A Case Study Regarding Dementia and

Health Care Services in UK

ID:

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Contents
1.1 Introduction................................................................................................................................3

1.2 A case study on the chosen health issue................................................................................3

1.3 Issues to be discussed in the context of the case study..........................................................4

1.3.1 Prevalence and extent of this problem in UK.................................................................4

1.3.2 Critical related health issues outcomes...........................................................................5

1.3.3 Causes and socio-economic factors................................................................................5

1.3.4 Theories or concepts related to the case study................................................................6

3.0.5 Experiences of service delivery and utilization..............................................................7

1.3.6 Ethical issues and principles...........................................................................................7

1.4 Critically analyzing government policies and legislations in the context of the chosen issue
.....................................................................................................................................................8

1.5 Conclusion...............................................................................................................................10

1.6 References................................................................................................................................11

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1.1 Introduction
The study will seek to find out how a dementia patient is provided with health and social care
service and what those services may require to provide efficient services to those patients. There
will also be a case study on an old person suffering from dementia and how it is affecting his
physical and mental health. The issues related with dementia like causes and socio-economic
factors, prevalence, ethics and principles will be discussed and policies and legislations legislated
by the government will be critically evaluated to find out their strengths and weaknesses. The
study will basically revolve around what would be best health and social care for any person
suffering from dementia and how these social cares affect those persons.

1.2 A case study on the chosen health issue

The case study is based on the issues that are faced by the elderly people at UK suffering from
different complications like dementia, diabetes, kidney failure and other mental sickness. The
case study focuses on a person who is in his 90s and suffering from dementia for the last ten
years. His wife being the only person who takes care of him sometimes can not handle him
because sometimes the person cannot even remember his daughter’s name or even recognize his
wife. The issue that has risen in this case is that people at this age do not get enough health care
service as required because they suffer from complications that are severe which can be either
physical or mental or both. In this case the person Mark (used as pseudonym) was a hard-
working person in his adulthood but when he was diagnosed with dementia, he started to become
both physically and mentally unstable simultaneously started losing pleasure in having treatment
from professionals. So, the issue to be seen here is that the elderly people suffer from lack of
interest and unwillingness to cooperate with medical professionals to resolve the issues that they
have been suffering from and the fact that there is not enough services or staffs to take care of
those elderly people.

The elderly people do contribute a lot to society and economy of the country when they had
worked hard in their early age and they need to be treated with better facilities and services when
they become ill or separated from family at an old age (Blakemore ET all, 2018). They may
require different type of services in order to lead a decent life and die in peace. The case study
clearly demonstrates such a scenario where an old person who was good, kind and hard working
in his adulthood is suffering from dementia and lost the interest and willingness to follow the

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activities to tackle the disease and there is even the issue that there are no other person than his
wife to take care of him which is also a problem because his wife is almost as old as him.

1.3 Issues to be discussed in the context of the case study

The issue rose in the above case study is that the scarcity of care services for elderly person and
lack of services that may provide them with motivation, self-realization or mental calmness.
Most of the agencies think that these elderly people will be better off if they are left in a home
care service for senior citizens. Now let’s discuss some of the factors and sections related to the
case study.

1.3.1 Prevalence and extent of this problem in UK

More than one fifth of the population in UK are aged over 60 and before 2025 the number will
rise to become 18.5 million. According to NHS website 75% of the people who are aged more
than 75 are surely suffering from one long term physical or mental condition and the number rise
when we go to 85-year old’s and here almost 82% of them are suffering from these conditions. A
person is considered old when aged more than 65 years and the rate of increment in older people
in UK is quite steep and NHS do not have enough equipment or resource to provide better
service to all of these elderly people (Bray ET all, 2021). Dementia in UK is such a common
disease and there are a lot of people suffering from it and most of them are old people. There was
an estimation by UK report that found 850,000 people suffering from dementia in 2015 in UK
where 75% of them were from age 65 to 100 which demonstrates the point of author.

