Jonah Kipkemboi Lagat

 The social contexts of Healthcare Provision and delivery (Dementia) Name Instructor Institution Course Date Introduction During my placement as a community health promoter nurse in Derbyshire, I was in a position to interact and help patients suffering from dementia and through that, I had an opportunity to interact with their guardians since the majority of them live together. This paper seeks to give extensive coverage of the condition of dementia from the community health perspective and provision of social care. The paper addresses the definition of community profiling and its advantages, dementia healthcare provision, the causes, risk factors, and its management. Secondly, the paper discusses an overview of the Derbyshire community on the various initiatives, strategies, and services implemented both at the national and local area. Community profiling Community profiling is a comprehensive description of the needs of a population that is defined or defines itself as a community and the resources that exists within that community, carried out with the active involvement of the community itself for the purpose of developing an action plan or other means of improving the quality of life of the community significant tool for community development and are undertaken by a range of different agencies for different purposes. The issues which people experience in their everyday lives cannot, typically, be defined as ‘housing problems’ or ‘health’ or social isolation’. Christakopoulou, et al., (2001) suggest that a comprehensive community profile ought to address the following aspects of people’s lives: the area a place to live, social, economic, political, and the personal space. It is a tool useful in policy formulation and service delivery processes. Community profiling, therefore, is a far-reaching depiction of the requirements of a populace that characterizes itself, as a network, and the assets that exist inside that network. This network must identify with the dynamic contribution of the system itself, to develop an action plan or other methods for enhancing the personal satisfaction of the net. Community profiles, if they conform to certain important criteria, can also be used as part of a broader community development strategy. Community profiling is the sole function of a health needs assessment (HNA) Which form a process of gathering and interpreting information from multiple and diverse sources in order to develop a deep understanding of the health of a community (Public Health Division and Epidemiology & Response Division, 2006). A description of community systems can be limited to health and medical care systems, but it also can be broad enough to include educational, family, political, and religious systems operating within that community. A community health assessment often yields a long list of public health needs, issues, and problems which in turn used to set priorities. Community profiling is the body that outlines how the various health resources will be distributed based on the health needs of the community. A community group wellbeing needs appraisal a dynamic procedure that includes the network to recognize medical issues and objectives with the goal that usage of wellbeing needs and efficient activity arranging can enhance the quality and amount of administrations required for that network. For Derbyshire, prosperity for the people who have dementia can recognize new medical issues or changes in the network's needs. Community Network appraisals give comprehension of attributes that support a sound living condition with the goal administrations should convey to the interface that mirrors the necessities of Derbyshire inhabitants. The primary merits of community health profiling are to: Implementing the planned activities. compile community data and interpretation of that data in one place, so that local health data can be reviewed and used by many sectors of the community; Deciding on priorities for action - clearly, present a community’s health needs and issues so that they can be prioritized for action. Planning public health and health care programmes to address the priority issues. Identify health indicators and sources of data that can be used to monitor change and progress in addressing priority health issues Evaluation of health outcomes in order to form the basis for the Community Health Improvement Plan and other community planning documents. Community Health Profiles are widely used in the communities and are quoted and referred to in a multitude of documents published by county and city governments and in funding proposals and reports done by community health centers, social service organizations, and community coalitions and thus exists minimum disadvantages. Network profiling is utilized to recognize the qualities, shortcomings, needs, and concerns of a network, to settle on choices about wellbeing administrations and to legitimize the portion of assets. Key issue: Dementia Dementia depicts an association of negative impacts that happen when the cells of the cerebrum are quit working legitimately. According to the World Health Organization, dementia is ‘a syndrome due to diseases of the brain, usually a chronic or progressive nature, in which there are disturbances of multiple higher cortical functions which occurs inside the cerebrum, a part of the brain stem which influences individual’s thoughts, memory, and language and speech development. There are different types of dementia; many being partially manageable through the condition worsens over time since they are reversible. These include Alzheimer’s disease, dementia with Lewy bodies, frontotemporal dementia, vascular dementia, mixed dementia, dementia arising from genetically inherited syndromes such as Huntington's chorea and dementia resulting from infections; such include; creutzfeldt-Jakob disease or HIV. However, drugs or non-organic psychiatric disorders upon bringing dementia are progressive and incurable. Despite the nature of the illness, medications are administered to suppress symptoms. The recent figures demonstrated dementia cases as approximately 224,000 individuals in the United Kingdom