SSI Units

SSI Units I. Introduction INTRODUCTION TO SSI UNITS After gaining independence India in 1947, there was a felt need of economic prosperity and to revive the nation. Hence India focused on developing itself as a manufacturing base. The planners then took the decision of promoting the small scale industries. They were of the view that ssi can play a significant role in the economic progress of the country as it had huge potential in employment generation, which was the major problem faced during that period of time. Earlier the small scale sector was a sector involved in traditional labor with outdated machineries and inefficient techniques of production. But since then due to the coordinated efforts of the government and the commercial banks the position of SSI has improved. These efforts include * Reservation of items to be manufactured by the SSI * Credit marketing * Technology and entrepreneurship development * fiscal, financial and infrastructural support II. Small Scale Industries 2.1Small Scale and Ancillary Industries Small scale industrial units are those engaged in the manufacture, processing or preservation of goods and whose investment in plant and machinery (original cost) does not exceed Rs.1 crore. These would, inter alia, include units engaged in mining or quarrying, servicing and repairing of machinery. In the case of ancillary units, the investment in plant and machinery (original cost) should also not exceed Rs. 1 crore to be classified under small-scale industry. The investment limit of Rs. 1 crore for classification as SSI has been enhanced to Rs.5 crore in respect of certain specified items under hosiery, hand tools, drugs pharmaceuticals, stationery items and sports goods by the Government of India. 2.2. Tiny Enterprises The status of ‘Tiny Enterprises may be given to all small scale units whose investment in plant machinery is up to Rs. 25 lac, irrespective of the location of the unit. III. Small Scale Industries Financing Finance is the blood for any organization. It is that resource which provides the resources for other factors of production, hence its importance cannot be ignored. After the independence, the Government of India has built upon the network of institutions to provide financial assistance to the small scale industries. Since small scale industries need promotionary help from the government and government has other sectors to look upon for the overall development of the country and hence it has entrusted this duty upon the commercial banks. They have evolved various methods of financing and left the traditional methods far behind and evolved themselves into development banks. The importance of the SSI sector can be best explained by the census according to which this sector employees around 60 million persons. And if we talk in terms of value then this sector accounts for about 48% of manufacturing output and 42% of the total exports of the country. 3.1 Types of Industrial Finance: Depending upon the time period requirement of funds the financing can be classified into the following three types: 1) Short term financing: this refers to those funds which are required by the entrepreneurs for short term ie. For a period ranging less than one year. The motive of such funding is to meet the working capital requirements of the enterprise. 2) Medium term financing: this refers to those funds which are required by entrepreneurs for a period ranging from one to five years. This type is needed to fund the permanent working capital requirements, small expansions, replacements, and modifications etc. these funds can be raised through the following resources: Issue of debentures Issue of shares Borrowing from banks and other financial institutions Ploughing back of profits ie the retained earnings 3) Long term financing: it refers to that financing which is extended for a period ranging for more than 5 years. Such funds are required by entrepreneurs for the purpose of investing into fixed assets, for expansion purpose, for bringing about modernization in the enterprise and introduction of new technology. 3.2 Means of finance: Credit Flow The main source of input to the sustained growth of small scale sector industries is CREDIT. Credit has already been classified into short term, long term and medium term on the basis of requirement of the enterprise. The institutional arrangement for providing the capital requirement of the SSI is as follows: SSI are provided the working capital by the commercial banks and in some case this initiative is taken up by cooperative banks and regional rural banks. In case of term loans the provision is made by the state financial corporations, small industries development corporations, national small industries corporation and NABARD. Financial assistance to SSI by NSIC is also made in the form of supply of machinery on hire purchase basis. Even tiny units are able to get loans from commercial banks along with working capital in the form of composite loans. Refinancing facilities to the above institutions are provide by Small Industries Development Bank of India(SIDBI) Term loans on long term basis are provided to the small scale units by SFCs mainly through Single window Scheme and National equity fund. Under single window scheme also the SFC provide some part of working capital for pre operative expenses. 3.2.1 Credit to SSI Sector from Public Sector Banks The table below gives the positions with regard to flow of credit to SSI Sector:- At the end of March 2005 At the end of March 2006 At the end of March 2007 At the end of March 2008 At the end of March 2009 Net Bank Credit 1,69,038 1,84,381 1,89,684, 2,18,219 2,46,203 Credit to SSI 25,843 29,485 31,542 38,109 42,674 No. of SSI Accounts (in lakhs) 32.25 33.77 N.A. 29.64 N.A. SSI Credit as percentage of Net Bank Credit 15.29 15.99 16.6 17.5 17.33 There is a marginal decline in share of credit to SSI sector as a percentage of net bank credit. 3.2.2 Credit to Tiny Sector The Table below gives the status of credit flow to tiny sector since 1995:- At the end of March 1995 At the end of March 1996 At the end of March 1997 At the end of March 1998 Net Credit to Tiny Sector 7734 8183 9515 10273.13 Tiny credit as percentage of net SSI credit 29.93 27.76 30.2 27.0 The advances outstanding against Tiny sector increased from Rs.9515 crores at the end of March, 1997 to Rs. 10273 crores at the end of March, 1998. The share of tiny sector in the advances to SSI sector has, however, decreased from 30.2% at the end of March 1997 to 27.0% at the end of March, 1998. As per RBI guidelines, 40% priority sector lending going to SSI has to go to tiny units with investment in plant and machinery below Rs. 5 lakhs and another 20% to tiny units with investment in plant and machinery between Rs. 5 lakhs and Rs. 25 lakhs. Thus, against the target of 60% of SSI credit for tiny units, actual flow at 27% is very low. 3.2.4 Steps taken by Reserve Bank of India to improve credit flow to SSI sector a) Investment limit has been enhanced from Rs.60 lakhs to Rs.300 lakhs and for tiny units from Rs.5 lakhs to Rs.25 lakhs. As per the RBI guidelines the funds normally available to SSI sector, 40% be given to units with investment in plant and machinery up to Rs. 5 lakhs; 20% for units with investment between Rs. 5 lakhs to Rs.25 lakhs and remaining 40% for other units. b) to expand the extent of Single Window Scheme of SIDBI to all districts to meet the term loan working capital financial requirements of SSIs. c) With a view to manage the cost of credit to SSI units, banks are advised to grant loans to only those SSI units with a good track record. 3.2.5 Monitoring Credit to SSIs is subject to regular monitoring by Reserve Bank of India, Department of SSI ARI, National Advisory Committee of SIDBI, State Level Bankers Committee and District Level Coordination Committees of the Bank. 3.2.6 Fresh initiatives announced in the Budget of 2008-2009 In this budget speech the Finance Minister has announced the following measures for improving credit supply to SSI sector a) A new credit insurance scheme launched. The problem of inadequate provision of security to banks and the rate of low recovery are recognized as the constraints of flow of credit to SSI units.the problem is more complex in case of tiny sector units and export oriented units. And the above scheme is launched in the purview of this problem for the help of SSI units. b) Composite Loan Scheme Limit Enhanced to Rs. 5 Lakhs Another provision made in the budget is that the composite loan scheme of SIDBI and commercial banks designed to solve operational difficulties of the small borrowers by presiding term loan and working capital through a single window. The limit for composite loans has been enhanced from Rs. 2 lakhs to Rs. 5 lakhs. c) Working Capital Limit Enhanced to Rs. 5 Crores In the case of SSi units, the need for working capital is determined on the basis of 20% of the annual turnover. There is a provision in the banks to enhance this limit from 4 crore to 5 crore. d) Credit Delivery to Tiny Sector To increase the outreach of banks to the tiny sector, leading by banks to Non-Banking Financial Companies (NBFCs) or other financial intermediaries for purposes of on-lending to the tiny sector is being included within the definition of priority sector for bank lending. 3.2.7 High level committee for credit (Kapur committee) Inorder to boost the financing activity of the SSI RBI appointed one man committee to improve the delivery system and simplify the procedures for the credit availability for the SSI. The Committee has submitted its report to RBI on 30th June, 1998. Some of the major recommendations of the Committee are:- i) Special treatment to smaller among small industries ii) Enhancement in the quantum of composite loans iii) Removal of procedural difficulties in the path of SSI advances iv) Sorting out issues relating to mortgages of land including removal of stamp duty and permitting equitable mortgages v) Allowing access to low-cost funds to Small Industries Development Bank of India (SIDBI) for refinancing SSI loans vi) Non-obtaining of collaterals for loans up to Rs.2 lakhs; vii) Setting up of a collateral reserve fund to provide support to first party guarantees; viii) Setting up of a Small Industries Infrastructure Development Fund for developing industrial areas in/around metropolitan and urban areas; ix) Change in the definition of sick SSI units; x) Giving statutory powers to State Level Inter-Institutional (SLIIC); xi) Setting up of a separate guarantee organisation and opening of 1,000 additional specialised branches; and xii)Enhancement of SIDBIs role and status to match with that of National Bank for Agriculture and Rural Development (NABARD). Kapur Committee has made 126 recommendations out of which RBI has already accepted 40 recommendations for implementation. 