Dementia is a syndrome which affect people’s thinking, memory, behaviour and carrying out daily tasks. Different types of dementia types include vascular dementia, frontotemporal dementia, Lewy body dementia and Alzheimer’s disease. People over the age of 65 are at higher risk of being affected by dementia although it can affect anyone at any point of life. Dementia is associated with continuous decline in brain functioning.
As at 31 January 2023 there were 431 845 patients diagnosed with dementia in UK. The UK government spent an estimated £25 billion on dementia in 2021 and it is expected that by 2050 the cost of dementia in UK will rise to £47 billion. Alzheimer diseases constitutes about 60-80% of dementia cases.
Signs and symptoms of dementia
People are affected by dementia differently and each one experiences the symptoms in their own way. Common symptoms include; memory loss, concentration difficulties, confusion and mood changes.
Vascular Dementia
Vascular dementia is one of the most common types of dementia, caused by problems of blood supply to the brain usually due to strokes or transient ischaemic attacks(TIAS) thereby causing cell damage in the brain. Vascular dementia is controlled with medicine to stop strokes and decrease the risk of further cerebrum injury.
Short term/long term memory loss
People with vascular dementia disease may have short term/long term memory loss due to sleep deprivation. Sleep is vital to preserve memory consolidation; ensuring memories are preserved and discarding of unnecessary information. Some sleep problems includes insomnia, sleep apnoea and narcolepsy. Alcohol consumption may impair short term memory and some recreational drugs such as cannabis may trigger short term memory impairments. Infections may also affect cognitive changes like delirium. These infections may cause diseases such as meningitis, human immunodeficiency virus(AIDS) and organ failures.
Mood behaviours on people with vascular dementia
People who suffer from vascular dementia may present loss of drive and disinhibited behaviours such as mood disorders like depression. When these behaviours are identified clinicians are able to mitigate these challenges by smart management; being able to educate and train caregivers. Care and support of people with dementia should be ‘person centred’ focusing on the individual needs such as their history, interests, relationships and including them within the decision making process of their care.
Speech and language on people with vascular dementia
People who suffer from vascular dementia may face problems with memory and speech imbalance. Problems in paying attention, activities planning, impaired language and information process characterise the symptoms of vascular dementia sufferers. Therefore speech and language therapy services should be accessible throughout in order to access communication for people with dementia. Early detection of speech and language difficulties and the intervention of language therapy at an early stage is essential in supporting people with vascular dementia.
Alzheimer disease signs and symptoms
Short term/long term memory loss
People who suffer from Alzheimer disease usually suffer loss of memory and are affected at outset of the disease. About 30 million people globally suffer from the Alzheimer disease and it is expected that in 20 years’ time this will double according to the World Health Organisation. Memory loss affect people in a lot of ways such as; inability to create new memories where the recent events are not recorded hence won’t be recalled later, for example forgetting the conversation they just had. People with memory loss take longer to retrieve information hence they may need someone to prompt them so they can remember. Memory loss sufferers may experience; forgetting how to carry on tasks, getting lost in familiar environments, forgetting appointments and struggling to recognise or identify familiar faces.
Speech and language
People with Alzheimer’s dementia face speech and language difficulties in a variety of ways that include; naming difficulties, difficulties in understanding and speaking in louder voices. People with Alzheimer disease suffer from language deficiencies as they struggle to achieve results in verbal expression; challenges in communication participation, speaking fluency, comprehensiveness and word production are some of the challenges of speech and language.
However these challenges can be mitigated by using non-verbal communication which includes facial expression and gestures. Speech and language pathologist/ therapists can also play a pivotal role in assisting people with dementia to improve their communication skills.
Mood behaviour on people with Alzheimer disease
People with Alzheimer disease can get upset, angry, worried, depressed and quickly losing interest. They are also associated with; hiding things, wandering out of home, pacing, unusual sexual behaviours, misunderstandings and even hitting others. These behaviours may also be associated with physical health issues exacerbated by hunger, pain, constipation or hearing issues. Surrounding environments such as noise, too many people talking or new medication reaction and even lack of sleep.
