Statistics on Dementia in Australia

Dementia is a form of Cognitive Impairment that accounts for 4,25,416 suffering individuals across Australia of which 45% are males and 55% are females (Dementia Australia National, 2018). By the end of 2017, it had been regarded as the second dominant reason for death, surpassing cardiac disorders that claim approximate 16% lives of the total population in Australia, each year (Knapp, Iemmi & Romeo, 2013). This alarming census indicates the absolute necessity of adequate provision for clinical intervention and care units for individuals suffering from Dementia. This disorder which leads to eventual memory loss is not essentially a result of ageing. A person might develop dementia at an age as early as 14 years (Borson et al., 2013). The primary diagnosis include several routine-based screening procedures which itemise the severity of the patient’s condition. Accordingly, the symptomatic and suspected cases are isolated from the critical ones and extensive professional health care regimes are administered to reduce their sufferance. Apart from this, Annual Wellness visits are made in Hospitals and Care Houses for the purpose of early detection of any sign leading to this disorder.

At times, these Medical Units conduct intervention programs keeping the environmental, psychological, pharmacological and social prerequisites under suitable settings and even extend their care services to the patient’s families in order to reduce their distress. This article would proceed with elucidation of these early symptoms of Dementia; what are the risks associated with the development of these symptoms; how an individual as well as his or her family cope with the adversities of the event; and most importantly, what are the different avenues in which ample support is provided to such patients and their families.  

Cognition is a multifaceted terminology referring to mental processes such as thinking, understanding, comprehending and retaining an information to use it further in decision making. Any deficiency or breakage at any stage of memory, attention, consciousness and language processing maybe considered as an onset of Dementia. The impairment might range from mild confusion and changes in behaviour like withdrawal or inability to perform daily task to progressive memory loss leading to apathy and depression. In certain cases, evidence has suggested that brain tumours and meningeal infections are significant physiological predisposition that can result in Dementia (Imtiaz et al., 2014). However, its symptoms are often attributed to factors that are yet to be verified for causing this psychopathology. These consist of hormonal deficiencies, vitamin deficiencies and overmedication for a different illness. Hence, it is essential for medical practitioners to broadly explore the causes, indicating towards frequent memory loss, impaired communication, confounded reasoning and judgment ability and problems in visual perception, right from the early stages in diagnosis. Medical Practitioners have devised certain methods by which Dementia could be identified. As observed by (Livingston et al., 2017) some of these devises include:

• The Personal History of the client: investigating any recent major change in his or her life which they are finding difficult to adjust with.
• Physical examinations in laboratory that include blood tests for traces of anaemia, infection in liver, drug addiction, deficiency in vitamin and thyroid, urine infection and imbalance in electrolyte.
• Cognitive assessments such as Mini-Mental Status Examination, Neuropsychological Tests, Radiological Tests and Techniques of Brain Imaging.
• There is a separate assessment for investing Alzheimer’s disease known as ADAS-Cog. It is undertaken by a trained professional to find out mild aberrations in memory and language abilities.

Early Symptoms and Risk Factors for Dementia

There is almost always a high probability of other mid-life diseases to occur in association with Dementia. People belonging to the age group of 30 years to 45 years often succumb to this cognitive impairment, later in life, owing to surmounting stress and intense pressure in their professional area as well as the anxiety to balance their work and personal life. The most common type consist of Cardiovascular Disease that manifest from hypertension and consecutive over-drinking and over-smoking. Lack of adequate physical exercise results in cholesterol problems that degenerate cell membrane enclosing the nerve cells. This in turn increases the risk of Alzheimer’s. Hereditary predisposition also plays a major role in accelerating the liability of dementia. Genetic mutation in the three Amyloid Precursor proteins are linked to increasing cholesterol issues which in turn leads to Alzheimer’s disease (Robinson, Tang & Taylor, 2015). The occurrence of Dementia was less frequent in the pre-industrial society as the popularity of old-age homes started growing from 20^th century onwards. Dementia can occur at any age. But its chances get increased with age, 65 years being the critical limit (Werner, Karnieli-Miller & Eidelman, 2013). Depending on the causal factors, Dementia is classified into various types such as:

• Alzheimer’s disease
• Front-temporal Dementia
• Vascular Dementia
• Dementia due to Alcohol Abuse
• Lewy Body Disease
• Dementia from Down’s syndrome
• Dementia associated with HIV

Alzheimer’s disease is the most prevailing type of Dementia, accounting for 75% of the cases, closely followed by Vascular Dementia that mostly gets triggered after a stroke (Knapp, Iemmi & Romeo, 2013).