3.3 Small Industries Development Bank of India (SIDBI) SIDBI was set up by an Act of Parliament, as an apex institution for promotion, financing and development of industries in small scale sector and for coordinating the functions of other institutions engaged in similar activities. It commenced operations on April 2, 1990. SIDBI extends direct/indirect financial assistance to SSIs, assisting the entire spectrum of small and tiny sector industries on All India basis. The range of assistance comprising financing, extension support and promotional, are made available through appropriate schemes of direct and indirect assistance for the following purposes:- } direct credit to the SME(small medium enterprises) . } support to micro-finance institutions for capacity building and on lending . } provides financial support to the sick / small scale industries. } Principal Financial institution engaged in development initiative in rural sector and improving the SSI unit. } Also encouraging SSIS and generating employment in rural India. The Bank also performing the rehabilitation duty and improving the performance of small Industries. VARIOUS SCHEMES FOR FINANCING OF SSI 3.3.1 Direct Assistance Schemes SIDBI directly assists SSIs under the following scheme: Project Finance Scheme Equipment Finance Scheme Marketing Scheme Vendor Development Scheme Infrastructural Development Scheme Technology Development Modernisation Fund Venture Capital Scheme These schemes aim at solving the key issues in SSI ie., the problems of high tech project, marketing, infrastructure development, quality improvement, export financing and venture capital assistance. 3.3.2 Indirect Assistance Schemes Under its indirect schemes, SIDBI extends refinancing facility of loans to small scale sector by SFCs, SIDCs and Banks. Till now refinance is extended to 896 PLIs and these PLIs have their network extended to more than 67000 branches with the help of which they provide financing to these SSI. 3.3.3 Promotional and Development Activities SIDBI is also into providing other assistance to the SSI for its development besides limiting itself to the provision of simple financing. It involves itself in Entrepreneurship development programmmes, modernization programmes and micro credit schemes inorder to bring about economic empowerment of women specially in the rural areas by providing them opportunities of training and development. A.Refinance against term loans in respect of projects/activities eligible for assistance under the Scheme Interest on term loans for fixed asets and working capital advances (excluding interest tax) (% p.a.) Interest on Refinance (% p.a.) (i)Upto and inclusive of Rs. 25,000 12.0 9.0 (ii) Over Rs. 25,000 and upto Rs. 2 lakh Not exceeding 13.5 10.5 B.Refinance against term loans (Applicable to all eligible institutions) (except RRBs) Interest on term loans (excluding interest tax) (% p.a.) Interest on Refinance (% p.a.) (i) Upto and inclusive of Rs. 25,000 12.0 9.0 (ii) Over Rs. 25,000 and up to Rs. 2 lakh Not exceeding 13.5 10.5 (iii) Over Rs. 2 lakh Not exceeding 14.0* 12.0 4.3.4 Performance SIDBIs efforts have resulted in increased flow of credit to SSI sector since inception as indicated below: Year Sanction Disbursement 2000-01 2412 1819 2001-02 2847 2038 2002-03 2909 2146 2003-04 3357 2672 2004-05 4706 3390 2005-06 6266 4801 2006-07 6485 4588 2007-08 7481 5243 SIDBIs assistance to: (i) Tiny Units about 89.2% of the total no. of projects under Refinance Scheme during the period of 2006-07 were tiny, receiving an assistance upto Rs. 5 lakh . The total sanctions for such projects accounted for 39.6% as against 36% of the total amount of sanctions in previous year. (ii) Women entrepreneurs under various schemes available for financing of SSI the total assistance amounting to Rs. 19.07 crores was given to 1067 women entrepreneurs during 2006-07. (iii) Backward areas during 2006-07, the projects originating from backward areas for which the need for financing was felt, received an assistance to the level of Rs. 778 crores of the total sanction which accounted for 33% of total assistance under Refinance Scheme of SIDBI. 3.3.6 Main Schemes of SIDBI A brief summary of the Schemes available with SIDBI. More details are available under the Section Policies Schemes. National Equity Fund Scheme providing support to those entrepreneurs which are into setting up of projects in tiny sector. Technology Development Modernisation Fund Scheme this scheme aims for providing financial assistance to existing SSI units for matters relating to technology upgradation/modernisation. Single Window Scheme aims to provide both term loan as well as working capital loans to the small scale units through the same agency. Composite Loan Scheme this aims at providing loans for equipment and/or working capital and also for worksheds to artisans, village and cottage industries in Tiny Sector. Mahila Udyam Nidhi (MUN) Scheme this scheme aims to promote women as entrepreneurs by providing equity support to them for setting up projects in Tiny Sector. Scheme for financing activities: the need is even felt for the assistance in the field of marketing the products produced by the SSI and these include marketing research, RD, product upgradation, participation in trade fairs and exhibitions, advertising branding, establishing distribution networks etc. Equipment Finance Scheme this scheme is available inorder to help SSI with ease in using the hi-tech machinery and equipment for facilitating quality production. Venture Capital Scheme this is a provision made to encourage SSI ventures to acquire capital equipment,for building up of export capabilities/import substitution including cost of total quality management and acquisition of ISO-9000 certification and for expansion of capacity. Major schemes Technology Development Modernisation Fund SIDBI has set up Technology Development Modernisation Fund (TDMF) scheme for the assistance os small scale sector units so as to enable them to modernize their production techniques with the help new and improved technology so that their products can stand the foreign competition and the quality of their products can be enhanced. This would also help them to reduce their cost of production and removal of the inefficiencies in the production techniques. Assistance is available for meeting the expenses on purchase of capital equipments, acquiring of technical know-how, upgrading of process technology. The Coverage of the TDMF scheme has been enlarged w.e.f. 1.9.1997. Non-exporting units and units which are graduating out of SSI sector are now eligible to avail assistance under this scheme. National Equity Fund National Equity Fund (NEF) under Small Industries Development Bank of India (SIDBI) provides equity type assistance to SSI units, tiny units at one per cent service charges. The scope of this scheme was widened in 1998-99 to cover all areas excepting Metropolitan areas, raising the limit of loan from Rs. 1.6 lakhs to Rs. 2.6 lakhs and covering both existing as well as new units: (a) The following are eligible for assistance under the scheme:- i. New projects in tiny and small scale sectors for manufacture, preservation or processing of goods irrespective of the location (except for the units in Metropolitan areas). ii. Existing tiny and small scale industrial units and service enterprises as mentioned above (including those which have availed of NEF assistance earlier), undertaking expansion, modernisation, technology upgradation and diversification irrespective of location (except in Metropolitan areas). iii. Sick units in the tiny and small scale sectors including service enterprises as mentioned above, which are considered potentially viable, irrespective of the location of the units (except for the units in Metropolitan areas). iv. All industrial activities and service activities (except Road Transport Operators). (b) Project cost (including margin money for working capital) should not exceed Rs. 10 lakhs in the case of new projects in the case of existing units and service enterprises, the outlay on expansion/modernisation/technology upgradation or diversification or rehabilitation should not exceed Rs. 10 lakh per project. (c) There is no change in the existing level of promoters contribution at 10% of the project cost. However, the ceiling on soft loan assistance under the Scheme has been enhanced from the present level of 15% lakh per project to 25% of the project cost subject to a maximum of Rs. 2.5 lakh per project. 3.4 State Financial Corporations (SFCs) SFCs were set up mainly to finance small and medium scale units. The area of operation of SFCs is generally limited to the States. SFCs also actively participate in assisting small scale units thereby helping them to modernize and upgrade the technology by making provision for term loans and soft loans and also restructuring the sick small scale units through rehabilitation and revival schemes through equity assistance under SIDBI seed capital scheme. At present, there are 18 SFCs (including TIIC which was set up as a company) in existence for more than 40 years and operate as Regional Development Banks. The SFCs have played an important role in the evolution and growth of small and medium scale industries in their respective states. They provide financial assistance to industrial units by way of term loans, direct subscription to equity, guarantees, etc. Over the years SFCs have expanded their activities and coverage of assistance. 3.5 National Small Industries Corporation (NSIC) 3.5.1 Bill Financing Bills drawn by small scale units for the supplies made to the reputed and well established enterprises and duly accepted by them will be financed / discounted by NSIC for a maximum period of 90 days. 3.5.2 Working Capital Finance working capital financing of sound and well managed units, will be done on selective basis in case of requirements emerging, to enable them to make payments for their purchases of consumable stores and spares and production related expenses particularly electricity bills, statutory dues, etc. 3.5.3 Export Development Finance Finance for export development to export oriented units for meeting their emergent requirements. Pre and post shipment finance shall also be provided to such units at usual terms conditions. 3.5.4 Equipment Leasing Scheme The object of the Leasing Scheme is to assist SSI Units to procure industrial equipment for modernisation, expansion and diversification of their industries. ELIGIBILITY Exclusively for existing financially viable SSI units including ancillary units, duly registered as SSI units with the Directorate of Industries. BENEFITS Ø 100% financing at very liberal terms with easy repayment schedule. Ø Simple formalities and speedy sanction. Ø Single window system for imported equipment. The Corporation undertakes to complete formalities like procuring import licence, opening of Letter of Credit etc. Ø Tax rebate on full 5 year lease rental. VI. Review of some of the articles studied under the purview of the study 1) ISSUES IN SSI FINANCING SOURCE: The Hindu Newspaper editorial dated 5 Dec 2006 ANALYSIS: the article argues that the provisions of the credit policy relating to the advances to the NBFC for on lending to SSI would be treated as priority sector. but financing of small units, especially those in manufacturing, is hardly an attractive proposition for NBFCs. Over the past few years, the concept of priority sector lending, implying a preferential access to bank funds that small entrepreneurs and other less privileged categories enjoyed , has been diluted by including in this category bank lending for individual housing, lending to State Finance Corporations (SFCs) and advances to NBFCs for financing small transport operators. This has helped banks fulfill their priority sector obligation without having to oblige the thousands of needy individual entrepreneurs. Some of the deemed priority sector advances are in any case made by NBFCs or SFCs from public deposits and other resources that they command and deemed credit is thus unlikely to result in substantial additional financing of SSIs. 2) SIDBI PLANS Rs 250 CRORE MICRO FINANCING (SOURCE: Business Line newspaper dated 7 th sep 2004) ANALYSIS: as per the articles besides direct lending SIDBI is into provision of refinancing to the SFC for lending to SSI. It has been into lending to SSI or large corporate who buy goods from SSI including: BHEL, Escorts, Bajaj electrical etc the SME Fund has been operational since April 1. SIDBI aims to disburse Rs 10,000 crore in the next two years, which would include refinance. During the last four months, they have already disbursed Rs 605 crore mainly to SSI sector. 