Dementia Prevalence, Management, and Health Promotion in the UK: The Role of Nurse Community Practitioners

Summary

Dementia is referred as the psychological condition in which individuals develop decline of effective cognitive functioning such as memory loss and others (Livingston et al. 2017). In the UK, it is seen that there is high prevalence of dementia among the elderly. This is evident as 448,300 elderly people are seen to be suffering from dementia which is 10,200 more compared to the number of dementia patients identified in 2017 (alzheimers.org.uk, 2018). Dementia has led people to face issues with performing everyday task and expresses effective well-being as seen from the local reports in the borough of Barnsley in the UK (barnsley.gov.uk, 2019). In this respect, NICE guidelines for dementia management are identified which mentions that pharmacological intervention such as donepezil, rivastigmine and galantamine are to be used and group cognitive simulation therapy is to used as therapeutic intervention for people suffering from dementia (NICE, 2018). The role and responsibility of the nurse community practitioners are identified for dementia patients. It informs that the community nurses are to act in support and provide appropriate care and healthcare intervention for the patients for enhancing their health (Dening and Hibberd, 2016). For health promotion regarding dementia, Health Belief Model is to be used. This is because the framework provides detailed information about the way behaviour changes required for health promotion regarding any disease is to be made (Yoo and Kim, 2017).

Introduction

In the UK, the most common mental health issue among elderly individuals who are 65 years and above is dementia. According to 2018 statistics, it is reported that presently 448,300 people are suffering from dementia and it is projected to rise to 1.6 million by 2040 in the UK. The statistics also revealed that 1 in 8 people who are aged over 80 can be considered to be suffering from dementia in the UK (alzheimers.org.uk, 2018). This indicates that dementia is prominent mental health issues among the population in the UK which is increasing at stiff rate. Thus, effective focus on dementia as the topic of discussion in the report is included so that enhanced information regarding the needs of the people with the disease along with the way it can be tackled can be explored.

The key aim of the report is to critically evaluate findings regarding dementia in the UK from existing literature and facts to develop data regarding the way it can be managed and resolved. In this purpose, prevalence of dementia and needs of the health issues are to be discussed by analysing local and national information and data within the UK. The role of nurse practitioners in managing risk of dementia among adults is to be critically evaluated. Further, the Health Belief Model is to be used to discuss the way health promotion regarding dementia in the UK is to be established.

Local and National Health data regarding Dementia

The national data regarding dementia informs that in 2018, 448,300 elderly people are seen to be suffering from dementia which is 10,200 more compared to the number of people suffering from dementia in 2017 (gov.uk, 2019). This indicates that there is rise in dementia among the elderly population in the UK compared to the previous year. According to local and national statistics, it is reported that 70% of the dementia patients reported moderate to severe memory problems (alzheimers.org.uk, 2018). In Borough of Barnsley, UK, the prominent needs of dementia patients are services to manage memory loss, support to execute everyday tasks, assistance in making communication and controlling mood changes (barnsley.gov.uk, 2019). This is because dementia leads to damage hippocampus area, frontal lobe and parietal lobe in the brain which is responsible for supporting cognitive functioning and memory of individuals (Bonifacio and Zamboni, 2016).

Impact of public health intervention for Dementia

In the UK, the NHS continuing healthcare provision has been formed for dementia patients with complex healthcare needs so that they can avail free healthcare in managing their symptoms of dementia. The funding for the services are made by the Clinical Commissioning Group (CCGs) in the UK (NHS, 2018). These public healthcare services are essential and effective for managing dementia in the UK among the people with complex symptoms who are of lower status and are unable to avail care due to poor financial condition. The National Intelligence of Care Excellence (NICE), UK has provided the guideline that donepezil in case of severe dementia is to be used and rivastigmine and galantamine are to be used for managing mild to moderate dementia (NICE, 2018). This is because donepezil acts in the brain as acetylcholinesterase to compensate for the loss of cholinergic brain cells, in turn, acting to improve memory and resolve confusion (Cummings et al. 2016). Moreover, the galantamine and rivastigmine act in slowing breakdown of acetylcholinesterase to slow down the progression of dementia (Kandiah et al. 2017). Thus, this information regarding medications to be used by NICE is an effective approach as it provided guidance about the pharmacological interventions to be made for dementia to effectively manage the disorder. As argued by Hwang et al. (2016), side-effects of donepezil, rivastigmine and galantamine include vomiting, nausea, diarrhoea and others. Thus, hindered physical disruption of health could be faced by individuals on availing the medication.

