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DEMENTIA Assessment Solution

INTRODUCTION

Dementia refers to a clinical condition that impair brain function and is characterized by memory loss, decline in health and functional ability as well as deterioration in independent living (Australias health, 2018 Prince et al., 2013). The world population suffering from dementias was 47.47 million in 2015 which is estimated to reach 75.63 million and 135.46 million in 2030 and 20150 respectively. Dementia increases with increasing age according to the studies and survey reports on the incidence of dementia with higher incidence witnessed in high income countries (WHO). Studies revealed that it doubles with increase in age and varies with different region which is mentioned in table 1.each 5.5 years from 3.1/1000 and 175/1000 person years respectively at the age of 60-64 and age above 95 (Prince et al., 2013).
Table 1. Incidence of dementia with every definite increment in the world
Increment in age Occurrence in the world
5.5 Asia Pacific, Latin America. North America
5.6 East Asia
6.3 South Asia, Western Europe
6.7 Australia, South East Asia

HEALTH ISSUE IN AUSTRALIA

There are 10 symptoms that are associated with dementia which is listed below (Alzheimer association).

  • Memory loss that slows down thinking
  • Difficulty in planning
  • Difficulty in doing work which is already familiar. eg. Daily tasks at home
  • Confusion in time, date, seasons, places etc.
  • Faces lot of struggle in analysing pictorial data of images
  • Problems in speaking and writing the words
  • Misplacing things and inability to think
  • Poor decision making
  • No or little involvement in hobbies, social activities
  • Become fearful, depressed and suspicious

According to 2018 reports, 376000 people was diagnosed with dementia and this number is expected to rise by 2030 to 550000. Dementia was more prevalent among women (61) than men (43) with most of them belonging to age group above 85. Only very few cases were reported with younger population and around 8.7 were of age group 65. The rate of prevalence depends on various subgroups existing in Australia. It was found to be more prevalent among Torres Strait Islander and Aboriginals than non - indigenous population. The associated risk factors is also higher among the former than the latter population (Australias health, 2018). Hence, it is important to study the risk factors associated with it in Indigenous population. Investigations were made on this area by many researchers and observed that dementia is associated with head injury, stoke, unskilled work, childhood trauma (Radford et al., 2018). There are many studies outside Australia reporting years of education as a factor involved in causing dementia but studies conducted by Radford et al., 2018 showed it is not a contributing factor in Aboriginals. In contrary to the global reports, dementia is not associated with cardiovascular, depression smoking risk factors in Aboriginals.
According to a recent report, there are 7 risk factors that can modified which includes depression, midlife hypertension, diabetes mellitus, low education, physical inactivity and midlife obesity (Ashby-Mitchell et al., 2017). These cannot be worked out separately and the estimates show that 117,294 out of 242,500 cases was associated with 7 lifestyle factors. According to their calculations, reduction of risk factor by 5 reduces dementia incidence to 1.6-7.2 in 2020 followed by a decrease in 2030 to 3.3-14.9, 2040 to 4.9-22.8 and 2050 to 6.6-30.7. The reported contribution of midlife obesity in dementia was 17 in Australia which was higher than that reported for other countries. In contrary to this, the contribution of dementia due to physical inactivity (17.9) and smoking (8.7) was lower when compared to other continents.

MEDICATION MANGEMENT

Medications that are administered to dementia people include anticholinergic drugs, analgesics, antibiotics and psychotropic drugs. Apart from the positive use of these drugs, numerous side effects have been reported which is described below. Old age people are mostly prone to anticholinergic burden due to its extensive usage. Some of the drugs which exert side effects include skeletal muscle relaxants, antispasmodics, antipsychotics, anti-Parkinson agents, antidepressants and antihistamines. The side effects are decrease in cognitive function due to low levels of acetylcholine which is a neurotransmitter responsible for cognition.
Psychotropic drugs are administered to reduce psychological and behavioural symptoms of dementia. Some of them are antidementia drugs, anticonvulsants, antidepressants, hypnotics, anxiolytics and antipsychotics.
Patients with dementia undergo various infections such as urinary tract infections and respiratory tract infections. To address this issue, antibiotics are given which may lead to overburden of medicines. Sometimes, the infections leads to a complicated diseased condition if not treated properly. Often, the patient fails to communicate the symptoms of infection due to the severity of dementia.
Around 50 of the affected experience pain due to neuropathies, previous fractures or musculoskeletal conditions. This necessitates the doctors to prescribe analgesics. As in the case of infections, the pain also remain undetected due to ineffective communication as well difficulties encountered by the observers (Parsons et al., 2017).
Polypharmacy which is defined use of 5 or more medications at once for different diseased condition. In a study conducted by Mueller et al., 2018, around 24.2 were administered with 4-6 drugs and 15.8 were given more than 7 drugs. This increased the risk of patients in emergency department. They evidenced an increase of 5 in risk of emergency department and 3 in hospitalization. Polypharmacy is related to high risk of adverse impacts which may occur dementia. Only very few studies have reported the association between dementia and polypharmacy. Inappropriate use of drugs was observed to be one of the reasons responsible for polypharmacy in older patients.