3) SSI SHARE IN BANK CREDIT FALLING (SOURCE: Business Line dated 25 aug, 2007) ANALYSIS: according to this article the credit flow towards the small scale units have declined in the past few decades. This fact can be supported by the figure that the level of financing was 16.2% in 1991 and till 2006 it declined to 8.5%. Total financing of the priority sector has declined accounting for the total disbursements by the scheduled commercial banks was 14,45,847 crore. Out of this only 6.24% was made available to the SSI. VII. Financing Norms: FOR LENDERS 1. The all India financial institutions stipulate a promoters contribution norm of 20% of the total project cost for industrial estates set up in notified less developed area and a 22.5% norm in other cases. In the case of estates costing less than Rs. 300 lakhs, the following margin money have been stipulated by IDBI to make them eligible for financing: * 15% margin for estates set up by technician entrepreneurs or unemployed engineers where the sheds are to be acquired by them on hire basis. * 20 to 30% margin for co-operative estates where the sheds are entirely by small scale units. * 30 to 35% margin for estates set up by joint stock companies whose shareholders occupies majority of the sheds. * 40 to 50% margin for estates set up by proprietary and partnership concerns. I. SFC/ SIDC should maintain separate and distinct accounts of fresh disbursements made to SSI units and outstanding amounts there against. II. Periodical statements to be obtained from SFC/ SIDC to monitor the position. III. Annually, a certificate issued by SFC/ SIDC statutory auditors certifying that the outstanding borrowings from banks were fully covered by the non-overdue loans outstanding in respect of fresh disbursements made to SSI units from out of term finance/ lines of credit granted by banks. IV. The rate of interest to be charged by banks on such term finance/ loans/ lines of credit will be in conformity with the directives on interest rates issued by the Reserve Bank from time to time. * In order to ensure adequate credit to this sector, the credit requirements of village industries and other SSI units having aggregate fund-based working capital limits upto Rs. 5 crores from the banking system, will be computed on the basis of a minimum of 20 percent of their projected annual turnover for new as well as existing units. VII. Analysis of growth of SSIs During Budget 2008-2009 1. The proposal that has been cornering much interest of industry players is minimum alternate tax (MAT), which has now been levied on technology companies. Though all technology firms have been brought under the ambit of MAT, the impact will not be much for big IT firms. 2. The Budget doesnt allow pass-through status to VC start-ups in sunrise sectors of BPO, media, advertising, financial services and mobile value added services. 3. Another budgetary reform that could also prove to be a thorn in the path for the SMEs is the 12.5% service tax on leased premises. President of Nasscom, Kiran Karnik, calls the increase as â€Å"unjust†. â€Å"It is usually the small guy who leases property. The big companies own their land,† 4. FM has proposed to exempt from service tax all services provided by technology business incubators. In turn, their incubatees whose annual turnover does not exceed Rs 50 lakh will be exempt from service tax for the first three years. How it affects SSIs 1. It was presented against a backdrop of high expectations with the economy having moved into the high growth trajectory of 8.5 per cent, supported by a strong growth in services and industry sector. 2. Yet many observers believe that big-ticket reform in Budget 2007-08 have not been taken on the way they should have and tax changes have left most quarters wanting, as substantial giveaways had been anticipated. 3. Small players felt serious impact on their net profits as now they would also have to shell out 11.33 percent MAT in addition to the 12 percent tax which they already pay. Also the small-sized BPO players suffered due to this levy. 4. The IT industry is happy with the proposal to grant pass-through status to VCFs investing in biotechnology and IT companies. But removal of this pass-through status for other areas such as mobile VAS and BPO had a negative impact. Targets under priority sector lending There are no targets set by domestic banks (both public sector and private sector banks) and foreign banks for lending to SSIs. as given in data below The targets and sub-targets set under priority sector lending for domestic and foreign banks operating in India are furnished below: Domestic banks (both public sector and private sector banks) Foreign banks operating in India Total Priority Sector advances 40 percent of NBC 32 percent of NBC Total agricultural advances 18 percent of NBC No target SSI advances No target 10 percent of NBC Export credit Export credit does not form part of priority sector

Nursing Knowledge

What makes Joanna Briggs Institute (JBI) a great source of knowledge for nursing references? It produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies. The column by JBI will cover a broad range of topics and will appear periodically in AJN. With reference to its official website, http://www.joannabriggs.edu.au, The Joanna Briggs Collaboration is a coordinated effort by a group of self-governing collaborative centres, coordinated through the leadership of The Joanna Briggs Institute. The legitimate operations of The Joanna Briggs Collaboration include the promotion of evidence-based health care; education and training; conducting of systematic reviews; the development of Best Practice Information Sheets; the implementation of evidence-based practice; and the conduct of evaluation cycles and primary research arising out of systematic reviews. Various collaborating centre have teamed up to produce excellent and up to date sources that are relatively relevant in medical field. A good source of research should be current, concise, and give factual evidences. The website also contains electronic copies of all JBI collaboration publications that includes such as; Best Practice Information Sheets, systematic reviews, evaluation cycle reports and practice manuals. What’s most important about this research source is that the evidence library offers a variety of reports such as product and technical reports, executive summaries, review protocols, and a Cochrane library. For further research, it offers various database such as a systematic review database and database of abstract reviews of effects. Overall, this research source will definitely help someone to find pertinent facts and information on medical field. Sigma Theta Tau International As a knowledge and leadership organization, the Honor Society of Nursing, Sigma Theta Tau International responds to health and nursing profession trends and issues that are germane to its mission.( http://www.nursingsociety.org/resources/main.html) The site is a good start point for research, here you will find; ØÂ   Resources and Position Papers – Position statements and resource papers about trends and key issues that are developed by the society. ØÂ   Global Alliances – affiliations alliances of society with other eminent international organizations for stronger organization. ØÂ   Various Organizational Affiliates ØÂ   National Quality Measures Clearinghouse – NQMC, sponsored by the Agency for Healthcare Research and Quality (AHRQ), it is a public storehouse for evidence-based quality measures and measure sets. The site offers more than a research source; it also acts a focal point for nursing communities where they can exchange information on various aspects of nursing. There is also a special link for student nurse resources and society resources. As they value their members they offer mentoring programs to enhance the leadership and potential skills of nurses. Its commitment does not only rely to library resources and research but also dedicated to its society, community and fellow members. They also have a foundation that serves the culmination of overall purpose of the organization. Certain communities are established to promote well being and participation in socio civic cultural activities of nurses. In general, this site offers a great mixture of facts, information, and interaction made by nurses to its fellow nurses. A well informative site that serves as a ground for various nurses all through out; thus, with the organization mission and vision that will has a parallel principle which will serve as continuous commitment to the society. References: http://www.joannabriggs.edu.au http://www.nursingsociety.org/resources/main.html

Dementia to Elderly in Uk

Abstract Dementia is characterized by evidence of short term and long term memory impairment with impaired abstract thinking, impaired judgment, disturbances of higher cortical thinking, and personality changes. It is basically a progressive decline of cerebral utility such as logic, remembrance, language, problem solving, or concentration. This disease greatly harms the day by day performance of a person and is seen more in older people, however, is not a normal part of aging. . INTRODUCTION 1. 1. Aim The aim of this dissertation is to analyze the effects of dementia in older people and to suggest possible solutions for its prevention and treatment. 1. 2. Objectives Primary objective of this research is to see how effective the health care management systems are for the diagnosis, treatment and prevention of dementia syndrome specially keeping in view the population of UK. 1. 3. Dementia defined The International Dictionary of Psychology (Sutherland, 1989) defines it as â€Å"an impairment or loss of mental ability, particularly of the capacity to remember, but also including impaired thought, speech, judgment, and personality. It occurs in senile dementia and in conditions involving widespread damage to the brain or narrowing of the blood vessels†. In the preceding definition, Sutherland introduced a different term, senile dementia. Senile is derived from the Latin adverb senex pertaining to age or growing old. This shows that some dementias occur at later or older ages for reasons not known. Definition of senile dementia as per The International Dictionary of Psychology is that it is â€Å"a progressive syndrome starting in old age with no clear cause, in which intellect, memory, and judgment are impaired; it is often accompanied by apathy or irritability† (Sutherland, 1989, p. 397). 1. 