The Impact of Dementia on Health and Well-being of Elderly Above 65 in UK

Background and Rationale for The Study

What Is The Impact Of Dementia On The Health And Well Being Of Elderly Above The Age Of 65 Years Old In The Uk.

Dementia is a growing challenge globally. Dementia is a neuro-degenerative disorder that affects the cognitive thinking skills of the affected person while promoting loss of memory. It is estimated that nearly 67000 people suffer from dementia in England and 676,000 in the UK. Dementia mainly affects the older adults who are at the age group of 65 years and above (NHS 2019).

The following research proposal is based on the UK based older adults with dementia and attempts to create a research format for elucidating their health and well-being. Thus dementia is selected as the specific health issue in this research proposal. In doing so, the research proposal will initiate with a detailed background about dementia patients, brief overview of previously conducted research along with rational of conducting this research. Papers that are published within the last 5 years will be included in the review. This will be followed by highlighting the aims and objectives of the research based on the gaps there are being highlighted in the brief review of literature. The second part of the research proposal will highlight the detailed methodology that will be used in order to conduct the overall research. The research will be secondary research and not orimary research. At the end, the proposal will highlight the ethical consideration that will be used in this research. The ethical consideration will be followed by the project outline and research time table with the help of the grant chart.

According to World Health Organisations (WHO) (2019), in dementia, there occurs deterioration in thinking, memory processing, behaviour and the ability of a person to perform activities of daily living. Dementia mainly affects the older adults. However, it is not a normal part of ageing. Alzheimer’s is one of the most common form of dementia leading to prime reason of disability and dependency over the older adults. Dementia has a strong physical, social, psychological and economic impact over the survivors and their family members along with the society at large. According to Leist (2017), in the progressive disorder like dementia, there is a need for supportive care to conduct activities of daily living (ADLs) starting from first to last. The need for residential care follows from bathing, grooming, dressing, walking, toileting and eating. Challenges with dressing begin with moderate dementia and when the disease moves on to its moderate phase there occurs challenges with toileting followed by need for support in eating during severe dementia (Leist 2017). This loss of independence to conduct the ADLs promotes poor quality of life and hamper in the comprehensive mental and physical well-being. Thus it is important to understand the guidelines for care and the proper utilization of the evidence-based strategies in order to promote ADL function (Prizer and Zimmerman 2018).

Importance of Supportive Care for Dementia Patients

Vernooij-Dassen and Jeon (2016) stated that the review of literature helped in understanding that no significant breakthrough has been made in the process of the dementia research in order to find possible cure during the last few centuries. However, a significant amount of progress has been made in analyzing the pathophysiology of the disease. The damage that is being cause by the neurons cast a multifaceted impact on the physical, psychological, neuropsychological and on the social life of the individuals at large. The societal impact of the dementia over the life of the affected older adults and their families further cast a significant financial harm (Vernooij-Dassen and Jeon 2016). Algar, Woods and Windle (2016) conducted a study in order to measure the quality of life along with well-being of the people suffering from dementia. The review of the peer-reviewed observational studies showed that inability to perform the ADLs affect the life of the older adults leading to the decrease in the level of social participation leading to social isolation and depression. The study also showed that problem in eating and walking and communicating further hampers their mental and physical strength hampering the overall quality of life further. However, the study was conducted over a review of only 11 articles moreover. The observational analysis of the articles was based on the understanding of the caregivers or the nurses and not solely by the affected individuals.  The topic of well-being from the perspective of the dementia patient is increasingly becoming significant in the present day dementia care. Personhood of the individuals who are suffering from dementia suggest that the subjective well-being of these people can be described in terms of the inclusion, comfort, identity, occupation and overall attachment. In the domain of the Tom Kitwood’s model of the psychological needs, Kaufmann and Engel (2016) conducted a study based on the self-reported questionnaire for elucidating the psychological needs and well-being of the dementia patients. Nineteen people under long-term care having moderate to severe dementia were included in the study. Semi-structured interview was used for data collection. The analysis of the data through conceptual framework showed that psychological needs of the dementia patient align with the Tom Kitwood’s model of care (Fazio et al. 2018). According to this model, the main components of dementia care include valuing and respecting person with dementia and their unique needs. The model also stress on creating positive social environment under which the individuals with dementia can enjoy comprehensive health and well-being (Fazio et al. 2018). In relevance to Kitwood’s model, Kaufmann and Engel (2016) study highlighted that psychological dimension of the people suffering from dementia is poor as they suffer from negative emotions and thereby increasing the severity of the neurological complication further. However, small sample size of the study reduced generalization of the research result. Giebel, Challis and Montaldi (2016) stated that the ability to conduct activities of daily living deteriorates among the people with dementia. This decline in ADL, is further reflected in difficulty in performing in the social activities. Decline in social participation creates depression hampering the mental well-being and increasing the severity of dementia further.

