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Understanding Dementia Among the Elderly in England

Introduction

Dementia is a serious health condition that occur when the brain is affected by certain diseases or conditions that causes the gradual death of brain cells, and this leads to progressive cognitive decline of health. How fast cognitive decline progress will depend from person to person, and may depend on which type of dementia the person has. (Alzheimer’s 2017). Mortality and morbidity rate of dementia is very huge and is one of the world leading diseases for 65 years and over, according to (Ott. el .al 1999). Dementia is a brain condition, It has cost the UK economy about £35 billion in 2019 and has putting enormous strain on National health service, Office of national statistic (ONS 2019). The proposal presents a background and rationale in relation to exploring dementia among elderly people (age 65+) in England, followed by the proposed methodology and ethical considerations. There after a project outline and project time table are presented.

Background and Rational

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Dementia is referred as the mental illness that affects adversely the normal functioning of Brain and nerve cells (Lingehall et al. 2017). Dementia is considered as the group of symptoms that affect cognitive functioning such as thinking, memory, decision making and social abilities. Alzheimer’s Society (2019) has mentioned that, dementia is the psychological condition in which capacity of nerve cells and Brain in transferring signals to different organs is severely damaged which leads to loss of proper cognitive function in people. In the UK majority of elder people suffer from dementia. This mental health condition not only impacts on the overall cognitive and behavioural functions of people but also spoils their social life badly.

While it comes to discuss dementia in aged people in UK, it needs to consider the possible cause and symptoms of this mental illness. Clinical interventions have mentioned that, dementia generally occurs due to severe damages in Brain and nerve cells that leads to poor brain functions. As mentioned by Sen et al. (2018), different parts of brain are associated with different functions. Evidences have suggested that, damages in any particular part of brain or nerve cells can hamper the functions of that part. The damages of brain cells in dementia patients lead to development of poor cognitive functions such as lack of decision making, poor problem-solving skill and permanent or frequent memory loss. Due to damages in nerve cells in dementia patients, these cells are unable to transfer and receive signals to and from brain respectively. On the contrary Valkanova et al. (2017) mentioned that there are evidences that state that, damages in of brain and nerve cells are not all time associated with occurring dementia, rather there are many other factors such as hormonal imbalance, biological changes, environmental changes and social factors that lead to development of dementia in aged people. Clinical studies have suggested that, different health conditions like low blood glucose, hypothyroidism, high or low sodium level, viral infection and vitamin B-12 deficiency can also be potential reasons behind developing dementia in elderly people. As mentioned by Streater et al. (2017), socio-culture factors such a poor social support, marginalisation poverty, social stress and discrimination also pose adverse impact on people’s cognitive ability that can lead to dementia. The common symptoms of dementia patients are memory loss, speech as well as communication difficulties, poor level of concentration, poor learning ability and lack of judgemental and critical thinking skill.

The statistical data on dementia in UK shows that, although the percentage of recent dementia attack has fallen at considerable rate in the UK, aged people in this country are at high risk of this mental illness [PHE, 2019]. Alzheimer’s Society (2019) has mentioned in its report that in England, more than 25,000 people belonging to minority and back ethnic community suffer from dementia. The report also shows that, in UK more than 923,000 people suffer from dementia among which majority of the people are above 65. Evidence based research has predicted that number of dementia patients in England and Wales will increase to more than 50,000 by the end of 2026. From the recent report Public Health England (PHE) it is clear that more than 600,000 women in UK are sufferer of dementia out of which most of the women belong to the age group 65-70 [PHE, 2019]. The report also says that more than two third of the people suffering from dementia in UK are women.

