1. Fund Us: Dementia

2. Definition of Dementia (American Psychiatric Association, 1994; WHO, 2016)
Dementia is a syndrome of a chronic or progressive nature involving a deterioration in cognitive function beyond what may be expected from normal ageing.
Multiple cognitive deficits:
Impairment of memory
Aphasia
Agnosia
Apraxia
Impaired executive functioning
These deficits must represent a decline from a previous higher level of functioning and cause impairment in occupational or social functioning

3. Facts and Figures 850,000 people with dementia in the UK Context:
1 million by 2025
2 million by 2050 (Alzheimer’s Society, 2017)
Context:
350,000 with aphasia (Stroke Association, 2017)
1 million children with speech, language and communication needs (I CAN, 2013)
BUT prevalence not increasing at same rate as dementia:
Research found rising obesity and ageing population will worsen future prevalence of dementia (Nepal, Brown and Anstey, 2014)

4. Impact of Dementia Communication
Mild dementia:
Word finding difficulties
Anterograde amnesia
Depression and anxiety
Moderate dementia:
Comprehension difficulties
Reduced attention span
Hallucinations and delusions (Alzheimer’s Association, 2017)
Severe dementia:
Echolalia
Neologisms
Apathy and aggression (Lyketsos et al., 2011)

5. Impact of Dementia Dysphagia
Dysphagia occurs in approximately 45% of people with dementia in institutional care (Horner et al., 1994).
Slowing of swallowing process (Groher & Crary, 2010):
Increased time taken to eat meals
Increased risk of malnutrition
Difficulties self-feeding due to cognitive impairment, motor deficits, loss of appetite or food avoidance (Groher & Crary, 2010):
Weight loss
Increased dependency for feeding
Increased risk of pneumonia
Increased risk of death

6. Impact of Dementia Carer
Majority of people with dementia are cared for in their own homes by family members (Callahan et al., 2012).
More than 500,000 family carers of people with dementia providing approximately £6 billion worth of unpaid care per year (Department of Health, 2009).
Carers of people with dementia experience more burden than carers of people with other chronic illnesses (Draper et al., 1992).
Dementia has wide ranging implications for individuals and their carers (Brodaty et al., 2003):
Physical
Mental
Financial
Quality of life

7. Role of the SLT in Dementia (NICE 2017, RCSLT 2014)
Assessment
Aid diagnosis
Language disorder plays a prominent role in some dementias
Many clients present with dysarthria
Work with MDT to avoid misdiagnosis
Identify the nature, severity and impact of eating/ drinking/ swallowing disorder
Assess aspiration/ choking risk
The impact of dementia symptoms on communication
Challenges and risks to the PWD as a result of communication difficulties
The extent to which challenging behaviours result from unmet communication needs
Capacity for decision making • Likely prognosis
Inform intervention
Direct intervention
Maintain/ maximise communication function
Implement personalised communication strategies
Manage stress arisen from communication difficulties
Group intervention to maximise communication skills and provide a supportive social environment
Make recommendations for managing swallowing difficulties
Contribute to end-of-life discussions around feeding
Work with carers to implement communication strategies
Facilitate use of communication strategies in all environments
Incorporate communication requirements into MDT care plan
Advocate for and facilitate equal access to services for PWD
Indirect intervention
Family
Carers
Health/ social/ voluntary sector staff
Students
Wider community
On all of the above things
Training

8. Risks of not providing SLT:
Communication Dependence, Low self-esteem, Risk of needs not being met
Loss of meaningful interaction strain on relationships, decreased QOL
Implications of dysphagia  aspiration, choking, malnutrition, dehydration, decreased QOL, reduced socialisation, anxiety around mealtimes
Delayed diagnosis and treatment
Barrier to communicating with other healthcare professionals (Orange & Ryan, 2000)
No communication or dysphagia training for carers
(RCSLT, 2014)

9. Cost of Dementia (Alzheimer’s Society, 2017)
Dementia costs the UK £26bn a year. 2/3 of this is paid by people with dementia or their families.
In 2013/2014, £264.2mn was wasted as a result of poor dementia care in hospitals. This cost could be reduced if hospital staff received adequate dementia training.
(Alzheimer’s Society, 2017)

10. Why fund SLT for dementia?
People with Dementia are considered to be one of the largest expanding caseloads for SLTs. (Mahendra & Arkins, 2003).
According to the RCSLT (2017), “It is important that SLT services are adequately resourced to provide quality care for people with dementia.” However, some services are currently unable to see people with dementia for communication problems because funding is not provided.
With extra funding, more focus can be put on providing communication therapy.

11. Why fund SLT for dementia?
People with dementia are at a significant disadvantage with healthcare staff. With extra funding, SLTs can offer education and training to healthcare staff, carers and families in effective communication strategies for people with dementia.
Speech and Language Therapy is successful in training care staff working with older adults to use positive communication strategies and have better understanding of communication disorders.
(Maxim et al., 2001).

12. References
Alzheimer’s Association. (2017). Stages of Alzheimer’s. Retrieved March 15, from
Alzheimer’s Society. (2017). Facts for the Media. Retrieved March 15, 2017, from r_the_media
Alzheimer’s Society. (2017). Financial Cost of dementia. Accessed online: cost_of_dementia
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington, D.C.: American Psychiatric Press,
Brodaty, H., Green, A. and Koschera, A. (2003). Meta-analysis of psychosocial interventions for caregivers of people with dementia. Journal of the American Geriatrics Society, 51, 657–664.
Callahan CM, Arling G, Tu W, et al. Transitions in care for older adults with and without dementia. J Am Geriatr Soc. 2012; 60(5):

13. References (continued)
Department of Health. (2009). Living Well with Dementia: A National Dementia Strategy. London: Department of Health.
Draper, B. M., Poulos, C. J. and Cole, A. M. D. (1992). A comparison of caregivers for elderly stroke and dementia victims. Journal of the American Geriatrics Society, 40, 896–901.
Groher ME, Crary MA. Dysphagia: Clinical Management in Adults and Children. Maryland Heights, MO: Mosby Elsevier; 2010.
 Horner J, Alberts MJ, Dawson DV, & Cook GM. Swallowing in Alzheimer’s disease. Alzheimer Dis Assoc Disord. 1994;8:177–19. 
I CAN. (2013). Some Children Struggle. Retrieved March 15, 2017, from
Lyketsos CG, Carrillo MC, Ryan JM, et al. Neuropsychiatric symptoms in Alzheimer’s disease. Alzheimer’s Dement. 2011;7(5):
Mahendra, N., & Arkins, S. (2003). Effects of four years of exercise, language and social interventions on Alzheimer discourse. Journal of Communication Disorders, 36 (5):
Maxim, J., Bryan, K., Axelrod, L., Jordan, L., & Bell, L. (2001). Speech and language therapists as trainers: enabling care staff working with older people. International Journal of Language and Communication Disorders 36 (1):

14. References (continued)
Nepal, B., Brown, L. J., & Anstey, K. J. (2014). Rising midlife obesity will worsen future prevalence of dementia. PLOS ONE. Retrieved March 15, 2017, from
NICE. (2017). Dementia overview. Accessed online:
Orange, J.B., & Ryan, E.B. (2000). Alzheimer’s disease and other dementias: implications for physician communication. Clinics in Geriatric Medicine, 16 (1):
RCSLT. (2014). Speech and language therapy provision for people with dementia.
RCSLT. (2017). Dementia. Accessed online:
Stroke Association. (2017). Aphasia and Communicating. Retrieved March 15, 2017, from
World Health Organisation. (2016). Dementia. Retrieved March 15, 2017, from