Only dementia costs 26 billion pounds a year for UK which is more than enough to pay annual
energy bill that comes from each household across the country. The number of people suffering
from dementia is estimated to become 1 million by the year 2021 and 2 million by the year 2025
the rate of the number rising is very steep and the estimation is done without taking into account
any type of changes in public service and health care and only by aging of population. The data
shows that one to every seven-person aged more than 65 years is suffering from dementia which
is almost 15% of the elderly population. Compared to the 2015 estimation, the current prevalence
consensus has found that there are slightly more people that are suffering from dementia in the
youngest (65 to 69) and oldest (90+) age bands and slightly fewer in the intermediate age groups
(Browne ET all, 2017). 65% of the costs to get treatment for dementia is defrayed by the families
of the patient which is almost 17.3 billion pounds which can be either in unpaid care where it

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costs a little less or in private professional care where it costs more. So, the issue has reached an
alarming state and need to be taken seriously across the country and people.

1.3.2 Critical related health issues outcomes

The health issues discussed here is dementia among elderly people in UK and the issue that
surely comes with it is lack of motivation or mental serenity or in other words mental health
issues. In the case study it is mentioned that the person suffering from dementia is mentally
depressed and do not have the willingness to go to medical professionals for treatment and
certainly lack interest in living, do not possess any motive and suffering from perplexed
behavior. As a result the person misses his appointments to doctors, go outside without any help
in which case police help him to find home and there are even other issues like the person do not
have anyone but his wife to take care of him and the health care service do come twice a week
but for his wife who is also an elderly women it is hard to take care of him and meet his needs.
This is an age when people want to spend their time relaxing, doing everyday work and engaging
with grandchildren but this old couple is not able to do any of those stuffs (Cooper ET all, 2017).
The person having dementia in the case study is not even able to recognize his own daughters
and grandchildren which may also be mentally pressuring as a result the person may go through
a tough state of mental health. So, the issues that come with dementia is basically mental health
problems for elderly people.

1.3.3 Causes and socio-economic factors

There are two major degenerative causes behind dementia where one is related with Alzheimer’s
disease which is progressive loss of nerve cells where the cause is unknown and second one is
vascular dementia which occurs due to a series of small strokes. The reason behind dementia for
the person in case study is surely Alzheimer’s disease due to generalized degeneration of the
brain which occurs when a person become very old. This is very common for older people as
they start to forget things after their 70s. there are even other causes like dementia patient in
family history, genetic disorders like Huntington’s disease, thyroid problems, diabetes, certain
medications, vitamin deficiencies, working with heavy metals or pesticides, abuse of alcohol,
tumor or cancer in brain and different large structure of brain (Donegan ET all, 2017). These are
the main causes behind dementia.

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As dementia patients do not remember who they are and even face different mental illness, they
require care for at least two thirds of the day and for those who have severe problems where the
patients suffer from hysteria or diseases like that need care for 24/7 and this costs a lot. In UK an
hour would cost from 15 to 20 pounds an hour which makes 2,000 to 3,000 pounds in one week
for 24/7 service and more than a thousand pounds for the people who need care for some time of
the day (Enshaeifar ET all, 2018). It is mostly observed that children do not live with parents in
UK when they age out and when these people become ill some of them may have a wife that live
with them and others that are divorced or did not get married is shifted to care homes and nursing
homes. Treatment of dementia is definitely quite expensive and people with not good enough
health insurance policy cannot go through these expenditures and in most of the cases their
children do not or cannot help them with this huge amount of money. Older people do not even
get mental support sometimes because their children may live far away even in another country
and the person may not possess any relatives to talk to which brings more depression for the
patient. So being economically not just stable but more than stable is mandatory to tackle this
disease and support from relatives or children is also necessary to overcome this stage.