and twenty-four point three million worldwide. (Department of Health, 2010, pp.78). Age is a risk factor for dementia, with a prevalence of two percent in individuals of sixty to seventy years and twenty percent for those of eighty years and above. Symptoms vary from patient to patient depending on the brain area affected. Patients with frontotemporal dementia have mood swings and memory lapses. Alzheimer’s disease patients are having loss of cognition due to neurofibrillary tangles and amyloid plaques present in the brain tissue. For patients with vascular dementia which accounts for twenty percent of dementia, cases of atrial fibrillation, hypertension and diabetes are common. In dementia of Lewy bodies, stroke is the main symptom. Lewy bodies are eosinophilic cytoplasmic inclusions that are distinct from neurofibrillary tangles. National dementia strategy aims to provide early diagnosis, intervention and improve the quality of dementia care most patients receive as well as create more awareness on the same. The policy encourages patients to take care of themselves and live well with the condition. Most people with dementia live at home, this is where they want to live, this is where their families want them to live, and this is where the government wants them to live [ CITATION Gra03 \l 1033 ]. However, lengthening the time that people with dementia spend at home is not necessarily the most appropriate indicator of success or quality of life for all concerned, as it fails to appreciate whether or not the person with dementia finds life organized around a care package a satisfying experience, and sight may be lost of the fact that for many people with dementia, admission into a care home can be a positive choice and a rewarding experience [ CITATION Sea07 \l 1033 ]. Factors in the vital care record may demonstrate the danger of treating dementia and could be joined in a prescient model to help discover patients who are feeling the loss of a conclusion (Walters, et al., 2016, pp. 10). With an aging population, dementia is turning into a relentlessly severe medical problem in the United Kingdom (UK) and all over the world. In 2015 it was evaluated that 46.8 million individuals worldwide were living with dementia, and this number is expected to increase to 74.7 million by the year 2030 and 131.5 million of by 2050. Over time, the experience of living with dementia leads to a high level of dependency and a reliance on care services (family and/or service-based) to maintain personal integrity and esteem, with the effect of dementia on patients, their caregivers, families, and society are significant (Prince, et al., 2015, pp. 89). Analysis and the therapeutic diagnosis were given to individuals with dementia in the UK begin with an acknowledgment of side effects by patients themselves, their families, or general experts (GPs/family doctors). The family is one of the contradictions of dementia care that the family carer is at one and the same time the greater provider and user of community support services. By far the greatest contribution to maintaining people with dementia in their own homes comes from the family of the person[ CITATION Sea07 \l 1033 ]. It is estimated that the value of services provided by unpaid family carers, about £57 billion, equates to the same amount of total health care funding for the UK over a 12-month period[CITATION Soc04 \l 1033 ]. While services provided by the family may be played down as simply a natural or normal extension of the family relationship, they have become essential to maintaining people with dementia in the community and are highly influential in terms of outcomes [ CITATION Sea07 \l 1033 ]. . If carers are adequately supported within their role, then people with dementia may live at home for much longer. The challenge often comes when resources are patchy, ineffective or non-existent [ CITATION Gra03 \l 1033 ]. Allied to this exploration is an analysis of the role that the community mental health nurse can actively play in promoting quality of life for people with dementia and their family networks as they make use of the available support services. It is also well established that the caring role can be arduous with frequently documented stress, increased psychological morbidity, diminished social life, reduced employment prospects, exhaustion and ill-health[ CITATION Sea07 \l 1033 ]. Early intervention services Increased social awareness of dementia, improved diagnostic services and the arrival of potential drug therapies have meant that increased numbers of people are receiving a diagnosis of dementia at a much earlier stage than at any other time[ CITATION Sea07 \l 1033 ]. Alzheimer’s Scotland Action on Dementia (2003) has previously articulated the provision of relevant and accurate information, the meeting of emotional needs and the provision of appropriate social support. Greater emphasis is, therefore, being placed upon the early introduction of support to promote adjustment and coping with the diagnosis, and emerging symptoms [ CITATION Sea07 \l 1033 ]. Early intervention services are therefore specifically designed to support people through the early stages of dementia and are rooted in the move towards crisis prevention (Department of Health 2001). The early introduction of appropriate medical treatments alongside psychosocial interventions not only improves the well-being of people with dementia but also potentially reduces carer stress to an extent that the need for residential care may be postponed [ CITATION Sea07 \l 1033 ]. The intention of support would appear to be inherently prophylactic, utilizing educational and psychological mechanisms to enhance coping strategies. A clear comparison can be made with the nature and psychological processes of palliative care support services and in this respect, the promotion of problem-focused solutions, rather than emotion-based ones, is the desirable outcome. Services aimed at post-diagnostic counseling form one area of early intervention that is growing in prominence and can be undertaken by the Community Mental Health Nurse working in specialist settings such as in the memory clinic [ CITATION Sea07 \l 1033 ]. Most