4. How common is dementia? In England only, there are approximately 570,000 people living with dementia. It is expected that this number would double in the coming 30 years (Barberger-Gateau, 2007). Generally dementia arises in people who are 65 years of age above. The chances of developing it are more as one gets old as compare to young people. Roughly, it is anticipated that dementia occurs in: †¢1. 4% of men and 1. 5% of women aged between 65 and 69, †¢3. 1% of men and 2. 2% of women aged between 70 and 74, †¢5. 6% of men and 7. 1% of women aged between 75 and 79, †¢10. 2 % of men and 14. 1% of women aged between 80 and 84, and †¢19. 6% of men and 27. 5% of women aged 85 or over. 2. LITERATURE REVIEW In the preceding paragraphs, we will discuss in detail the different kinds of dementia that occur to people at older age along with a number of causes that lead towards this syndrome. . 1. Types of dementia Following are the different types of dementia recognized so far (Davidson, 2005): †¢Alzheimer's disease, where tiny clusters of protein, known as plaques, start to build up around brain cells. This upsets the regular workings of the brain. †¢Vascular dementia, where troubles with blood distribution result in uneven supply of blood and oxygen to certain parts of the brain. †¢Dementia with Lewy bodies, where irregular structures, known as Lewy bodies, grow inside the brain. †¢Frontotemporal dementia, where the two parts of the brain, frontal and temporal lobes, start to shrink. Not like other types of dementia, frontotemporal dementia typically grows in people who are below 65 years of age and is very rare than other types of dementia. 2. 2. Different Kinds of Dementia Different kinds of dementing disorders exist. One way of classification is according to parts of the brain being affected. Some frequently used classifications are as follows: †¢Cortical dementia: This type of dementia damages the brain particularly affecting the brain's cortex, or outer layer. Problems such as memory, language, thinking, and social behavior results due to this disoder. Sub cortical dementia: It affects parts of the brain below the cortex and causes changes in emotions and movements along with damaging memory. †¢Progressive dementia: It gets worse with the passage of time, thus interfering more and more with cognitive abilities. †¢Primary dementia: This denotes to that form that does not result from any other disease such as AD. †¢Secondary dementia: This type of dementia occurs due to some physical disease or injury. †¢Treatable Dementia: About 10 percent of conditions that cause dementia are treatable. With treatment, the dementia can either be upturned or at least halted. Instances of conditions that cause treatable cases of dementia comprise of the following: ?Normal pressure hydrocephalus ?A brain tumor or brain cancer ?Hypothyroidism ?Vitamin B12 deficiency ?Neurosyphilis ?Reactions to medications ?Poisoning. †¢Non-Treatable Dementia: Types of dementia that currently have no cure include: †¢Lewy body dementia †¢Binswanger's disease †¢Frontotemporal dementia †¢Corticobasal degeneration †¢Certain conditions that can cause childhood dementia †¢HIV-associated dementia Other infections within the brain, such as Creutzfeldt-Jakob disease †¢Huntington's disease and other rare hereditary dementias †¢Head trauma, such as dementia pugilistica (also known as boxer's syndrome). Several types of dementia fit into more than one of these classifications. For instance, AD is considered both a cortical as well as progressive dementia. 2. 3Causes 2. 3 . 1Alzheimer's disease It is the most common cause of dementia, affecting around 417,000 people in the UK. German neurologist Alois Alzheimer first described Alzheimer's disease. According to him, it is a physical disease affecting the brain. All through the course of the disease, plaques and tangles develop in the brain, thus leading to the loss of brain cells. Shortage of some important chemicals in the brain also results due to this disease. These chemicals are concerned with the spread of messages within the brain. 2. 3. 2Vascular dementia Vascular dementia is the second most common form of dementia after Alzheimer's disease. It is caused by problems in the supply of blood to the brain. There are a number of conditions that can cause or increase damage to the vascular system. These include high blood pressure, heart problems, high cholesterol and diabetes. This means it is important that these conditions are identified and treated at the earliest opportunity. 2. 3. 3Dementia with Lewy bodies Dementia with Lewy bodies (DLB) is a form of dementia that has characteristics similar to both Alzheimer's and Parkinson's diseases. It makes around four per cent of all cases of dementia in older people. Lewy bodies, named after the doctor who first identified them in 1912, are tiny, spherical protein deposits found in nerve cells. Their presence in the brain disrupts the brain's normal functioning, interrupting the action of important chemical messengers, including acetylcholine and dopamine. Researchers have yet to understand fully why Lewy bodies occur in the brain and how they cause damage. 2. 3. 4Fronto-temporal dementia The term ‘fronto-temporal dementia' includes conditions such as Pick's disease, frontal lobe degeneration, and dementia associated with motor neurone disease. All these are due to damage to the frontal lobe and/or the temporal parts of the brain. These areas are responsible for our behaviour, emotional responses and language skills. . 3. 5Korsakoff's syndrome Korsakoff's syndrome is a brain disorder usually linked with heavy alcohol utilization over a long period. Sometimes it is referred to as ‘alcohol amnestic syndrome' ? ‘amnestic' meaning loss of memory ? although in rare cases alcohol is not the cause. Although Korsakoff's syndrome is not strictly speaking a dementia , people with the condition suffer loss of short-term memory. 2. 3. 6Creutzfeldt-Jakob disease Prions are contagious agents that onslaught the central nervous system and then occupy the brain, causing dementia. Known prion disease is Creutzfeldt-Jakob disease, or CJD. It was first reported by two German doctors (Creutzfeldt and Jakob) in 1920. 2. 3. 7Aids-related cognitive impairment Individuals with HIV and AIDS occasionally develop cognitive impairment – particularly in the later stages of their sickness. AIDS (acquired immune deficiency syndrome) is caused by the presence of the human immunodeficiency virus (HIV) in the body. HIV attacks the body's immune system, making the person affected more susceptible to infection. HIV-related cognitive impairment can be caused by: ? The direct impact of HIV on the brain Infections (called ‘opportunistic infections') that take advantage of the weakened immune system. 2. 3. 8Binswanger's disease Binswanger's disease is a unusual form of vascular dementia in which harm occurs to the blood vessels in the deep white matter of the brain. Symptoms of Binswanger's mostly occur in people over the age of 60 and it is usually linked with long-ter m hypertension. The disease chiefly affects memory and mental abilities such as thinking and learning. The individual may also experience mood swings, tremors, seizures and problems with walking. 2. 3. 9Huntington's disease Huntington's disease is a progressive inherited disease. It typically becomes obvious in adults in their 30s, even though it can occur earlier or later. There is also a puerile type of Huntington's, which affects children. The route of the disease varies for each person, and dementia can occur at any stage of the illness. 2. 4Diagnosis Diagnosis of dementia is based on the following: †¢History †¢Physical exam †¢Tests The process of identifying dementia is made only if two or more brain functions such as memory and language skills are extensively damaged without loss of consciousness. An early and precise dementia diagnosis can help in early treatment of dementia symptoms and maybe reversing the dementia or stopping its development, if the cause of dementia is reversible (such as normal pressure hydrocephalus, a brain tumor, or B12 deficiency). †¢Patient History History taking is a very important step in identifying dementia. It is important to know how and when symptoms developed and about the patient's overall medical condition. Is there any risk factor involved or there is any family history of similar symptoms along with any medication the person is taking. Physician also try to evaluate the patient's emotional state and the degree of day to day actions being affected in spite of of the fact that patients with dementia frequently are ignorant of or in denial about how their disease is affecting them. Typically the family members also deny the reality of the disease because they take this in the beginning as a usual procedure of aging. Therefore, additional steps are necessary to confirm or rule out a dementia diagnosis. †¢Physical Exam: A physical examination can help in the following: ?Rule out treatable causes of dementia Classify signs of stroke or other disorders that can add to dementia ? Identify indications of other illnesses, such as heart disease or kidney failure that can be related with dementia. A thorough neurological assessment is performed to evaluate the balance, sensory function, reflexes, and other functions of the patient and to spot signs of conditions that may have an effect on the diagnosis of dementia. †¢Tests Used in Diagnosing Dementia Tests that are used to diagnosis dementia include the following: ?Cognitive and neuropsychological tests (Mini-Mental State Examination (MMSE) ? Brain scans (MRI or CT scan) Laboratory tests ?Psychiatric evaluations ?Pre-symptomatic testing. †¢Cognitive and Neuropsychological Tests for Dementia Tests are done to measure memory, language skills, math skills, and other abilities associated to mental functioning to help them analyze a patient's condition precisely. A test called the Mini-Mental ® State Examination (MMSEâ„ ¢) is used to judge cognitive skills in people with assumed dementia. This test examines: ? Orientation ?Memory ?Attention Doctors also use a diversity of other tests and rating scales to categorize explicit types of cognitive problems and abilities. †¢Brain Scan Tests for Dementia Brain scans are carried out to recognize strokes, tumors, or other problems that can result dementia. A brain scan may also demonstrate cortical atrophy (the progressive loss of neurons causes the ridges to become thinner and the sulci to grow wider), which is the deterioration of the brain's cortex (outer layer) and is frequent in many forms of dementia. Brain scans can also spot changes in the brain's organization and function that would propose Alzheimer's disease. †¢Computed Tomography Scan or Magnetic Resonance Imaging The most general types of brain scans are computed tomography (CT) scans and magnetic resonance imaging (MRI). A CT scan of the brain frequently suggested in a patient with suspected dementia. These scans, which use x-rays to detect brain structures, can show evidence of: ?Brain atrophy ?Strokes and transient ischemic attacks (TIAs) ?Changes to the blood vessels ?Other problems (such as hydrocephalus and subdural hematomas). MRI scans use magnetic fields and focused radio waves to detect hydrogen atoms in tissues within the body. They can detect the same problems as CT scans but they are better for identifying certain conditions, such as brain atrophy and damage from small TIAs. †¢Electroencephalograms (EEGs) Electroencephalograms (EEGs) are another tool to assist in inspecting