Dementia in UK Essay Example for Free

De work armytia in UK tryThere be currently 800,000 tidy sum with craziness in the UK. There atomic number 18 over 17,000 younger community with craziness in the UK. There atomic number 18 over 25,000 volume with hallucination from b miss and minority heathenish groupsin the UK. There will be over a million hoi polloi with craziness by 2021. twain thirds of passel with aberration ar women. The proportion of community with lunacy doubles for every 5 form age group. One third of stack over 95 rescue dementia. 60,000 deaths a year ar aspirely credited(predicate) to dementia. Delaying the on pitch of dementia by 5 eld would reduce deaths directly attri scarcely able-bodied to dementia by 30,000 a year. The financial cost of dementia to the UK will be over ? 23 billion in 2012. There are 670,000 chargers of muckle with dementia in the UK Family shell offrs of passel with dementia however the UK over ? 8 billion a year. 80% of mint living in safekeepin g homes remove a form of dementia or severe keeping problems. Two thirds of people with dementia sojourn in the community while one third live in a care home. scarce 44% of people with dementia in England, Wales and Northern Ireland receive a diagnosing UK dementia statistics Affects 820,000 people in the UK Financial cost is over ?23bn pa, that is twice that of crabby mortal, three propagation the violation of heart unsoundness and four epochs that of stroke Two thirds (425,000) of people live in the community, one third (244,000) in a care home Two thirds of people with dementia are women (446k) and one third men (223,000) Affects 1 in 100 people aged 65-69, 1 in 25 aged 70-79 and 1 in 6 people aged over 80 Key risks from assessment are falls and walking or so (60% experience walking round) 25 million people, or 42% of the UK population, are stirred by dementia through knowing a close fri repeal or family member with the condition.(Source Alzheimers search Trust / Y ouGov poll, 2008) 163,000 new causas of dementia occur in England and Wales each year one every 3. 2 minutes The number of people in UK with dementia is expected to double in the next 40 years to 1. 7million people Statistics courtesy Alzheimers Research Trust and www. alzheimers. org. uk Government Policy The National Dementia scheme The objectives of the project are to develop a case dementia strategy and implementation externalize for consequence in October 2008.The strategy will address three key themes raising awareness, premature diagnosis and discourse and improving the quality of care. For more than than information visit National Dementia Strategy Dementia rivals 820,000 people in the UK. 25 million of the UK population have a close friend orfamily member with dementia. As well as the huge psycheal cost, dementia costs the UK economy ? 23 billion a year, more than basiscer and heart disease combined. Despite these figures, dementia inquiryis desperately u nderfunded. Impact of dementia in the UKThere are over 820,000 people living with dementia in the UK today, a number expect to rise rapidly as the population ages. Just 2. 5% of the governments health check research budget is spent on dementia research, while a quarter is spent on domiciliatecer research. One in three people aged over 65 will die with a form of dementia. Dementia costs the UK economy ? 23 billion per year. That is twice that of burn downcer, three times the impact of heart disease and four times that of stroke. Combined government and charitable investment in dementia research is 12 times lower than spending on tidy sumcer research.?590 million is spent on so-and-socer research each year, while just ? 50 million is invested in dementia research. feeling disease receives ? 169 million per year and stroke research ? 23 million. 1. What is dementia? The term dementia is spend to describe a collection of symptoms, including a decline in memory board, reasoning and talk skills, and a deliberate red of skills get hold ofed to carry out workaday activities. These symptoms are caused by structural and chemical changes in the heading as a result of physical diseases such as Alzheimers disease.Dementia can affect people of whatever age, but is virtually common in older people. One in ? ve people over 80 has a form of dementia and one in 20 people over 65 has a form of dementia. Researchers are keep mum working to ? nd out more close the different types of dementia, and whether whatever have a genetic link. It is thought that umteen factors, including age, genetic dry land, medical history and lifestyle, can combine to lead to the onset of dementia. Dementia is a progressive condition. This means that the symptoms go more severe over time.Understanding how this progression happens can be useful in back up mostone with dementia anticipate and plan for change. The modal value each psyche experiences dementia, and the rate of their decline, will regard on many a(prenominal) factors non just on which type of dementia they have, but overly on their physical misrepresent-up, their emotional resilience and the musical accompaniment that is available to them. Typically symptoms will include Loss of memory for example, forgetting the way home from the shops, or organism unable to remember names and places. Mood changes these happen especially when the parts of the nous which control emotion are affected by disease. People with dementia may feel sad, angry or frightened as a result. Communication problems a decline in the ability to talk, read and write. There are different types of dementia caused by different diseases of the brain. Because these diseases affect the brain in different ways, they produce different symptoms. or so of the most common forms of dementia are listed down the stairs 1. 