Introduction
This essay will aim to provide a comprehensive overview of the mental health problems and needs that are characteristic of older people with dementia who live alone in the United Kingdom. Accordingly, in addition to clinical management, the social and legislative aspects of the same have been taken into account.
The mental health of the elderly living alone and uncared for became a primary concern almost a decade ago when the “Forget me not” 2000 report was published by the UK government to highlight the dire state of circumstances pointing to neglect in terms of mental health provision of older people (Burns et al, 2005). A 2002 Audit Commission update commissioned by the UK government followed this and it was duly pointed out that the provision of welfare for old mental health patients did not spell equity of access for these people in terms of mental health across the United Kingdom (Nice, 2006,2009).
It has been a general complaint particularly in welfare based economies such as that of the UK, that government provisions do not always seem to be adequate in addressing the needs of old people with mental health problems, particularly dementia, especially in more remote, less economically stable areas of the country (Burns et al, 2005). This is mainly due to inadequate training of the medical staff and the unavailability of social services and multiagency frameworks to support the caring and social needs of old people suffering from dementia (Chew et al, 2008). Even though things have since improved in the United Kingdom based on the efforts of governmental and non governmental organisations, a number of gaps still remain with the provision of specialist mental health interdisciplinary teams for senior citizens and day care services at old homes (Nice, 2009).
Needs of the Elderly Dementia Patients in General
Basically, the experience of dealing with senior citizens living alone and coping with dementia has shown that there needs to be a better collaboration between the social and medical sectors caring for the elderly in a more multiagency context (Lindesay et al, 2002). This would mean establishment of more primary care trusts for mentally ill old people with better mechanisms for testing clinical governance and better care management procedures and integrated planning arrangements (HL Paper 156). The urgency of the matter was sensed more than ever a few years ago when it was estimated in the year 2007 when the Alzheimer’s society website[1] estimated (using extrapolation) that the by the year 2010 the number of people in United Kingdom with dementia would rise to 840,000 and by 2050 this figure would rise over 1.5 million[2].
Dementia in the UK: Problems and symptoms
Specifically analysing the major mental health problems and needs of dementia patients living in seclusion in the UK, the author has come to the following conclusions based on the relevant literature. Dementia itself is a result of mental disorders like Alzheimer’s disease or vascular dementia where as the brain tissue will experience shrinkage and there will be an overall reduction in the brain fibres (Burns et al, 2005). The primary cause remains nonetheless Alzheimer, which is basically an ulterior alteration in the brain chemical function to cause long-term memory loss in the patient causing dementia (Hodges, 2007). Very rarely the patient will be suffering from dementia based upon Lewy Bodies (DLB) which is an incidence of protein deposits with in the brain and can badly affect the cognitive functioning of the brain by blocking oxygen and blood for the same. When this happens dementia will occur as the thinking and reasoning ability of the patient will decline (Jacoby et al, 2008).
By nature this disorder is primarily a mental illness affecting senior citizens and is characterised by a slow cerebral deterioration in the patient to the extent that they suffer memory loss and experience problems in performing day-to-day functions. The disorder can hit other vital and cognitive senses in terms of perception, judgment, calculation and attention spans of the patients.
The first thing a person facing dementia-like conditions has to realize is that this is not a reversible disorder and while avoiding alcohol abuse, stress and drugs might slow down the process, the deterioration is more likely than not to proceed. It may be the result of a stroke or even brain infection (Butler, 1998). In the UK the most common symptoms, which are noted in terms of dementia, are the occurrence of memory loss and the tendency to misplace objects. This is generally be followed by low self esteem and mood swings. This does not mean that this will begin as memory loss of a long-term nature but it will begin as a memory loss of recent events (Burns et al, 2002).
The patient, especially if living alone, might feel emotionally disturbed and disorientated when recalling places and people’s identities (Lindesay et al, 2002). Mild dementia based attacks might make the patient prefer sticking to their home base for long periods of time in order to avoid more confusion. At the same time another well-known symptom is losing track of time and having a general disregard towards the timings in a day (Ibid).