While it comes to improve the health outcomes of aged people in England suffering from dementia, it is important to understand the possible factors that impact on their mental health such as socio-cultural, financial and environmental factors. As mentioned by Goncalves et al. (2016), socio-cultural condition of community has potential impact on psychological process of human being. The current social perception, cultural trend and modern healthcare perspective in England impact on overall mental and emotional health of people which can be a potential cause of dementia. For example, in rural and semi-urban areas of England., there remain many ethnic and minority community who still are unable to access modern thoughts, ultra-modern technologies and improved healthcare services. There are many black and minor ethnic communities who believe in superstition, traditional customs and impractical viewpoint that spoil their normal thinking and decision-making ability and lead them toward development of dementia. On the contrary Streater et al. (2017), argued that although socio-culture factors impact on cognitive and mental processes of people, they can hardly affect overall brain function of people. Evidence based studies have suggested that, economic factor is strongly associated with development of dementia in aged people in England. It has been reported in many evidences that, there are many ethnic communities residing in rural and semi-urban areas of England and Wales who are devoid of proper job opportunities. There are many minor ethnic communities who live at below poverty level and are devoid of any kind of employment and healthcare opportunities that affect the overall mental and physical health of these people (Valkanova et al. 2017). Recent survey in England has shown that, aged people who residing in poor community are unable to have healthy life styles, proper nutrition and better healthcare services which impact adversely on not only their physical health but also on their psychological processes by affecting brain functions. On the other hand, there are many criticisms regarding this viewpoint such as many theorists believe that dementia is not confined in people who reside in poor and minority community rather there are many aged people in England who despite having rich and high society lifestyles and high living standard suffer from dementia. In this context Starr and Walesby (2017) mentioned that, although social and financial factors can affect the physical and mental health of people that can lead to dementia, biological changes and nutritional imbalance are considered as the major reasons of developing dementia in aged people. In England, majority of aged people suffering from over weight and dementia due to their lack of exercise, poor diet, inappropriate food selection and irregular lifestyles. Many evidences have suggested that, in England, clinical intervention of many elderly people suffering from dementia have shown that, the types of food they eat on regular basis are completely irrelevant to their age and physical condition, that enhances their body weight at faster rate.

Medical researcher has stated that, for improving health outcomes in aged people in England suffering from dementia, it is important to provide them with healthy diet, good practices, positive environment, social support and relevant foods. Additionally, elderly people also need strong mental and physical support from their society, family members and social care staffs that can improve their cognitive skill and psychological processes.

Study Aim:

An investigation into the effectiveness of Government Strategies (2010 to present) improving Health Outcomes for Elderly people (age 65+) living with dementia in England.

Study Objectives:

To analyse and explore the effectiveness of the government plan from 2010 till present, on improving the lives of those living with Dementia in England, UK

  • To explore the prevalence of Dementia for 65 and over
  • To investigate the health implications of elderly people 65 + black minority ethnic groups in England suffering from with dementia
  • To assess the impact of the government intervention ‘NHS Health check 2016’ improving the care and creating dementia friendly community

Methodology

Secondary Research will involve reviewing published literature, which will be used for the proposed project. Original research is primary research it includes, collecting data from the field, more desirable, time limitations makes this a challenge. According to (CCCU, 2006) conducting primary research requires times to seek ethical approval, designing data collection instruments, collecting the data and analysing data before writing up. Wallman el al, (2011) notes that, primary research demands appropriate skills in teams of designing the data collection instruments, establishing rapport with participants and negotiating access. Comparing both research, secondary research will take less time and is not expensive, in which information will be accessed freely via the library. How ever the research will consider about the limitation of the approach. Dementia is a research topic already available, literature in the public domain and sometimes needs payment to get access to some date (Wallman 2011). Some time the concern of information will not be not up to date. In terms of overcoming this problem, the inclusion and exclusion criteria in team of data research will be used to identify the recent publication to avoid out of information.