2 Who is affected and how?Dementia can affect anyone regardless of gender, ethnicity, socio-economic situa tion and residential status. Nearly two-thirds of people with the disorder live in the community, while the opposite third reside in a residential home. A small number of people with dementia are from b insufficiency and minority ethnic (BME) groups. This is referable to the current younger age profile in Londons BME communities. As this population ages, with a mellower prevalence of physical conditions which may contribute to dementia, the rate of dementia is expected to increase.A particular analysis of the London population segments affected by dementia is available in appendix 1. This highlights that most cases of dementia are late-onset and therefore affect people aged 65 and over. Approximately one in 40 cases is early-onset dementia and occurs before the age of 65. Many factors, including age, genetic background, medical history and lifestyle can combine to lead to the onset of the disorder. Key points to emerge from late(a) studies and consultations with people with dem entia and their carers showed Dementia is ailing understood, it re primary(prenominal)s a gradetised condition and those affected often experience social exclusion and discrimination. Seeking assistant is frustrating admission to run typically includes contact with the NHS, topical anaesthetic councils and the third sector sometimes being referred elsewhere and often duplicating activities. Current services do non meet the needs of people with dementia. work are fragmented and lack robust integration and strong partnership working. There are gaps in provision and the quality of specialist services remains inconsistent. Reliability and continuity of services are compromised because many staff lack the requisite knowledge and skills to respond appropriately to those affected. Most health and social care services are non delivering the outcomes that are important to people with dementia early diagnosis and treatment, well accessible services, information and advice and h igh quality reinforcing stimulus. 8 wellnesscare for London IntroductionDementia services guide 9 3 Source Based on Dementia UK prevalence rates applied to GLA populations Introduction THE hassle OF DIAGNOSING ALZHEIMERSMost diagnoses of Alzheimers are delayed until more than two years subsequently symptoms first expect because patients and families ignore, deny, or dont recognize common signs of early Alzheimers, according to a 2006 Alzheimers Foundation of America survey. Fifty-seven percentage of caregivers who answered the poll said they put off anticipateing diagnosis for symptoms of memory loss, confusion, and language problematicies because they or the someone they cared for were in denial about having the disease, or because they feared the social stigma associated with AD.Another 40 percent didnt resonatek a diagnosis because they knew little about Alzheimers or its symptoms, they said. 38 percent of those surveyed said it was the patient who resisted handout to see a doctor 19 percent of caregivers admitted they themselves didnt want to face the possibility that something was wrong. Spouses were three times less likely than children of people with Alzheimers to delay seeking diagnosis, the survey effectuate. What Is Dementia? by Maureen Dezell with Carrie Hill, Ph. D. Dementia itself is not a disease but a term that describes different brain disorders that cause memory loss and other symptoms of cognitive decline.While various kinds of dementia are more common the longer we live, no(prenominal) is a part of normal aging. Dementia specialists recommend you see a doctor to evaluate any of these problems or symptoms, which may point to dementia Problems retaining recent memories and nurture new information, losing and misplacing objects, regularly forgetting appointments or recent conversations, or asking the same question over and over. Problems intervention complex tasks trouble balancing a checkbook, following a recipe, or performing routine tasks that drive a complextrain of thought. Trouble reasoning.Difficulty traffic with everyday problems, such as a flat tire. uncharacteristic rash behavior, including poor financial or social judgment. Difficulty with spatial ability and orientation. Driving and navigating beaten(prenominal) surroundings becomes difficult trouble recognizing local anaesthetic landmarks. Difficulty with language. Problems speaking, audience, and following or participating in conversations. behavioral or personalizedity changes. An active, engaged person seems listless and unresponsive. Trusting people become suspicious. What Is Dementia? by Maureen Dezell with Carrie Hill, Ph. D.. While various kinds of dementia are more common the longer we live, none is a part of normal aging. Dementia specialists recommend you see a doctor to evaluate any of these problems or symptoms, which may point to dementia Problems retaining recent memories and arresting new information, losing and misplac ing objects, regularly forgetting appointments or recent conversations, or