As the disease progresses, it will be possible to observe the lack of an attention span on behalf of the aging patient. This may be accelerated in people with a history of alcohol abuse and be followed by a slow disability or reluctance to engage with new gadgets or technologies. Memory loss is likely to cause irritation and the patient’s relations with their families are more likely to be a target of this slowing down (Chew et al, 2008).
The patient will clearly suffer a break down in his or her social and personal activities and display varying personality patterns at times. The most concerning aspect of the situation remains the fact that such people might not be paying attention to personal hygiene and their families and caregivers have to understand the need to help them with such issues at the earliest (Burns et al, 2005).
A person who is losing brain functions might neglect his or her daily meals or nutrition. Dementia patients often lose track of time and become prone to weight loss and unexpected accidents. In its most ulterior forms the patient might need to become dependent on full time care due to the inability to move or to speak (ibid.). Perhaps the trickiest aspect of dementia is that sometimes it may go undetected for many years and it is often recommended that if the patient has a history of mental health problems, there is a tendency for mental health practitioners to confuse the symptoms of depression with dementia; even though there is a thin red line between the two, they tend to manifest themselves in terms of long-term effects very differently (ibid.). Thyroid and brain tumour malfunctions can always display similar symptoms, but the patient’s complete Liver Function Test profile and the TSH (Thyroid functions T3 and T4) should be carried out in conjunction with MRI’s before the presence of dementia is confirmed (Burns, 2005).
In the case of Britain, studies show that such patients will also tend to suffer from mood swings and irregular patterns of sexual desire over time. Such patients are very vulnerable due to the constant impairments and deterioration they suffer emotionally and mentally as time passes (Hodges, 2007). Older patients might suffer a loss of self-esteem and dignity. Caregivers for such people suffer from ethical and legal dilemmas themselves. For example the position is still unclear whether a old person suffering from dementia should be allowed by the care giver to have sexual relations with their partner without facing prosecution under the Mental Health Act 2007. The problem with dementia in a medical sense is that its intensity varies from day to day as well as during different parts of the day. It is medically accepted that the person living alone might be facing more misery due to heightened sexual desire arising from a damaged frontal part of the brain (Hodges, 2007).
It is important that the caregivers of such people are trained in emotionally counselling them out of their miserable condition. Such people are a part of the vulnerable groups within society and are thus more likely to suffer abuse from unscrupulous relatives or people close to them. In the UK, the problem of abuse involving elders with dementia has been identified.
There is a need in line with the NICE guidelines (2006.2009) to treat this issue as a matter of social gravity as well as a serious matter of public health. The perceived embarrassment of a patient and his or her family in losing control over their daily functions as well as the cognitive and behavioural trauma the patient goes through should all be a focus of therapy and care being given to the same (Hodges, 2007).
Pertaining specifically to the condition of old people in Britain suffering from dementia, their cognitive deterioration is coupled with loss of health and energy. Such people might be losing their vitality and at its worse the old patient living alone will face ulterior memory loss as well as possibly displaying inappropriate social behaviour (The Alzheimer’s Website).
Such a condition can at times mandate a complete dependence upon a caregiver or even the relatives of the patients. The clinical facilities for the treatment of the same will need to provide for full time care. However, it can be seen that while some families in UK will be willing to provide their elders home support, many will choose to admit such patients into care facilities due to their reluctance to spend time caring for them, as well as the their lack of resources (Chew et al, 2008). In more traditional, rural societies the extended family would arguably provide the care.
Therefore, if this happens and the families cannot afford private facilities for this patient there is a chance that the patient will have to rely solely on government support for the alleviation of their condition as well as their daily care. The behaviour and deteriorating condition of a patient suffering from dementia can be a stressful experience for their families as well as spouses (Ibid). The main problem remains that the near and dear ones have to watch the patient’s condition get worse every day, as this is not a reversible disease at all. While private nurses are readily available in the UK for their care the amount of costs involved therein as well as the standard of care vary (Lindesay, 2002).