Training for Allied Healthcare Professionals

Dementia has no cure as it a progressive disorder. However, maintaining healthy lifestyle and getting proper assistance from the family members might help to reduce the rate of exponential progression of the disease (Leist 2017). Giebel et al. (2019) stated that key to live well with dementia is to stay healthy both mentally and physically. It is easier for a people living with dementia to stay well and to take up new challenges and live a positive yet meaningful life when they feel well. Giebel et al. (2019) further stated that people living with dementia at the residential care often have complex mental health problems, social needs and disability. These needs differ from one person to another. Providing a comprehensive training to the nursing professionals and other allied healthcare professionals in the residential care homes or at the primary assisted healthcare centers are thus important. It is also important that skills or the topics that are being covered in this training are evidence-based such that it would be more beneficial for the dementia patients. Thus in order to generate customized yet evidence-based training skills for the nurses and for the other allied healthcare professionals it is important to understand the health and the well-being perspective from the dementia individuals and their primary care givers (family members). However, no significant research has been conducted so far in order to gather the lived experience of the dementia patient about their disease prognosis and quality of life. Moreover, there is also lack of research that has been conducted under the UK based healthcare settings. Mackintosh et al. (2016) stated that the healthcare system of each of the country is different from others with the difference in the health insurance policies. Thus in order to promote the evidence-based practice for the training of the UK nurses and other healthcare professionals towards improving comprehensive health and well-being of the dementia patients, conduction of a research under UK-based population is important.

To explore the impact of dementia over the comprehensive health and well-being of the older adults above 65 years of age and are residing in UK

To study the prevalence of dementia among the elderly population aged 65 years and above in the UK

To examine the risk factors associated with dementia among the older adults who are aged 65 years and above and are residing in the U

To analyse the effect of dementia on the comprehensive health and well-being of the older adults aged 65 years and above in the UK

Conclusion

To explore the impact of the government policies and other strategies for decreasing the impact of dementia on the comprehensive health and well-being of the older adults with dementia and are aged 65 years and above in the UK.

Methodology is an important aspect of the research. Research method means a procedure of gathering data in order to answer the research question (Bryman and Bell 2007). According to Creswell and Poth (2016), research methodology is defined as a process through which individuals try to conduct the overall research through step by step approach.

The main methodological approach, that will be selected for this research include secondary research. Secondary research is selected over the primary research in this case. Creswell and Poth (2016) stated that the use of the secondary research by the use of the secondary data would help to increase the scope of the developing evidence-based guidelines in nursing. Development of the evidence-based guidelines in nursing will help to promote the overall care aspects of the patients who are suffering from dementia and thereby assisting to increase the overall health and well-being of the older adults with dementia who are aged 65 years and more and are living in the UK. The conduction of the primary research though is associated with lesser degree of bias however is not selected for the conduction of this study. In order to conduct the primary research a significant number of sample size must be used like sample size of 100 in order to increase the scope of the generalization of the research results (Creswell and Poth 2016). However, including the sample size of 100 will increase the overall cost of conducting the research and at the same time will increase the overall time-frame required for the completion of the research. Moreover, conduction of the primary research by suing interview based analysis is also associated with certain degree of limitations. The collection of the primary data with the help of interview is associated with higher degree self-reported bias and thus helping to decrease the credibility and reliability of the study. Thus keeping into considerations about the importance of the evidence-based practice guidelines, secondary research, is best suited (Creswell and Poth 2016). 

The research will make use of the systematic review of the academic articles that are published online in the esteemed databases. The main databases that will be employed for the search of the literary articles include Academic Search Complete, MetCat, Zetoc and PubMed. Another database that will be selected for the doing the search of the literary articles includes CINAHL. Full form CINAHL stands for the cumulative index to nursing and allied health literature (Wong, Wilczynski and Haynes 2006). This is one of the exhaustive databases of the nursing articles and since the scope of the research is aligned with the nursing perspective, CINAHL is selected as one of the potential databases. PubMed is free to access electronic databases that provide easy search to esteemed journals by the use of the MESH terms (search terms or key words) (Wong, Wilczynski and Haynes 2006).