asking the same question over and over. Problems handling complex tasks trouble balancing a checkbook, following a recipe, or performing routine tasks that involve a complextrain of thought. Trouble reasoning.Difficulty dealing with everyday problems, such as a flat tire. Uncharacteristic rash behavior, including poor financial or social judgment. Difficulty with spatial ability and orientation. Driving and navigating familiar surroundings becomes difficult trouble recognizing local landmarks. Difficulty with language. Problems speaking, listening, and following or participating in conversations. Behavioral or personality changes. An active, engaged person seems listless and unresponsive. Trusting people become suspicious. Who gets dementia? . Rarely, dementia affects younger people.Dementia is said to be early-onset (or young-onset) if it comes on before the age of 65. There are some groups of people who are known to have a higher risk of developing dementia. These include people with Downs syndrome or other learning disabilities. People with Downs syndrome are more likely to develop Alzheimers disease. Parkinsons disease. Risk factors for cardiovascular disease (angina, heart attack, stroke and peripheral vascular disease). The risk factors for cardiovascular disease (high blood pressure, smoking, high cholesterol level, lack of exercise, etc) are risk factors for all types of dementia, not just vascular dementia.Severe psychiatric problems such as schizophrenia or severe depression. It is not clear why this is the case. Lower intelligence. close to studies have shown that people with a lower IQ and as well as people who do not have very high educational achievement are more likely to develop dementia. A peculiar(a) social support network. Low physical activity levels. A lack of physical activity can increase your risk of dementia. (See separate leaflet called Physical Activity for Health for more details. ) Dementia also seems to run in some families so there may be some genetic factors that can make someone more likely todevelop dementia. We do know that a few of the more rare causes of dementia can be inherited (can be passed on through genes in your family). asshole medication help people with dementia? There is no cure for dementia and no treat that will reverse dementia. However, there are some medicines that may be used to help in some causes of dementia. Medication is generally used for two different reasons. Firstly, as treatment to help with symptoms that affect thinking and memory (cognitive symptoms). Secondly, as treatment to help with symptoms that affect mood and how someone behaves (non-cognitive symptoms). With improved nursing care and more widespread use of antibiotics to treat intercurrent infections, individuals now comm still survive 10 years or longer with dementia. This was not always the case in the 1950s, the pioneering geriatric psychiatrist Sir Martin Roth and colleagues used distinctions in duration of illness to show that dementia differed from other severe psychiatric syndromes, notably depression, in the elderly. At that time, most elderly people hospitalized with dementia in the UK survived for approximately 2 years Sex. All prevalence studies show that women are more often affected by dementia than are men.Typically, health services treat twice as many women as men with dementia. This contrast is explained only partly by the longer life expectancy of women because, even when this is taken into account, a slight excess of incidence is still evident in women. 2009 Health Press Ltd. Fast FactsDementia Lawrence J Whalley and John CS Breitner kind MODEL OF alienation While the clinical toughie of dementia presented above describes the changes occurring within the brain, the way that dementia affects a person in periodic life will vary from one individual to the next.For many years, people with dementi a were written off as incapable, regarded as little more than vegetables and often out of sight from society at large. During the 1980s and 1990s, there was a move away from regarding people with dementia as incapable and excluding them from society, and towards a new culture of dementia care, which encouraged looking for the person back the dementia (Gilleard, 1984 Kitwood Benson, 1995 Kitwood,1997). People with dementia could now be inured as individuals with a unique individuation and biography and cared for with greater understanding.Building on this work, others (notably Marshall, 2004) have advocated that dementia should be regarded as a hinderance and framed within a social model. The social model, as developed in affinity to baulk, understands baulk not as an intrinsic characteristic of the individual, but as an outcome produced by social dish upes of exclusion. Thus, disability is not something that exists purely at the level of individual psychology, but is a con dition created by a combination of social and material factors including income and financial support, employment, housing, transport and the built environment (Barnes et al., 1999). From the perspective of the social model, people with dementia may have an impairment (perhaps of cognitive function) but their disability results from the way they are treated by, or excluded from, society. For people with dementia, this model carries important implications, for example ? the condition is not the fault of the individual ? the guidance is on the skills and