Social, clinical and legal considerations
On a final note, it is also worth perusing the connected ethical and legal aspects for the care of dementia patients in Britain. In addition to the above, many other considerations come to fore in terms of the dignity and confidentiality of such patients. For example, the NMC code of 2008 lays down clear guidelines pertaining to the retention of confidentiality in terms of the patient’s private life and data. Any information retained by the nurses and caregivers at this point is governed by the safeguards inherent not only in the Data Protection Act 1998 but also, as McKenzie explains, the notion of confidentiality, “as applied to information obtained by health professionals has ethical, legal and clinical dimensions…. (With) three basic ethical principles relating to confidentiality: autonomy, duty of care and non-maleficience” (2002:1). The duties of a caregiver or a medical professional caring for a person with dementia include an express requirement under the NMC (2004) to “treat information about patients and clients as confidential, and use it only for the purposes for which it was given” (NMC, para 5.1) unless the disclosure of the same would mandate some sort of a prevention of public harm.
Another point to note in terms of patients suffering from dementia is the application of the Mental Health Act 2007 which is aimed at the protection of elderly mental health patients suffering undue influence and unfair extortion where as their weak mental conditions are taken advantage of by those close to them to fake financial transactions by gaining false consent (NMC, 2008). To counter this, in addition to legal provisions, important NICE (2006,2009) and NMC (2004,2008) codes are in place dealing with aspects of ethics and clinical governance with regards to caring for Dementia patients. It has also been observed that the fact that, as Britain has an increasing number of potential dementia patients every year, more has to be done to secure their physical, mental and psychological welfare – though perhaps it is only the presence of large numbers of older patients with dementia that the issue is receiving more attention.
In conclusion, it is clear that dementia is a growing problem in the UK and all developed countries due to the ever-expanding population of older people. That does not, however, mean that the problems posed are insoluble; rather, this large aging population could well be seen as an opportunity to improve the care of the old and those with dementia. After all, in time perhaps most families and people in the UK with have experience of dementia via their families, relative and friends.
References
The Alzheimer’s Website (2007-2009)- Alzheimers.org.uk
Butler R, Pitt B (Editors) Seminars in Old Age Psychiatry (College Seminars Series) Gaskell (Royal College of Psychiatrists), 1998
Burns A, Lawlor B, Craig S. Assessment Scales in Old Age Psychiatry (2nd edition). London, Taylor and Francis 2003
Burns A, Denning T, Lawlor B. Clinical Guidelines in Old Age Psychiatry. London, Martin Dunitz 2002
Burns A, O’Brien J, Ames D. Dementia. London, Hodder Arnold 2005.
Chew-Graham CA, Baldwin R, Burns A. Integrated Management of Depression in the Elderly. Cambridge University Press 2008
Eighteenth Report of Session 2006-07, The Human Rights of Older People in Healthcare, HL Paper 156-I, HC 378-I.
Jacoby R, Oppenheimer C, Dening T, Thomas A (Editors) Oxford Textbook of Psychiatry in the Elderly. Oxford University Press, 2008.
Mckenzie.K (2002) Complaints And Confidentiality: Practice And Research Vol 5 No 4 May 2002 Learning Disability Practice
National Institute of Clinical Excellence: Clinical Guideline 42: Dementia, 2006. Available from: www.nice.org.uk
National Institute of Clinical Excellence: Clinical Guidelines 90 and 91: Depression in adults and Depression with a chronic physical health problem, 2009. Available from: www.nice.org.uk
Hodges JR. Cognitive assessment for clinicians 2nd edition. Oxford University Press, 2007.
Lindesay J, Rockwood K, Macdonald A. Delirium in Old Age Oxford University Press, 2002;
The NMC Code (2004) and (2008) as available online
The NMC Guidelines on Confidentiality (2008) available at http://www.nmc-uk.org/aDisplayDocument.aspx?documentID=4289
[1] Alzheimers.org.uk
[2] Ibid.