Complexities of Adult Nursing

Early onset of dementia in veterans

Introduction

Dementia is quite prevalent among military veterans. Aging veterans are highly at risk for dementia due to career-related injuries, posttraumatic stress disorder, and traumatic brain injury. The prevalence of the disease among military veterans in the United Kingdom is estimated to be 563,700 persons. In the next three decades, the number of those affected by the disease is expected to rise significantly (Hugo and Ganguli 2014, p.441). The prevalence of the disease in former army personnel is expected to increase due to rising frequency of posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI). Early onset of the condition is expected owing to the rising number of soldiers in Afghanistan and Iraq war zones who are identified with PTSD and TBI. Precisely, between 2003 and 2013, more than 300,000 and 83,000 persons were newly identified with TBI and PSTD. The combat-associated injuries has raised the incidence of PTSD and TBI which are often considered the unseen war’s wounds since the victims look as if they are uninjured (Ismail, Smith, Geda, Sultzer, Brodaty, Smith, Agüera-Ortiz, Sweet, Miller and Lyketsos 2016, p.13). Both PTSD and TBI are associated to rising risk of early onset of dementia among veterans in on-going war.

TBI occur when an external pressure is exerted on the head leading to head injuries or unconsciousness. Persons with severe and moderate head injuries are 2-4 times at risk of dementia in their lives (Morse 2010, p.10). On the other hand, PTSD is a unique psychological problem that usually co-exists with TBI although it may take place in the brain injury absence. In this regard, it is a product of reaction during emotionally upsetting situations (Hugo and Ganguli 2014, p.441). PTSD prevalence is higher among veterans as compared to the rest of the population owing to the traumatizing events. For instance, the prevalence in veterans is 13-31 per cent relative to 7 per cent in the general population in the UK. Individuals with PTSD are twofold risk of dementia (Ismail, Smith, Geda, Sultzer, Brodaty, Smith, Agüera-Ortiz, Sweet, Miller and Lyketsos 2016, p.15).

Current Commissioning structures for dementia

The policy framework has concentrated on enhancing the quality of life for veterans suffering from early onset of dementia. For patients of dementia and their families, the provision and organization of care towards quality of life remains a major challenge (Tam‐Tham, Cepoiu‐Martin Ronksley, Maxwell and Hemmelgarn 2013, p.26). The expenses of dementia care among these persons are quite high. The healthcare services commissioning in the UK has engaged clinicians through the recently established clinical commissioning groups (CCGs). General practitioners (GPs) head the groups. Furthermore, CCGs are administratively distinct structures to those offering care, with role for a substantial section of the healthcare. Currently, guidance to help commissioners in arranging better care for persons with dementia has been restricted. On the contrary, healthcare providers have an evidence-based guidance (Morse 2010, p.5).

Current services provided for veterans

Current services in the US are intended to empower individuals to seek self-management or support for their conditions. The NHS offers mental health services for veterans suffering from dementia across the UK. In this respect, support and treatment services are provided  to the veterans as well as those who are likely to be cleared from the military (Ismail, Smith, Geda, Sultzer, Brodaty, Smith, Agüera-Ortiz, Sweet, Miller and Lyketsos 2016, p.17). It involves recognizing the early symptoms of mental health challenges and offering access to initial support and treatment. It also encompasses therapeutic care for complicated psychological trauma and mental health challenges (Tam‐Tham, Cepoiu‐Martin Ronksley, Maxwell and Hemmelgarn 2013, p.27). Others services provided for these patients include admiral nurses who are expert dementia nurses. They are responsible of delivering emotional, clinical, and practical support to individuals and families suffering from these conditions.

How provided services are integrated to ensure the health and well-being of veterans

Integrated care for dementia patients in the UK is conducted to ensure social and health care are achieved. Formulation of integrated care offers a chance to change the lives of veterans experiencing dementia and their caregivers (Hugo and Ganguli 2014, p.441). Since most of these patients lives in their homes, it is essential to provide a co-ordinated and collaborative approach in provision of integrated services in the society settings. More importantly, it is by serving the patients jointly with other professionals in social and health care that tailored integrated care for victims with dementia and their guardians can be accomplished. The nurses deliver services which as person-centred. The government also provides policies that establish plans for integrating social and health care to strengthen service delivery and user wellbeing. Similarly, integration intends to enhance the services’ efficiency (Ismail et al. 2016, p.17).

How the care provided for the veterans is fragmented

The mental health care for veterans with dementia is normally fragmented. Empirical evidence have pointed to the fact that such persons take a minimum of two years between coming back for military duty and commencement of mental health care. The research examines the service men and women who participated in Afghanistan and Iraq wars from 2001 to 2011 (Tam‐Tham et al. 2013, p.35). Notably, most of these veterans spent approximately eight years between the first visit to the mental health centre and the beginning of therapy that would be regarded “marginally adequate” for such health conditions. In this regard, they require at least eight meetings of treatment in a year. The majority of these people lack continuous and prompt care. In particular, prompt care is crucial since mental illness can damage the lives of people and interfere with their jobs and relationships (Hugo and Ganguli 2014, p.443).

Critical appraisal of risk management strategies to optimise outcomes in complex care delivery

A broad range of risk management strategies has been adopted to optimize outcomes in dementia treatment among the veterans (Tam‐Tham et al. 2013, p.36).  Primarily, early diagnosis is important because it provides an opportunity to respond and recognize symptoms related to the disease. Timely diagnosis of the disease may be beneficial to patients even devoid of disease-altering treatment. It could also be valuable because it permits sound planning (Ismail et al. 2016, p.20). Screening for the veterans is also useful because it assist in detecting an individual suffering from such conditions.

References

Hugo, J. and Ganguli, M., 2014. Dementia and cognitive impairment: epidemiology, diagnosis, and treatment. Clinics in geriatric medicine, 30(3), pp.421-442.

Ismail, Z., Smith, E.E., Geda, Y., Sultzer, D., Brodaty, H., Smith, G., Agüera-Ortiz, L., Sweet, R., Miller, D. and Lyketsos, C.G., 2016. Neuropsychiatric symptoms as early manifestations of emergent dementia: provisional diagnostic criteria for mild behavioral impairment. Alzheimer’s & dementia: the journal of the Alzheimer’s Association, 12(2), pp.195-202.

Tam‐Tham, H., Cepoiu‐Martin, M., Ronksley, P.E., Maxwell, C.J. and Hemmelgarn, B.R., 2013. Dementia case management and risk of long‐term care placement: a systematic review and meta‐analysis. International journal of geriatric psychiatry, 28(9), pp.889-902.

Morse, A., 2010. Improving Dementia Services in England—an Interim Report. London: National Audit Office.