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Dementia In Australia: Perception And Memory

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Question: 

Discuss about the Dementia in Australia for Perception and Memory. 

 

Answer: 

Introduction

Dementia refers to a syndrome that is characterized by the impairment of the functions of the brain including cognitive skills, personality, language, perception, and memory (World Health Organization, 2012). Dementia should not be understood as a natural part of aging although this condition became more prevalent and shared with advancement with age (Alzheimer's Association, 2013). Therefore, mostly dementia affects older individuals. The most prominent consequence of the aging population among the Australian people is the increase in the number of persons with dementia (Prince, Bryce, Albanese, Wimo, Ribeiro & Ferri, 2013). In Australia, Dementia is a major health problem that has profound health consequences and reduces the quality of living for individuals with the condition as well as their friends and family. Dementia is prevalent among persons aged 65 years and above. Sixty-five percent of those diagnosed with dementia are older women who live in the community (Alzheimer's Association, 2013). The Indigenous persons have higher rates of dementia than the other Australians. In the Aboriginal communities of Australia, dementia prevalence is almost five to six times that of the general public. Dementia has remained a health priority in Australia since the year 2012. The old people diagnosed with dementia are widespread in the community, hospitals and residential care. Dementia poses a serious challenge to health, social policy as well as the aged (Brodaty & Cumming, 2010). In Australia, dementia is the fourth leading cause of death and the third cause of the burden of disability. Persons with dementia rely deeply on the health and aged care services. This is because this individual, mostly women from the Aboriginal communities have other health problems hence the need for high health care. Various factors have led to the increased cases of dementia among the Australian population. These factors include poverty and lack of early medical intervention (Ambrose, Paul & Hausdorff, 2013).
 

How Poverty Impacts on Dementia

The early exposure in life to the various unfavorable conditions that are related to poverty reduces the longevity for persons in the various developing countries. The conditions that are associated with poverty include infectious diseases, prenatal stress, and malnutrition (Wimo, Jönsson, Bond, Prince, Winblad & International, 2013). These poverty-related conditions and the increasing age are the risk factors for dementia worldwide. The Alzheimer’s society approximates that close to seventy-one percent of dementia patients in the year 2050 will be from the weak middle-income states. In these low-income countries, the ratio of the dependents to non-dependents will rise than the rich countries. Poverty and low income among poor people leads to the lack of early diagnosis and treatment of dementia. The lack of access to medical care due to poverty makes the condition deteriorate faster. Poverty in the developing countries has also led to the lack of resources required for the research that is needed for management and reduction of dementia (Nay, Bauer, Fetherstonhaugh, Moyle, Tarzia & McAuliffe, 2015).

The World Health Organization states that dementia do not only affect the individual, but it also impacts and changes even the lives of other family members. Dementia is a very costly condition regarding health, social and economic dimensions. The need for the long-term care for persons with dementia strains the social and health systems as well as budgets. The cost of care for the individuals with dementia drives many families below the poverty line (Alzheimer's Association, 2013). The Australian government among other government have committed funding and programs to help the poor persons who have dementia. Poverty restricts the dietary requirements that are needed by individuals with dementia (Arkles, Jackson Pulver, Robertson, Draper, Chalkley & Broe, 2010). The nutritional risk increases in poor, older adults who are unable to meet the dietary requirements that are necessary to improve the working of the brain as well as reduce the risk of dementia. The low risk of dementia in the developed countries is due to the adherence of the dietary requirements of the brain that is only affordable to the rich. Various diets rich in fiber, fruits, and vegetables increase the well-being of humans and reduces the development of the pathological processes which are characteristic of neurodegenerative disorders. Poverty among various governments has made it hard for the government to educate and sensitize the citizens on the different ways of prevention and management of dementia (Hutchinson, Roberts, Daly, Bulsara & Kurrle, 2016).

 

The Social Determinants of Dementia

The story of Wilson is an inspiration to many (YouTube-Living with dementia, (Sep 25, 2013). Wilson was diagnosed with dementia by the Alzheimer’s Society and died at age of sixty six after living with dementia for ten years. The family members believes that Wilson’s diagnosis has not changed him much and they are happy with the course of treatment (YouTube-Living with dementia, (Sep 25, 2013). There are various therapeutics that are designed for the enhancement of cognition and memory in the Alzheimer Patients as seen in Wilson’s case. The therapeutic agents have limited efficacy, but their introduction has shone a new light on the field. From the video of Wilson, we see that the medication has enabled him to live almost a normal life as they improve the quality of life hence his social life has not changed much. Therefore, it is crucial to have a look at the past or understand the present and gain insight into the future through understanding of societal and cultural values (Willis & Elmer, 2011).

