It was reported that dementia accounted for 69, 478 deaths in the UK in 2018- one in eight deaths. Dementia predominantly affects older people, and has until recently been neglected as attention has been focused on cancer and heart disease. Things are changing, as more and more people and families face up to the effects of dementia in an ageing society and the NHS has to deal with the rising costs of treating the disease.
Dementia is a major worldwide health care problem, with half of the known sufferers to be found in developing countries. An estimated 850,000 people currently suffer from dementia in the UK. Alzheimer’s disease is the commonest form of dementia in people aged 65 years or older
The cost of caring for people aged over 65 with dementia has been estimated at around £400 billion annually worldwide, accounting for 1% of global GDP. In the UK, the cost of dementia care is around £26 billion annually, which is more than the cost of care for cancer, heart disease and stroke combined. This equates to around £32,000 per year per dementia sufferer.
Dementia is not an inevitable part of natural ageing. However, dementia is age-related, and the likelihood of being diagnosed with it rises progressively with advancing age. Dementia manifests as a progressive decline in cognitive function, which produces short-term memory loss-typically affecting the registration, retrieval and storage of new information. Older memories are often preserved. Other cognitive deficits include difficulties with speech and the use of language, and with performing previously learned tasks.
The formidable list of behavioural and psychological symptoms of dementia includes aggression, anxiety, apathy. depression, agitation, paranoid ideas, delusions, hallucinations, mis-identifications, insomnia, food preferences, and wandering (sundowning) and getting lost. This demonstrates why caring for people for dementia can be so challenging.
Dementia leads to an inability to perform the basic and instrumental activities of daily living. As the illness progresses, sufferers are no longer able to care for themselves, and require assistance with grooming, bathing, dressing and toileting. The victim may become incontinent of urine and faeces. Socially and sexually inappropriate behaviour may emerge. The end result is a person who is just a shell of their previous self, unable to even recognise relatives and friends. This total breakdown of personality is the most distressing feature of advanced dementia.
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When dementia is suspected in the UK, referral to a specialist dementia diagnostic service, such as a memory clinic or community old age psychiatric service, is recommended. It is important to be able to confirm the diagnosis, while simultaneously identifying and treating other treatable and potentially reversible conditions that can produce similar symptoms.
Dementia is progressive, irreversible, and life-changing. It affects all aspects of daily life, including self-care (washing, eating, toileting), driving, and recreational activities. The victim’s finances may have to be managed by a responsible person though a grant of power of attorney.
In the early stages, counselling, cognitive behaviour therapy , cognitive stimulation and cognitive rehabilitation may help a dementia sufferer cope with the effects of memory loss and remain independent. In the words of the National Institute for Health and Care Excellence (NICE) in 2018, healthcare professionals should “consider cognitive rehabilitation or occupational therapy to support functional ability in people living with mild to moderate dementia.”
Long-term social care is frequently the most expensive aspect of dementia care. Social care is means-tested, and is only funded by the state when the individual’s assets are £23, 250 or under. Looking after a relative with dementia at home is difficult, and can lead to psychological distress and financial loss for the carer. One of the greatest problems in the UK is the fragmented and uncoordinated support for dementia sufferers as well as their carers. Politicians of all loyalties need to collaborate to develop a viable long-term strategy for dementia care in the UK.
Ashis Banerjee (ex-NHS; treated many dementia victims; lost my father to dementia)