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Essay on Care and Support of Vulnerable Individuals and Groups

Introduction

Dementia, the disease associated with loss in memory functions, thinking, problem-solving, language-speaking abilities interferes with routine life-style of individuals and affects a majority of people within the age-group of 65 - 90 years at an exponential rate of increase, doubling in incidence every 5 year of time span with age (Strachan, et al., 2011). However, younger people can also be affected by dementia. Vulnerable groups or individuals are those who are considered to be at a greater risk over other average individuals or groups in terms of poor status of health and access towards health-care facilities; with greater risk than average in development of health problems (DalPezzo, and Jett, 2010). Elderly people suffering from dementia has been considered as prime focus in the present study, identified as the vulnerable group, due to the fact that the disease and its incidence may prevent elderly from recognizing it or from reporting its abuse. Elderly also often fall prey in hands of strangers due to the disease incidence and end up being taken advantage of such cognitive impairment. Hence, the severe criticality of the condition has been one of the prime reasons behind selecting this topic. Also at UK during 2015, estimations suggest that there were 850,000 dementia patients approximately, with the numbers forecasted to increase and reach to 2mn by the year 2051, which is an alarming rate of incidence (Dementia UK report, 2020).

Thus, considering how grave the situation of dementia sufferers is at present, particularly the elderly populace of UK, the present essay has been formulated to focus on elderly dementia patients as vulnerability-group; to analyze the contributing factors of the disease; and to further discuss multi-agency and multi-professional interventions and their outcomes towards reducing the same.

Component 1

Contributing factors to Vulnerability - Elderly with dementia

According to the 'Care-and-support-Statutory-guidance' and 'Care-Act-guidance' of 2014, support and care responsibilities of local-authorities have been guided thoroughly and documented for providing adult support and care for helping them to achieve important and significant outcomes which matter to life. Wellbeing is another term used in relation to aspects of an individual's mental-physical-emotional health; personal dignity; protection from neglect and abuse, control and care by care-givers; participation in education, recreation, work; economic-social-wellbeing; living-accommodation suitability; personal-family-domestic lifestyle; societal contribution. According to Fitzgerald, et al., (2016) vulnerable population in field of nursing, refers to population groups of individuals most likely in developing health-specific problems with increased difficulty faced in accessing services related to health-care facilities and experience shorter and poorer health outcome and life-span in relation to the health-problems, over other average individuals. For example - Vulnerable groups may comprise of population groups suffering from poverty, homelessness, racial and/or ethnic minority, or comprise of migrant population, elderly patients all exhibiting greater risks due to poor access to health-care facilities due to age, physical, mental or economic barriers, increasing their vulnerability and outcomes to poorer health. Elderly people specifically those who are dementia sufferers are considered as the vulnerable group in the present study, due to the fact that the disease and its incidence may prevent such population from recognizing dementia on their own or from reporting the abuse related from it (Thuné-Boyle, et al., 2010).

Elderly also often fall prey in hands of strangers due to the disease incidence and end up being taken advantage of such cognitive impairment; increasing the criticality of the disease. Also recent statistics suggest that the incidence rate of dementia sufferers is rising rapidly with estimations to reach an alarming number of 2mn by the year 2051 (Lewis, et al., 2014). The increasing number, vulnerability associated with elderly dementia patients, spiraling costs of dementia treatment and facilities, challenge is being posed to the UK government which cannot be ignored. The increasing costs of dementia and elderly care suggests that unless a system of intervention with enhanced support is developed for both elderly dementia patients and care-givers, through progress and commitment towards national-dementia-strategies in Wales, England and North Ireland, the deep-rooted problems cannot be solved (Dementia UK report, 2020).

Some critical contributing factors to elderly dementia patients adding on to the group's vulnerability are namely- age, family or genetic history, alcohol and smoking, cholesterol, atherosclerosis, plasma homocysteine, mild-cognitive-impairment, ethnicity, gender and diabetes.

Age - This being a primary contributing factor of the disease as the onset of dementia in most individuals starts from 65 years with few cases of younger affected individuals and a majority of elderly patients suffering from the disease (Power, et al., 2018). Beyond 65 years the risk of an individual to developing vascular dementia, Alzheimer's disease roughly doubles in every 5 year with one individual amidst 6 having chance of getting detected by the disease crossing 80 years.

Family or genetic history - Alzheimer's disease is in some cases hereditary and passed on from generations to the next thus making people having family history of dementia sufferers vulnerable to the incidence of the disease even younger than 65 years of age (Paulson, and Igo, 2011).