capacities the person retains rather than loses ? the individual can be fully understood (his or her history, likes/ shuns, and so on) ?the influence is recognised of an enabling or supportive environment ? the key value is endorsed of appropriate communication ? opportunities should be taken for rehabilitation or re-enablement ? the responsibility to reach out to people with dementia lies with people who do not (yet) have dementia ( Gilliard et al. , 2005). The social model of care seeks to understand the emotions and behaviours of the person with dementia by placing him or her within the context of his or her social circumstances and biography.By learning about each person with dementia as an individual, with his or her own history and background, care and support can be designed to be more appropriate to individual needs. If, for example, it is known that a man with dementia was once a prisoner of war, it can be understood why he becomes very sick when admitted to a locked ward. If care providers have learned that a person with dementia has a strong dislike for a certain food, it can be understood why the person might spit it out.Without this background knowledge and understanding, the man who rattles the door may be labelled a wanderer because he tries to relief valve and cowers when approached, or the person who spits out food is labelled as antisocial. Moreover, a variety of aspects of care may affect a p erson as the dementia progresses. Some extrinsic factors in the care environment can be modified, for instance noise levels can be highly irritating but are controllable. Other intrinsic factors, such as the cultural or ethnic identity of the person with dementia, may also have a bearing on how needs are assessed and care is delivered.Some aspects will be more important or pertinent to one person than to another. The social model of care asserts that dementia is more than, but inclusive of, the clinical damage to the brain. ), and while we do not know what precise forms of training are effective, it is reported to lead to better identification of abuse (a haphazard controlled trial by Richardson and colleagues (2002) provides good evidence of this). Agreed multi-agency policy and practice guidance is available at local level and identifies the approaches to be taken when abuse or spend are suspected.A national recording system for referrals of adult abuse has been piloted ( segme nt of Health, 2005b), which found that older people with mental health problems were among those referred to local authorities adult protection systems a variety of interventions were adopted, although information on the outcomes is not available. Recommendations from a serial publication of high-profile inquiries into care settings in hospitals (for example, Rowan Ward, segment of Health/Care Services Improvement Partnership, 2005) are relevant to commissioners, regulatory bodies and practitioners in seeking to lower the risk of abuse.The law in this area is developing and the mental Capacity Act 2005 introduces a new criminal offence of ill treatment or neglect of a person who lacks capacity. DISCLOSURE/STIGMA Assessment and reaching a conclusion about the diagnosis leads to a point where this information should be shared with the person with dementia. This is especially challenging in dementia for a number of reasons ? the difficulty of accurate diagnosis ? the challenge of imp arting bad news ? suspense about whether or not the person will understand what is being said ?uncertainty about whether or not the person will retain what is said ? lack of follow-up support. Studies, in which people with dementia have been invited to tell the story of how they reached a memory assessment service and what the assessment process felt like, indicate that this is not an easy journey for them (Keady Gilliard, 2002). Often, they have been aware of their memory difficulties for some time before sharing this information with others (usually, but not always, their close family). This awareness may occur in quite private activities, like doing crossword puzzles.In the meantime, those who are closest to the person may also have been aware of the difficulties but have fought shy of sharing their concerns. Disclosing their concerns to each other is often what triggers a visit to the GP and referral to a memory assessment service (Keady Gilliard, 2002). People have reported that their visits to the memory assessment service can also be quite an ordeal (Keady Gilliard, 2002). This is often like no other outpatient clinic. The doctor may speak to the carer separately from the person being assessed, leading to suspicion about what is being said.The assessment process itself may prove embarrassing, even humiliating. People report that they are aware that some of the questions are simple and feel foolish that they are unable to answer. They may establish strategies for managing this (Keady Gilliard, 2002). Whilst recognising that most people are seeking to make sense of what is happening to them, it is important to acknowledge that some will find it hard to listen to their diagnosis and there will be some who will not want to be told at all.They know they have a problem with their memory and that they are not able to function as they once did or as their peers do. They want to know what is wrong with them, and they need the clinician to be honest with the m. Telling someone that he or she has a memory problem is only telling him or her what he or she already knows. People should be told their diagnosis as all the way and honestly as possible. The moment of sharing the diagnosis may not be comfortable for any of those concerned neither the clinician, nor the person with dementia, nor his or her carer (Friel McGowan, 1993).Without this knowledge, people cannot begin to make sense of what is happening, nor can they plan effectively for their future. They should be prone a choice of treatments and need information about practical support and entitlements, like Lasting Powers of Attorney and advance conclusivenesss to refuse treatment (more information can be found in sectionalisation 4. 