Assessing the mental health needs of older people



Dementia is an 'umbrella' term used to describe a collection of symptoms associated with physical changes in the brain which result in the gradual loss of mental functions such as memory and the ability to use words or to carry out previously familiar tasks.

Dementia encompasses a number of conditions, the three most common being:

The cause of Alzheimer's is not yet known. The disease is usually characterised by a gradual deterioration over several years.

In contrast, vascular dementia (or multi-infarct dementia) is typically a step-like progression, caused by a series of tiny strokes resulting in the loss of blood supply to the brain.

Lewy body dementia is similar to Alzheimer's, but with fluctuating symptoms and features similar to Parkinson's disease.

For more information on the different types of dementia, see the websites of the Alzheimer's Research Trust or the Royal College of Psychiatrists.

Dementia is mainly a disease which affects older people - 98 per cent of people affected in the UK are over 65 (Help the Aged) - and the prevalence increases significantly with age. The Alzheimer's Society calculates that while only 1 in 1,000 people under 65 will develop dementia, that figure rises sharply to 1 in 50 between the ages of 65 and 70, and 1 in 5 for people over 80. It is important to bear in mind, however, that dementia is not an inevitable consequence of ageing, and the majority of older people will not develop dementia.

Every person with dementia is affected differently, but common symptoms include:

Memory loss and confusion can be frightening and distressing for the older person, and may cause behaviour problems, such as agitation or aggression, or make it difficult for them to take part in normal social interaction. As the disease progresses, it is likely to affect the person's ability:

Although there is no cure, a great deal of encouraging research is going on. A number of new drug treatments for dementia have been developed, and many older people who have taken part in trials, and their carers, believe they have experienced improvements in memory and alertness, if only for a short while. At the time of writing, however, there is a debate about how cost-effective these treatments are, or at what stage they provide most benefit. In January 2006 the National Institute for Health and Clinical Excellence (NICE) updated its guidance on the use of the drugs donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl) for use in mild to moderate Alzheimer's.

Key research findings

Further information

If you want to know more about dementia, factsheets are available from the Royal College of Psychiatrists and the Alzheimer's Society. The Alzheimer's Society covers all forms of dementia, not just Alzheimer's, and has a range of useful publications particularly for older people and their families.

for dementia, is an organisation which aims to to improve the quality of life for people affected by dementia. The organisation provides Admiral Nurses, who are specialist dementia care nurses working in the community and in health and social care settings, provides training and education for care staff working in residential, nursing, day care and domiciliary settings and develops projects, in partnership with other organisations, designed to improve the quality of life for people with dementia and their carers.

See also:

Connect with us’: A resource for care home managers developing services for people with dementia (PDF 138kb)

Idea from practice

Ysbyty'r Tri Chwm have been involved in a project for the last two years to explore how the creative arts can enhance the lives of people with dementia. The project aimed to maintain a healthy living ethos, provide stimulation, assist cognitive ability, increase self esteem and provide respite for carers. The project has had very positive outcomes including dance classes resulting in increasing social contact, self esteem, a positive outlook, building confidence, improved concentration and enhanced feelings of identity. There are also positive physical outcomes such as improved strength, improved co-ordination and improved muscle tone. The programme has won a Queen's Nursing Institute award for creativity and innovation. The group is now extending activities to include creative writing using reminiscence and local community visits using photographic collages. For further information contact - Kevin Wood at Gwent Healthcare NHS Trust - 01495 353206 - email -

Next: Other mental health problems