Alcohol and smoking - According to Peters, (2012) dementia risk and decreased mental health risk is associated with smoking, and individuals smoking showing higher risk towards vascular diseases and atherosclerosis as well. Increased alcohol uptake also enhances chance of dementia incidence in individuals on heavy drinkers; though moderate drinking and abstinence from alcohol shows reduced risk.

Cholesterol - High LDL (low-density-lipoprotein) level, increases risks of an individual to develop vascular-dementia significantly, as per recent researches (Mielke, et al., 2010). Also LDL has been linked with development of Alzheimer's disease in other researches.

Atherosclerosis - The deposition of fatty matter, cholesterol as plaque in inner arterial lining leads to atherosclerosis which becomes a contributing factor for incidence of vascular dementia, interfering with blood-delivery to human brain. Atherosclerosis also leads to strokes and acts as a risk factor to Alzheimer's disease (Dolan, et al., 2010).

Plasma Homocysteine- Researches suggest that if level of homocysteine in blood is higher than the average level, then it acts as a strong contributing factor not only towards Alzheimer's disease but also towards vascular dementia (Ford, et al., 2012).

Mild-Cognitive-Impairment- Though not every individual in this category is prone towards dementia, a significant number of individuals however, pose increased risk of developing the disease in comparison to rest of population. Researches found how in individuals aged 65 years and above and suffering from cognitive-impairment (mild) dementia developed within 3 years (Risk Factors, 2020).

Ethnicity- Some ethnic communities show an inclination towards developing dementia over others like the African, South-Asian or African-Caribbean ethnicities and demonstrate potent risk factors towards diabetes, stroke, hypertension, cardiovascular diseases over white European ethnicities (Prevention and risk factors - Dementia UK, 2020).

Gender- As per recent studies, women are more affected and inclined towards dementia over men, outnumbering them 2:1 in ratio (Rocca, et al., 2014). Alzheimer's disease incidence in women over 65 years is also twice as much as that of men the same age. However, incidence of vascular dementia in men is higher than that of women.

Diabetes- Diabetes acts as a contributing factor to both vascular dementia and that of Alzheimer's disease; also common as risk-factor for stroke and atherosclerosis, all of which add on to contributing for vascular dementia in elderly (Exalto, et al., 2012).

Amongst the aforementioned contributing factors age and getting older undeniably takes the prime position acting as biggest dementia contributing-factor. However one of three dementia cases are preventable on basis modifiable-risk-factors. Such modifiable-risk-factors include: the intake of alcohol; high BP (blood-pressure), diabetes, lacking exercise, obesity, lower educational attainment, poor physical stamina and health and smoking (Prevention and risk factors - Dementia UK, 2020).

Component 2

Interventions for reducing vulnerability factors - multi-professional-intervention

1. Aging - Aging being a major contributing factor for dementia in individuals above 65 years of age, needs to be considered while developing interventions for proper therapy and treatment of the disease. According to Power, et al., (2018), vascular dementia risk of an individual and that of Alzheimer's disease becomes twice in every 5 year; while 1 out of 6 individuals above 80 years being prone to the disease.

Intervention - Multidisciplinary-team

According to Zucchella, et al., (2018), the best intervention for addressing and reducing the negative impacts of aging as a vulnerability factor in elderly patients can be in form of multiple-source based team-support towards the patient, integrated in parallel fashion or in combination being ideal for both caregivers and elderly patients by offering a blend of multidisciplinary-services from social-service agency, healthcare-provider, and professionals. Such formal or informal multidisciplinary teams providing multi-professional intervention vary in composition comprising of - nurse practitioners, neurologists, neuropsychologists, geriatricians, physical therapist, social workers and nutritionists (Grand, et al., 2011).

The nurse's role lies in managing and assessing caregiver response alongside patient health responses involving -symptom monitoring, medication, providing education, relaying information to families, assistance provided to prepare patients and caregivers for dementia progression. Admiral nurses registered in NHS, on basis of their expertise with dementia care deliver clinical, practical, emotional support towards patients and families; working in hospitals, community, hospices or care homes (Help and support for people with dementia, 2020). The geriatrician or neurologists help in disease diagnosis, formulating prognosis with treatment plan for addressing dementia symptoms. Nutritionist provide a well-balanced dietary plan. Physical-therapist help patients in optimizing physical condition, in maintaining safe mobility for enhanced prolonged independent living. Social-workers assist the family and elderly dementia sufferer by aiding in acquiring resources necessary for management of the chronic illness via - community-programs, financial-services, respite-care, crisis-management and counseling (Kaufman, et al., 2010).

2. Mild-Cognitive-Impairment- Researches found that mild-cognitive-impairment often leads to incidence of dementia with elderly aged 65 years suffering from (mild) dementia within 3 years of detected mild-cognitive-impairment (Risk Factors, 2020).

