Resources

There are many challenges in providing palliative and end-of-life care to people with dementia; some of which may be reduced through advance care planning (ACP) to support the person with the diagnosis to have a greater influence on their care at end-of-life.
Advance care planning has been defined as a process of discussing and recording wishes, values, and preferences for future care and treatment held between an individual, family members and their care provider(s) that takes effect when the person loses capacity. This
paper considers some of the barriers and enablers to lead to better support of ACP in families affected by dementia.

The link between physical and mental wellbeing is widely recognised, especially for those with a long-term condition. Such conditions can have a marked impact on mental health, while poor mental health can exacerbate chronic illness, thus creating a vicious circle due to the connection between the body and mind. Community nurses
are well placed to care for those with long-term conditions, not just in terms of health promotion, putting preventative measures in place, encouraging self-care etc, but also to address more complex mental health issues, and maybe even needing to advocate for patients.

Despite the medical advances of the past century, modern healthcare services often seem to treat our bodies as a series of unconnected parts, our ailments divided according to arbitrary physical labels. We may see a urologist for our weak bladder, a cardiologist for a malfunctioning heart, and a psychiatrist for any mental health issues. While it makes sense to apportion separate parts of the body to qualified specialists, these divisions can result in an inability among healthcare staff to see the ‘bigger picture’ — or to use modern healthcare terminology, to treat the patient ‘holistically’.

The sun was shining, the scene was a glorious array of colourful rainbows and the
atmosphere was embracingly joyous when a community of LGBTQ+ and allies
came together in celebration and support over two days for Pride Cymru. After
waiting two years since last attending this event due the pandemic, the All Wales
Tissue Viability Nurses Forum, along with the All Wales Lymphoedema Network,
and TVN2gether returned on the 27th and 28th August 2022 to celebrate diversity
in the Welsh capital by supporting LGBTQ+ rights.

Before the pandemic, the UK was spending only 9.8% of gross domestic product (GDP) on health care, which is one of the lowest in the developed world, and only had a bed capacity of 2.5 per 1,000 people (Maizland and Felter, 2020). Thus, when the pandemic hit, NHS frontline services were rapidly overwhelmed. They responded by postponing nonemergency procedures, closing nonemergency services, and redeploying specialists, which released necessary hospital beds. Unfortunately, these actions had negative consequences for older people and their carers.

Early diagnosis of bowel cancer is key to saving lives. It is the UK’s second biggest cancer killer with more than 16,500 deaths from the disease every year — one every 30 minutes (Cancer Research UK, 2022a). Yet, it is treatable and curable if detected early. Almost everyone diagnosed at stage I will survive bowel cancer, but sadly early diagnosis has remained stubbornly low with less than 40% of diagnoses at stages I and II (Cancer Research UK, 2022b).

The growing prevalence of venous leg ulcers in an ageing population presents challenges for wound care and management (McIntyre et al, 2021). Many people with leg ulcers are elderly, poor and alone, and experience reduced quality of life.

Modern day health and social care dementia practice, as with other conditions, is driven by its current evidence base. This is understood not only through a range of means, such as research, best practice, expert consensus about the most effective way to care for a person with dementia, but also through the lived experiences of people with the diagnosis and their families and supporters. Practice and care should also be guided by clinical ethics; often traditionally referred to as medical ethics.