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This month's InsideHealth&Care discussed the problem of undiagnosed dementia, as the NHS ramp up efforts to reduce the issue.
insideCare magazine issue 5, August 2013
Recently announced by the NHS is a prize of up to £1million for ‘a major new idea to achieve a dramatic reduction in the proportion of people who have undiagnosed dementia'. To date 28 expressions of interest have been received. The prize winners will be announced in 2014. It's certainly an issue that could galvanise an integrated service of health and social care towards resolving this problem.
Checking our Staggering Stats, you'll see that only 45% of those with dementia are diagnosed. This means that most don't have access to services or support. More importantly it points to a major issue – that those who do get a diagnosis tend to be so severely disabled by it that there's no research base to work from to track the onset of dementia through its early stages. This is crucial. If early diagnosis could be established there would be increased hope of finding the means, whether in medication or support, to delay or prevent its emergence in its most serious form.
Certainly Aricept is effective for many forms of dementia, but less so when the disease has entered its mid or late stages. The NHS suggests combining mental tests with flu jabs at doctors' surgeries, operating outreach schemes to resolve transport problems for the elderly, or increased use of technology that might enable patients to access services in their own homes, all to enable an early diagnosis.
But this is where we must consider input from social work expertise, and ask if our failure to diagnose is related to a much wider problem in society? What exactly do we know about the elderly? Who is going to flag up the issue? Certainly this is unlikely to be the dementia sufferer or someone who loves them. It's a highly stigmatised disease. Carers and family hope that these small indications are just part of normal aging and only to be expected, and that muddling through is an option. We've been misled for years into thinking that memory loss is an inevitable part of growing older. Research tells us that it isn't.
For those with a living spouse, or very close to their family, the small indications may occasionally be noted early, diagnosed, and treatment commenced, despite the social consequences of burdening someone with the news that they have an incurable illness. But, as recent research has pointed out, continually, many of the elderly are socially isolated from daily companionship. It's often this isolation which may speed depression and hence dementia, but we really don't know, as the research is limited. According to Independent Age and four other voluntary organisations, social isolation is the important key, as highlighted in their Campaign to End Loneliness. The elderly are not as often, as they once were, a valued part of a nuclear family or a community, and befriending is important, as is empowerment.
It's almost as if the way we live has ignored or stereotyped the elderly who may feel no longer a contributing part of our communities. How many of us actually know someone over 65 in our community or street as a friend rather than family?
The failure to diagnose early dementia may just be the tip of the isolation iceberg.
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