Running Head: Dementia

Enhanced Service Delivery in Specialist Mental Healthcare: Dementia.

[Name of the Student]

[Name of the Writer]

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TABLE OF CONTENTS
Part A...................................................................................................................................3

Part B.................................................................................................................................11

References..........................................................................................................................17
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Introduction

The current assignment aims to provide insightful information about the problems related

to mental health which patients face. It is noted that different patients have different symptoms

and problems which need an adequate amount of attention from health care professionals. It is

eminent that dementia is considered one of the most common problems globally, and it can affect

people. It is analysed that Alzheimer's is considered the most common cause of dementia.

However, it is important to understand that Dementia is not a normal disease. Still, it has severe

outcomes, and it is noted that different term is covered certain conditions, including Alzheimer's

disease. Diseases classified as dementia are mainly occurred due to abnormality in the brain.

Therefore, this kind of result in decreasing mental performance, that is, mainly cognitive decline.

It is quite dangerous, and therefore it also interferes with the daily life of the elderly patient. For

this reason, people’s behaviour, emotions, and attitudes can be changed.

Part A

It is noted that Dementia is the common disease in the UK and Alzheimer's disease can

be found in more than 60% to 80% of patient in the UK. On the other hand, in the UK heart

diseases such as cardiovascular disease is considered a second-leading problem in elderly patient

as compared to dementia (Westera et al., 2020). It is caused by microscopic bleeding and a

blockage in the cerebral blood vessels. Many people have different experiences, and due to

which concomitant brain changes in dementia, they have several kinds of dementia. It is

important to understand the symptoms of dementia caused by a variety of other conditions,

including some reversible symptoms such as thyroid disease and vitamin deficiency. It is noted

that dementia is commonly known as Alzheimer's disease that represents severe developmental

disabilities that are a normal part of ageing (Mo et al., 2021). Many conditions occur, which
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means that dementia symptoms begin gradually and progressively worsen. Therefore, it is

important to seek medical attention as soon as possible for a diagnosis, and in this way,

professional evaluation can effectively reveal treated conditions. Even if symptoms indicate

dementia, early diagnosis can enable people to take advantage of current treatments and provide

volunteer opportunities in clinical trials (McKenzie and Brown, 2020).

Treatment for dementia depends on the cause, and there is no cure for the most advanced

dementia, including Alzheimer's. Certain medications can temporarily improve the condition of

the patient and minimise the symptoms. Some medicines can be used to treat other types of

dementia and Alzheimer's disease. Non-drug treatment can also relieve some of the symptoms of

dementia (Klimova et al., 2019). Finally, there is more funding for research and greater

participation in clinical trials to get a successful new treatment for dementia. However,

volunteers will soon be required to increase their involvement in clinical trials and conduct

different research into Alzheimer's disease and other dementias. Alzheimer and dementia care

and treatment programs are designed to fulfil the needs of all older patients. The cause,

symptoms and long-term treatment plan for Alzheimer's disease vary from case to case. As

researchers and doctors continue to study dementia and conduct research to determine the best

treatment for dementia, new methods have become important for the modern world.

Traumatic brain injury (TBI) has been resulted due to an impact to the head that has

disrupted normal functions of the brain. It is noted that TBI can affect the cognitive abilities such

as learning, thinking capabilities and other skills. It is noted that TBI can increased the risk of

developing dementia. According to the study of Fortuna et al. (2019), it is found that dementia

and TBI has been inter-linked with each other. It is found from the qualitative study that the

older adults which have a TBI history has 2.3 times greater risk of developing dementia. On the
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other hand, it is found in the study of Handley, Bunn and Goodman (2017) that elder patients

who do not have any head injury has little risk of dementia as compared to senior citizens with

head injuries history. Moreover, it is analysed that the long-term consequences of dementia TBI

is dementia. According to multiple epidemiologic studies, it is found that patients suffering from

TBI has experienced dementia in their later life.

It is found from another study piloted by researchers at Umea University in Sweden

confirmed that head injuries are a risk factor for dementia (Røsvik and Rokstad, 2020). It is

noted that the risk of being diagnosed with dementia was highest considered to the first year after

any individual can faced injury. At this time, people with head injuries with dementia are

diagnosed four to six times more often than people without head injuries. According to the study

published by PLOS Medical Journal on January 30, 2018 and concluded that even concussions

or other brain injuries increase the risk of dementia. Further research is needed to fully

comprehend the link between traumatic brain injury and dementia and to understand why the risk

of minor, moderately severe and recurrent injuries increases. Ongoing research on how traumatic

brain injuries alter brain chemistry suggests a link between traumatic brain injuries and abnormal

protein abnormalities associated with Alzheimer's disease (Clarkson et al., 2017). Within a few

hours of injury, severe brain injury increased the beta levels of beta-amyloid, a symptom of the

Alzheimer's protein. Tau protein precipitation, another symptom of Alzheimer's disease, appears

to be a symptom of CTE, the dementia associated with recurrent brain injuries. Beta-amyloid

deposits have also been found in some patients with CTE.