people with suspected dementia. In an EEG, electrodes are placed on the scalp over several parts of the brain in order to detect and record patterns of electrical activity and to check for abnormalities. This electrical activity can indicate cognitive dysfunction in part or all of the brain. Many patients with moderately severe to severe Alzheimer's disease have abnormal EEGs. An EEG may also be used to detect seizures, which occur in about 10 percent of people with Alzheimer's disease. It can also help diagnose Creutzfeldt-Jakob disease. †¢Other Brain Scan Tests Several other types of brain scans allow researchers to watch the brain as it functions. These scans, called functional brain imaging, are not often used as diagnostic tools, but they are important in research and they may ultimately help identify people with dementia earlier than is currently possible. Types of functional brain scans include: ?Functional MRI (fMRI): It uses radio waves and a strong magnetic field to measure the metabolic changes that take place in active parts of the brain. ?Single photon-emission computed tomography (SPECT): It shows the distribution of blood in the brain, which generally increases with brain activity. Positron emission tomography (PET): This scans can detect changes in glucose metabolism, oxygen metabolism, and blood flow, all of which can reveal abnormalities of brain function. ?Magneto encephalography (MEG): This can show the electromagnetic fields produced by the brain's neuronal activity. †¢Laboratory Tests for Dementia Doctors may use a variety of laboratory tests to help diagnose dementia or rule out other conditions, such as kidney failure, which can contribute to symptoms. A partial list of these tests includes: ?A complete blood count (CBC) Blood glucose test, which measures sugar levels in the blood ? Urinalysis ?Drug and alcohol tests (toxicology screen) ?Cerebrospinal fluid analysis (to rule out specific infections that can affect the brain) ? Analysis of thyroid and thyroid-stimulating hormone levels. ?A doctor will order only the tests that he or she feels are necessary to improve the accuracy of a diagnosis. †¢Psychiatric Evaluation The healthcare provider may recommend a psychiatric evaluation to determine if depression or another psychiatric disorder may be causing or contributing to a person's symptoms. Pre-Symptomatic Testing In most cases, testing people before symptoms begin in order to determine if they will develop dementia is not possible. However, in cases involving disorders such as Huntin gton's where a known gene defect is clearly linked to the risk of the disease, a genetic test can help identify people who are likely to develop the disease. Since this type of genetic information can be devastating, people should carefully consider whether they want to undergo such testing. 2. 5Treatment For about 10 percent of conditions that cause dementia, treatment is available that can help reverse or at least slow down its progression. Some examples of these treatable causes of dementia include: †¢A brain tumor †¢Normal pressure hydrocephalus †¢Hypothyroidism. For most cases, treatment does not exist to reverse or halt the disease's progression; however, this does not mean that nothing should be done. People with dementia can benefit to some extent from such things as medications and cognitive training. There are also options for the family to help them cope. 2. 6Risk Factors Scientists have found a number of risk factors for dementia that affect the likelihood of developing one or more kinds of dementia. While these are not causes of dementia, they may increase a person's chances of developing the symptoms referred to collectively as dementia. Some dementia risk factors can be treated or controlled and some cannot Some of these risk factors for dementia are modifiable, while others are not.. Also, certain risk factors are more likely to increase the risk for certain types of dementia. For example, the risk of vascular dementia is strongly correlated with risk factors for stroke. Finally, the more dementia risk factors you have, the greater your chances of having dementia. An example of risk factors for dementia that you cannot change involves getting older (the risk of dementia tends to increase with age). Other dementia risk factors you cannot control include having: †¢Age †¢A family history of dementia †¢Down syndrome †¢Mild cognitive impairment †¢History of a stroke. Dementia risk factors that you can control include: †¢Hypertension †¢hypercholesterolemia †¢Diabetes †¢Atherosclerosis †¢Smoking †¢Heavy alcohol use. †¢Homocysteine levels in the blood. There are also things that can be controlled that increase your risk for developing diabetes, atherosclerosis, and other conditions that may increase your risk of developing dementia. These include: †¢Being overweight or obese †¢Lack of physical activity †¢Unhealthy diet. ?Age Age is the utmost risk aspect for dementia. Dementia influences one in 14 people over the age of 65 and one in six over the age of 80. However, Alzheimer's is not limited to aged people: in the UK, there are 15,000 people under the age of 65 with dementia, although this figure is likely to be an underrated. ?Genetic inheritance Several people fear that they may become heir to Alzheimer's disease, and scientists are presently exploring the hereditary background to Alzheimer's. In most of the cases, the effect of inheritance appears to be minute. If a parent or other family member has Alzheimer's disease, probability of developing the disease is only a slight elevated than if there were no cases of Alzheimer's in the direct family. ?Environmental factors The ecological factors that may add to the onset of Alzheimer's disease have yet to be discovered. Not many years ago, there were concerns that revelation to aluminum might cause Alzheimer's disease. Nevertheless, these fears have largely been discounted. ?Other factors Because of the dissimilarity in their chromosomal structure, people with Down's disorder who live into their 50s and 60s may develop Alzheimer's disease. People who have had stern skull or whiplash wounds also come out to be at increased risk of developing dementia. Boxers who get frequent blows to the head are at risk too. Study has also revealed that people who smoke, and those who have elevated blood pressure or sky-scraping cholesterol levels, augment their risk of developing Alzheimer's. 2. 7 Care of people with dementia People with moderate and advanced dementia typically need round-the-clock care and supervision to prevent them from harming themselves or others. They may also need assistance with daily activities such as eating, bathing, and dressing. Meeting these needs requires patience, understanding, and careful thought from the person's caregivers. For people involved with dementia care, there are some important things to consider. These include such things as: †¢Making the home safe †¢Helping to reduce stressors †¢Providing mental stimulation. Good dementia care always involves the issue of driving. One of the hardest things to do is to take away a person's independence that comes with driving. However, for a number of reasons that we will explain later, people with dementia should not drive. 2. 7. 1Dementia Care and the Home A typical home environment can present many dangers and obstacles to people with dementia, but simple changes can overcome many of these problems. For example, sharp knives, dangerous chemicals, tools, and other hazards should be removed or locked away. Other safety precautions include: †¢Installing bed and bathroom safety rails †¢Removing locks from bedroom and bathroom doors Lowering the hot water temperature to 120 °F (48. 9 °C) or less to reduce the risk of accidental scalding. People with dementia should also wear some form of identification at all times in case they wander away or become lost. Caregivers can help prevent unsupervised wandering by adding locks or alarms to outside doors. 2. 7. 2Reducing Stressors People with dementia ofte n develop behavioral problems because of frustration with specific situations. Understanding and modifying or preventing the situations that trigger these behaviors may help to make life more pleasant for the person with dementia as well as his or her caregivers. For instance, the person may be confused or frustrated by the level of activity or noise in the surrounding environment. Reducing unnecessary activity and noise (such as by limiting the number of visitors and turning off the television when it's not in use) may make it easier for the person to understand requests and perform simple tasks. Caregivers may also reduce confusion in people with dementia by: †¢Simplifying home decorations †¢Removing clutter †¢Keeping familiar objects nearby †¢Following a predictable routine throughout the day. Calendars and clocks also may help patients orient themselves. . 7. 3Mental Stimulation as Part of Dementia Care Caregivers should encourage people with dementia to continue their normal leisure activities as long as they are safe and do not cause frustration. Activities such as crafts, games, and music can provide important mental stimulation and improve mood. Some studies have suggested that participating in exercise and intelle ctually stimulating activities may slow the decline of cognitive function in some people. 2. 7. 4Is Driving Safe? Many studies have found that driving is unsafe for people with dementia. They often get lost and they may have problems remembering or following the rules of the road. They may also have difficulty processing information quickly and dealing with unexpected circumstances. Even a second of confusion while driving can lead to an accident. Driving with impaired cognitive functions can also endanger others. Some experts have suggested that regular screening for changes in cognition might help to reduce the number of driving accidents among elderly people, and some states now require that doctors report people with Alzheimer's disease to their state motor vehicle department. However, in many cases, it is up to the person's family and friends to ensure that the person does not drive. 2. 7. 5How the local authority assesses need Local authority social services departments are the main providers of care and support services. If a person with dementia or their carer is in need of support, they should contact the local social services department to explain. The department will then carry out an assessment of the person's needs and identify what services would be appropriate to meet those needs. This is known as a community care assessment If the department assesses a person as being in need of certain services, it has a duty to provide the services that fall within their eligibility criteria (locally set rules on what type of needs the local authority will meet). The person may have to contribute towards the cost of these services. Local authorities can provide services directly themselves, or may make arrangements for private or voluntary-sector organizations to provide care on their behalf. Services ary from area to area, but range from those that allow someone to remain independent in their own home (such as meals on wheels, day care, equipment and home adaptations) to residential care. The views and preferences of the person receiving the service should always be taken into account. 2. 7. 