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CLINICAL: OLDER PEOPLE


John Keady PhD RMN RNT Professor of Older People’s Mental Health Nursing,


School of Nursing, Midwifery and Social Work, Greater Manchester West Mental Health NHS Foundation Trust


Meeting the needs of people with dementia and their carers


N


ursing plays a central and sustaining role in the lives of people with dementia and their families living in the community, from the role of the district nurse, the practice nurse or health visitor, to the more ‘specialist’ psychological interventions and activities conducted by community mental health


nurses. The policy architecture and community landscape that supports such practice has changed significantly over the last decade or so. England, Scotland and Northern Ireland now each have a National Dementia Strategy, with Wales in the process of implementing a National Dementia Vision to eventually create dementia-supportive communities. Whilst all of these strategies have their own set of objectives, all agree upon the importance of early detection and diagnosis of dementia, and acknowledge that people who may be concerned about their memory performance are most likely, in the first instance, to seek out the support and guidance of their general practitioner.


PROMOTING EARLY DIAGNOSIS This is significant, as an influential report published by the Alzheimer’s Society, freely available to anyone with access to the internet,1


has highlighted that there are 750,000 people with


dementia currently living in the United Kingdom with around two-thirds living at home, and one-third in a care home. However, only 40% of people with dementia currently have a formal diagno- sis. The same report reminds us that there is no cure for any of the dementias, and that advancing age is the most notable risk factor for their acquisition, although dementia can also be found in mid-life, with some 15,000 sufferers less than 65 years of age. Interestingly, some recent work conducted by Alzheimer Europe, called the Value of Knowing survey (n=2,6780), examined public perceptions and awareness of Alzheimer’s disease for adults aged 18 and over in five countries (United States of America, Germany, France, Spain and Poland) and found that dementia was the most ‘feared’ diagnosis of all, even more so than cancer.2


in primary care There are many challenges associated with providing appropriate care and support to the three quarters of a million people living with dementia


Therefore, one of the main challenges for those working in


primary care is to help minimise public anxiety over dementia and facilitate an early and timely diagnosis. Why is this important? Well, an early diagnosis can help those living with dementia to gain a sense of relief from better understanding their symptoms, maximise opportunities for personal decision-making, find time to plan for the future when capacity is not compromised and allow access to psychosocial and peer support that may help adjustment and improve quality of life, such as by attending a local memory cafe or ‘living with memory loss’ group. An early diagnosis of dementia can also trigger more intensive counselling and family support for those who may be struggling to come to terms with their symptoms and


‘There is much that can be done to improve quality of life and care, with primary care staff ideally placed to undertake this work and forge new paths into the future’


what the future may hold. Furthermore, following a recent technol- ogy appraisal published by the National Institute for Health and Clinical Excellence3


an early diagnosis of Alzheimer’s disease or, in


some instances, a mixed diagnosis of Alzheimer’s disease and vascular dementia, can offer those living with the condition an opportunity to be prescribed medical treatment (such as Donepezil, Galantamine and Rivastigmine) that may help to prolong memory performance and everyday living skills and activities.


SUPPORTING THE CARER Whilst facilitating and promoting an early diagnosis of dementia is an important role in primary care, there will be members of the community who have been living with the condition for some considerable time. In such circumstances, it is important to not only


www.nursinginpractice.com Nursing in Practice March/April 2012 63


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