Once diagnosed with Dementia, patient can avail assistance in medication, psychotherapy and also care-group support from National Dementia Helpline. This helpline provide ample resources that help the patient to improve his or her quality of life.

As per the latest statistics provided by the Australian Government, around 413,106 people are suffering from Dementia who are supported and looked after by approximately 291,163 Carers (Mioshi et al., 2013). It must be understood by health workers and care givers that even though an individual is suffering from a degenerative neurological disease such as Dementia, his values and dignity must remain intact. For this purpose, it is essential for both nursing home and residential attendants to build a significant relationship with the patient which is based on trust and empathy. It is a very crucial requirement that enhances the quality of care. At times when the patients experience lack of adequate attention and care by the nurses or their needs are not heeded, owing to their age or social background, it deeply affects their self esteem. Such occasions increase the risk associated with this illness and heightens the feeling of loneliness and despair within the patients. To further illuminate on this matter, it must be ensured that the caregiver is aware of all the sustainable means of supervision to prevent the patients from recoiling into a passive life.

Types of Dementia

The patient’s subjective experience of Dementia is filled with a lot of suffering. For those who don’t have companions to take care of them at their residence, there are day care centres as well as professional residential care units. With old age, a person has to adjust with certain new and unpleasant changes in their lives. Adding to those changes, Dementia emerges as a significant deterioration in their quality of living. When this disease persists for a relatively longer period escalating in severity, the individual is faced with disability challenges. This leads to an increased dependency of these patients on their care givers. As highlighted by (Brooker & Latham, 2015) in their study on a significant patient population, it is not only the patients who suffer challenges on moving into care-houses but their immediate families, friends and relatives too who happen to invest their time, energy and assets for the well being of their loved one. They too have to undergo radical changes in their daily routines for their companion who has fallen victim of Dementia.

As discussed before, Dementia damages the quality of life to a large extent. Behavioural disturbances in the patient, such as agitation and cognitive failure, affect the quality of the carer’s life as well who at times exhibit depressive symptoms. Thus, in those occasions, it becomes essential to admit the patient in a long term care facility instead of continuing with the community-based or residential unit treatments (Robinson et al., 2013). With the radical change in environment, the patient does face an initial challenge of coping, but, eventually gets accustomed with the new setting owing to their functional status of cognition. However, there are case evidences that have bestowed a negative remark on institutionalization as the patient’s quality of life has also been found to degrade considerably after moving them to a facility (Boots et al., 2014). Another concern that stems out from this aspect is the dearth of cost effectiveness of these care houses. Facts collected from the relevant studies have suggested that pharmacological therapies were more cost-effective than the interventions provided to the patients (Dening, Jones & Sampson, 2013). These showcases how poorly co-ordinated these care facilities are and how irresponsible are the people who fail to take this grave matter into consideration and resolve it without further ado.

In recent past there has been an increasing demand in the cost-effectiveness of psychosocial intervention for Dementia. These tailored occupational therapies, when provided in combination with pharmacological administration, yield better outcomes with respect to the patient’s quality of life (Poppe, Burleigh & Banerjee, 2013). However, critical evidences suggest that there is a considerable amount of difficulty in achieving the cost effectiveness owing to lack of probe in the matter and mismanagement on part of the government care facilities (Mullick, Martin & Sallnow, 2013). Scarcity of cost effective facility has increased the popularity of residential care facilities which has comparatively lesser drawbacks.