6Care plans If, after assessing the person's care needs, the social services department agrees that certain services should be provided, it will give the person a written care plan out lining these services. This applies whether the person lives at home or in a care home. Care plans should be reviewed regularly and as needs change. If a review has not been carried out recently, or if one may be necessary, the person or their carer should contact social services and ask for a review. In addition, care homes must provide an individual care plan for each resident. This must be regularly reviewed to take account of changing needs. 2. 7. 7Thinking through the options Once the social services department has confirmed what services the person is eligible to receive, the person and their carer can begin to think through the options. Even if the assessment concludes that the person's needs are not yet urgent enough to receive help from social services, or if some services are not available under the local authority's eligibility criteria, an assessment will give everyone clearer information about the situation and the kinds of help available from other sources. The person or their family or carer could arrange services themselves, or through a voluntary organization or private agency. A key decision is whether the person can remain in their own home, or whether they would prefer to move into sheltered housing or a care home. If they stay in their own home, there are many additional support options available. It is also important to consider the financial implications of the options available. Social services should be able to give an idea of how much the person will have to pay towards the costs of the various services that are arranged through them. Services provided by the NHS, such as community nursing, are free. Anyone who is arranging services themselves, whether through a voluntary organisation or a private agency, will need to make their own enquiries. It is important not to rush into a decision. It might help to also talk to friends and relatives, other carers and your local Alzheimer's Society branch. Local voluntary organisations are a source of further information, advice and practical help. Below is some guidance about what to consider when you are thinking about the kind of care the person in question needs. 2. 7. 8Understanding and respecting the person with dementia It's very important that people with dementia are treated with respect. It is important to remember that a person with dementia is still a unique and valuable human being, despite their illness. If you can understand what the person is going through, it might be easier for you to realise why they behave in certain ways. When a person with dementia finds that their mental abilities are declining, they often feel vulnerable and in need of reassurance and support. The people closest to them – including their carers, health and social care professionals, friends and family – need to do everything they can to help the person to retain their sense of identity and feelings of self-worth. 2. 7. 9Helping the person feel valued The person with dementia needs to feel respected and valued for who they are now, as well as for who they were in the past. There are many things that the people around them can do to help, including: †¢trying to be flexible and tolerant †¢making time to listen, have regular chats, and enjoy being with the person †¢showing affection in a way they both feel comfortable with †¢finding things to do together. Our sense of who we are is closely connected to the names we call ourselves. It's important that people address the person with dementia in a way that the person recognises and prefers. Some people may be happy for anybody to call them by their first name or nickname. †¢Others may prefer younger people, or those who do not know them very well, to address them formally and to use courtesy titles, such as Mr or Mrs. Make sure you explain the person's cultural or religious background, and any rules and customs, to anyone from a different background so that they can behave accordingly. These may include: †¢respectful forms of address †¢what they can eat †¢religious observances, such as prayer and festivals particular clothing or jewellery that the person (or those in their presence) should or should not wear †¢any forms of touch or gestures that are considered disrespectful †¢ways of undressing †¢ways of dressing the hair †¢how the person washes or uses the toilet. Many people with dementia have a fragile sense of self-worth; it's especially important that people continue to treat them with courtesy, however advanced their dementia. †¢Be kind and reassuring to the person you're caring for without talking down to them. †¢Never talk over their head as if they are not there – especially if you're talking about them. Include them in conversations. †¢Avoid scolding or criticising them – this will make them feel small. †¢Look for the meaning behind their words, even if they don't seem to be making much sense. Whatever the detail of what they are saying, the person is usually trying to communicate how they feel. †¢Try to imagine how you would like to be spoken to if you were in their position. †¢Try to make sure that the person's right to privacy is respected. †¢Suggest to other people that they should always knock on the person's bedroom door before entering. If the person needs help with intimate personal activities, such as washing or using the toilet, do this sensitively and make sure the door is kept closed if other people are around. †¢Everyone involved – including the person's friends, family members, carers, and the person with dementia themselves – reacts to the experience of dementia in their own way. Dementia means different things to dif ferent people. There are lots of things you can do to help the person with dementia feel good about themselves. This factsheet offers some suggestions. When you spend time with someone with dementia, it is important to take account of their abilities, interests and preferences. These may change as the dementia progresses. It's not always easy, but try to respond flexibly and sensitively. Dementia affects people's thinking, reasoning and memory, but the person's feelings remain intact. A person with dementia will probably be sad or upset at times. In the earlier stages, the person may want to talk about their anxieties and the problems they are experiencing. †¢Try to understand how the person feels. Make time to offer them support, rather than ignoring them or ‘jollying them along'. †¢Don't brush their worries aside, however painful they may be, or however insignificant they may seem. Listen, and show the person that you are there for them. †¢Make sure that, whenever possible, you inform and consult the person about matters that concern them. Give them every opportunity to make their own choices. †¢Always ex plain what you are doing and why. You may be able to judge the person's reaction from their expression and body language. †¢People with dementia can find choice confusing, so keep it simple. Phrase questions so that they only need a ‘yes' or ‘no' answer, such as ‘Would you like to wear your blue jumper today? ‘ rather than ‘Which jumper would you like to wear today? ‘ †¢Avoid situations in which the person is bound to fail, as this can be humiliating. Look for tasks that they can still manage and activities they enjoy. ive plenty of encouragement. Let them do things at their own pace and in their own way. †¢Do things with the person, rather than for them, to help them retain their independence. †¢Break activities down into small steps so that they feel a sense of achievement, even if they can only manage part of a task. Our self-respect is often bound up with the way we look. Encourage the person to take pride in their appearance, and compliment them on how they look. Make sure that anyone involved in caring for the person has as much background information as possible, as well as information about their present situatio n. This will help them see the person they're caring for as a whole person rather than simply ‘someone with dementia'. It may also help them to feel more confident about finding conversation topics or suggesting activities that the person may enjoy. 2. 8How effective is heath care management? Health care management involves several techniques to cater the needs of the patient. It should be kept in mind that patient is not responsible for the disease and therefore should not be ignored or avoided. With the advancement in technology, different techniques can be used to look after the suffer of this disorder. However, these techniques and ways could only help the victim survive a bit since. Those kinds of dementia which are treatable and such patients have a different perspective and outlook of life as compared to those who are the victims of the untreatable ones. So the care also varies with these two kinds of patients. Effectiveness of the present day health care management system is satisfactory but as said earlier it cannot bring back the life of the victim, however could let him or her survive for few more days with a happy face. 3. DEMENTIA IN UK Following statistics give a clear cut idea about the ratio and proportion of dementia patients in UK: †¢There are currently 700,000 people with dementia in the UK. †¢There are currently 15,000 younger people with dementia in the UK. †¢There are over 11,500 people with dementia from black and minority ethnic groups in the UK. There will be over a million people with dementia by 2025. †¢Two thirds of people with dementia are women. †¢The proportion of people with dementia doubles for every 5 year age group. †¢One third of people over 95 have dementia. †¢60,000 deaths a year are directly attributable to dementia. †¢Delaying the onset of dementia by 5 years wo uld reduce deaths directly attributable to dementia by 30,000 a year. †¢The financial cost of dementia to the UK is over ? 17 billion a year. †¢Family carers of people with dementia save the UK over ? 