Maximise Health And Well Being Health And Social Care Essay

Ageing is the progressive loss of function with decreasing fertility and increasing mortality with age1. Over the past decade, the older population has grown at a rate of 2.4% per year2. The outcome of ageing is seen as frailty and age-related diseases, such as dementia, which is now an epidemic. Over 700,000 people in the UK and over 35 million people worldwide have dementia. It is predicted that over 100 million people worldwide will have dementia by 2050 3. The prevalence doubles with every 5 years increase in age.4 64.8% of the population above 95 have dementia, as opposed to only 55.6% in those aged 65-695. The importance, therefore, to maximise health care and well being, especially among older people arises. Delaying the onset of dementia by 5 years can reduce deaths due to dementia directly by 30,000 a year.

This neurodegenerative chronic disease is manifested by loss of brain cells and protein aggregation. The symptoms - cognitive impairment, behavioural and psychological symptoms and physical/neurological - need to be present for over 6 months to confirm the presence of dementia. The main forms of the disease are vascular dementia, lewy body disease, alcohol-related dementia and Alzheimer's disease. The equation between genetic susceptibility and environmental factors usually lead to dementia. As such, there are many protective and risk factors pertaining to both. It is essential to maximise the latter, while improving on the risk factors for better health. This depends largely on organisations, policy makers and self-motivation.

Healthcare organisations and related health policy

Policy makers are expected to cater for the well-being of older people worldwide through the implementation of new policies. Their goal is to devise preventative measures to maintain good health. The strategies need to be curative, symptomatic or disease-modifying. Until recently, the measures undertaken left a lot to be desired. Improvement was hindered by discrimination, lacklustre prevention techniques and little interest in the caring pathway. The creation of the National Service Framework (NSF) by the NHS has however changed the way things work. Being exclusively designed to provide high quality care facilities for the older people; its potential is being tapped out to admirable results. As a 10 year programme6, the main aims are to promote independence amongst old people, provide specialised services to support good health in advanced conditions, improve the quality of care in care homes and ensure that carers are properly guided. The "Challenge on Dementia" was launched in early 2012 by the UK Prime Minister as a means to boost health amongst older people. This is hoped to be achieved by working upon the betterments yielded by the National Dementia Strategy7. One of the latter's outcome was the Living well with dementia campaign started in 2009, which is set to be extended till 2014. The focus here is completely shifted to improving care through carers, individuals and local delivery.

Working as part of a multi-agency team

Good training of team members by managers to meet the needs of patients

Support of family members and carers

Recognition of signs of distress and support to reduce anxiety

Encourage activity and promote independence

Sensitive communication for meaningful interaction

Early diagnosis of dementia

Know early signs of dementia

Common Core Principles

Figure 1 shows the recently adopted principles to support people with dementia 8The Workforce Advisory Group was developed to improve the quality of workforce, by establishing a set of 8 common core principles in 2011 to sustain patients and ameliorate their health, as seen in figure 18. A general framework will be set using these guidelines to provide the basis of training for individuals, professionals and organisations. Mental health services are also designed for older people. By addressing to the needs of the patients, looking at the factors affecting recovery, promoting good mental health and providing access to specialist care, these services act to maximise health of the patients. Extending the services to local communities would only make them more accessible and systematic.9 Specialist mental health services should provide trained staff on hospital wards to cope with the behavioural problems associated with people who have dementia. Since the older affected people often become sensitive to crowds, noise and flashes; wards should be designed properly. Introducing "high-quality evidence-based care" for people with dementia will enhance their well-being9. With the number of people affected rising exponentially, healthcare organisations should carry out timely diagnosis. Ideally, the process should be as shown in figure 2. Moreover, the NSF is now working through new reforms to increase availability of professionals for older people, devise new caring strategies and making better use of technology and funds allocated.9

Figure 2 showing the ideal process to screen patients 2

It is essential that policy makers make use of local and national organisations in their struggle to maximise healthcare. With more research through NIHR and with NICE helping to provide workforce training and provide good caregiver support, the quality of care is certain to go a few notches higher. About £10 million will soon be invested to investigate why dementia only affects certain people.10 Increase in awareness through the use of Health and Social Care Information Centre to sensitise people will be a crucial move. With 50 billion invested in the UK to promote early diagnosis and develop services to assist people living well with dementia, it is hoped that this will be a jump start.10 Furthermore, the Dementia Friends programme is set to reach out to 1 million people in the UK by 2015.11