Literature Search Strategy

The literature search strategy that are used for study includes the following data bases which will be accessed through the University online catalogue: academic search. Here researcher will use keywords to select relevant articled and journals out of many sources. Research will also use Boolean Operator (AND, OR), which will assist research to reduce the number of resources in each search and finally select limited as well as relevant resources that can assist researcher to meet research outcomes. National institute for clinical excellence (NICE) Evidence Search Health & social care PubMed, social care on line. The Data bases literature for the topic in question will be accessed via the London Metropolitan University Library. The following open access search engines will be used to search for additional literature: Microsoft Academic & Google Scholar. The table below will show the Key words and Boolean operators which will be used for the literature search. The search will add the key wards UK, England, dementia, elderly people and over sixty-five in all searches to ensure that the literature is accessed and allowed comparisons to be made.

Key wards Key wards

The literature search inclusion and exclusion criteria will be as a follows: Geographical boundaries is used, focusing on Over 65+ in England which is in UK and only use literature generated in the UK and used the data for the topic. Data side UK was excluded. The search will also utilize times including that is 2004 -2019 will be considered. It is important to use the current material.

Ethical Considerations:

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While conducting the research, researcher will consider different important ethical aspects to accomplish the research in systematic way. First if all, the researcher will assure that all the evidences as well as database that are going to be used in this research are collected from valid and relevant resources. Researcher would also assure the transparency of information, that means all the information that will be used in this research are genuine and valid that will maintain authenticity of research. Researcher will maintain confidentiality of database that will be used in the research. In this context researcher will assure that all this information that are going to be used in this research will be protected from any unauthorised access or hacking. Researcher will not use the database in any commercial purpose but only in academic purpose. Additionally, researcher will assure the transferability of information that are going to be used in this research. Transferability means these databases can be used by future researcher in their research if all other factors remain same.

The respect for individual autonomy is a key ethical principle governing health care provision (Beauchamp and Childress, 2013), on this note the over 65 plus suffering from dementia with support may chose to live in their own home with help of dementia friendly programme and admire nurses in the community. On a positive note, It will be difficult with over 65 plus with dementia making that choice of living in their own home without support probably dependently on the georgical area and finances for support, according to Alzheimer’s (2017) people with dementia suffers progressive cognitive issues like loss of memory, changes in behaviours, mood and communication and reasoning skills, If they are living on their own they may abscond and get lost or even killed. Beneficence (doing good) and non- maleficence (doing a harm) out line by Beauchamp and Childress (2013) will enable the researcher to engage with ethical tension and assesses the intervention impart in the study.

Proposal timetable:

Proposal timetable

Reflection:

Reflecting is about the experience of writing this research proposal, I will be using Gibb’s 1988 model of reflection. At the beginning, I did not fully understand the meaning of a research proposal, but after talking to my lecturer, she encourages me to read literature first and this help me to think about the question. Using the workbook weekly helped me to focus on reading articles. Not knowing the literature first was wrong, because I thought I can formulate any question that I want. I have now understood that the more I read, the more I develop my research question. Without reading I would not have known more about Dementia and its types and the group of people it affects most and the government intervention, how much they invested to try and provide better health care for those living with dementia.

Writing up the proposal was difficult; I was unable to connect the objective to the research question. I am not critical naturally, and it affected my ability to critically assess literature. But I have learnt, that every literature needs to be criticise. So, to increase the credibility of the research proposal, which enabled me to start questioning and evaluating information for potential bias especially. I struggled also to write the back ground and rationale as I did not understand to even justify the proposal. But I got help from the group remember.

Overall writing research proposal and repeating the assignment has enabled me to develop my ability to gather information, interpret, and analyse information in a more critical way. AS Gibbs (1988) emphasised that it is also good within reflection to come up with an action plan as part of learning process. This being the case, in future I will refer back to relevant lecture notes. Lastly, next time I work on research proposal, I will remember that I have to read literature first before formulating random question.