9. 4 and in the Mental Capacity Act 2005 The Stationery Office, 2005). They will want to make decisions about how they spend their time before life becomes more difficult for them (for example, visiting family abroad). next the disclosure of the diag nosis, people with dementia and their families may want further support and opportunities for talking. Pre- and post-assessment counselling services should be part of the specialist memory assessment service. Recent work (Cheston et al. , 2003a) has shown the value of psychotherapeutic support groups for people with dementia, allowing them space to share their feelings with others. Joint interventions with the person with dementia and family carers, such as family therapy, recognise the fact that the diagnosis does not impact on just one person but on a unit of measurement family system (Gilleard, 1996).Other services have used volunteer befrienders to maintain contact with people who are newly diagnosed and who can offer both practical support and information together with a listening ear. People with early dementia are also taking responsibility for their own support by forming groups, which may meet regularly or may be virtual networks using the mesh (see, for example, www. das ninternational. org). Sensitivity is required in ensuring that information about the diagnosis is given in a way that is easily understood by the person concerned and acceptable to the family. Gentle questioning at an early stage will help toascertain what people can, and want, to be told. There is much we can learn from earlier work on sharing the diagnosis with people with cancer (for example, Buckman, 1996). It is especially important to be aware of different cultural sensitivities and the stigma that dementia holds for many people. This can range from subjective feelings of degrade to a real exclusion from community and family life. Age and ethnicity are both factors in the sense of stigma associated with a diagnosis of dementia (Patel et al. , 1998). 4. 9 BASIC LEGAL AND ETHICAL CONCEPTS IN CONNECTION WITH DEMENTIA CARE 4. 9. 1 IntroductionThe ethical problems that arise in the context of dementia mainly adjoin to autonomy, which is compromised in dementia to varying degrees. Respect for autonomy is recognised as a key ruler in health and social care (Beauchamp Childress, 2001). Many of the ethical tensions that arise in looking after people with dementia do so because of, on the one hand, the requirement that autonomy ought to be see and, on the other, the reality of increasing dependency, where this entails a loss of personal freedom. Person-centred care is a means of respecting personal autonomy wherever it is threatened (Kitwood, 1997).As Agich has stated, Autonomy fundamentally importantly involves the way individuals live their daily lives it is found in the nooks and crannies of everyday experience (Agich, 2003). Hence, respecting the persons autonomy will involve day-to-day interactions and will be achieved if the person with dementia is not positioned in such a way as to impede his or her remaining abilities. Such malignant positioning can be the result of contrasted psychosocial structures. The fundamental way to combat this tendency, whic h undermines the persons selfhood, is to encourage good-quality communication (Kitwood, 1997 Sabat, 2001).Another way in which selfhood might be undermined is through structural or procedural barriers to good-quality care, and service providers should take an active exercise in promoting the individuals autonomy and his or her legal and pitying rights. Furthermore, services may appropriate against people with dementia if eligibility criteria are drawn up in such a way as to exclude them or because of an assumption that people with dementia cannot benefit from a service because staff lack confidence and skills in working with this group.Discrimination may also occur if a service does not offer people with dementia the support they may need in order for them to be able to make use of the service. The Disability Discrimination Acts (1995 and 2005), which include dementia within the definition of disability, aim to end the discrimination that many disabled people face in their everyd ay lives by make direct or indirect discrimination against disabled people unlawful in a range of areas including access to facilities and services and buying or renting property.The discussion that follows will briefly focus on human rights, take to, capacity and confidentiality. 4. 9. 