Dementia is a general term that describes a category of symptoms that are related to a general decline of memory or decline in thinking and social interaction enough to hamper an individual’s ability to carry out their day to day activities. (Wimo et al 2013). Alzheimer’s is considered to be one of the most common type of dementia. People with dementia often have problems remembering short term incidences around themselves such as tracking their car keys, remembering appointments or they forget phone passwords. (Wimo et al 2011). Dementia is known to be caused by a damaged part of the brain, in which cells fail to communicate with one another normally, thereby affecting thinking and behavior of a person. Various types of dementia can be associated with the malfunctioning of a particular cells in the brain. At some point of this illness, some individuals may develop psychological and behavioral symptoms such as aggression, depression and wandering. The severity of these symptoms may vary according to the individual, but are more likely to make the care of the individual more complicated and difficult. (Banerjee, & Wittenberg 2009).
Dementia is one of the world’s leading causes of non-fatal disabilities, and by the year 2030, it is estimated that this disease will be on the top in the list of the causes of years and abilities lost due to death and disabilities. (Wortmann 2012). In the UK, there are approximately 825,000 people with dementia according to the Alzheimer’s Society, with the prevalence of this disease rising with advanced age. Currently, the recorded prevalence rates in England stands at 30 to 50% out of the expected prevalence associated to age and gender categories. (Kalaria et al 2008).
Generally, the general financial burden of dementia in the UK is immense, with statistics of this disease overtaking those for stroke, cancer and heart disease combined. From the present approximations, the tax payer in UK is expected to incur $20 billion per year, much of these expenses being incurred in the social care sector rather than in the budget of the national health docket. (Xie, Brayne & Matthews 2008). According to Alzheimer’s Society, it is also estimated that private carers reduce the burden of the taxpayer by shouldering an estimated $ 5.4 billion per year by continuing to take care of dementia patients either from their homes or from privately owned social homes.
I have taken an interest to carry out my research on this topic because currently, dementia is fast rising to becoming one of the leading causes of life years wasted from deaths and disabilities in the world. It is important to note that this disease has not been categorized as ‘fatal disease’ yet, but statistics indicate that dementia is rising to become a health defining factor of the 21st century in the UK and even worldwide. Hence, it is important that defining factors on and around such an important disease be looked into in order to understand the social and health impacts that this condition would have on the social care resources and costs. No much research has been done on condition that is a leading cause for worry across the world.
I also decided to study on this particular topic because I would like to understand more on dementia. This is an interesting topic to research on since dementia is currently affecting a number of families and friends I know, who form part of the statistics given of whom the disease is affecting.
Additionally, since no much studies have been carried out in this topic, it is my desire that with this review work and many other studies that others will carry out on this topic will ameliorate the state of social care that people with dementia will receive. More research and study on this topic will improve the general quality of service that is offered to this people and their families. Such research undertakings will enable more commitment towards monitoring trends and prevalence of the condition, which will enable us to approximate global costs and trends of this condition with greater accuracy. By documenting a greater number of studies on this topic, I believe that we will be able to realize more effective ways of reducing costs of management for persons with dementia.
The general objective of this review is to investigate and evaluate the impact of dementia on social service delivery and costs.
How do the current trend of dementia prevalence affect the services of social carers and how does this affect the costs of the same?
Currently, about 835,000 families are being affected by dementia in the UK. Behind the numbers are families and friends. Considering the immense personal costs involved that are attributed to dementia, the current situation has had a great impact on the economy and clearly, more needs to be done in order to ameliorate the situation. Dementia costs the UK taxpayers an estimated $26 Billion per year, with a larger portion of this figure incurred by the affected families and careers, (Wimo et al 2010). Many families struggle to afford the carer services that they so need for their family members, and many end up struggling with the condition through offering the best personal care that they can. While the government has put much resources in researching for cancer and heart disease, which have been considered national disasters, dementia has not been regarded as a chronic disease yet. (Knapp, Iemmi & Romeo 2013)
Dementia has not yet generated any political or community response and therefore there has been a general negligence of the disease. (Milne, 2010). Reasons for this trend may be complex, but advanced age and a sense of hopelessness as regards dementia may contribute to this negligence. However, current statistics indicate a fast rising trend on the prevalence of the disease amongst the aged. The aim of this literature review is to evaluate the impact of dementia on social service delivery and on costs.