1.3.4 Theories or concepts related to the case study

There are different mechanisms related to the functioning of brain and related to aging brain
changes which may cause things like stress, telomere loss or progressive loss of nerve cells
which may result in dementia. There are mainly four types of dementia two of which has been
discussed and the other two are minor than them which are Lewy body disease and alcohol
induced dementia. Treatment of dementia best work in the early age because at that time patients
do not forget as much and are motivated and listens to medical professionals. The risk factors
behind dementia is not quite clear and there is a requirement of two or three years of research on
thousands of test subjects which is quite unlikely to happen (Fisher ET all, 2018). And thus,
discovering the ways of prevention of dementia is not an option as of now which is why
physicians embrace the way of clinical judgement. Professionals need to be more careful while
treating people with dementia and have to maintain a certain number of factors and concepts to
be more efficient.

Person centered care approach for sufferers of dementia was developed by Thomas Kitwood in
the late 80s of 20th century which revolves around understanding and responding to challenging

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behavior in dementia. This approach takes into account individual aspect of the world who is
suffering from dementia and analyze that to reach a conclusion (Wotton and Goldacre, 2017).
This approach is very strict where the routine of a person is fixed like in this case study the
person named Mark when he will take his breakfast is fixed like maybe 8am. Go for a walk for
20 minutes afterwards, having his shower at 10am and engage in more activities afterwards and
meanwhile taking his medications. Kitwood’s person centered care is very strict where the
person is forced to engage in his daily activities even if he resists to do so. Following this person-
centered approach may be effective for most people as this is designed in respect to that specific
individual and it would have the best impact and result if conducted appropriately.

3.0.5 Experiences of service delivery and utilization

Experiences encountered by a patient of dementia like Mark from case study has a mixed feeling
because the person has to follow a strict routine and sometimes services do not care about the
mental calmness of the people. Dementia is also a huge burden in his marriage as his wife is
almost as old as him which makes it harder for her to take care of her husband and they do not
possess the amount of money that can provide them with a full-time nurse. An early diagnosis
can give time to the patients to arrange financial and health support but Mark being a very old
guy who retired in his early 50s do not have the privilege to acquire money by doing anything
which is why he is dependable on his children and the state (Floud ET all, 2019). Sometimes
services provided by the state is not enough due to person specific reasons which is why private
health care can provide a better solution or care. Mr. Mark is also having a lack of interest and
unwillingness to complete the daily activities assigned to him which may affect in a bad way and
this may be caused by not good enough services. Staying positive is one of the biggest
challenges for a dementia patient and Mark has not really been able to achieve that which is why
he should be engaged with different groups with similar issues faced and where everyone will be
able consult each other. The group can even follow forget-me-not motto (Wilkinson ET all,
2019). Experiences of Mark after being diagnosed with dementia has not really been positive as
he is falling apart from his family and wife, being helpless and not getting enough health care
that is required. So, experiences of service delivery for dementia patients need to be utilized by
providing them with both physical and mental support.

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1.3.6 Ethical issues and principles
Ethical issues need to be evaluated in the context of a dementia patient because individuals have
to right to do what they want but in the case of dementia it is not the case always as the patients
are not able to remember most of the things. But some of the principles need to be fixed in
anybody’s case like demonstrating that their opinions do matter by listening to them,
encouraging them to involve with more people, gossip with them and share own perspectives.
The privacy of the patients should also be considered and they have to feel that they are not a
burden for anybody. As patients of dementia are bound to follow what their caretaker says the
care giver should maintain ethics and principles because a person is dependent on the ways that
the care giver follows.

There are some other ethics and principle which need to be considered while taking care of a
patient of dementia such as autonomy and well-being, kindness, equity and fairness and
truthfulness (McGuinness ET all, 2019). Autonomy is the most important thing because a person
must have the right to know present condition and what need to be done in that condition. A
person also needs to be informed about benefits and risks of a treatment. Beneficence is also
mandatory as it can build relationships between care giver and client. Justice also need to be
ensured in the case of patient with dementia and a fair distribution of benefits of burden has to be
assured. Ethical reasoning like truthfulness has to be maintained while speaking with the patient.
A caretaker needs to be fully aware of these ethics and principles to take care of patients more
efficiently.