In the past few years, there have been substantial developments in the understanding of the epidemiology, pathogenesis, and diagnosis of the Alzheimer’s disease and the other related disorders (Willis & Elmer, 2011). The prevalence of dementia is about three percent. The social determinants of dementia are factors that include male sex, rising age, better socioeconomic status and presence of preceding involvement in the family decision making as seen in Wilson’s case since the family members are fully involved in his life and dementia management (Smith, Flicker, Dwyer, Atkinson, Almeida, Lautenschlager & LoGiudice, 2010). The family history, genetics, and heredity play a crucial role in determining a person’s possibility of developing various types of dementia therefore, Wilson’s family is at a high risk of developing dementia hence early detection and treatment of all the family members with signs and symptoms of dementia. There are some types of dementia that cannot be attributed to the environment or the lifestyle factors. Therefore, the risk reduction is not a guarantee of a person’s prevention but the patient and family should strive to reduce these risks through involvement in the social policies (Bradshaw, 2015). This experience therefore will fit the principles of a safe culture as well as those of person centered care. However, the risk reduction has a crucial role at the population level, and this level represents the effective method to decrease the occurrence and the societal impact of dementia. These social risk factors include diabetes prevalence, physical inactivity depression, midlife hypertension, smoking, cognitive inactivity and midlife obesity (Barnes & Yaffe, 2011).

In the political aspect, the Australian government has invested adequately in the management and prevention of dementia through the formulation of favorable policies and funding. Australia has been named the world leader in fighting dementia through risk reduction (Radley & Bell, 2011). From the story of Wilson, it is evident that the government has subsidized the medication for dementia and that there are policies to cater for old people with dementia (YouTube-Living with dementia, (Sep 25, 2013). The Australian government initiated and is funding the Your Brain Matters program which is the number one publicly funded program aimed at preventing dementia. This program is delivered via the Australia’s Alzheimer’s Federation. The Your Brain Matters directs individuals on the ways of looking after the health of their brain based on the lifestyle factors as well as modifiable health factors that are associated with the risk of dementia development (Smith et al. 2010). The Australian government has also introduced other forms of passing information to the general public about dementia, for instance use of artwork. Illnesses are at the intersection of medicine, art and social action. The artwork tells us about the illness experience and are used to claim for social justice (Radley & Bell, 2011).

 

Health Services and Australian Healthcare System

The National Health Care Reform has developed various health promotion principles that shape the health and the aged care system offering long term and continuing care. The commission argues that the treatment of dementia should be people and family centered (Louviere & Flynn, 2010). The health system is supposed to be responsive to the person’s cultural diversity as well as the various preferences. The equality principle ensures that the health care services in Australia are accessible to all the citizens based on the individual health needs and not the ability to pay for the services according to the fundamentals of nursing (Crisp, Douglas, Rebeiro, & Waters, 2017). The principle of shared responsibility helps in the health promotion as all the Australians are held responsible for the health and the success of the various health systems. The consumers and the family should decide on the health system while the driver should communicate clearly and enable the customer to understand the choices that are available (Louviere & Flynn, 2010).

The management of dementia should strengthen the prevention and wellness as all Australians try to understand dementia and work towards health improvement. The services provided by various health facilities should be worth the amount of money invested for that purpose (Adams, 2001). The government takes the long term view through strategic planning and ensures that the acute does not crowd out the attention and the planning meant for long term management of dementia. Health promotion encourages transparency and accountability through transparency into the government funding. The models predominating in the Australian health care system for dementia include the two models which include; Person-Centered Care and the Palliative Care (Downs & Bowers, 2014). The palliative care in dementia ensures that life is affirmed, treatment of distressing symptoms in treatment and maintaining of the quality of life and the primary care should be biological, social, spiritual and psychological. Person-Centered care calls for dementia management by following individual needs (Crisp & Taylor, 2008). The provision of the various health services should revolve around the health requirements and needs of the patient.