It is noted that comprehensive care consists of treating the whole person, not just the

internal system of the disease itself. The technology focuses on the tone, strength and ability of

older people to provide comprehensive care. It is analysed that comprehensive dementia

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treatment combines medical information and responsive care from senior doctors to provide a

supportive environment for older people with memory problems. Elderly patients facing problem

such as dementia often experience confusion, anxiety or depression. Human health care uses

positive reinforcement to fulfil the emotional needs of the older patient and help them discover

their identity. Incorporating holistic, humane treatment for dementia into their favourite care

program requires communication between patient, professionals and the elderly (Iliffe and Gallo,

2020).

Doctors can explain the severity of dementia in the elderly, determine its limitations and

ability to persist. They can also prescribe medication and agree that comprehensive treatment is

included in the health plan. This enables caregivers and family members to develop

individualised care plans (Clarkson et al., 2017). The environment, language, nutrition and

activities are four dimensions of holistic and people-centred care. For this type of treatment to be

successful, it is necessary to create a comfortable, safe and neutral attitude. Caregivers can create

a warm environment by organising family gatherings. Using simple and comfortable language

can reduce anxiety and depression in Alzheimer's patients. It is important to remember that

language encompasses oral and non-oral communication (Yous et al., 2020). Older people with

dementia often experience negative body language and become depressed when they are

overweight.

While a healthy diet is important for all older adults, good nutrition is an important part

of an overall plan for dementia. Hunger and dehydration can increase discomfort and anxiety. A

regular meal plan and encouraging social interactions with meals can delight their loved ones.

Finally, interventions can be a good way to incorporate individualised care into an Alzheimer's

treatment plan (Lees Haggerty et al., 2020). Therefore, comprehensive care is based on the belief
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that people with dementia can live full lives. It allows loved ones to take an active part in

gardening, painting, music, or other hobbies they have previously pursued, promoting a

meaningful lifestyle and preventing depression, loneliness, and boredom. The general approach

to treating dementia involves professionals, family members, and people with Alzheimer's or

dementia, and it is important to develop and implement an effective service plan (Brown,

Agronin, and Stein, 2020).

In recent years, the understanding of the profound emotional impact of a diagnosis of

dementia has increased, and the need for holistic and individualised approaches to the disease

has increased, which also increasing interest in counselling for people with disabilities and also

in dementia patients (Røsvik and Rokstad, 2020). Although there is no consensus on the

prevalence of dementia patients, given that diagnostic criteria may differ from one study to

another, patients with dementia often suffer from depression and anxiety. It is noted that

depression is present in many forms; it is often accompanied by apathy. On the other hand,

dementia can be defined as intentional behaviour, loss of consciousness or emotion, or decreased

apathy, and it is the symptoms of AD with 21% to 84%. Even apathy and depression can

manifest themselves in symptoms such as social withdrawal or diminished initiative and

motivation. The onset of apathy appears to be associated with the higher workload in nursing,

faster dysfunction, reduced quality of life, increased disease, and a reliable long-term predictor

(Gibson et al., 2021). The effectiveness of psychological interventions, mainly because the

reviews cover many interventions, called psychological interventions, are not based on

theoretical interventions.

Communication is an important material that flows through data and contains 5 of 32

codes. It is important to understand roles, goals and objectives, interdisciplinary teams, many
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organisations and participation in research. Some professionals and stakeholders involved in the

study found the scope and nature of UCM's role strange. They pointed out that the lack of a clear

overview of interventions could lead to uncertain role and implementation constraints (Handley,

Bunn and Goodman, 2017). It is believed that a more accurate profile will help to invest in

activities and improve collaboration and communication between partners. Although

stakeholders do not agree on the overall goals and objectives of coordinated dementia

interventions, many agree that the agency should take a holistic and people-centred approach to

dementia management (Wang et al., 2020).

Some respondents believe that feedback and communication through meetings,

collaborative learning and resources can contribute to more effective interdisciplinary teamwork

that can work together at the primary, secondary and tertiary levels. Participated in local

services, coordinated dementia intervention can increase referrals, share knowledge and

experience, and build a broader dementia network. It is found from the experts indicated in the

study that this factor expands available information and promotes the integration of health and

social services (Yates et al., 2019). The study contains a large amount of data related to the

research group's participation in dementia care coordination, which is probably responsible for

supporting the definition and implementation of roles by facilitating communication and

collaboration.