Intervention- Cognitive Intervention

According to Carrion, et al., (2018) a widely acclaimed NPT (non-pharmacological-treatment) exploring in dementia is Cognitive-intervention acting as complement and/or alternative to that of pharmacological treatments in elderly patients classified as CS (Cognitive-Stimulation), CT (Cognitive-Training), CR (Cognitive-Rehabilitation). CS comprises of activities namely - reminiscence therapy, reality-orientation-therapy) helping to enhance social functions and general cognition of patients, with high result rate for elderly dementia patients, leading to improved cognitive functioning after CS sessions (Woods, et al., 2012).

Component 3

Outcomes of Multi-professional-interventions

The Interventions for dementia patients is mainly focused on achieving 3 types of outcomes - primary outcomes (improved QOL, Quality-Of-Life and ADL, Activities-of-Daily-Living); secondary outcomes (improvement in family relations, mood and activity participation), and exploratory outcomes (self-efficacy and memory-related-distresses) (Rebecca, et al., 2018). The outcomes of the interventions are mainly - enhanced general-wellbeing of affected individuals, promoting comfort in daily life style and work functions, providing guidance and support for solving the issue of both patients and caregivers, providing independence to patients, enhancing safety, improving the nutritional input and health-quotient of elderly and stopping abuse to elderly dementia patients (Rosenberg, et al., 2018).

The multidisciplinary-intervention based approach helps in achieving both primary and secondary outcomes by proper management and diagnosis of dementia. This is highly recommended in most clinical practice as no single particular health-care specialty possesses expertise in dealing with all complicated problems of dementia patients involving - physical, cognitive, emotional and social issues.

Through multiple-professional-interventions, as aforementioned the primary outcomes in elderly dementia patients, are largely achieved. The outcomes like improved Quality-Of-Life (QOL) in individuals are often achieved successfully in patients suffering from early-stage based dementia, helping both family-caregivers and the patients through supportive multi-dimensional treatment and care facilities (Zucchella, et al., 2018). Such dementia patients often showcase improved outcomes related to their QOL via - improved mood, improved engagement in several pleasant activities in life, improved ability in performing Activities-of-Daily-Living or (ADLs). Also secondary outcomes which are achieved in dementia patients and elderly are - improved family relations, upliftment in their mood and participative nature in several pleasant activities (Zucchella, et al., 2018).

The admiral nursing practitioners provide support and expert help to families of patients, elderly and caregivers by planning their schedule, medication and lifestyle requirements and changes which they need to address as disease progresses with age. This helps the elderly dementia patients to live the life they want and in achieving their life goals and outcomes with supportive care and health. Physical-therapist help patients with institutionalization for better professional care and improved life services for patients health and independent living with boosted confidence, attempting towards patient-centric care. Occupational therapists also aid elderly dementia patients in maintaining their home independence by helping caregivers in adapting to diminished ability of elderly in dealing with routine life challenges through use of devices assisting in eating, toileting, home-management or dressing. This helps in enhancing patients' independence reducing burden on caregiver, also boosting patient confidence and health (Matrix Evidence, 2011).

Also in case of CS (Cognitive-Stimulation), evidence shows how it helps to enhance social functions and general cognition of patients, delivering successful result by improved cognitive functioning after conduction of variable length based CS sessions (Woods, et al., 2012). Through the intervention of Cognitive-Therapy thus the exploratory outcomes of self-efficacy development in elderly dementia patients as well as lessened memory-related-stress or distress is achieved, helping patients to not only live their life free from distress but also to enjoy the qualities of life, participating in daily life activities and pleasant associations with families.

Conclusion

In the present essay the vulnerable group of elderly dementia patients have been taken into consideration, to identify the factors contributing to the disease, to analyze the interventions for reducing the impacts of such contributing factors in the vulnerable group and for finally discuss the outcomes which such interventions bring forth. Out of several intervention measures, the multi-professional intervention and cognitive-intervention measures have been delved upon, aligned with the contributing factors of age and cognitive-impairment in elderly. While Cognitive therapy in form of CS has extensive evidences supporting successful results in the treatment of dementia, multi-agency intervention suits as the best approach towards holistic and complete care and rehabilitation of the elderly dementia patients.

References

Alzheimer's Society. 2020. Dementia UK Report. [online] Available at: [Accessed 26 October 2020].

Carrion, C., Folkvord, F., Anastasiadou, D. and Aymerich, M., 2018. Cognitive therapy for dementia patients: a systematic review. Dementia and geriatric cognitive disorders, 46(1-2), pp.1-26.