 

Cultural Safety and the Person-Centered Care

The cultural safety refers to the various experiences of the individual who is receiving the medical care. Cultural safety is similar to the clinical safety which allows the patient to feel secure in the medical care interactions (Carel, 2008). The Nursing and the Midwifery Board of Australia (NMBA) contains the standards of practice that are set by the health practitioner Regulatory National Law (Scanlon, Cashin, Watson & Bryce, 2012). The NMBA controls the practice of the nurses and the midwifery in Australia whose role is to protect the public. The NMBA develops the registration standards, the professional codes which include; patient privacy, autonomy, informed consent, equality, confidentiality and fairness (Sheedy & Whitter, 2013). There are also various guidelines and the standards for the practice that establish the different requirements for the nursing and the safe practices of the nurses and also the midwives in the Australian population. The standards set helps in better management of the patient and maintaining patient confidentiality (Bernoth, Dietsch, Burmeister & Schwartz, 2014). However, these standards are very high for some nurses and midwives in Australia to maintain. The inability of these health practitioners to meet the high standards that are set reduces their full involvement in the management of the patients.

The code of ethics contained in the NBA 2008, state the ethical framework which each employee must follow. The code of conduct include: ethical standards, provisions for the compliance with the applicable law, fairness, equality, employment practices and contract termination in case of failure to comply with these code of conducts (Sheedy & Whitter, 2013).  These codes of conduct sometimes are too demanding hence they underpin the nursing care as the nurses’ proceeds with care to avoid carelessness. Nurses and midwives have been taken to court or even dismissed from work due to failure to comply with these set code of conduct even though they may have acted in the best interests of the patient (Sheedy & Whitter, 2013). These restrictions leads to slower and poor service delivery as the nurses and the midwives are limited on the actions they can take. Although these code of conducts are meant to safeguard the wellbeing of the patient, sometimes they act as barriers to service delivery hence leading to reduced outcomes. Some of these code of conduct include; the provision that the suppliers will conduct their business according to the highest ethical behavior which occasionally limits the decision making capabilities of the nurses and midwives. Most of the cultural values and principles in the Australian health system becomes barriers to the social safety and the Consumer-centered medical care in the nursing practices (Crisp & Taylor, 2008).

Conclusion

There is the need to formulate flexible codes of ethics and practice standards that offer the nurse a wide range of options before choosing a particular option. This will enable the nurses to take appropriate actions that are required for the betterment of the patients with dementia. Management of dementia depends on the whole society as each individual has a role to play in taking care of the elderly population to reduce dementia or reduce the risks that are associated with dementia (Walker, 2003).  The government should be more involved in the eradication of dementia through the building of aged homes where the elderly can be treated and managed. The government needs to offer mass education on the management of dementia, the control, and prevention. The management of the patient should be evidence-based so that all the needs of the patient are met (Walker, 2003). Medication and other therapeutic interventions that help in the management of patient with dementia should be available as well as affordable to all citizens to ensure reduction and elimination of dementia. This can be achieved by the government lowering tax on medications used for treatment of dementia so that the poor elderly individuals can access these medication to improve the quality of life.

 

References 

Adams, T. (2001). The conversational and discursive construction of community psychiatric nursing for chronically confused people and their families. Nursing Inquiry, 8(2), 98-107.

Alzheimer's Association. (2013). 2013 Alzheimer's disease facts and figures. Alzheimer's & dementia, 9(2), 208-245.

Ambrose, A. F., Paul, G., & Hausdorff, J. M. (2013). Risk factors for falls among older adults: a review of the literature. Maturitas, 75(1), 51-61.

Arkles, R., Jackson Pulver, L., Robertson, H., Draper, B., Chalkley, S., & Broe, A. (2010). Ageing, cognition and dementia in Australian Aboriginal and Torres Strait Islander peoples: a life cycle approach 34-56

Australian Nursing & Midwifery Federation. (n.d.). Retrieved from https://anmf.org.au/pages/climate-change

Barnes, D. E., & Yaffe, K. (2011). The projected effect of risk factor reduction on Alzheimer's disease prevalence. The Lancet Neurology, 10(9), 819-828.

Bernoth, M., Dietsch, E., Burmeister, O. K., & Schwartz, M. (2014). Information management in aged care: cases of confidentiality and elder abuse. Journal of business ethics, 122(3), 453-460.