1.4 Critically analyzing government policies and legislations in the context of the chosen issue
England is one of the countries that have a huge number of dementia patients and the
government is taking various steps to assure better care for those patients and it is expected that
the number of patients will become double in the next decade which is why the challenge on
dementia 2020 had to goal to provide world’s best service care for the patients suffering from
dementia. Some of the basic objectives of Dementia 2020 challenge are,

 Providing equity in accessing diagnosis so that the disease would take diagnosed earlier
and it may help to reduce the side effects.
 The role of GPs here is to ascertain coordination and continuity for dementia patients
across the country.

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  Providing meaningful care for those diagnosed with dementia as soon as possible.
 Giving proper training to NHS staffs to create a better caretaking workforce.

Now when comes to critically analyzing these policies the biggest strength of the challenge on
dementia 2020 are the facts that the facility of having diagnosed and if the person has dementia
then start care service instantly. Another strength is that NHS is training their staffs to take care
of these rising dementia patients. But there are some downsides to the challenge as they are not
recruiting more staffs to ensure person centered care which is more efficient and effective (Pham
ET all, 2018). Another issue is that they are not arranging any campaigns to let general people
know about these facilities which should one of their primary concerns because people need to
learn how to handle dementia and how to live with it.

Another policy taken in England to counter dementia is NHS England’s Well Pathway for
Dementia and some of the basic methodologies proposed in the policy are,

 Recommending people that taking care of own health may prevent them from having
dementia. They even have a slogan like “What’s good for heart is good for the brain” and
issues in brain eventually causes dementia for older people.
 Diagnosing well is also their motto and they try to direct people for timely diagnosis and
having proper health care by any means necessary.
 They even promote living well for dementia patients where the messages contain
information on physical, mental and oral health of dementia patients and their care givers.
 Planning individual treatment is a part of their scheme and they try to make it as personal
as possible and even create opportunities where the care givers are able to participate in
research such as Join Dementia Research and enable them to make own decisions and
involve in other activities.
 Finally allowing people to die well and with dignity in a place chosen by the patient and
having a good moment passed is also one of their major concerns.

These government policies are to build the best care service for those suffering from dementia.
There are some strengths behind the Well pathway for Dementia like they are promoting the
ways to prevent the disease through social platforms and campaigns. They even have taken into
account person centered care to build more effective caring system which is also a strength and

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they even care about the dignity of the patients and offer planning of spending their last days in
peace (Reeves ET all, 2019). Now when it comes weaknesses of the policies the first thing that
comes to mind is doing nothing about the motivation of patients. It is very common among
dementia patients to struggle to remain positive in their course of action and even in the case
study Mark had a lack of interest and unwillingness to go to professionals and follow daily
routine. So, the policy has to include motivating factors or specialists who will work on helping
the patients to stay positive and always active. Another weakness of the policies is that there is
no discussion on how the family of the patient will be involved and how they can play a role to
help the patient or process. Dementia patients are sometimes not able to recognize their own
blood but sometimes when they do, they feel relieved and confident which gives them more
energy to cope with dementia (Singleton ET all, 2017). Which is why the policy also need to
include these factors.

There are a lot of ways to handle a dementia patient but the policies and legislations need to look
for a way that is both effective and efficient and where the best interest of dementia patient will
be the first priority. Thus, ascertaining proper health and social care service for dementia patients
may bring down the number of people suffering from it or decrease their sufferings and mental
sickness.

