Assessing the mental health needs of older people

Dementia

Introduction

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:

Alzheimer's disease, which accounts for approximately 60 per cent of cases
Vascular dementia (20 per cent)
Lewy body dementia (15 per cent).

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:

forgetfulness, particularly about recent events
becoming confused about what day or time it is
not recognising people or surroundings.

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:

to drive
to perform day-to-day tasks such as shopping, cooking, and looking after themselves and their home
to read
to talk and understand what is said to them.

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

Although only a minority of older people in the population as a whole have dementia, a high proportion of those using community care and long-term services are affected.

Alzheimer's and other forms of dementia often remain undiagnosed, but there can be advantages to early diagnosis, which is becoming more usual. These include:
- relief to the person because he or she understands what has been happening
- enabling people affected, and their families, to make decisions and plan for the future
- the person can be considered for drug therapy.
People who are told their diagnosis always need follow-up support.

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.

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 - Kevin.Wood@gwent.wales.nhs.uk

Next: Other mental health problems