Role and responsibility of nurses

In dementia care, the role of the nurse community practitioners is to deliver care, treatment and support to the individuals suffering from the disease. In this respect, the nurse community practitioners have responsibility to assess the health condition of the individuals suffering from dementia to determine the progress of the disease and effect of the intervention or treatment provided to them (Lang et al. 2017). As argued by Davies et al. (2018), inability to examine the progress of health condition of the patients based on the care plan leads to deliver inappropriate care. This is because the impact of care and the changes required in care for the patients are unable to be identified by the nurses, in turn, making them fail to modify the care as per the health need and satisfaction of the patient. The nurse community practitioners in dementia care have the responsibility to execute risk assessment of the patients so that any probable harm or accidents can be avoided that may deteriorate health of the patient (Dening and Hibberd, 2016).

Health Promotion for Dementia

In order to promote health of the dementia patients, the Health Belief Model is to be followed. This is because it is the most prominent model which makes effective behaviour change among population by raising awareness regarding any disease (Yoo and Kim, 2017). The theoretical constructs of Health Belief Model (HBM) mention that through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, modifying variables, cues to action and self-efficacy, the individuals are able to promote health (Mo et al. 2016). The perceived susceptibility indicates that individuals when perceive they are susceptible or prone to get affected by certain health disorder develops enhanced healthcare behaviour to get over the risky health issue (Goeman et al. 2016). Thus, to promote health awareness regarding dementia, the health practitioners are required to provide information to target population to make them realise the risk and prevalence among them of getting affected by the disorder which would make them aware to change behaviour in coping with dementia. According to perceived severity, the HBM indicates that individuals on judging the seriousness of the health issue become aware to take actions in coping with it (Mo et al. 2016). Thus, to create awareness for dementia among people, effective information on the seriousness of the disease and its worst effects are to be informed. The perceived barriers are referred to individual’s examination of the obstacles faced in making behaviour change (Goeman et al. 2016). Thus, to effectively promote behaviour changes for controlling dementia among individuals, the health professionals are to identify the barriers faced by people in making the change and develop strategies to resolve them for effective health promotion. The cues to actions inform that a trigger is required for making behaviour change and self-efficacy informs presence of belief of competence among individuals in making behaviour change is required for achieving effective health condition through the change (Yoo and Kim, 2017). Thus, the health professional for creating health promotion regarding dementia is required to identify the trigger to make people concerned in taking steps towards behaviour change for controlling dementia. Moreover, they are to make people believe they are competent in making behaviour change to cope with dementia for enhanced health promotion regarding the disease.

Conclusion and Recommendations

The above discussion informs that dementia is a key health issue in the UK which is growing at a stiff rate. The key care needs regarding the disorder are controlling memory loss, accessing assistance in executing everyday work, enhanced cognitive ability and others. In this context, NICE guidelines are to be used for making healthcare intervention regarding the disorder. The Health Belief Model is to be followed in promoting change in health behaviour regarding dementia.

On the basis of the existing literature, it is recommended that health professionals involved in dementia care are to be trained regarding the way they are to use Health belief Model. This is because it would provide them skills and knowledge of the way to follow each of the theoretical constructs of the model to successfully promote health information regarding dementia. It is also recommended that the health professionals are to further explore NICE guidelines regarding dementia management so that they can understand the activities to be specifically provided to each dementia individuals to develop a person-centred care environment. Moreover, it is suggested that the nurse community practitioners are to provide effective training regarding the way to perform health assessment of the dementia patients in all condition so that timely and appropriate changes in care can be made to deliver successful and holistic care support to the patient in enhancing their health.

