a desire to all nowadays people usually tend to suffer from
unhealthy ageing? Current system and policies in health and social care in the UK are
working in order to eradicate these long term conditions from the ageing process and
provide people with a healthy long lives but the effectiveness of this system and policies
is questionable as the prevalence rate of such diseases as dementia and others are not
reducing rather it is increasing with an alarming rate every year. It is clearly evident that
the strategies of care are not effective in the manner they should make the call for
improved and better strategies to creep in the system. The major cause of why services
for dementia and the preventive services for dementia are unable to show considerable
effects is that the dementia care model is kept restricted only to hospitals rather
dementia is not a thing that can be treated only in hospital sting the person requires
support at home and so community care model for dementia should be strengthened
(Robinson, Tang and Taylor, 2015.).
6

Wellbeing is defined as the state of health and safety with all positive attitudes in
domains of life such as physical, mental and psychosocial wellbeing. A person in his
entire life even different stages of life urge to attain wellbeing and health. According to
the Maslow's hierarchy of needs the human requirements are different at different
stages but health and wellbeing is the basic requirement that a person thrives to
achieve throughout his life for a better quality of life. In dementia, wellbeing is one of the
major aspects that is considered by carers and family members. Even the services
today provide facilities that concern regarding the wellbeing of the individual. The family
members and carers of an individual usually get exhausted due to the tedious job of
caring and low support and fewer resources. Their wellbeing is at stake while caring for
the patient with dementia. Security is another requirement that is every individual’s right
as well as need to lead a better life. The impacts of dementia on the family and carers
are usually felt in many areas of their lives and the carers who assist the patients in
carrying out their daily activities do not fare better in its impacts on them. It is worth
mentioning at this juncture that impacts of the impact of dementia on families and carers
are varied and diverse. These impacts extend over a spectrum of social,
psychological/emotional and financial condition (Miller, Whitlatch and Lyons, 2016).
Several studies into the impacts of dementia in particular Long-term condition, in
general, have been identified. Dementia patient always is more vulnerable to abuse and
harm so the protection from such environmental aspects and people who can harm
them is one of the basic concepts of fostering their wellbeing. In good practice for
dementia, it is essential for the policymaker to understand that two aspects of policy
should be present on the services provided should secure the wellbeing of the patient
and even their family members and carer. A large number of carers interviewed
expressed that caring for a dementia patient's severely impacted their ability to perform
their tasks ((Dewing and Dijk, 2016). Healthcare professional, as a matter of practice,
must recognize that family and carers’ quality of life must be taken into account when
appropriate supports for dementia patients are being developed and planned.
The department of healthcare (DH, 2016) published a guidance note “Making a
Difference in Dementia Nursing: Vision and strategy (2016) which outlined goals and
new roles for nursing professional. This policy represents the roles of nurses as
7

interpersonal, intensity and action taking place in various settings and embracing
support networks and including cultural diversities (Lloyd, Patterson and Muers, 2016).
The main impact of the policy indicates that the future roles of nurses in dementia care
is viewed as community based and contrary to the hospital setting which will enable
nurses to support and empower people living with dementia together with their family
and caregivers in order to active quality of life in an environment surrounded by their
families (National Institute for Health and Care Excellence, 2016). It also focuses on the
vision of nurses roles on issues of recognizing signs, symptom and progression of the
condition, how they signpost individuals to appropriate allied services and planning care
for the patient with families and cares in mind. It is also seen that the role of nurses
caring for dementia patient lacks proper and specialized training and education
specialized for dementia. This concern led to the development of core skill training in
nurses for dementia services. Training to develop skill, developing dementia-friendly
communities in order to reduce stigma, support care for people at the risk of developing
dementia to recognize the early signs and collaborating with different services are the
goals of the framework. The framework categorizes nurses in the community into two
levels of involvement in the hierarchy of dementia care. These categories involve being
aware, alert and dementia friendly, while the 2nd level stipulates community being
actively involved and able to respond and understand patient’s needs. The aim of the
programme should be to improve diagnosis and permit necessary interventions to be
developed, Lack of involvement of family members and carers in care planning for
family and caregivers and inappropriate training of hospital staff, repeated appointment
and not having enough information about the patient’s condition are among the issues
impacting the quality of life of families and carers (Murphy, Jordan and Casey, 2015.)
Health inequalities are present everywhere related to every condition. The major health
inequality that is most common in long term conditions including dementia is the
socioeconomic level of the patient. This determines which kind of services and what
type of care a person can achieve for his wellbeing with dementia. Even this impact the
quality of life of the family members of dementia patient as it makes them deprive of any
external support and help from the services that are paid and they cannot afford it.
Another thing that is identified is the gender-based bias and distribution of the disease.
8

