The mental health and well-being of people living with dementia

Chapters 8 & 9 focus on dementia. There is growing evidence of links between lifecourse inequalities and dementia. These are a mixture of structural issues such as poor education; mental health issues such as persistent mid-life depression; and physical conditions such as diabetes. Age related risk factors include social isolation and loneliness. These links reinforce the ‘accumulation of risks’ thesis and suggest that the causes of dementia are more complex and situated than is traditionally believed. In community-based populations, depression is estimated to affect about a fifth of people with Alzheimer's disease and a third of those with vascular dementia; up to half of care home residents with dementia have depression. Dementia produces high rates of anxiety symptoms particularly restlessness, agitation and fear; delirium is relatively common. The issues that protect quality of life of people with dementia are: psychological wellbeing, autonomy, having a meaningful role, acceptance, agency, promotion of selfhood and identity, relationships, financial security, and religious beliefs. Pre-dementia attributes such as personality type and how well a person adjusts to their diagnosis have a stronger influence on quality of life than having the condition per se. Most work capturing the perspectives of people living with dementia is done with those in the earlier stages.