In addition of the costs incurred in the management of the disease, there are ethical considerations that are involved in caring for the persons with dementia. With the current trend of the prevalence of the disease, it is clear that the services that people with dementia are receiving from the statutory organizations is inadequate. (Moriarty, Sharif & Robinson 2011). Furthermore, the quality of the services offered in the social care centers is likely to decline drastically due to the drastic augmentation of the dementia cases in the country. This review therefore is going to investigate, evaluate and measure the effect of dementia on the social care services and the cost implications of the same.
Social care can either be carried from one’s home or from care homes. Before a person can be enlisted into the care homes, they have to undergo a scrupulous examination to evaluate the needs of the person and how much money they can spend. (Graff et al 2008). It is a means tested process whereby one has got to have a lot of need and quite less money for him/her to qualify into the care homes. With the current system, older people who own assets and property of more than $23,250 in value are required to fund for part of the care that they receive. (Graff et al 2008).
The overall financial burden in the UK is immense, greater than cancer, stoke and heart disease combined. (Wimo et al 2010). It is predicted that casers of recorded prevalence of dementia will be on the increase in the next ten years due to increase in the longevity of people and also due to an enhanced diagnosis and understanding of the disease. With time, this is going to result to the overburdening of the social care services in the country and an escalation in the financial resources that will be incurred in maintaining the dementia invalids, both to the state ad personally. This will remain to be constant if the care services that are offered to dementia invalids will remain to be the way it is. (Werner, Stein-Shvachman & Korczyn 2009).
Dementia is not only a health condition, but also a social condition. (Knapp, Iemmi& Romeo 2013). Dementia has an immense impact on social implications of the general population. It not only affects the person with the condition, but also the general population, more especially the family members and friends of the person with dementia. The lives of the person affected with dementia are greatly impacted by the society around them and the vice versa. Therefore, it is wise to look at the social implications of dementia not only to the person with the condition, but also to the people surrounding the affected person, who may include spouses, partners, friends and relatives. (Gibson et al 2016). For the people hailing from indigenous populations, the social implications of dementia can be intolerable. To get a full extent of the social impact of dementia on social care services, we look at the following considerations on how far the social impact of dementia can get:
Caring for persons with dementia is not an easy task. There are many challenges that are met on the way. The cognitive capacities of the persons with this condition keep on degenerating progressively, which leads to a critically reduced ability to communicate and or undertake the day to day activities. (Matthews et al 2013). The condition may also render the affected unable to recognize themselves and would therefore mean that general cost implications of taking care for such cases either from home or from the formal home care centers will be high. (Prince et al 2013). Hence, there are serious health and social implications for both family careers and formal carers.
Social impacts involve reduction in the affected person’s social interaction with the rest of the people and their families, reduction in working hours and loss of employment losing relationships and the eventuality of relocating from usual home, (Duggan et al 2008). Health impacts would include anxiety and stress coupled with depression, sleep disruption and physical problems. Additional stresses are likely to occur if the affected family member may seem to get worse or in the event of an eventual death of the affected member, the rest of the family members may be subjected to anxiety and or depression. (McCrone, 2009). Additionally, for the person with dementia, diagnosis and identification of the disease may lead to depression and anxiety and, may attract stigma, personal discrimination or isolation.
There are serious inadequacies in terms of facilities and staff in social care centers to meet all the needs of the growing number of dementia cases. According to Alzheimer’s Society, over 90% of the general population believe that they can only visit health professionals only when they are concerned about their memory. (Pimouguet, et al 2010). This means that more people are likely to be affected by dementia without their knowledge, as the severity of the symptoms of dementia may not be notable at first. At the same time, evidence has shown that many general practitioners (GP) have difficulty in diagnosis and identification of dementia, with many reluctant in labelling dementia on someone. (Brett et al 2013). Many GPs will prefer to refer their clients to alternate support centers and or specialists.