In addition to this, the research will also make use of the database search like the search engines of Google Scholar and Sage Journals Online. Additional grey literatures were retrieved from Public Health England, World Health Organisation and Department of Health England. Other information and reports will be gathered from the Alzheimer’s Society. Making use of the numerous data sources, this research will harness the majority of the update, relevant yet authentic information centring the topic and thus helping to increase the scope of generating evidence-based practice guidelines in dementia care for the older adults who are above 65 years and age and are residing in the UK (Garrard 2016). The use of the secondary research format will help this research to be more sensitive towards the trends and the patterns that are associated with the problem that is being studied (Moule et al. 2016). Moreover, the conduction of the literature review, do not require significant level of human resources and other resources against the primary research as proposed by Aveyard (2014). Moreover, as discussed above, the use of the secondary research approach will help to materialize the research within the given time frame through the utilization of the available resources. 

The literature search was conducted systematically by the use of keywords that are selected from the research aims and objectives. The main keywords that will be used for the search of the articles in the electronic databases include “dementia and elderly”, “prevalence of dementia”, “impact of dementia”, “dementia policies”, “health and well-being of dementia”, “health implication of dementia, “well-being of dementia”, “65 years old and above” “Dementia and UK, “health and elderly”. These keywords will be used in different combinations in order to yield best search results. In order to use several combination of keywords, Boolean operators AND and OR will be used.

Aveyard (2014) highlighted in their study that for the conducting the search of the literary articles in the electronic databases proper use of the inclusion and exclusion criteria is important. The proper selection and implementation of the inclusion and exclusion criteria helps to increase the overall probability of getting the relevant search results and at the same helps to filter out the unwanted search hits and thereby helping to decrease the overall time of selection of the relevant research articles that matches with the scope of the research aims and objectives. 

Articles that are selected within the last 10 years were selected for the review because this will help to understand the current trends in the dementia care. Selection of the articles that are published within the last 10 years will help to increase the scope of getting relevant search hits. Exclusion of the articles that were published before 10 years will help to eliminate the unwanted hits and at the same time will help to focus on the developments that are taking place within the last 10 years in the dementia care in the UK along with health and well-being and policy building for the older adults who are 65 years and above. The research will also exclude articles that discuss the dementia in the early onset and focusing people who are less than 65 years of age. English has been selected as the main language for research as this language is internationally acclaimed and thus helping to increase the global acceptation of the research. Only peer-reviewed articles were selected for the research because it will help to increase the overall strength of the review. Only primary research articles will be selected for the conduction of the literature review. According to Aveyard (2014) selection of the primary research articles for the generation of the systematic review format will help to increase the scope of getting unbiased results and at the same time will help to increase the scope of generating evidence-based practice guidelines. The research that were conducted under the context of the UK will be selected for this study as the scope of the research aims mainly focus on the UK-based older adults. This would also help in analysing the dementia based polices under the context of the UK proposed for the up regulation of comprehensive health and well-being of the older adults. While the search of the literary articles will help to gather majority of the data that are subjected to analysis within this particular research, the research will also remain sensitive to other vital information like the policies and other research papers that are published by non-government agencies, government agencies and other international agencies in order to cast a significant impact on the elderly population and dementia care. 

The literary articles and other grey literatures that will be gathered from the database search and other website search will further pass through a stringent screening. For the literary articles, stringent screening will begin from abstract. Analysis of the abstract will help to identify the methodology and the elucidated research results. This would help to ascertain whether the research results fall within the scope of the research questions of this particular research. The grey literatures will analysed from scratch in order to filter out the important data that will be important for the research of the articles. According to Garrard (2016), following the process of filtering of the relevant literature, the research will analyse the selected piece of literature critically for the enumeration of the principle themes of the research and this would enable this research to answer the research objectives.