People who work in mental health services face difficult moral and legal decisions every

day. Caregivers must balance the needs of many residents or clients with the patient's privacy,

the potential for abuse and the pros and cons of medication and surgery (Moniz-Cook et al.,

2017). If the patient can no longer express his will, the designated administrator must make a

difficult decision. Policymakers must move away from their needs and expectations and do what
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they think people with dementia are doing to safeguard their rights. Healthcare professionals

often have to make ethical decisions, and ethical principles must be incorporated into daily care.

This is especially true in the complex and morally demanding areas of dementia management.

The basic principle is to understand and remember that people with dementia have the same

value in all their illnesses, no matter how much their mental capacity changes (Banerjee et al.,

2020).

It is noted that self-control is a person's right to make independent decisions regarding

their health and life. The patient must be told the truth about his condition and the risks and

benefits of treatment (Heiden et al., 2017). Even if the best and most reliable information shows

that the treatment is beneficial, the patient can refuse the treatment if the decision does not harm

the other person's health as such conflicts can pose moral problems. For people with dementia,

independence means building meaningful relationships, maintaining self-awareness and a way to

express values. Autonomy is not just a matter of making wise decisions (Handley, Bunn, and

Goodman, 2019). The well-being of the individual includes feelings of pleasure or satisfaction

and more objective factors such as the level of cognitive activity. It is especially important to

allocate resources to support dementia treatment.

It is analysed that, to some extent, this is a matter of adequate resources, but it also

involves recognition and gratitude from caregivers and nurses, as they have important

professional (Westera et al., 2020). When communicating with people with dementia, the moral

justification for most communication is based on caring for the happiness of people with

dementia. There is a conflict between wanting to be safe and wanting to avoid pain at the same

time. Considering people with dementia should go hand in hand with views on the ethical

meaning of views and practical questions on how to get through the day. Some people believe
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that lying undermines self-confidence and destroys the boundaries people with dementia still

have in their daily lives (Klimova et al., 2019). Others pointed out that it is true to say that when

a person with dementia does not think it will damage their self-esteem. Another problem for

nurses is that lies undermine the integrity of professional nursing, but nurses who do not tell the

truth feel their moral well-being.

The Mental Capacity Act (MCA) 2005, enacted in England and Wales in 2007, provides

people with dementia with a basis for making their own decisions and empowers decision-

makers to make decisions in their best interests. This can involve important decisions about care,

treatment and finances, and day-to-day decisions (Iliffe and Gallo, 2020). It is conducted that

approximately 3-4 quality interviews with 12 bisexuals over a 9-12-month period to discuss their

daily decisions for 2011-2012. It is analysed that different types of decisions, decision-making,

joint decision-making and supporters are available for dementia patients. The results of the study

revealed several decision-making methods. Although most people with dementia feel that they

should be able and able to make their own decisions daily, they are generally happy to share

them with a trusted caregiver (McKenzie and Brown, 2020).

Spouses’ caregivers seem more likely to base their decisions on information about their

loved ones' identities and desires than adult caregivers rely on past conversations. Some

caregivers mentioned using CAM's interests to consider the importance of decision-making and

the need of parents with dementia (Clarkson et al., 2017). However, it is challenging to

understand how best to make these decisions, especially when one person's happiness depends on

another. The caregiver finds the ombudsman's decisions frustrating, and daily conversations are

often used in the decision-making process.

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In many cases, caregivers talk about decision-making on behalf of their loved ones with

dementia without trying to involve them. These caregivers believe that the decisions of their

representatives reflect the choices of their loved ones. Understanding how and when people with

dementia can or should make decisions is essential for the healthcare system and exercise. In

addition, it can provide information on daily and long-term care (Mo et al., 2021).

Cognitive behaviour of dementia can be presented as inappropriate voice, sound or

different skills for the surroundings, which reflect inadequate control of internal and

conservational stress. It is noted that they also contain a variety of psychological responses,

psychiatric signs and activities. On the other hand, different sources of internal and external

pressure may be involved. However, around 80% to 90% of people with dementia suffer from

mental disorder (Fortuna et al., 2019). Therefore, it is noted that aggression is considered a

severe symptom, and 30% of dementia patients in clinics seem aggressive. However, even in

controlled trials, current attack management is relatively successful. The lack of effectiveness of

aggressive treatment emphasises pharmacological interventions to treat a serious emergency.

