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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: 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, 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 works 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 improving 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 difficult 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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