Dementia
10: Explain (1500 words), how to support a patient with dementia. You should include.
• Describe the ageing process and how
• Summarise health and social care support available to older people
• Describe considerations that should be considered when assessing an older person
The process of ageing begins as soon as we are born, though immediate changes are subtle and gradual. Cells are constantly being renewed because of lifestyle, genetics, and environment amongst other. Maturity is a short period around 30 to 35 years of age on average. As we age vital organs and systems become less efficient such as kidney function and temperature control.
Organs develop gradually and mature to their maximum efficiency in early adulthood, though most organs do have spare capacity if needed (i.e. the heart can enlarge in pregnant women to accommodate the additional blood volume). This spare capacity and organ efficiency decline slowly over time.
Most organs can self-repair, all except the brain and heart muscles. Self-repair is easiest when younger and as we age this process is laboured and less efficient. As a result of ageing we are more suspectable of developing illness and chronic conditions. Examples of this include, Dementia, Heart Disease, Cancer and Arthritis. Genetics and lifestyle have some impact on life span and how quickly we age also affects this.
Ageing is poorly understood and there exists wide variations between nations, continents, gender, and race. The advances in medical care have increased our lifespan, however recently this has started to drop due to lifestyle factors. Ageing affects everyone differently; the loss of body reserves occurs first before physiological factors take effect.
Changes in body systems:
As we age the nervous system changes. This leads to a decrease in fine motor control, memory, and nerve function due to a slowing in nerve impulses. Our senses become less efficient, hearing is affected by high frequency sounds becoming difficult to sense and cells in the ears become damaged with time. Taste and smell fades due to cell damages and our sight becomes longer sighted, lenses can stiffen and increase in opacity causing cataracts.
In the respiratory system, the muscles stiffen, less mucus is produced to keep the airways clear and the ability of the body to inspire deeply and expand the chest is reduced due to the rib cage stiffening.
The endocrine system changes, leading to a reduction in Beta cells in the pancreas causing diabetes to develop and in women oestrogen deficiency causes the menopause. The thyroid gland becomes less active meaning that tiredness becomes more problematic.
Digestively, the bowel slows down, teeth decay and the liver function decrease and atrophies.
The function of the kidney is reduced from the age of 30 on because of fewer nephrons and lower glomerular filtration rate. The prostrate gland in men can become enlarged leading to dysuria, and UTIS become more common.
Immunity declines with age as the body is less able to fight off infection.
The heart becomes less contractile with age, is prone to calcification of the valves meaning increased workload so it becomes hypertrophied but is less efficient leading to heart failure. The coronary arteries are susceptible to plaque build up and rupture causing Angina or Myocardial Infarction.
The skeletal system is affected by a loss of cartilage between joints causing arthritis, bone density causing osteoporosis and other aging factors such as kyphosis of the spine.
Finally, the reproductive system is affected by lower fertility in males and the menopause in females.
Visually are bodies show this ageing with grey hair, wrinkles, larger ears, and larger noses. Are skin becomes less elastic and our hearing and sight is poor.
One of the main factors in ageing is dementia. There are various types of dementia and these are listed below:
• Alzheimer Disease
• Vascular Dementia
• Dementia with Lewy Bodies
• Korsakoff Disease
• Mixed Dementia
Dementia is a progressive disease and may only ever show slight symptoms or severe symptoms. As this is progressive it will cause irreversible degeneration of the cerebral cortex within the left and right hemispheres of the brain. Progression varies between people, however most show problems with short term memory, emotional reasoning, and a reduction in intelligence.
Supporting a patient with dementia:
The population in the UK is ageing, there are now more people over the age of 80 since records began. As a result of this the social care system is not able to meet the needs of an ageing population. This directly affects the care and support that patients with dementia need.
Patients with dementia may need support with illness, respite, and re-enablement. As their condition progresses, they may need care home support to ensure that they are cared for safely. Other care that can be provided is 24-hour care within the patients own home, or care visits by health carers as needed to meet the need of the patient.
Adults social services and care agencies are responsible to provide care to support patients with dementia, for this an assessment needs to be done. Sadly, waiting times are currently long for these assessments.
Adults social services complete the following assessment to establish whether a patient needs care support of need. This would include:
• Level of support needed, such as continuous support, 1 carer support or 2 carer support with short care visits.
• Type of support such as feeding, washing, personal care, incontinence need or medication support and help with getting up and going to bed.
• Mobility assessment: is the patient safe to mobilise, is a standing aid needed, is a hoist needed or a stair lift?
• Safety support: can the patient be safely left alone overnight or for periods during the day? Do they wander, become confused? Do they have a personal care alarm, telephone access, key safe? Are they at risk of any forms of abuse? Are family nearby to help if needed?
• Financial assessment: Can the patient pay for care? ( If patient has assets of more than £23,250 they pay for care, however if the patient has between £14,250 and £23,250 then they would contribute toward the cost of care, however the value of the patients home is not taken into account in these assessments).
• Family support: How much can the family or close friends support the patient?
• Care home assessment: Can the patient remain at home safely, or do they need to be moved to a suitable care home?
In the UK some local NHS trusts have carers that provide care for patients in their own home, however the majority of care is provided by private care companies who are governed by the CQC and the Care Quality Act 2014.
There are also some charitable companies, such as Mencap, Scope and Dementia UK to name but a few who can provide some care and advice as needed.
Health support is provided by the following:
• GP
• Community based health services: 24 hr District Nurse support, Physiotherapy, re-enablement team, JET team (health assessment and treatment), disability drop-in centres and clinic
• Community based mental health services, support worker, community mental health nurse, mentor, drop-in centres, and clinics.
• Community
• Charity support, Mencap nurses, age UK therapists.
• Local Hospital outpatients
• For acute developments, the ambulance service and accident and emergency departments.
Considerations when assessing an older person:
An elderly person must be treated fairly and allowed time to make decisions for themselves. They retain the right to decide if they want care or not and to make informed decisions. Consideration must be given to support them as physiological changes due to being elderly may put barriers in place preventing clear informed decisions from being made. It is important to support the elderly as needed following the 5 principles of the Mental Capacity act.
The elder person may often not want to leave their home out of fear, isolation, neglect, and shame. They may also feel that they are coping for fear of being a failure. The ambulance service is often one of the first service providers that the patient will have an encounter with, and we can, as a service make referrals to social services, GP’s, and safeguarding services with the consent of the patient.
The overriding consideration is that if it is safe, in the patient’s bests interests and the patient has access to support, that the patient remains at home to help promote their independence and mental wellbeing.
When assessing the elderly, the following must be considered:
• Medical history, can this be confirmed with carers, relatives or GP if needed?
• Does the patient need visual or hearing aids to help with the assessment?
• Does the patient know why they are being assessed?
• Does the patient have capacity?
• What are the normal physiological baseline observations for the patient?
• Does the patient know what medications and are they compliant with them? Can this be confirmed?
• Is the patient in pain?
• Can the patient describe how they feel emotionally or physically?
• Does the patient have carer support?
• If the patient has fallen, can they remember this?
• Is the patient mobile? Do they have sufficient mobility aids?
• Do they wander?
• Do they recognise their own surroundings?
• Are they eating and drinking well?
• Can they access help if needed?
• Do they have a pendant alarm they can press in case of emergency?
• Is the patient safe to be left at home?