References:

  • Alzheimer’ disease facts and figures (2017) Available at: https//doi.org/10.1016/j.jaiz.2017.02.00
  • Beauchamp T, Childress (2013) Principle of Biomedical Ethics. 5th edn, Oxford University press, oxford.
  • Bhattacharyya., (2012) Vascular dementia contribution to increased prevalence
  • Canterbury Christ Church University (2006) Code of Conduct: Practice for Research Involving Human Participants and Animals
  • Crosby., ( 2004) Black, Asian and minority Ethnic communities: Resources- Race Equality
  • Dementia Uk : helping families face dementia 2019 Available at: is dementia-new-style-WEB-pdf (Accessed 09 May 2020).
  • Department of Health (2015) Prime minister challenge on dementia : Delivering major improvement in dementia care and research: Department of Health : London
  • Department of Health (2009) living well with Dementia: A National Dementia Strategy for England
  • Department of Health (2012) Available at: https:/wwww.gov.uk/government /news/pm-next-phase-of-britains-fight-against-dementia (Accessed 15 April 2020).
  • Department of Health (2012b) : The mandate . A mandate from the Government , NHS commissioning Board. London: Department of health
  • Gibbs, G (1988). Learning by doing: a guide to teaching and learning methods. Oxford: further Education Unit Oxford polytechnic
  • Global Burden of disease Study (2016) Available at: https://www. Gov.uk/government/publications/burden-of-disease-study-England. (Accessed at:22 May2020)
  • Goncalves, M.M., Pinho, M.S. and Simoes, M.R., 2016. Test–retest reliability analysis of the Cambridge neuropsychological automated tests for the assessment of dementia in older people living in retirement homes. Applied Neuropsychology: Adult, 23(4), pp.251-263.
  • https://asset.Publishing.service.gov.uk/government/uploads/system/attachment_data/file/507981/PM_Dementia_acc.pft (Accessed: 20 May2020)
  • Lingehall, H.C., Smulter, N.S., Lindahl, E., Lindkvist, M., Engström, K.G., Gustafson, Y.G. and Olofsson, B., 2017. Preoperative cognitive performance and postoperative delirium are independently associated with future dementia in older people who have undergone cardiac surgery: a longitudinal cohort study. Critical Care Medicine, 45(8), p.1295.
  • Newton., J. (2015) change in health in England with analysis by English regions and areas of deprivation, 19190-2013, a systematic analysis for the Global Burden of Disease study 2013.
  • NHS Health Checks a naked emperor (2015) Available at: https//www.research gate.net/publication 277407941-NHS-Health-checks-a naked emperor (Accessed 12 April 2020)
  • Office For National Statistics (2018) Available at:https:www.ons.gov.uk>deads.registrationssummary tables>2018 (Accessed 14 May2020)
  • Office for National Statistics 2018 : Available at: https://www. Ons.gov.uk>deathsregistrationsummarytables. (Accessed 5 May 2020)
  • Ott., A, Brandreth J, J, Bertler, M,. (2014)Burden of mortality and morbidity from dementia
  • Prime Minister Plan Challenge on Dementia ( 2012), implementation plan . Available at:
  • Race Equality foundation 2013. Available at: https// www. Better-health.org.uk Statistical commentary: Dementia profiles 2018: Available at: https: www,gov.uk>government>publication>statistical (Accessed15 April 2020)
  • Sen, A., Capelli, V. and Husain, M., 2018. Cognition and dementia in older patients with epilepsy. Brain, 141(6), pp.1592-1608.
  • Starr, J.M. and Walesby, K.E., 2017. Diagnosis and management of dementia in older people. Medicine, 45(1), pp.51-54.
  • Streater, A., Coleston-Shields, D.M., Yates, J., Stanyon, M. and Orrell, M., 2017. A scoping review of crisis teams managing dementia in older people. Clinical interventions in aging, 12, p.1589.
  • Valkanova, V., Ebmeier, K.P. and Allan, C.L., 2017. Depression is linked to dementia in older adults. The Practitioner, 261(1800), p.11.
  • Wallma., N. S. and Wallman, N., (2011) Research methods: the basics
  • World Health organization (2012) WHO fact sheet on dementia Available at: https.//.who.int (accessed 26 May 2020)
  • World Health organization (2012) WHO fact sheet on dementia Available at: https.//.who.int (accessed 26 May 2020)

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