Assistance and Support for Dementia Patients

Residential Care units are those that emphasise caring for the suffering individual in the setting of their own residences. It prioritises the patient’s needs above anything else. The caregiver is a professional who complies with the patient’s and his or her family’s comforts and discomfort as well as lend their own perspectives into the care plan. This collaborative partnership brings about better results in the patient’s condition. Across several cross-cultural studies on patients and carers of Dementia, a common fact accumulated was the correlation of subjective experience with the acceptance of tailored care facilities (Dam et al., 2016). Dementia lead patients to eventually lose restriction over personal hygiene, yet, patients can express their denial in compromising their privacy in the presence of a complete stranger. Even though their expressions are incoherent, they demand to be taken seriously and above all, to be understood. For their well-being, it is mandatory for the family to address to their needs and arrange for residential care units whereby the chances of improvement become relatively higher (Clissett et al., 2013). Family members must invariably educate the patient about his or her psychological impairment in the most non-threatening way as possible. This helps the patient to eventually come in terms with his or her disability. Adequate social support is needed by the patient to cope with their changed life conditions.

As observed by (Boots et al., 2014), a patient suffering from Dementia, who has been moved to a long term care facility finds immensely difficult to accommodate to their new daily routine. These care facilities also lack in person-centred approach to therapy which is very crucial in this disorder. In extreme cases, the patient might refuse to eat, sleep or take medication and lose their self control when they find their preferences in dissonance with those that the facility provides and their needs are not being catered to. They might also misinterpret the care and support at these facilities for dominance and abuse which further worsens their condition. If any action or step taken by the members of these care facilities fails to meet the standard of the patient’s requirements, it might lead to breach of trust between them and ultimately the patient might deny any participation of the facility member for his or her intimate requirements. Since each individual has a unique personality with their own share of inhibitions and contentment, it is critical to recognize the psychological validity of the patient’s refusal and accept the therapeutic potential of the family’s moral and social support (Dempsey, 2013). Under these conditions, the family members should attend to the underlying needs of the patient and consider opting a residential care unit rather than an institutionalized care unit for the health, safety and well being of their loved one who is suffering from Dementia. The person does not understand what they are being asked to do.

The Importance of Quality Care for Dementia patients

A few recommendations that could be suggested towards Dementia care would be:

• Advocating ethical training to address the needs of Dementia affected people in the geriatric units in Care Facilities (Stokes, 2017).
• Ensuring cost effectiveness as well as quality services in the Care Houses.
• Professional Care Providers must try to abide by the legal formalities in assisted residential care as well as be empathetic towards patients (Sjögrenet al., 2013).
• Adequate social support must be catered to the patient’s families who suffer indirectly from this disorder.
• To encourage adoption of a congenial setting at both Residential and Institutionalised care facilities where the patient can be at physiological and psychological comfort (Rokstadet al. 2013).
• To make sure that the requirements of quality assurance are met at the residential care units which are comparatively informal to the long-term facilities.
• To ensure that medication is provided with adequate amount of psychotherapy
• Special policies by the Government to assist those patients who lack a family, companion and considerable finances to continue with the treatment.
• To establish an interactive forum for the patients, their families and the care providers so that each can share their own experiences and insights about their journey towards betterment (Zabaleguiet al., 2014).
• To empower the individuals who had been a victim of Dementia but have considerably improved with treatment.

Conclusion:

To conclude the above discussion on the various possibilities of uplifting the quality of life of those suffering from Dementia, it can be stated that with proper guidance and care on behalf of the patient’s family and the society at large, the adversities of this disorder can be controlled to a reasonable degree and the patients could thus have another opportunity at life. Dementia is a degenerative disorder that impairs the cognitive ability with time. Since it mostly affects the geriatric community, it has been observed that proper care in the Care Houses is largely mismanaged. Often the family is found to be avoidant too. These factors lead to worsening of the patient’s condition and the little possibility of his or her improvement also diminishes. Therefore, providing these individuals with ample care and support is the first step in their treatment. The second most important aspect is addressing their personal and social needs. By doing so, their dignity is protected from being undermined. Their comforts and inhibitions must also be taken into account before administering care therapy. Along with these measures, support should be extended towards the patient’s family to help them cope with the adversities of the situation. At each step of the treatment it is important that the care giver is empathetic and is proficient in his profession. A mutual understanding among the family, the care giver and the society at large can ensure a better quality of life for the sufferers of Dementia.

References:

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Residential Care Facilities for Dementia Patients

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