1.5 Conclusion
Dementia is one of the major contemporary health issues in UK and the number of patients is
rising drastically which concerns the government to take measures that may provide better health
care for the patients and even build awareness among citizens to make them more cautious.
Throughout the study there were discussions on different aspects of dementia, how its sufferers
are managed and how it affects their daily life. As dementia patients are vulnerable, they need to
be handled with care and patience. As the number of people suffering from dementia is rising in
UK, government is taking matters into own hands and making policies and legislations which is
directed by NHS or kings fund so that those policies reach people and campaigns and social
platforms and helping them to achieve those goals. They are even embracing new ideas to
provide better health care for dementia patients and have built resolutions for the future to
become best at it.

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1.6 References
Blakemore, A., Kenning, C., Mirza, N., Daker-White, G., Panagioti, M. and Waheed, W., 2018.
Dementia in UK South Asians: a scoping review of the literature. BMJ open, 8(4), p.e020290.

Bray, J., Atkinson, T., Latham, I. and Brooker, D., 2021. Practice of Namaste Care for people
living with dementia in the UK. Nursing older people, 33(2).

Browne, J., Edwards, D.A., Rhodes, K.M., Brimicombe, D.J. and Payne, R.A., 2017. Association
of comorbidity and health service usage among patients with dementia in the UK: a population-
based study. BMJ open, 7(3), p.e012546.

Cooper, C., Lodwick, R., Walters, K., Raine, R., Manthorpe, J., Iliffe, S. and Petersen, I., 2017.
Inequalities in receipt of mental and physical healthcare in people with dementia in the UK. Age
and ageing, 46(3), pp.393-400.

Donegan, K., Fox, N., Black, N., Livingston, G., Banerjee, S. and Burns, A., 2017. Trends in
diagnosis and treatment for people with dementia in the UK from 2005 to 2015: a longitudinal
retrospective cohort study. The Lancet Public Health, 2(3), pp.e149-e156.

Enshaeifar, S., Barnaghi, P., Skillman, S., Markides, A., Elsaleh, T., Acton, S.T., Nilforooshan,
R. and Rostill, H., 2018. The internet of things for dementia care. IEEE Internet
Computing, 22(1), pp.8-17.

Fisher, L.H., Edwards, D.J., Pärn, E.A. and Aigbavboa, C.O., 2018. Building design for people
with dementia: a case study of a UK care home. Facilities.

Floud, S., Balkwill, A., Reus, E.M., Green, J., Reeves, G.K. and Beral, V., 2019. OP50
Cognitive and social activities and long-term risk of dementia in UK women: prospective study.

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McGuinness, L.A., Warren‐Gash, C., Moorhouse, L.R. and Thomas, S.L., 2019. The validity of
dementia diagnoses in routinely collected electronic health records in the United Kingdom: a
systematic review. Pharmacoepidemiology and drug safety, 28(2), pp.244-255.

Pham, T.M., Petersen, I., Walters, K., Raine, R., Manthorpe, J., Mukadam, N. and Cooper, C.,
2018. Trends in dementia diagnosis rates in UK ethnic groups: analysis of UK primary care
data. Clinical epidemiology, 10, p.949.

Reeves, C., Lillie, A.K. and Burrow, S., 2019. A review of end of life care for people with
dementia in UK care homes: staff and family carer perceptions. Journal of Community
Nursing, 33(2), pp.60-65.

Singleton, D., Mukadam, N., Livingston, G. and Sommerlad, A., 2017. How people with
dementia and carers understand and react to social functioning changes in mild dementia: a UK-
based qualitative study. BMJ open, 7(7).

Wilkinson, T., Schnier, C., Bush, K., Rannikmäe, K., Henshall, D.E., Lerpiniere, C., Allen, N.E.,
Flaig, R., Russ, T.C., Bathgate, D. and Pal, S., 2019. Identifying dementia outcomes in UK
Biobank: a validation study of primary care, hospital admissions and mortality data. European
journal of epidemiology, 34(6), pp.557-565.

Wotton, C.J. and Goldacre, M.J., 2017. Associations between specific autoimmune diseases and
subsequent dementia: retrospective record-linkage cohort study, UK. J Epidemiol Community
Health, 71(6), pp.576-583.

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