There are some symptoms and conditions that have been discovered over time that stand out as especially difficult when it comes to how healthcare providers and medical specialist centers can help specific patients. Such can be the case for ailments that specifically worsen in the terminal phase of the disease or condition. This being said, certain conditions lack a well-structured and proper care system to best suite the patient during their lifetime, especially the time leading to their death due to disease. Such is the case for dementia.
The current problem is that most patients suffering from the advance stages of dementia are not receiving the necessary care plans that are normally structured by specialists in the respective field. Instead, patients in this case are receiving care from general practitioners, of which are commonly not specifically trained to care for patients in these types of scenarios. This is not however, the fault of the general practitioners. Often times, the case is that the nursing home staff that commonly tend to these patients with dementia are not given the support from external services that are necessary for the patient’s well-being.
A study conducted by the Marie Curie Palliative Care Research Department at the University College London (UCL) looked into this very phenomenon. Following their research, the findings were very clear in that the problem is indeed prominent among the population diagnosed with dementia. The research department found that those with advanced dementia commonly suffered severe symptoms such as chronic pain or psychiatric symptoms, and at this time the affected patients rarely had contact with the necessary specialist services. These available specialist services often include what is known as palliative care (a specialized type of care that is normally carried out with a team focused on relieving the severity of symptoms associated with serious illnesses), geriatrics, or mental health facilities or services.
Statistics obtained from the study showed that only about 1 percent of patients with advanced dementia were seen at the follow period within the study by either a geriatrician or psychiatrist. Another key insight from the conducted research show that general practitioners made up roughly 96 percent of the care sought after by patients with dementia. As alluded to earlier, this method of care is not the most ideal for patients as their conditions worsen and become terminal, due to the need for more specialized care.
The reason for these trends may be due to a variety of reasons. One proposed idea is that most healthcare services are not as of this moment structured to care for the complex demands and symptoms that come with patients diagnosed with advanced dementia. The study also suggest that often times when care is sought after, it is done so in more emergency-related scenarios, as opposed to preventative methods that can potentially create a better quality of life for the patient diagnosed with dementia. For those that did indeed seek out a palliative care team, they had done so predominantly in the last month of life, as the study suggests. This group of the population being analyzed for the study made up less than a third of the individuals being observed.
The research surrounding the lack of specialist-type care for patients with dementia has also linked this occurrence to the fact that this type of healthcare requires the overlooking of very complex symptoms, requiring a multitude of resources. When asked about this very phenomenon, Dr. Liz Sampson, Reader at University College London’s Marie Curie Palliative Care Research Department, stated, “There are challenges that we face in terms of providing high-quality end of life care to people with dementia, including an uncertain prognosis, the difficulty in knowing when people are entering the terminal phase of their condition and when specialist services should be involved. However, this uncertainty needs to be taken into account in the planning, commissioning and delivery of services.” In terms of what the health care for these patients entail, Dr. Sampson said, “Complex symptoms require active specialist intervention, multidisciplinary working and effective care coordination but many GPs are not supported by these services and feel that they do not have the time or knowledge to do this themselves.”
What is dementia?
Over the years, dementia has become a widespread occurrence, with estimates that someone in the world is diagnosed with dementia every three seconds. Roughly 46.8 million patients in the world are said to be living with dementia, as a 2015 study suggests. The condition itself consists of a decline in mental capabilities, which can include both mental and physical abilities. Dementia is the result of damage done to brain cells. The damage results in the inability for the cells to properly communicate with each other. It is because of this that seemingly trivial tasks such as thinking and moving become increasingly difficult for patients diagnosed with dementia.
The type of dementia a patient has is ultimately dependent on the region in which damage to the brain is found. For this reason, it is not uncommon for patients to be diagnosed with Alzheimer’s disease, which occurs when the region of the brain known as the hippocampus is damaged. This location of the brain is responsible for learning and memory, and is most often the first region to become damaged. Complications associated with dementia are often permanent, however, some conditions are able to be treated with the proper care. These conditions include depression, side effects from certain medications, excessive alcohol consumption, thyroid problems, as well as vitamin deficiencies.
Although dementia has become a commonly diagnosed condition, there has yet to be an exact test for diagnosing the disease. Medical professionals will often take into account the patient’s medical history, conduct a physical examination, and conduct a series of laboratory tests. In addition to these, doctors will take note of specific cues associated with the ability to think and recall memories, as well as potential abnormal or inconsistent behaviors of the patient. Although doctors will most often be able to identify whether or not someone indeed has dementia, the specific type of dementia is more difficult to identify. This occurs because in most cases the symptoms and alterations in the brain are very similar and will overlap with the various types of dementia.
In this case, doctors making the initial diagnosis may default to simply dementia, with no specific type identified. For further analysis, patients and loved ones in this scenario are required to consult specialists such as a neurologist or what is known as a geropsychologist (a type of psychologist responsible for mental health disorders, commonly catering to older adults).
The future for patients with dementia
As the study mentioned above suggest, healthcare professionals, such as nurses, doctors, as well as workers in care homes, are taking notice of the apparent problem associated with the care dementia patients are getting. Workers in the healthcare field have identified that the patients often need the care and treatment of specialists. In order to do this however, it is necessary to have these types of services implemented into care homes, or simply more accessible for the patients.
Key insights into the corrective actions needed for this dilemma included the findings, as previously mentioned, that most patients will often fail to receive the specialist care they need for the complex symptoms that come with the condition, and are then required to obtain care from general practitioners. For real ground to be made, care facilities will need to integrate specialist care into their systems, which can make way for a new generation of refined healthcare for patients with dementia.