ASSESSMENT/SERVICES

Dementia increases the dependence among old people since they loss he ability to think and do the usual activities. Often, a confused state is seen among dementia people which necessitates them to depend on others for their daily essential and basic work. The onset of dementia will mark the entry of a caregiver and continues till the death of the patient. The strain which a caregiver has to experience is respectable since she/he neglects other activities like leisure, undergoes psychological stress, and economic loss. If some patients require extra help they can approach government services. Aged care services have been undertaken in many parts of the world including Australian Government services. Commonwealth support programme also provide services to support dementia patients. The home care package include helping in daily activities like grooming, dressing, washing as well as maintenance of their respective houses.
Some of the services help the patients in accessing the services during their stay at home. In few situations, counselling is necessary to help them understand certain issues. This is done by counsellors in the governmental services in Australia. They are trained for advising and supporting them. The patients who can seek counselling are as follows

  • People who show early signs of dementia
  • People who take of the patients
  • Patients family relatives, friends etc.
  • This will have a great impact on family and friends as it helps in the following things
  • Gaining knowledge on the implications of dementia
  • Steps that should be adopted to live with dementia
  • Planning for future care
  • Reduces the problems of stress and confusion
  • Getting reference sources for assistance

To develop uniform level of understanding, it is advised to attend the counselling session along with the whole family of affected. This practice essentially helps to understand the level of support required and improve their relationship to a great extent. Also, it helps the listeners to learn stress management, anger, guilt, grief and other emotions. Apart from the above, listeners can share the ideas to other care takers as well as learn how to tackle if a similar situation arises in the future. All these practices assist the patients and his/her family members to cope up with disease signs and symptoms.
Moreover, the social service provides in the local community are also involved in the daily activities care and personal care. These services can provide meals on day today basis, laundry services, carers etc. They can also help with access to similar care centers and other local service support centers.
NHS helps to the get the treatment done in hospital along with other healthcare including language and speech therapy, foot care, eye tests, hearing care, physiotherapy. It also aid in accessing the help from Older Peoples Mental Health Team. The support for NHS can be continued depending on the severity of the condition and mere diagnosis of dementia is not enough to get support from NHS.

CONCLUSION

Dementia is cognitive disorder which reduces the brain functioning and loss of memory. The population which is affected by dementia is increasing at an alarming rate in the world. The incidence of dementia is more common in Indigenous people in Australia and the occurrence could be reduced by reducing the risk factors associated with dementia. Numerous of initiatives needed to be taken including educational programmes to increase the awareness and care that should be taken during different stages of dementia, cost-effective medical care and increase of care service providers.

References

https//www.aihw.gov.au/getmedia/bcf051e3-8f52-4399-8a52-790c507b3c53/aihw-aus-221-chapter-3-14.pdf.aspx

Prince, M., Bryce, R., Albanese, E., Wimo, A., Ribeiro, W., amp Ferri, C. P. (2013). The global prevalence of dementia a systematic review and metaanalysis. Alzheimers amp dementia, 9(1), 63-75.

https//www.who.int/mental_health/neurology/dementia/dementia_thematicbrief_epidemiology.pdf

Radford, K., Lavrencic, L. M., Delbaere, K., Draper, B., Cumming, R., Daylight, G., ... amp Hill, T. Y. (2018). Factors Associated with the High Prevalence

Dementia in Older Aboriginal Australians. Journal of Alzheimers Disease, (Preprint), 1-11.

Ashby-Mitchell, K., Burns, R., Shaw, J., amp Anstey, K. J. (2017). Proportion of dementia in Australia explained by common modifiable risk factors. Alzheimers research amp therapy, 9(1), 11.

https//www.alz.org/alzheimers-dementia/10_signs

https//www.nhs.uk/conditions/dementia/social-services-and-the-nhs/

Wells, C. E., amp Smith, S. J. (2017). Diagnostic care pathways in dementia A review of the involvement of primary care in practice and innovation. Journal of primary care amp community health, 8(2), 103-111.

https//www.dementia.org.au/services/counsellingMueller

C., Molokhia, M., Perera, G., Veronese, N., Stubbs, B., Shetty, H., ... amp Stewart, R. (2018). Polypharmacy in people with dementia Associations with adverse health outcomes. Experimental gerontology, 106, 240-245.

Parsons, C. (2017). Polypharmacy and inappropriate medication use in patients with dementia an underresearched problem.Therapeutic advances in drug safety,8(1), 31-46.

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