6 billion a year. †¢64% of people living in care homes have a form of dementia. Two thirds of people with dementia live in the community while one third live in a care home. 4. LIVING WITH DEMENTIA People with dementia have become increasingly involved in the work of the Alzheimer's Society since 2000. Through a national programme called ‘Living with Dementia', people with dementia have been sharing their experiences and knowledge, and raising awareness of dementia at local and national levels. This contribution is crucial to ensure that the Alzheimer's Society develops appropriate information and support for people with dementia. It ensures that people with dementia can influence the work that the Society carries ut on their behalf. On a national level the Living with Dementia programme consults with people with dementia in support of the Alzheimer's Society's work of influencing government policy. †¢People with dementia in action People with dementia are involved in the Alzheimer's Society in a variety of ways: ? Giving presentations and raising public awareness. ?Organising the unique UK wide convention of people with dementia. ?Lobbying MPs and commenting on government legislation. ?Being interviewed by national press and television. ?Recruiting and inducting new staff at the Alzheimer's Society. ?Helping to make the website easier to use. Developing information for other people with dementia and their families. ?Participating in the national consultative body, the Living with Dementia Working group. These are just a few examples. There are many opportunities in the Living with Dementia programme †¢Living with Dementia Programme Various initiatives in the Alzheimer's Society have focused on ways of supporting people living with dementia. Many started as two year pilots in 2001 and 2002, but are now established as a core part of the Alzheimer's Society activity. Examples of current initiatives are listed below: †¢West Kent Computer project Started in 2001. It supports people with dementia using computer equipment, to find new ways of communicating, pursuing interests and have fun. †¢Living with Dementia presentation skills training For people with dementia. Everyone affected by dementia has their own unique story to tell. Personal experiences and views are a powerful way of raising awareness about dementia, making issues come alive. Training people with dementia to share their experience on TV, press and at meetings, helps to reduce the misunderstanding that surrounds dementia and offers hope to people facing the same situation. Providing key skills enables people to undertake publicity work with confidence. †¢Helpcard for people with dementia Developed in 2007 by people with dementia and piloted by people with dementia. The helpcard enables people with dementia to feel confident, not alone and able to ask for help at anytime. It is very useful in emergency situations, and is an effective communication tool that informs others of a person's circumstances. There are three different designs, with three different options for describing particular situations. †¢National conference for people with dementia The Alzheimer's Society has hosted three conferences for people with dementia in London, Newcastle and Birmingham (Thompson, Nanni & Schwankovsky, 1990). The latter two involved members from the Living with Dementia Working group and the Scottish Dementia Working Group, making them the only UK wide events for people with dementia. In Newcastle the ‘Improving Our Lives' feedback included: ?Get out and enjoy life ?Laugh! Confidence ?Remaining the same person after diagnosis ?Open positive communication ?Speak up – have your voice listened to ?Speak to your MP Being denied treatment – medication because of a ‘cost cutting' exercise – it's a disgrace ? Set up an email group ?Done more since having dementia – living my life to the full 5. RESEARCHES Currently, scientists are conducting research on many different aspects of dementia. This research promises to improve the lives of people affected by such symptoms and may eventually lead to ways of pre venting or curing the disorders that result in dementia. Some areas of focus for dementia research include: †¢Causes and prevention †¢Diagnosis †¢Treatment. Researching the Causes and Prevention of Dementia Research on the causes of Alzheimer's disease (and other disorders that are causes of dementia) includes studies of: †¢Genetic factors †¢Neurotransmitters †¢Inflammation †¢Factors that influence programmed cell death in the brain †¢The roles of tau, beta amyloid, and the associated neurofibrillary tangles and plaques in Alzheimer's disease. Some other dementia research scientists are trying to determine the possible roles of cholesterol metabolism, oxidative stress (chemical reactions that can damage proteins, DNA, and lipids inside cells), and microglia in the development of Alzheimer's disease. Current research on dementia prevention and causes includes the following: †¢Research to better understand the role of aging-related proteins (such as the enzyme telomerase) in the development of dementia. †¢Studies of abnormal clumps of proteins in cells. Researchers are trying to learn how abnormal clumps of protein in cells develop, how they affect cells, and how the clumping can be prevented. †¢Studies that examine whether changes in white matter — nerve fibers lined with myelin — may play a role in the onset of Alzheimer's disease. Myelin may erode in Alzheimer's disease patients before other changes occur. This may be due to a problem with oligodendrocytes, the cells that produce myelin. †¢Work being done by scientists to search for additional genes that may contribute to Alzheimer's disease. These researchers have identified a number of gene regions that may be involved in the development of Alzheimer's. Some researchers suggest that people will eventually be screened for a number of genes that contribute to Alzheimer's disease and that they will be able to receive treatments that specifically address their individual genetic risks. However, such individualized screening and treatment is still years away. †¢Studies on insulin resistance. Insulin resistance is common in people with Alzheimer's disease, but it is not clear whether the insulin resistance contributes to the development of the disease or if it is merely a side effect. †¢Several dementia research studies have found a reduced risk of dementia in people who take cholesterol-lowering drugs called statins. However, it is not yet clear if the apparent effect is due to the drugs or to other factors. Therefore, more research is being currently being done be better understand this possible relationship between statins and dementia. †¢ A 2003 dementia research study found that people with HIV-associated dementia have different levels of activity for more than 30 different proteins, compared to people who have HIV but no signs of dementia. The study suggests a possible way to screen HIV patients for the first signs of cognitive impairment, and it may lead to ways of intervening to prevent this form of dementia. Research in this area continues. Research Involving Diagnosis of Alzheimer's Disease Improving early diagnosis of Alzheimer's disease and other disorders that may cause dementia is important not only for patients and families, but also for researchers who seek to better understand the causes of dementia and find ways to reverse or halt them at early stages. Improved diagnosis can also reduce the risk that people will receive inappropriate treatments. †¢In some resea rch, scientists are investigating whether three-dimensional computer models of positron emission tomography (PET) and magnetic resonance imaging (MRI) can identify brain changes typical of early Alzheimer's disease, before any symptoms appear. This research may lead to ways of preventing the symptoms of Alzheimer's disease. †¢One study found that levels of beta amyloid and tau in spinal fluid could be used to diagnose Alzheimer's disease with an accuracy of 92 percent. If other studies confirm the validity of this test, it may allow doctors to identify people who are beginning to develop the disorder before they start to show dementia symptoms. †¢This would allow treatment at very early stages of the disorder, and may help in testing new treatments to prevent or delay symptoms of the disease. Other researchers have identified factors in the skin and blood of Alzheimer's disease patients that are different from those in healthy people. They are trying to determine if these factors can be used to diagnose the disease. Treatment Research †¢Researchers are continually working to develop new drugs for Alzheimer's disease and other causes of dementia. Many researchers believe a vaccine that reduces the number of amyloid plaques in the brain might ultimately prove to be the most effective treatment for Alzheimer's disease. In 2001, researchers began one clinical trial of a vaccine called AN-1792. The research study was halted after a number of people developed inflammation of the brain and spinal cord. †¢Despite these problems, one patient appeared to have reduced numbers of amyloid plaques in the brain. Other patients showed little or no cognitive decline during the course of the study, suggesting that the vaccine may slow or halt the disease. Researchers are now tryi ng to find safer and more effective vaccines for Alzheimer's disease. Researchers are also investigating possible methods of gene therapy for Alzheimer's disease. In one case, researchers used cells genetically engineered to produce nerve growth factor and transplanted them into monkeys' forebrains. The transplanted cells boosted the amount of nerve growth factors in the brain and seemed to prevent degeneration of acetylcholine-producing neurons in the animals. †¢This suggests that gene therapy might help to reduce or delay symptoms of the disease. Researchers are now testing a similar therapy in a small number of patients. Other researchers have experimented with gene therapy that adds a gene called neprilysin in a mouse model that produces human beta amyloid. They found that increasing the level of neprilysin greatly reduced the amount of beta amyloid in the mice and halted the amyloid-related brain degeneration. They are now trying to determine whether neprilysin gene therap y can improve cognition in mice. †¢Since many studies have found evidence of brain inflammation in people with Alzheimer's disease, some researchers have proposed that drugs that control inflammation, such as NSAIDs, might prevent the disease or slow its progression. Studies in mice have suggested that these drugs can limit production of amyloid plaques in the brain. Early studies of these drugs in humans have shown promising results. †¢However, a large NIH-funded clinical trial of two NSAIDs (naproxen and celecoxib) to prevent Alzheimer's disease was stopped in late 2004 because of an increase in stroke and heart attack in people taking naproxen (Aleve ®, Naprosyn ®, Anaprox ®, Naprelan ®), and an unrelated study that linked celecoxib (Celebrex ®) to an increased risk of heart attack. Some research studies on dementia have suggested that two drugs, pentoxifylline and propentofylline, may be useful in treating vascular dementia. Pentoxifylline improves blood flow, while propentofylline appears to interfere with some of the processes that cause cell death in the brain. †¢One research study is testing the safety and effectiveness of donepezil (Aricept ®) for treating mild dementia in patients with Parkinson's dementia, while a nother is investigating whether skin patches with the drug selegiline can improve mental function in patients with cognitive problems related to HIV. . CONCLUSION An appropriate cost effective workup of dementia includes a complete history, a complete physical examination (including a neuropsychiatric evaluation), a CBC, blood glucose, serum electrolytes, serum calcium, serum creatinine, and serum thyroid stimulating hormone (Whitlatch, Feinberg & Tucke, 2005). Other tests should be done only if there is a specific indication for e. g. vitamin B12 and folate if macrocytosis is present (Wilkinson & Lennox, 2005). A CT or MRI should be considered if the onset of dementia is before the age of 65 years, symptoms have occurred for less than 2 years, there is evidence of focal or asymmetrical neurological deficits, the clinical picture indicates normal pressure hydrocephalus, or there is a recent history of fall or other head trauma. If a patient has a history of cancer or is on anticoagulation therapy, then neuro imaging should also be considered. Thus to conclude, it is sufficient to say that dementia, though a dangerous disorder, having not much cures, can be prevented by undergoing certain precautionary measures as illustrated above.