DalPezzo, N.K. and Jett, K.T., 2010. Nursing faculty: A vulnerable population. Journal of Nursing Education, 49(3), pp.132-136.

Dementia UK. 2020. Prevention And Risk Factors - Dementia UK. [online] Available at: [Accessed 26 October 2020].

Dolan, H., Crain, B., Troncoso, J., Resnick, S.M., Zonderman, A.B. and OBrien, R.J., 2010. Atherosclerosis, dementia, and Alzheimer disease in the Baltimore Longitudinal Study of Aging cohort. Annals of neurology, 68(2), pp.231-240.

Fitzgerald, E.M., Myers, J.G. and Clark, P., 2016. Nurses need not be guilty bystanders: Caring for vulnerable immigrant populations. OJIN: The Online Journal of Issues in Nursing, 22(1).

Grand, J.H., Caspar, S. and MacDonald, S.W., 2011. Clinical features and multidisciplinary approaches to dementia care. Journal of multidisciplinary healthcare, 4, p.125.

Grand, J.H., Caspar, S. and MacDonald, S.W., 2011. Clinical features and multidisciplinary approaches to dementia care. Journal of multidisciplinary healthcare, 4, p.125.

Kaufman, A.V., Kosberg, J.I., Leeper, J.D. and Tang, M., 2010. Social support, caregiver burden, and life satisfaction in a sample of rural African American and White caregivers of older persons with dementia. Journal of Gerontological Social Work, 53(3), pp.251-269.

Lewis, F., Karlsberg Schaffer, S., Sussex, J., O'Neill, P. and Cockcroft, L., 2014. The trajectory of dementia in the UK-making a difference. Office of Health Economics Consulting Reports.

Matrix Evidence, 2011. An economic evaluation of alternatives to antipsychotic drugs for individuals living with dementia.

Mielke, M.M., Zandi, P.P., Shao, H., Waern, M.M.D.P., Östling, S., Guo, X.M.D.P., Björkelund, C., Lissner, L., Skoog, I.M.D.P. and Gustafson, D.R., 2010. The 32-year relationship between cholesterol and dementia from midlife to late life. Neurology, 75(21), pp.1888-1895.

nhs.uk. 2020. Help And Support For People With Dementia. [online] Available at: [Accessed 26 October 2020].

Paulson, H.L. and Igo, I., 2011, November. Genetics of dementia. In Seminars in neurology (Vol. 31, No. 5, p. 449). NIH Public Access.

Peters, R., 2012. Blood pressure, smoking and alcohol use, association with vascular dementia. Experimental gerontology, 47(11), pp.865-872.

Power, M.C., Mormino, E., Soldan, A., James, B.D., Yu, L., Armstrong, N.M., Bangen, K.J., Delano‐Wood, L., Lamar, M., Lim, Y.Y. and Nudelman, K., 2018. Combined neuropathological pathways account for age‐related risk of dementia. Annals of neurology, 84(1), pp.10-22.

Rebecca G. Logsdon, Susan M. McCurry, Linda Teri, 2018. Evidence-Based Interventions To Improve Quality Of Life For Individuals With Dementia. [online] PubMed Central (PMC). Available at: [Accessed 26 October 2020].

Rosenberg, A., Ngandu, T., Rusanen, M., Antikainen, R., Bäckman, L., Havulinna, S., Hänninen, T., Laatikainen, T., Lehtisalo, J., Levälahti, E. and Lindström, J., 2018. Multidomain lifestyle intervention benefits a large elderly population at risk for cognitive decline and dementia regardless of baseline characteristics: The FINGER trial. Alzheimer's & Dementia, 14(3), pp.263-270.

Stanfordhealthcare.org. 2020. Risk Factors. [online] Available at: [Accessed 26 October 2020].

Strachan, M.W., Reynolds, R.M., Marioni, R.E. and Price, J.F., 2011. Cognitive function, dementia and type 2 diabetes mellitus in the elderly. Nature Reviews Endocrinology, 7(2), pp.108-114.

Thuné-Boyle, I.C., Sampson, E.L., Jones, L., King, M., Lee, D.R. and Blanchard, M.R., 2010. Challenges to improving end of life care of people with advanced dementia in the UK. Dementia, 9(2), pp.259-284.

Woods, B., Aguirre, E., Spector, A.E. and Orrell, M., 2012. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database of Systematic Reviews, (2).

Zucchella, C., Sinforiani, E., Tamburin, S., Federico, A., Mantovani, E., Bernini, S., Casale, R. and Bartolo, M., 2018. The multidisciplinary approach to Alzheimer's disease and dementia. A narrative review of non-pharmacological treatment. Frontiers in neurology, 9, p.1058.


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