Chapter I: Introduction
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).
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: Research 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, 201