Carers contribute enormously to the healthcare of older people with dementia. In the UK, they save the NHS over £6 billion a year. Funds should be allocated fairly and nursing care should be made free in homes to alleviate the psychological and financial strains on patients.9 In the UK, NICE should be actively involved to support the carers, offer them good training and push them to the best of their abilities. The integrated care of dementia, along with other mental problems, also needs to be supported by proper rules and regulations given by the Department of Health. Extra support to GPs and carers will soon be provided, along with a dementia toolkit and renewed standard health checks to improve management of dementia.10

Public Health, Epidemiology and the Role of individuals and their families

Maximising well-being in older people with dementia is feasible via a shift in focus, from treatment to the prevention of dementia. This is where the epidemiology and public health come into play. It is crucial to target the risk factors to improve health. Lifestyle, age, and vascular risk factors have a direct bearing on risks of having dementia. For instance, someone with high blood pressure or diabetes is almost certain to have dementia12, while cerebral microangiopathy activates amyloid deposition13.

It has been statistically proven that a 10-25% decrease in the risk factors of AD can prevent 3 million of cases of AD worldwide. As per Flicker, ''the adult brain maintains plasticity and response to external stimuli''14, showing that lifestyle interventions can reduce risks of dementia. Physical activity, smoking cessation, social engagement, diets and decreased consumption of alcohol slow cognitive decline12 . Cognitive stimulation exercises are also encouraged for a healthy life13. Good eating habits may negatively influence the generation of free radicals and help reduce oxidative stress, maximising health. Vitamins E and C, being powerful antioxidants, are highly encouraged for a better health.12 The benefits of a Mediterranean diets are fast becoming popular. A significant reduction in risk of dementia was noted with this diet according to Sofi.15

With two thirds of people with dementia living in the community, it is important that prevention occurs primarily at this level. Since 1990, there has been a shift to from hospital care to self-care, with the credit going to the Promoting Independence Grant.9 Family members and community matrons are expected to provide integrated services, especially in cases of chronic illnesses.16 With the National Carers Strategy which was passed on in 2008, carers are now given equal opportunities and are properly surrounded to provide the best care. Self-care is a highly controversial - yet unexplored - possibility since it is entirely up to the individual or family to self-support. It is hoped that with an increase in awareness through the Expert Patients Programme and with the Supporting People initiative, patients will be able to improve their self-management abilities, build upon their understanding and live independently making use of the housing support services provided.9

Ageing is accelerated, in 75% of cases, by stress, poor diet and adverse environment. Minimising the impact in all three can help slow down ageing and the onset of dementia. Families and individuals should abide by the nutritional guidelines, i.e. lower energy, calcium/vitamin and higher caloric intake from fat. Other factors such as sedentary lifestyle, limited income and reduced energy expenditure have a negative impact. Special attention must be given to promote a healthy lifestyle. Regular outdoor exercises and socialising is primordial to maximise health, by boosting cognitive reserve.12 Nursing homes should organise stimulating exercises such as aromatherapy.9 Modulating the environment (moderate lighting and compact arrangements) will also lower visual confusions.

Conclusion

While the treatment of diseases previously took centre-stage when it came to maximising health, prevention is now becoming the talking point. Along with the enormous progress which had led to the better understanding of the mechanisms leading to dementia, early diagnosis is now being encouraged. For instance, the NHS now provides access to integrated mental health services, ensuring that the older patients and their carers are properly diagnosed, treated and supported.9 The implementation of new policies by the state, the better allocation of funds and the reinforcement of the concept of self-care are certainly expected to be fruitful socially and economically. Impeccable coordination within all practitioners and good advice from healthcare staff can reassure patients and help them adapt to their disease and live well.8 It is thus important to follow the core principles recently published. Although the developments will take a while to show a positive result on the improved well-being of the older population16, the short-term benefits suggest that older people are mostly satisfied with the services provided.9

Word count excluding references and figure legends: 1629