Exploring the relationship between physical health and mental health for the person with dementia.
“Dementia results in a progressive decline in multiple areas of functioning, including memory, reasoning, communication skills and the skills to carry out daily activities. Alongside this decline, individuals may develop behavioural and psychological symptoms such as depression, psychosis, aggression and wandering, which complicate care and can occur at any stage of the illness. Family carers of people with dementia are often old and frail themselves with high levels of depression and physical illness” (DOH 2009)
The following Essay will consider the relationship and impact between physical health and a diagnosis of dementia, for the person with dementia and their family carers. The importance of having a focus on both physical health and healthy living will be discussed, and reflections of this being an area which is often neglected by health care professionals and the wider population as a whole will be made. Finally, a rationale for supporting a more holistic approach to the care and support of the person with a diagnosis of dementia will be presented and an overview of how this has been included within my own practice area will be given.
It is believed that nationally, there are currently 821,884 people in the UK who are living with a diagnosis of dementia, with 163,000 new cases of dementia being diagnosed in England and Wales every year. However, until only relatively recently, dementia has suffered from poor awareness and understanding of the diagnosis and its disease trajectory. This may also have been made worse by the stigmas which are often attached to both mental health problems and old age. It has now been widely recognised that a diagnosis of dementia is considered to be one of the main causes of disability in older adults. The World Health Organisation (2003) in their global burden of disease report estimated that dementia contributed 11.2% of all years which were lived with a disability among older adults aged over 60 years of age. This was more than stroke (9.5%), musculoskeletal disorders (8.9%), cardiovascular disease (5%) and all types of cancer (2.4%).
Dementia can result in a range of difficulties: memory; thinking and planning; orientation to time, place and person; communication; learning; judgement; emotion; motivation, perception. These can all have an impact on mobility, for example: remembering where to go, understanding instructions or having something pleasurable to move for (Oddy, 2003). People with a diagnosis of dementia and their family carers may therefore be vulnerable to poor physical health and are often unlikely to have access to opportunities to participate in activities that will maintain good physical health, for example, appropriate physical activity, improved dietary advice etc. From an experiential perspective, activities which lead to improved physical health can have a positive impact on the ability to maintain levels of and behaviours which challenge others amongst people with dementia, in conjunction with reducing some of the symptoms of ill health and age related cognitive decline.
For some time, voluntary organisations have been proactive in raising concerns regarding the both the quality of and the appropriateness of the health and social care which is currently provided for the person with dementia and their family carer’s. These concerns were reinforced in The Audit Commission’s Forget me not report (2002) which observed that some GPs may treat the diagnosis and treatment of dementia with less urgency than other long term conditions such as cancer and COPD. in 2005 “Everybody’s business” was published which offered Clear policy guidance on how health and social care should commission and provide specialist services for older people with mental health problems...
References: Alzheimer 's Society (2007) Dementia UK: the full report. London; Alzheimer 's Society.
Audit Commission (2002) Forget Me Not 2002: Developing mental health
services for older people in England, Audit Commission, London.
Banerjee S (2009) The use of antipsychotic medication for people with dementia: Time for action. Department of Health. London, The Stationery
Burton LC, Zdaniuk B, Schulz R, et al (2003) Transitions in spousal care giving. Gerontologist; 43:230–241
Care Service Improvement Partnership (2005) Everybody’s business – integrated mental health services for older adults
Colcombe, S. and Kramer, A.F. (2003). Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychological Science, 14:125-130.
Department of Health (2010). Quality outcomes for people with dementia. Building on the work of the National Dementia Strategy. London: Department of Health.
Department of Health (2001). National Service Framework for Older People. London: Department of Health.
Department of Health; (2008) Carers at the heart of 21st - century families and communities: a caring system on your side, a life of your own, London;
Department of Health.
Donnell. MP. (1989)Definition of Health Promotion: Part III: Expanding the definition. Am J Health Promotion: 3:5.
Price R, Keady J (2009) Introducing the 4ME cue card for vascular dementia, Journal of Dementia Care 17 (4) 24-26.
Glaser R, Kiecolt-Glaser JK (1997) Chronic stress modulates the virus specific immune response to latent herpes simplex virus Type 1.
Kramer A.F. and Erickson, K.I. (2007). Effects of physical activity on cognition, wellbeing, and brain: Human interventions. Alzheimer’s & Dementia, 3:S45-S51.
Larson, E.B., Wang, L., Bowen, J.D., McCormick, W.C., Teri, L., Crane, P. and Kukull, W. (2006). Exercise is associated with reduced risk for incident dementia among persons 65 years of age or older. Annals of Internal Medicine, 144:73-81.
Laurin, D., Verreault, R., Lindsay, J., MacPherson, K. and Rockwood, K. (2001). Physical activity and risk of cognitive impairment and dementia in elderly persons. Archives of Neurology, 58:498-504.
Manchester Dementia Strategy. (2009) Manchester City Council Item 8, Appendix Health and Well-being Overview and Scrutiny Committee 21 May 2009.
Manchester Mental Health and Well-being Commissioning Strategy. (2009) Manchester City Council and NHS Manchester.
National Audit Office (2007) Improving Services and Support for People with Dementia; London: The Stationery Office.
National Institute for Mental Health in England (2005) Making it possible: Improving mental health and well-being in England. London: National Institute for Mental Health in England.
NHS Information Centre (2010) Survey of carers in households 2009-10 England, London The Health and Social Care Information Centre.
O MacRae R, Cox S (2003) Meeting the needs of people with alcohol related brain damage, Stirling: A literature review on the existing and recommended service provision and models of care, University of Stirling.
Price R, Keady J (2010) Systematic review: role of health promotion in vascular dementia, Journal of Nursing and Healthcare of Chronic Illness (2) 88-101.
Rockwood, K. and Middleton, L. (2007). Physical activity and the maintenance of cognitive function. Alzheimer’s & Dementia, 3:S38-S44.
Rovio, S., Kåreholt, I., Helkala, E.L., Viitanen, M., Winblad, B., Tuomilehto, J., Soininen, H., Nissinen, A. and Kivipelto, M. (2005). Leisure-time physical activity at midlife and the risk of dementia and Alzheimer’s disease.
Schulz R, O’Brien AT, Bookwala J, et al: (1995) Psychiatric and physical
morbidity effects of Alzheimer’s disease care giving: prevalence, correlates, and causes
Schulz R, Newsom J, Mittelmark M, et al: (1997) Health effects of care giving:
The Caregiver Health Effects Study: an ancillary study of The Cardiovascular Health Study
Shaw WS, Patterson TL, Semple SJ, et al: (1997) Longitudinal analysis of multiple indicators of health decline among spousal caregivers.
Ann Behavioural Medicine; 19:101–109
Schultz R and Martire L: (2004) Family Care giving of Persons With Dementia: Prevalence, Health Effects, and Support Strategies American Journal of Geriatric Psychiatry 12:3, 249
World Health Organization. (2003) Integrated prevention of non communicable diseases: draft global strategy on diet, physical activity and health, Geneva, Switzerland. World Health Organization.
Yaffe, K., Barnes, D., Nevitt, M., Lui, L.Y. and Covinsky, K. (2001). A prospective study of physical activity and cognitive decline in elderly women: women who walk. Archives of Internal Medicine, 161:1703-1708
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