Traditional BPSD therapies generally include aggression, the use of typical antipsychotics,

antidepressants, hypnotics and KEIs. In particular, antipsychotics can cause increased

extracellular signalling, abnormal gait, sedative effects, increased vascular events and increased

mortality (McKenzie and Brown, 2020).

A Complex adaptive system (CAS) is open, powerful, and considered complex because it

involves many interconnected, semi-independent, competitive, and collaborative participants.

CAS members can be persons, groups, individuals, public establishments or administrative

processes (Handley, Bunn, and Goodman, 2019). It is noted that it can learn from experience and

the flexibility to adapt to changes in its membership structure; it is considered adaptive. A

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complex adaptive system is characterised by abnormal behaviour and autonomous management,

as opposed to negligent behaviour, rather than centralised management based on the hierarchy of

the pyramid (Yates et al., 2019). Healthcare professionals, such as health care centres, are

examples of CAS. These clinics typically include directors, nurses, clinical service providers,

billing professionals, and others who share their views, skills, experience, and goals in inpatient

care. Any attempt to control CAS strictly can undermine participants' ability to learn and work to

influence performance and thus increase problems. However, the current primary health care

system failed to provide comprehensive diagnosis, assessment of people with dementia.

Therefore, the understanding of clinics such as CAS can enhance their ability to develop a

flexible standard for food and assessment. Treatment of dementia approach of patients with

diseases, such a process is likely to help overcome the unknown problems that these clinics face

(Banerjee et al., 2020).

Part B

With the growing demand for fast and efficient health care among the elderly in many

countries, health care cooperation is seen as the next goal. By 2050, about 20% of the world's

nine billion people will be over sixty, up from 10% in 2000. Family members are often the first

to approach people with dementia or dementia (Moniz-Cook et al., 2017). Therefore, they are at

the forefront of diagnosing dementia early and are essential for these patients' subsequent

diagnosis and clinical care. However, it is noted that the actual number of people who were

missing and late with dementia was unclear. The main factors that contributed to this were

providers' and patients' communication with service providers, lack of education, and systematic

restrictions on resources. Primary care physicians report difficulties in diagnosing and treating

dementia in many countries (Wang et al., 2020). In the UK, a survey of GPs found that one-third
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of GPs in the sample did not have confidence in their diagnostic skills, and two-thirds did not

control behaviour related to dementia and other problems. The participants' main challenges

were diagnosing patients, solving behavioural problems and coordinating support services. In the

UK, it is found that they questioned the effectiveness of existing drugs, the uncertainty as to

whether the correct methods for diagnosing dementia should be followed.

A recent study in the UK on the attitudes and trust of patients with dementia found that

while early diagnosis and treatment of dementia are considered important by almost all doctors,

only half of those who agree that they are good at diagnosing dementia (Røsvik and Rokstad,

2020). The block in dementia treatment is the diagnosis of dementia without a formal diagnosis,

and their caregivers do not get the support and services they need quickly. Universities and

colleges diagnose dementia mainly in the UK. Family patients are usually the first point of

contact for dementia patients and spines in the health care system in the UK. The first memory

clinic in the United States was established in the 1980s to diagnose, examine, and treat memory

defects, including dementia (Lees Haggerty et al., 2020). Consider an interdisciplinary approach

to diagnosing and treating memory impairment and dementia. In recent years, specialised

memory clinics have been opened worldwide to treat the increasing severity of dementia, and

training has been intensified. An example is a case from the UK where health care professionals

completed a five-day interdisciplinary training program to establish a memory to improve

treatment for dementia, and participants had to establish an independent memory (Clarkson et al.,

2017).

Some services aim to improve the health services that GPs can provide at the primary

health care level but are not intended to replace the patient's role as therapists or counsellors,

which is an even more valuable resource for finding a more complex solution. Although many of
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these services are patient-centred, families in many Asian countries play an important role in the

care and education of elderly parents (Moniz-Cook et al., 2017). The burden of caring for family

members is a multifaceted phenomenon that includes their mental health. It is important to

maintain information about loved ones and caregivers, especially knowledge of previous

understanding and functioning. This is complicated by the rapid transit of the elderly reception

system. Repeatedly seeking medical attention and care may result in a loss of knowledge and

information. Cognitive impairment can interfere with their safety, such as asking staff to wash

their hands to prevent nosocomial infections (Yous et al., 2020). It is important to decide about

prescribing services that often lack knowledge and understanding of the risk of falls for each

patient. Insomnia and an unfamiliar environment can also increase the risk of inflammation in

people with dementia.