Both in the UK and worldwide, there is immense evidence that shows that people who have dementia will not receive any formal diagnosis of the condition any time in their lives. For those who would happen to get their diagnosis, the gap between their diagnosis and the appearance of symptoms would be 10 to 32 months. (Verbeek et al 2009). Barriers to early diagnosis of dementia may include:
In the aged population, most people experience cognitive impairments, and amongst such, as much as 60% may be diagnosed with dementia or otherwise. (Conwell & Thompson 2008).
Dementia is one of the biggest triggers for the aged population to join social care homes.
An estimated 30% of the people with dementia live at home with their families. (Kirkley et al 2011). Many of those which are no table to support bills if they were to be taken care of are the ones to be found receiving care from home. However, there is a growing recognition for development of better community based services that would allow for efficient care mechanisms for people with dementia. Improving the community based care services will also give people living with dementia flexibility in choosing to remain at home as opposed to being taken to ‘strangers’ in care homes. (Rait, et al 2010).
The current system used for aged care planning needs to be revised, especially to incorporate ability to change preferences based on the community and or residential cares.
According to the National Audit Office, there is huge evidence that the quality of service that dementia case patients are likely to receive from the social care centers is likely to decline due to the pressure from rising cases of dementia in the population. (Cameron et al 2014). Having considered that’s, it is therefore clear that there is a challenge in in both health and the social care sectors in the UK, and there is a dire need to improve the quality of the services offered and to improve the consistency of such services that are provided by for the population affected by dementia. (McLellan et al 2011). The consistency of the services that are offered to the population and their carers needs to be improved while maintaining the quality of those services, and ensuring that they are offered in a cost effective way that will reduce the financial burden on the same. (Jones, Edwards & Hounsome 2012).
One vital approach that should be considered when offering services to both invalids and their carers is how to approach them. (Banerjee,et al 2011). The distinct interaction with the invalids and their carers is of vital importance as it will ensure that mutual relationships are maintained throughout the care delivery process. This one of the ways that the quality of services offered will be increased in the care homes. Consideration of the history and current status of the family or carer and the persons with dementia is vital in the identification of the vulnerabilities, weaknesses and strengths of the persons with dementia and their carers will allow for modelling and customization of interventions needed to meet their needs.
Social care can either be carried from one’s home or from care homes. Before a person can be enlisted into the care homes, they have t undergo a scrupulous examination to evaluate the needs of the person and how much money they can spend. It is a means tested process whereby one has got to have a lot of need and quite less money for him/her to qualify into the care homes.
The role of social service systems in addressing the needs of people with dementia and their carers in UK is extremely crucial for the health and social wellbeing of the general population in the UK. As shown in table one below, shown are all the social care centers in the UK, with a percentage approximation of the number of people with dementia that they take care of in Wales, Scotland, Northern Ireland and England.
Table 1: Social service provision Care Center Distribution in the UK
|
UK Country |
Percentage support for people with dementia |
|
Wales |
2.8 |
|
Scotland |
4 |
|
England |
2.5 |
|
Northern Ireland |
4 |
As shown in table 1 above, larger proportions of people with dementia are being supported in Scotland and Northern Ireland as compared to England and Whales. Cost implication of this review include the costs provided by social care homes as well as costs of informal care at family and friend levels. Total costs in the UK, according to the UK Alzheimer Report of 2017 stand at $ 17 Billion.
In in order to curb this challenge, the UK government has formulated a number of policies that are geared to drive and guide commissioning of dementia services within the UK. Some of these policies include the Dementia Strategy (2009) and the subsequent Quality Outcomes for dementia invalids of 2010. The aforementioned policies are dementia specific, though there are other policies that are generic, which deal with innovation, quality and prevention agenda. Implementation of these policies is working towards better service delivery to make the caring for dementia invalids more cost-effective and efficient within the UK. (Duncan et al 2008).