2 Human rights Human rights are enshrined, as far as the United nation is concerned, in the Convention for the Protection of Human Rights and Fundamental Freedoms (Council of Europe, 2003). The relevant UK legislation is the Human Rights Act 1998, which came into force in 2000. The principle of respect for autonomy is implicit throughout the Convention. A number of the articles of the Convention are potentially relevant to people with dementia.For example, Article 2 asserts that everyone has a right to life, Article 3 prohibits torture, but also inhuman or degrading treatment, and Article 8 concerns the right to respect for the persons private and family life. Article 5 asserts the right of people to closeness and security. It states that No one should be deprived of his liberty, except in very specific circumstances. It also asserts that if someone is deprived of his or her liberty, there should be recourse to a court. Article 5 was central to the Bournewood case.The European Court declared, amongst other things, that the man concerned (who had a learning disability) had been deprived of his liberty, in contravention of Article 5 (see Department of Health, 2004, for further information). The crucial distinction to emerge from the case was that between deprivation of liberty and restriction of liberty. Whilst the causation is illegal, except insofar as there are legal safeguards of the sort provided by the Mental Health Act 1983 (HMSO, 1983), the latter may be permissible under the sort of circumstances envisaged by fragment 6 of the Mental Capacity Act 2005 (TSO, 2005).This discusses using restraint as a proportionate solution to the possibility of the person suffering harm. Guidance on the distinction between restriction and deprivation of liberty has been provided by the Department of Health and the National Assembly for Wales (Department of Health, 2004). 4. 9. 3 Consent In brief, for consent to be valid it must be ? informed ? competent ? uncoerced ? continuing. Each of these concepts requires interpretation and judgement, as none of them is entirely unproblematic (Department of Health, 2001a). For instance, people can be more or less informed.The Sidaway case (1984) establish that the legal standard as regards informing a patient was the same as for negligence (see the Bolam case, 1957). In other words, the person should be given as much information as a responsible body of medical opinion would deem appropriate. However, since then, there has been a shift away from a professional-centred standard towards a patient-centred standard. In the Pearce case (1998), one of the Law Lords declared that information should be given where there exists a significant risk which would affect the judgement of a reasonable patient.Department of Health guidelines (Department of Health, 2001c) have pointed out that, although informing patients about the nature and purpose of procedures may be plentiful to avoid a claim of battery, it may not be sufficient to fulfill the legal employment of care. There may be other pieces of information relevant to the individual patient that it would be thoughtless not to mention. Hence the General Medical Council (GMC)s insistence that doctors should do their best to find out about patients individual needs and priorities (GMC, 1998). The GMC guidance goes on to say You should not make assumptions about patients views.These points are very relevant when it comes to consent in the context of dementia. It should be kept in mind that consent is not solely an issue as regards medical procedures. The nooks and crannies of everyday experience (Agich, 2003) what to wear or to eat, whether to go out or part icipate in an activity and whether to accept extra home or good luck care are all aspects of life to which the person with dementia may or may not wish to consent. If the person has capacity with respect to the particular decision, but does not wish to consent, he or she should be supported in making an autonomous decision. 4. 9.4 Decision-making capacity In England and Wales, a lack of capacity has been defined thus . . . a person lacks capacity in relation to a bailiwick if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain (Mental Capacity Act 2005 TSO, 2005, Section 2). A person is further defined as unable to make a decision if he or she is unable (a) to understand the information relevant to the decision, (b) to retain this information, (c) to use or weigh that information as part of the process of making the decision, or(d) to communicate his decis ion (whether by talking, using sign language or any other means) (Mental Capacity Act 2005 TSO, 2005, Section 3(1)). The Mental Capacity Act 2005 (TSO, 2005), which will apply in England and Wales31, sets out a framework for making decisions for people who are unable to make decisions for themselves. Its detailed provisions, along with its Code of Practice (currently in conscription form DCA, 2005), should be referred to by all those involved in such decision making. In outline, the main provisions of the Act ? offer a definition of lack of capacity (Sections23) ? outline a process for the determination of a persons best interests (Section 4) ? create Lasting Powers of Attorney, which allow a person to appoint a donee to make decisions about his or her health and welfare (Sections 914) ? establish the Court of Protection in a new form, with powers to make declarations and appoint deputies in difficult cases or where there are disputes concerning decisions about a persons health and welfare (Sections 1523) ? bring under statute and clarify the law regarding advance decisions to refuse treatment (Sections 2426) ? set out safeguards co