Dig deeper into Dementia Harmony: The Comparative Analysis of Music Therapy Approaches with our selection of articles.

References

• alzheimers.org.uk 2018, What is dementia?, Available at: https://www.alzheimers.org.uk/about-us/news-and-media/facts-media [Accessed on: 27 July 2020]
• barnsley.gov.uk 2019, Dementia: Barnsley council, Available at: https://www.barnsley.gov.uk/services/adult-health-and-social-care/looking-after-your-health/dementia/ [Accessed on: 27 July 2020]
• Bonifacio, G. and Zamboni, G., 2016. Brain imaging in dementia. Postgraduate Medical Journal, 92(1088), pp.333-340.
• Cummings, J., Lai, T.J., Hemrungrojn, S., Mohandas, E., Yun Kim, S., Nair, G. and Dash, A., 2016. Role of donepezil in the management of neuropsychiatric symptoms in Alzheimer's disease and dementia with Lewy bodies. CNS neuroscience & therapeutics, 22(3), pp.159-166.
• Dening, K.H. and Hibberd, P., 2016. Exploring the community nurse role in family-centred care for patients with dementia. British Journal of Community Nursing, 21(4), pp.198-202.
• Goeman, D., King, J. and Koch, S., 2016. Development of a model of dementia support and pathway for culturally and linguistically diverse communities using co-creation and participatory action research. BMJ open, 6(12).pp.67-90.
• gov.uk 2019, Statistical commentary: dementia profile, April 2019, Available at: https://www.gov.uk/government/publications/dementia-profile-april-2019-data-update/statistical-commentary-dementia-profile-april-2019
• Hwang, T.Y., Ahn, I.S., Kim, S. and Kim, D.K., 2016. Efficacy of Galantamine on cognition in mild-to-moderate Alzheimer's Dementia after failure to respond to Donepezil. Psychiatry Investigation, 13(3), p.341.
• Kandiah, N., Pai, M.C., Senanarong, V., Looi, I., Ampil, E., Park, K.W., Karanam, A.K. and Christopher, S., 2017. Rivastigmine: the advantages of dual inhibition of acetylcholinesterase and butyrylcholinesterase and its role in subcortical vascular dementia and Parkinson’s disease dementia. Clinical interventions in aging, 12, p.697.
• Lang, L., Clifford, A., Wei, L., Zhang, D., Leung, D., Augustine, G., Danat, I.M., Zhou, W., Copeland, J.R., Anstey, K.J. and Chen, R., 2017. Prevalence and determinants of undetected dementia in the community: a systematic literature review and a meta-analysis. BMJ open, 7(2).pp.30-45.
• Lang, L., Clifford, A., Wei, L., Zhang, D., Leung, D., Augustine, G., Danat, I.M., Zhou, W., Copeland, J.R., Anstey, K.J. and Chen, R., 2017. Prevalence and determinants of undetected dementia in the community: a systematic literature review and a meta-analysis. BMJ open, 7(2).pp.30-45.
• Mo, P.K., Chong, E.S., Mak, W.W., Wong, S.Y. and Lau, J.T., 2016. Physical activity in people with mental illness in Hong Kong: Application of the health belief model. Journal of Sport and Exercise psychology, 38(2), pp.203-208.
• NHS 2018, Dementia, Available at: https://www.nhs.uk/conditions/dementia/care-homes/ [Accessed on: 27 July 2020]
• NICE 2018, Dementia: assessment, management and support for people living with dementia and their carers, Available at: https://www.nice.org.uk/guidance/ng97/chapter/Recommendations#involving-people-living-with-dementia-in-decisions-about-their-care [Accessed on: 27 July 2020]
• Yoo, R. and Kim, G.S., 2017. Factors affecting the performance of the dementia screening test using the health belief model. Journal of Korean Public Health Nursing, 31(3), pp.464-477.