People who suffer with these behaviours can be supported through; keeping things simple, having a daily routine, reassurance of their safety, being compassionate and being able to offer help when needed. For example if someone pace a lot; they can be supported by giving them comfortable sturdy shoes, enough water provision for hydration, light snacks or fruits as they pace and also ensuring that they don’t lose a lot of weight.
Impact of a diagnosis of dementia on the individual and others
Grief and loss
People who are diagnosed with dementia have high risks of experiencing feelings of loss and grief during the progression of their disease. People are encouraged to accept and acknowledge their current situation. There are feelings of loss and grief which makes them become angry and helpless. Support is needed from the caregivers to offer therapeutic engagement and compassionate care. People may be affected by feelings of grief in different ways such as; shock, guilt, sadness, social withdrawal or despair. Friends and relatives may feel they have lost; a relationship, future plans, mutual relationship, intimacy and shared activities.
Isolation
People who have been diagnosed with dementia suffer from negative stereotypes that are held by the society, friends and family. They lack confidence, experience self-doubt, lower self-esteem, lack of motivation and avoid family contact. People with dementia isolate themselves socially because the changes within their cognitive abilities and behaviour lead them to feel lonely and depressed. People experiencing such can be assisted by connecting them to join support groups and participate in those activities they enjoy.
Employment
People diagnosed with dementia find it difficult at work due to challenges in communicating with colleagues or clients. They experience difficulties in concentration, they forget meetings and appointments, difficulties in multi-tasking, they struggle with larger groups and prefer to work alone, they have no confidence in their work and do not feel certain on making important decisions. Dementia can lead to ending working life earlier resulting in embarrassment, lack of confidence and distress. People with dementia may also experience bullying at work. It is therefore of paramount importance that employers understand the severity and impact of dementia and adjust the work environment in order to support them.
Support
People with dementia lack social support. People who support people with dementia may also experience challenges to their own health and well-being. People with dementia experience a lot of social exclusion and this can be mitigated by provision of support groups where positive outcomes may impact positively on their mental health and also improve their quality of life. Support groups provide personal support, emotional support, funding opportunities and arranging social events.
Strategies to support individuals with memory loss
People who suffer from dementia can be assisted by various strategies that use information in supporting an individual’s memory. Reminiscence therapy uses life story albums such as photographs which can prompt someone’s memory. Life story strategy involves one to one or group to group collection of memory photographs which can enable or evoke positive history recalls. Cognitive orientation can also be used and memory boxes which contain some special items from the past. The other strategy is of finding simple things from the person past such as where they used to live. These strategies can help family and caregivers to foster better communication and provide person centred care. Communication should be simple such as giving simple answers and repeating them as often as required.
Person centred approaches in relation to an individual with dementia
Person centred care is a best approach towards dementia suffers. Its values are based on focusing on placing the dementia sufferers at the core of creating and encouraging positive interactions with others. Person centred care encourages empowerment through providing care that is respectful, trustworthy, involving of family, provides emotional comfort and respect of individual values. Person centred care ensures that dementia suffers are able to participate in things they enjoy and are treated with dignity and respect.
Person centred care empowers people to develop knowledge and skills that can elevate them to high levels of confidence in dealing with their own health and well-being. The Health and Social Care Act 2008(Regulated Services) made a statutory provision that people in care should be treated with dignity and respect. For example when assisting someone with personal care the carer should ensure that the dignity and respect of the service user is preserved. Respect and dignity can be achieved through treating an individual as a valued person and accept them the way they are, carers should also understand that some of the actions exhibited by dementia suffers are not within their control such as shouting, biting or screaming; they should be provided with suitable choices which they are capable to manage, provide them with opportunities to be independent in certain tasks and to speak to them with respect in both verbal and nonverbal communication.
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