Dementia is mostly seen in older ages and as female live more than male, most
dementia patient is identified as females. An estimated 38% dementia population in the
UK are male and the majority of them are females. Ethnicity is another variable that
shows evidence towards health inequality in dementia. Patients from some minority
ethnic group are more likely to suffer from comorbid diseases such as hypertension and
diabetes that is a risk factor for the development of dementia and this population is at
higher risk for development of dementia. According to the survey done by Truswell,
(2015) it was revealed that some of the minority black ethnic group in the UK is more
likely to develop dementia than other normal groups. It was said that this population is
underestimated t have risk towards dementia and are 2.2 times more at risk than other
population. Pöysti et al, (2012) in their study identified that females are more developing
dementia then males in the UK. The major factor identified for this gender-based
inequality was prolonged age and stress levels.
In UK the current policies that are working to promote health are improving the scenario
but at a very slow pace and requires more strong approaches to address the issue. The
prevalence rate of dementia is not reducing and the issue is rising every year estimation
about 2 million sufferers till the year 2050. The health promotions campaigns are led by
NHS and government of UK to aware people regarding the symptoms of dementia and
if they identify it the importance of early detection for its treatment and control. One of
the charities for people with dementia is Alzheimer's Research UK. It carries out
research on the disease and also answers questions regarding the disease. People can
also sign up to the website of the NHS Dementia information service that can assist
them through the often difficult time after a dementia diagnosis. Another is the
Alzheimer’s UK that introduced the concept of Admiral Nurses who are specially trained
for providing services to dementia patients (Harrison Dening, Crowther and Adnan,
2018).
Community nurses are those who are registered under the government of UK. These
nurses are well-trained professionals but the nurses who are trained for dementia are
known as community psychotic nurses. These nurses are more specialized in imparting
training and practising procedures for a dementia patient and their families. They help
9

the on community level at their home setting in their daily routine tasks as well as
provide help to the family members. Health determinants on other hand or dementia are
supposed to be age, gender, socioeconomic status and race as well as the social
environment the person lives in, education, lifestyle, genetics, diet and stress (Gibson,
Newton and Robinson, 2016).
10

CONCLUSION
Dementia is a neurogenerative disorder that is long term condition and incurable. As
because of its long term nature it can only be controlled by medication and therapies but
beyond its support from external sources is important. It implies great impact on health
and wellbeing of carers and family members too. Different policies in the UK are
introduced to ensure the wellbeing of the dementia patient and their family members but
more specialized strategies are required to achieve this. Hence, in the end, it can be
concluded that the prevalence of dementia can be reduced only by specializing nurses
in training for dementia care and integrating the health care with social care on a
11

community level. Most family members and carers have a limited understanding of the
long-term condition of dementia disease. For family members caring for someone with
dementia, there is a clear sense of loss of the person. It is vital to suggest that with
patients consent where possible, the clinician and nursing professionals should involve
the family in a discussion about management.
REFERENCES
1. Chenoweth, L., Merlyn, T., Jeon, Y.H., Tait, F. and Duffield, C., 2014. Attracting
and retaining qualified nurses in aged and dementia care: outcomes from an A
ustralian study. Journal of Nursing Management, 22(2), pp.234-247.
2. Dewing, J. and Dijk, S., 2016. What is the current state of care for older people
with dementia in general hospitals? A literature review. Dementia, 15(1), pp.106-
124.
3. England, N.H.S., 2014. Five year forward view.
4. Gibson, G., Newton, L. and Robinson, L., 2016. The provision of assistive
technology products and services for people with dementia in the United
Kingdom. Dementia, 15(4), pp.681-701.
5. Giebel, C.M., Sutcliffe, C. and Challis, D., 2015. Activities of daily living and
quality of life across different stages of dementia: a UK study. Aging & Mental
Health, 19(1), pp.63-71.
6. Gridley, K., Aspinal, F.J. and Van Den Berg, B., 2018. Supporting carers of
people with dementia: a mixed methods evaluation and feasibility study (January
2018).
12