Dementia patients with inflammation are at particular risk of unnecessary restraints or

bed rest, leading to surgery, pneumonia in the nose, thromboembolism, and pressure ulcers.

Promoting mobility is important for people with dementia, although it can increase their risk and

issues related to falls. In this case, the first relatively preventive harmless side effect leads to

several medical complications (Klimova et al., 2019). Alzheimer's patients have both physical

and cognitive impairments. Dementia patients are particularly susceptible to side effects,

especially antipsychotics, leading to excessive sedation, indigestion, Parkinson's disease, stroke

and other fatalities. The use of other classes of drugs, such as chemotherapy, which may increase

cognitive decline and cause urinary retention or opioid delusion and constipation, should also be

considered (Westera et al., 2020). Cross-pharmaceuticals are inherently harmful, especially due

to loss of consistency. Improper clinical practice is a severe issue because when dementia
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patients are associated with Urinary Tract Infections (UTIs) and it is noted that UTIs can caused

sudden confusion among elderly patients with dementia.

Primary care workers may not always have the confidence to diagnose dementia, and

they may not have specialised rural memory centres or protected areas. Early detection of

cognitive decline can improve treatment outcomes, but a lack of trust from a physician and close

contact with a specialist make early diagnosis difficult (Fortuna et al., 2019). In the collaborative

nursing model, each nurse member contributes his or her clinical, managerial and administrative

power to provide patients and nurses with comprehensive medical care beyond that. An

interdisciplinary approach ensures that patients and families use their strengths and expertise to

provide appropriate services and advice to all team members to maximise success for patients

and their families. Quality improvement projects comparing the role of primary patients with and

without PCP in treating various ageing diseases such as Alzheimer's disease. Involving a

computer in the coordination of nursing can improve the treatment of dementia and increase

adherence to recommended treatments by 30% (Mo et al., 2021).

A randomised study of routine and coordinated treatment with a social worker who

carefully assessed the family consulted a physician, and continued follow-up was conducted. The

activity also includes training courses for doctors on dementia. Interventions have increased

adherence to dementia guidelines and improved patients' quality of life (Brown, Agronin, and

Stein, 2020). It should be noted that the UK’s primary health care includes a team of physicians,

registered nurses, nurses, social workers and pharmacists who advise family health specialists in

geriatrics. People with dementia and their caregivers usually receive mental health and specialist

services with the advice of a therapist or health care team. There is no single way to access

service, and therefore access can be delayed and painful. Almost all mental health institutions
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now offer professional mental health services (Lees Haggerty et al., 2020). Although there is no

single model for providing mental health services to Alzheimer's patients in the UK, different

models have been developed using national guidelines and the methods and levels of service

provided by the Royal Academy. Professional mental health services for the elderly usually

include mental health teams in the community, assessment services in hospitals and daycare

centres and clinics.

The team can also be assisted by physiotherapists, pharmacists, speech therapists and

support staff. When defining a successful service, common characteristics are single access, case

management, due diligence, and an interdisciplinary team. Literature research and qualitative

evidence reviews were conducted to find evidence of the best way to plan and organise services

for patients suffering from dementia (Heiden et al., 2017). Unfortunately, few studies on the

efficiency of treatment in elderly people suffering from dementia and their caregivers have

yielded useful comparisons between services to bring together the best and most effective

services for the planning and organisation of dementia patients and their approach. It is also

difficult to determine whether the impact is related to the service.

Furthermore, as other countries have different systems for planning and funding well-

being and social services, the usefulness of data on health and social care research for people

with dementia outside the UK is limited (Yates et al., 2019). The ability of patients suffering

from dementia to cope with daily tasks is constantly declining during illness, and the impact on

the family is well described. Although patients with dementia need more intensive care, many

informal caregivers are reluctant to seek professional help than people without dementia.

Experimental results suggest that access to treatment for patients with dementia is relatively

limited for personal and systemic reasons. For example, informal counsellors may not think
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about the need for services, but counsellors may be reluctant to use services or unaware of

existing services (Gibson et al., 2021). They feel the need to extend the time it takes to get help

from a specialist, and they are seeking professional support, which is related to other influences

at the individual level and in the system. Greater emphasis should be placed on the views of

dementia patients and their active participation in the further development of research and

services. It is important to propose to develop a theoretical basis for the use of medical services

for patients with chronic diseases. Therefore, all relevant perspectives must be taken into

account; this means that in addition to dementia in patients and informal caregivers, the views of

healthcare professionals must also be taken into account (Lees Haggerty et al., 2020). Additional

research may include a review of the views and experiences of healthcare providers using

dementia services.
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