Analysis Of Oedipus The King - 917 Words

Those who believe they can triumph over fate deserve to be crushed by the overwhelming weight of reality that will come crashing down on them. Ordinarily confidence yields benefit in moderation, however, it proves damaging when used excessively. Oedipus the King was written by Sophocles thousands of years ago as a cautionary tale about hubris. As a king, Oedipus rules over the city of Thebes with an arrogant attitude and believes that he can defy the gods. Through the events of the novella, Oedipus lost everything after uncovering that he killed his father and had children with his mother. Conversely the real downfall of Oedipus came from his pride and failure to handle the situation carefully. Oedipus fills the archetype of tragic†¦show more content†¦He could have saved himself a lot of grief if he had used this information to his advantage and exiled himself right then and there. Tiresias even warned that â€Å"wisdom is a dreadful thing when it brings no profit to the possessor† (Sophocles 23). Once again Oedipus could have listened to the prophet or at least payed closer attention. There was no part in the prophecy that said anyone would even find out about it. If this information was used correctly, he could have left Thebes using some excuse and prevented people from finding out the truth that led him to suffer. Oedipus may have deserved some of the punishment he was given, but the extent which he received rouses pity from the characters and audience alike. At the climax of the story Oedipus stated, â€Å"I stand revealed- born in shame, married in shame, an unnatural murderer† (Sophocles 88). After this realization he comes to admit the nature of his existence and no longer attempts to subvert the will of the Gods. His brother-in-law comes to pity him saying â€Å"I have not come to mock you, Oedipus, nor reproach you for the wrong you did. If you have no respect for the feelings of human beings at least show some for the sunlight, which nourishes them all† (Sophocles 101). Creon shows pity for Oedipus and all he has done, including accusing him of conspiring to take his place as king. He also directs the people on how they should respond to Oedipus and his predicament. The inescapability ofShow MoreRelatedAnalysis Of Oedipus The King 1127 Words   |  5 Pages For A Life Of Regrets Oedipus the King is a play written by Sophocles. Oedipus is the main figure and legend of Sophocles play. After Oedipus birth into the world, his father King Laius of Thebes heard from a prophet that his own child was destined to kill him. Sophocles play begins from past to present and starts to unravel the journeys Oedipus goes through. Oedipus isn t an evil character as one would think while reading the story. He neverRead MoreAnalysis Of Oedipus Oedipus The King 1152 Words   |  5 Pagesreading Oedipus the King. The number of times the words â€Å"see† or â€Å"blind† are in the play make it make it undeniably obvious that they are significant. The theme is developed throughout the dialogue, through characters such as Tiresias and Oedipus, and also directly in the irony of the play. It is important in a play about the truth because almost every character was â€Å"blind† to the truth. All of the characters, except one, can physically see, bu t mentally cannot see the truth. Oedipus seems toRead MoreCritical Analysis Of Oedipus The King1025 Words   |  5 PagesCritical Analysis: Oedipus the King Oedipus the King is a tragic play showing a shift from the belief of fate to freedom of choice. Therefore, Oedipus the king is a great example of those who run from fate ends up fulfilling their fate After reading this type of tragic play â€Å"Oedipus the King† written by Sophocles you can see that the author did a very outstanding form of presenting a tragedy that has the characteristics of mimesis and a tragic hero. Specifically, the writer written the playRead MoreOedipus the King Character Analysis1321 Words   |  6 PagesLancaster ENG230 11/25/2010 Oedipus the King Character Analysis Oedipus the King had accomplished many great things during his reign of Thebes and in his life time. Oedipus found out during his reign in Thebes that the Gods who loved him also knew his devastating fate. As a young man when Oedipus answered the riddle the Sphinx he soon found his self having everything want and need. He earned his spot as the new King of Thebes, he had a great wife and lovely set of childrenRead MoreAnalysis Essay: Oedipus the King1017 Words   |  4 Pages Casual Analysis Essay: Oedipus the King Sophocles play Oedipus the King has endured for over two thousand years. The plays lasting appeal may be attributed to the fact it encompasses all the classical elements of tragedy as put forth by Aristotle in Poetics nearly a century before it was written. According to Aristotle, tragedy needs to be an imitation of life according to the law of probability or necessity. Tragedy is serious, complete, and has magnitude. It must have a beginning, middleRead MoreOedipus The King Character Analysis1429 Words   |  6 Pages Mrs. Long-Goldberg Honors World Lit/Comp 26 September, 2017 Ignorance Can Lead to Great Agony Plays were of great importance in early Greek culture. Plays were the main source of entertainment, and one of the most prominent examples is Oedipus the King written by Sophocles. The drama is uplifted by the character development and excellent structure Sophocles has put forward. Interactions between characters and each character’s motivations generate brilliant themes throughout the play. SophoclesRead MoreCharacter Analysis Of Oedipus The King1419 Words   |  6 PagesAdhikari Mrs. Long-Goldberg Honors World Lit/Comp 26 September, 2017 Ignorance Can Lead to Great Agony Plays were of great importance in early Greek culture. Plays were the main source of entertainment, and one of the most prominent examples is Oedipus the King written by Sophocles. The drama is uplifted by the character development and excellent structure Sophocles has put forward. Interactions between characters and each character’s motivations generate brilliant themes throughout the play. SophoclesRead MoreOedipus The King Analysis1357 Words   |  6 PagesThe Greek play, Oedipus the King, shows how easy it is for a man to fall apart, while trying to make things right. Sophocles’ tragedy tells the story of Oedipus, a regular man turned king of Thebes. Throughout the tragedy, Oedipus searches for the cause of the chaos and havoc encompassing his land; however, he discovers that he is the one responsible for the hardships plaguing Thebes. As the tragedy continues, Sophocles’ exposes a dark side to power, fame, and ambition. Further, Sophocles’ expose sRead MoreAnalysis Of Oedipus The King 1696 Words   |  7 PagesDaKan Wei Professor Annjeanette Wiese HUMN 1110 1 October 2014 Fatalism in Oedipus the King Tragedy has always been considered the highest form of literature; Oedipus the King is written by Sophocles who is one of the three ancient Greek tragedians, it fully represents the enduring charm of the ancient Greek tragedy, leaving the reader endless thinking. Through Oedipus’ misfortune, Sophocles tries to reveal the cause of their tragedy is ubiquitous and ever-present fate,Read MoreAnalysis Of Oedipus The King1145 Words   |  5 PagesOedipus goes against the Chorus as he strongly defends himself as the people intensify his incrimination of killing the old king. Oedipus could not believe in his wildest dreams that he murdered his own father and was the husband of his mother. As an adopted runaway boy and a newfound king, he had to dig deep in his past to ease his burden. The Chorus’ incrimination of the King has brought the town into a downward spiral due to finding the real truth of the blind prophet. The relevance of Oedipus’