treatment of dementia occurs in hospital set-ups even though some are in homes. Nurses play a huge role in the management of dementia. A vital role for the Community Mental Health Nurse emerges in terms of vigilance for indicators of abuse, whether intentional or otherwise, advocating on behalf of people with dementia and advising domestic carers about appropriate behavior, communication approaches, daily living skills, and other related matters [ CITATION Sea07 \l 1033 ]. It takes a patient nurse to manage such patients because of many presents with difficult behavioral conditions. In the different stages of dementia, a patient presents with different conditions where their actions require monitoring. Their bodies physiological conditions also need regulations especially their blood pressure due to the extrapyramidal activities associated with the situation. People with dementia and severe psychiatric symptoms associated with increased risk could be effectively maintained within the community when they would otherwise have been compulsorily detained in hospital. Derbyshire Long-term complications and diseases majorly affect the wellbeing of the majority of the Derbyshire population. Checking the primary driver of death in Derbyshire; a tumor, liver, respiratory and circulatory infection, and individuals who are perishing at more youthful ages from these ailments, guarantees that general wellbeing can distinguish the requirements of the network and ensure early discovery, access to successful treatment and change to the more extensive determinants of wellbeing; this will lessen premature mortality from these real ailments. The best reasons for death from illness in England are broadly viewed as preventable - way of life decisions and more extensive determinant factors, for example, smoking, substance mishandle and destitution, all add to untimely mortality from sickness (Stephan & Brayne, 2014, pp. 42; Schulz, and Martire, 2014, pp. 541). In the UK, Dementia Consensus estimates that; the occurrence of dementia is decidedly associated with age, i.e., as generation builds the level of individuals influenced by dementia increments. Between the ages of 65 and 69, 1.3% of individuals are affected, however between 85 and 89 the extent increases to 20%. Also between 65 and 74, the occurrence rate is higher for males as compared to females, the occurrence rates for late beginning dementia are turned around with women after age 74 having a more noteworthy pre-air to dementia than males (Connolly, et al ., 2012, pp. 980). Recent research has recommended that there might be a lower predominance in the UK than already anticipated; all things considered, the number of individuals with dementia would rise significantly following two decades (Stang, 2010, 603). The Derbyshire Dementia Support Service and conveyed by the national philanthropy, Making Space and prepared dementia counsels that are accessible in every aspect of the area to offer help, data and direction for those living with dementia and for their carers (Moher, et al., 2010, pp. 267) The Derbyshire Dementia Support Service is there to: assist you with staying free urge you to live well with dementia help you with enjoying as full and dynamic an existence as could be expected under the circumstances bolster you as you react to the diverse phases of dementia The Derbyshire dementia pathway is run through five main steps, phase one (pre-clinical) it involves focusing on maintaining good health and independence through preventative action and promotion of healthcare lifestyle and raising awareness. Phase two (mild cognitive impairment) that consists of a diagnosis of early stages of dementia through regular carrying of referral to memory assessment services and gaining access to dementia support services (Jammeh, et al ., 2015, pp. 167). Phase three (early dementia), which involves confirmation of dementia, through focusing on the provision of practical and emotional needs and adult care assessment. Phase four (middle dementia) a phase that consists in caring for those having complex needs resulting out of the loss of independence and function. In addition to that, at this stage, the process includes potential guidance for the carers. The last phase is termed as the late dementia phase. It involves long-term admission caring or hospitalization, through focusing on relevant support, carefully review and even end of life support (Pentzek, et al., 2015, pp. 968; Davies, et al., 2011, pp. 609). It is suggested that much rehabilitation work associated with Old Age Psychiatry occurs not in the community but in the few remaining hospital beds that psychiatrists have access to (Bullock 2002). Introducing a concept of rehabilitation to dementia care has a number of advantages. Initiatives and policies Dementia presents one of the highest well-being and social care challenges. Around half of the individuals (428,000) in England, Wales and North Ireland living with dementia do not have a formal analysis. This means they are not in positions to access medications and support despite the rise in dementia cases (Banerjee & Wittenberg, 2013, pp. 751). At the heart of this is the poor care that many receive in acute hospital wards, these are frequently cited as over-medication, dehydration and communication failure, leading to deteriorating physical health and consequently to deterioration in mental health [ CITATION Sea07 \l 1033 ]. Associated with this are the attitudes towards dementia, which are found in the traditional model, that is, people with dementia are vulnerable, burdensome, problematic, draining of resources and incapable of rehabilitation (Godfrey, et al. 2004). Dementia was assessed to cost the UK £20 billion in 2010 which is required to develop to over £27 billion by 2018. In the course of the three-months, Derbyshire County Council (DCC) and Clinical Commissioning Groups (CCG's) in Derbyshire have consolidated to audit and invigorate a current Derbyshire methodology which started usage in 2010. Dementia Voice (2002), the Dementia Services Development Centre for the South West, have developed a framework for developing intermediate care services around the needs of