Bradshaw, A. (2015). Shaping the future of nursing: developing an appraisal framework for public engagement with nursing policy reports. Nursing Inquiry, 22(1), 74–83. doi:10.1111/nin.12072

Brodaty, H., & Cumming, A. (2010). Dementia services in Australia. International journal of geriatric psychiatry, 25(9), 887-995.

Carel, H. (2008). Illness (the Art of Living). Durham: Acumen Publishing.

Consumer expectations and health care in Australia. (n.d.). Retrieved from https://ahha.asn.au/system/files/docs/publications/deeble_issues_brief_nlcg-3_consumer_expectations_and_healthcare_in_australia.pdf

Crisp, J., & Taylor, C. (2008). Potter and Perry's fundamentals of nursing. Elsevier Australia.

Crisp, J., Douglas, C., Rebeiro, G., & Waters, D. (Eds.). (2017a). Potter & Perry’s fundamentals of nursing (5e?; Australia and New Zealand edition). Chatswood, NSW: Elsevier Australia (a division of Reed International Books Australia Pty Ltd.).

Downs, M., & Bowers, B. (2014). Excellence in dementia care: Research into practice. McGraw-Hill Education (UK) 111-132

Hughes, J. C. (2011). Thinking through dementia. Oxford University Press.

Hutchinson, K., Roberts, C., Daly, M., Bulsara, C., & Kurrle, S. (2016). Empowerment of young people who have a parent living with dementia: a social model perspective. International Psychogeriatrics, 28(04), 657-668.

Living with dementia, (Sep 25, 2013). Living with dementia-the Wilsons' story - Alzheimer's Society [Video file]. Retrieved from: https://www.youtube.com/watch?v=4YZDJlcyq-4/

Louviere, J. J., & Flynn, T. N. (2010). Using best-worst scaling choice experiments to measure public perceptions and preferences for healthcare reform in Australia. The Patient: Patient-Centered Outcomes Research, 3(4), 275-283.

Nay, R., Bauer, M., Fetherstonhaugh, D., Moyle, W., Tarzia, L., & McAuliffe, L. (2015). Social participation and family carers of people living with dementia in Australia. Health & social care in the community, 23(5), 550-558.

Nursing and Midwifery Board of Australia - Professional standards. (n.d.-a). Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Prince, M., Bryce, R., Albanese, E., Wimo, A., Ribeiro, W., & Ferri, C. P. (2013). The global prevalence of dementia: a systematic review and metaanalysis. Alzheimer's & Dementia, 9(1), 63-75.

Radley, A., & Bell, S. E. (2011). Another way of knowing: Art, disease and illness experience.

Scanlon, A., Cashin, A., Watson, N., & Bryce, J. (2012). Advanced nursing practice hours as part of endorsement requirements for nurse practitioners in Australia: A definitional conundrum. Journal of the American Academy of Nurse Practitioners, 24(11), 649-659.

Sheedy, C. K., & Whitter, M. (2013). Guiding principles and elements of recovery-oriented systems of care: What do we know from the research?. Journal of Drug Addiction, Education, and Eradication, 9(4), 225.

Smith, B. J., Ali, S., & Quach, H. (2014). Public knowledge and beliefs about dementia risk reduction: a national survey of Australians. BMC Public Health, 14(1), 661.

Smith, K., Flicker, L., Dwyer, A., Atkinson, D., Almeida, O. P., Lautenschlager, N. T., & LoGiudice, D. (2010). Factors associated with dementia in Aboriginal Australians. Australian and New Zealand Journal of Psychiatry, 44(10), 888-893.

Walker, K. (2003). Why evidence-based practice now?: a polemic. Nursing Inquiry, 10(3), 145–155. doi:10.1046/j.1440-1800.2003.00179.x

Willis, K., & Elmer, S. (2011). Society, culture and health: an introduction to sociology for nurses (2nd ed). South Melbourne, Vic: Oxford University Press.

Wimo, A., Jönsson, L., Bond, J., Prince, M., Winblad, B., & International, A. D. (2013). The worldwide economic impact of dementia 2010. Alzheimer's & Dementia, 9(1), 1-11.

World Health Organization. (2012). Dementia: a public health priority. World Health Organization.

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