The proposed research proposal, aims to conduct a secondary research. According to the O’Leary (2004), secondary research format conducted by the selection of the articles form the databases is not significantly affected by the ethical dilemmas as opposed to the primary research that aim towards exploring the human behaviour and other related issues. This signifies that the research is not required to consider the process of gaining of the informed consent before initiation of the research or to facilitate the privacy and confidentiality of the study for its participants (O’ Leary2004). However, the review of literature will make use of the primary research studies and thus the research need to remain sensitive towards the privacy and confidentiality norms of the selected primary research studies. Thus while selection of the literary articles for he conduction of the systematic review, the articles will be screened in the domain of the ethical considerations followed while the conduction of the research. The analysis of the ethical consideration of the primary research will be done alongside with the assessment of the methodological quality of the study. This would help this secondary research to follow the ethical guidelines of the autonomy, beneficence, non-maleficence and justice (Beauchamp and Childress 2001). If the primary research article is found deviating from any of the ethical norms, then those primary research articles will be opted out from the study, this would further help in increasing the ethical aspect of this secondary research (Sherratt et al. 2007). Any primary research making use of the oppressive practice will be ruled out from this secondary study. Two of the most important ethical theories that will be considered for this research include utilitarianism (act is right if and only of it has certain good consequences) and deontology (this ethical aspect signifies the important of respecting the autonomy). These principles and theories are needed when the practitioners find themselves in the dilemma as this will guide them to give good service to the service users.

While conducting the review of literature, plagiarism will be avoided strictly and information drafted from the literary articles will be referenced stringently. This would help to abide by the copy-right issues (Sherratt et al. 2007). While analysis of the government policies specific policy analysis framework will be used like the policy analysis framework designed by Centre of Disease Prevention and Control. The use of proper policy analysis framework will help to increase the credibility of the policy for the promotion of the health and well-being of the older adults with dementia (Sherratt et al. 2007). 

References

Algar, K., Woods, R.T. and Windle, G., 2016. Measuring the quality of life and well-being of people with dementia: A review of observational measures. Dementia, 15(4), pp.832-857.

Aveyard, H. (2014). Doing a literature review in health and social care: A practical guide. McGraw-Hill Education (UK).

Beauchamp, T. L., and Childress, J. F. 2001. Principles of biomedical ethics. Oxford University Press, USA.

Bryman, A., and Bell, E. 2007. Business Research Methods (2nd ed.). Oxford: Oxford university press.

Creswell, J.W. and Poth, C.N., 2016. Qualitative inquiry and research design: Choosing among five approaches. Sage publications.

Fazio, S., Pace, D., Flinner, J. and Kallmyer, B., 2018. The fundamentals of person-centered care for individuals with dementia. The Gerontologist, 58(suppl_1), pp.S10-S19.

Garrard, J. (2016). Health sciences literature review made easy. Jones & Bartlett Publishers.

Giebel, C., Zwakhalen, S., Louise Sutcliffe, C. and Verbeek, H., 2019. Exploring the abilities of performing complex daily activities in dementia: the effects of supervision on remaining independent. Aging & mental health, pp.1-7.

Giebel, C.M., Challis, D.J. and Montaldi, D., 2016. A revised interview for deterioration in daily living activities in dementia reveals the relationship between social activities and well-being. Dementia, 15(5), pp.1068-1081.

Kaufmann, E.G. and Engel, S.A., 2016. Dementia and well-being: A conceptual framework based on Tom Kitwood’s model of needs. Dementia, 15(4), pp.774-788.

Leist, A., 2017. Social inequalities in dementia care, cure, and research. Journal of the American Geriatrics Society.

Mackintosh, M., Channon, A., Karan, A., Selvaraj, S., Cavagnero, E. and Zhao, H., 2016. What is the private sector? Understanding private provision in the health systems of low-income and middle-income countries. The Lancet, 388(10044), pp.596-605.

National Health Service (NHS). 2019. Dementia. Access date: 5^th Jan 2020. Retrieved from: https://www.england.nhs.uk/mental-health/dementia/

O'Leary, Z. (2004). The essential guide to doing research. Sage.

Prizer, L.P. and Zimmerman, S., 2018. Progressive support for activities of daily living for persons living with dementia. The Gerontologist, 58(suppl_1), pp.S74-S87.

Sherratt, C., Soteriou, T., and Evans, S. 2007. Ethical issues in social research involving people with dementia. Dementia, 6(4), 463-479.

Vernooij-Dassen, M. and Jeon, Y.H., 2016. Social health and dementia: the power of human capabilities. International psychogeriatrics, 28(5), pp.701-703.

Wong, S.S.L., Wilczynski, N.L. and Haynes, R.B., 2006. Optimal CINAHL search strategies for identifying therapy studies and review articles. Journal of nursing scholarship, 38(2), pp.194-199.

World Health Organisations (WHO). 2019. Dementia. Access date: 5^th Jan 2020. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/dementia