people with dementia, they begin by stating the aim as being: To enable people with dementia to retain or regain abilities where the loss of these abilities would lead to significant change in their quality of life, and/or living arrangements, and such change would not be consistent with their understood wishes[ CITATION Sea07 \l 1033 ]. Clearly this creates a role for the Community Mental Health Nurse to be attached to existing intermediate care teams and to coordinate or case manage rehabilitation for people with dementia, that it may be not only doing people with dementia achieve a greater equity of access to rehabilitation leading to greater opportunities to return and remain home but also that their participation in decision-making is enhanced[ CITATION Sea07 \l 1033 ]. People with dementia are entitled to live as ‘normal a life as possible’ for as long as is possible and one of the primary aims of health and social care services should be to provide the means to make this happen. Change in policy is evidenced by a growing desire being placed upon the movement away from a traditional focus upon ill-health and the frail elderly towards preventive strategies [ CITATION Sea07 \l 1033 ]. In the context of dementia care, this move is therefore away from a focus predominantly on services that respond to those people with severe symptoms or carers in crisis. We seem to be on the verge of a new and positive policy agenda which is influenced by the quality of life, well-being, anti-ageism, equality, social inclusion, empowerment and valuing the individual. Future services need to reverse the trend by inverting the triangle so that the community strategy and promotion of well-being is at the top of the triangle and the extension of universal services for all older people is seen as crucial to all agencies [ CITATION Sea07 \l 1033 ]. Through the Partnerships for Older People Projects (POPPS) (Care Services Improvement Partnership 2006), local authorities are starting to test mechanisms that will act to shift resources across whole systems, thereby encouraging preventive strategies to flourish with the aim of moving away from the current patchwork, characterized by inconsistent, incoherent and uncoordinated services with unstable resources, towards a network of services with consistency in commissioning and funding. Under POPPS, many services, including those aimed at low-level need and prevention, will be commissioned and evaluated and there appears to be a built-in preparedness to learn from mistakes [ CITATION Sea07 \l 1033 ]. It is suggested that in judging value the emphasis moves away from quantifiable reductions in expenditure towards improvements in quality of life and independent living, as perceived by older people themselves, if these are to be the new standards by which we measure services, then it becomes evident that preventive strategies should be aimed at promoting quality of life and not simply focus upon the prevention of admission to hospital or institution. At the local level, the involvement of the Community Mental Health Nurse may be fundamental to the overall success of this strategy. The Chief Nursing Officer for England and Wales recognizes the valuable contribution that all community nurses play in supporting people with long-term conditions (Department of Health 2005a). In doing so, she draws attention to concerns about those with complex needs who experience uncoordinated care and frequent unplanned crisis interventions. Although many professionals and specialists may be involved, no one assumes overall responsibility for ensuring that all health and social care needs are met. A framework for impacting upon this is offered (Department of Health 2005b), and while its emphasis upon the 20–30 percent of people in greatest need continues to reflect the traditional model, it does also focus much upon the value of preventive interventions. This emphasis moves towards effective case management within which all care needs (health and social) are identified and met in an integrated way by skilled and knowledgeable practitioners [ CITATION Sea07 \l 1033 ]. For some time now in the United Kingdom case management has been regarded as central to government policy for the management of people with long-term conditions who, with a specialist and intensive support, are able to remain at home longer and have increased choice on health and social care options (Department of Health 2005a). Conclusion In summary, the traditional model of community support often fails to meet the needs and expectations of its customers. Available resources are targeted towards the most vulnerable while preventive strategies for those in less need are inadequately provided for. And this achieves a perpetuation of an inherently flawed model as the risk of vulnerability is neither addressed nor reduced, and we are forced to conclude that many people with dementia aren’t provided adequate services provision and thus condemned to move towards a point of crisis and, ultimately, into continuing care without access to the choice, equality, and autonomy of will that is becoming central to public policy and legislation (see Department of Health 2005a, 2005b). Depending on the future progress, it seems evident that the Community Mental Health Nurse is conceptually and practically well placed to play a significant role in the provision of community and social care and support, whether this is under the traditional model or a radically different inverted model or perhaps in the transition between the two. The findings from this assignment may help in the choosing of relevant care provision risk tools which aid in the management and eliminating of all dementia cases in Derbyshire. Reference list Alzheimer Scotland (2003) Making the Journey Brighter: Early Diagnosis and Support for People with Dementia and their Carers, policy report. Edinburgh: Alzheimer Scotland – Action on Dementia. Banerjee S, Wittenberg R. (2013). Clinical and cost effectiveness of services for early diagnosis and intervention in dementia. International journal of geriatric psychiatry, 24(7):748–754. Banerjee S. (2012). 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