Besides these steps to improve quality of service delivery to dementia patients, there are challenges that are hampering diagnosis and identification of dementia patients in the healthcare profession. It has been reported that a lack of skill and knowledge in the management and assessment of dementia, which results to a lack of benefit to the patient and worse, the practitioners fearing to label the patients unnecessarily of dementia.
The method that were employed in this review is literature research to identify the impact of dementia on model of social service and its cost implication.
From the evaluation that has been done in this review, it has been observed that the community based dementia support would be very effective in curbing the identified challenges and in managing the disease. The community dementia support will prove to be a crucial tool as it will improve care services and yet reduce both social and health care costs on each patient, which will greatly reduce therapeutic nihilism. (Jones, Edwards & Hounsome 2012). This approach will help service users who include both invalids and their carers to access services at the right time. Furthermore, it will help to offer patients and carers with the support that they need at the right time and in the environment of their choice.
The first recommendation towards removing the inefficiency that characterize social care services that are offered by people with dementia and their families is to make dementia a national priority. If this disease is mace a national and public priority, that is the only way that more and sufficient planning can be done for it. Furthermore, a national policy for dementia must be formulated so as to respond to the growing need of social care homes and families with people with dementia in the UK, (Bowling 2014). Funding towards dementia researching should also be increased as an urgent priority in order to increase knowledge on the disease and also to increase general public knowledge about the disease. Researching will also improve the treatment of people with h dementia in the future. Furthermore researching on dementia will lead to the following benefits:
Clearly, the most effective approach towards managing any chronic disease is prevention. However, while dementia has not yet entered the lexicon of the programs responsible for prevention, it is now time that this disease be given a second, look as the statistics of the prevalence of the disease are fast escalating.
Conclusion
Despite the many steps taken by the government in ameliorating the general healthcare status in the UK, there is a widespread negligence of people with dementia and also their families. As it has been observed in this review, there are immense social and financial implications of dementia on social service delivery. Clearly, there needs to be something done to manage the condition. It is expected that with time, the burden on social homes and personally is going to go high. To successfully meet the ageing population’s demands whose cases of dementia are escalating day by day, this will require a restructuring of health care and service delivery.
While the government has put forth sound principles across the general health care sector, there needs to be an investment in the support given to carers in order to achieve a sustainable and efficient social care sector that will comfortably cover all the needs of the ageing population. This will further ensure that families that have taken the responsibility of taking care of dementia persons, and they will have the support they require to take care of themselves when necessary. There is a great need to address the financial crisis as has been observed in order to ensure that the bills for persons with dementia are footed fairly.
References
Banerjee, S. and Wittenberg, R., 2009. Clinical and cost effectiveness of services for early diagnosis and intervention in dementia. International Journal of Geriatric Psychiatry: A journal of the psychiatry of late life and allied sciences, 24(7), pp.748-754.
Banerjee, S., 2010. Living well with dementia—development of the national dementia strategy for England. International journal of geriatric psychiatry, 25(9), pp.917-922.
Banerjee, S., Hellier, J., Dewey, M., Romeo, R., Ballard, C., Baldwin, R., Bentham, P., Fox, C., Holmes, C., Katona, C. and Knapp, M., 2011. Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicentre, double-blind, placebo-controlled trial. The Lancet, 378(9789), pp.403-411.
Bowling, A., 2014. Research methods in health: investigating health and health services. McGraw-Hill Education (UK).
Brett, J., Stniszewska, S., Mockford, C., Herron?Marx, S., Hughes, J., Tysall, C. and Suleman, R., 2014. Mapping the impact of patient and public involvement on health and social care research: a systematic review. Health Expectations, 17(5), pp.637-650.
Cameron, A., Lart, R., Bostock, L. and Coomber, C., 2014. Factors that promote and hinder joint and integrated working between health and social care services: a review of research literature. Health & social care in the community, 22(3), pp.225-233.
Conwell, Y. and Thompson, C., 2008. Suicidal behavior in elders. Psychiatric Clinics of North America, 31(2), pp.333-356.
Duggan, S., Blackman, T., Martyr, A. and Van Schaik, P., 2008. The impact of early dementia on outdoor life: Ashrinking world’?. Dementia, 7(2), pp.191-204.
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