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Guide
The Independent Age advice service offers free information and advice
on issues affecting older people. All the guides we publish are available
from our website www.independentage.organd paper versions can be
ordered by calling 020 7241 8522.
You can also call our advice line on 0845 262 1863to arrange an
appointment to speak to one of our experienced advisers.
Guide 9
Memory loss, depression,
confusion and dementia
Memory loss, depression, confusion and dementia are not an inevitable
part of ageing, but these conditions do happen to people in older age. This
guide explains what to do if you or someone you know experiences any of
these illnesses, and what support and help is available.
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Independent Age is a unique and growing charity providing information,
advice and support for thousands of older people across the UK and the
Republic of Ireland.
There are differences in the ways each country cares for and supports older
people. The information in this guide applies to England and Wales although
there may be similarities with countries in the rest of the UK.
If you live in Scotland and have concerns about your, or someone elses
mental health, contact the Scottish Association for Mental Health (SAMH)
([email protected],samh.org.uk). If you have questions about dementia,
please contact Alzheimer Scotland (0808 808 3000,alzscot.org).
If you live in Northern Ireland and have concerns about your, or someone
elses mental health, contact the Northern Ireland Association for Mental
Health (028 90328 474,niamhwellbeing.org). If you have questions about
dementia, please contact the Alzheimers Society (0845 300 0336,
alzheimers.org.uk).
All of the guides we publish can be downloaded fromindependentage.orgor
posted to you if you call our guide order line on 020 7241 8522.
Guide 9: Memory loss, depression, confusion and dementia, August 2013August 2013
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mailto:[email protected]:[email protected]://www.samh.org.uk/http://www.samh.org.uk/http://www.samh.org.uk/http://www.alzscot.org/http://www.alzscot.org/http://www.alzscot.org/http://www.niamhwellbeing.org/http://www.niamhwellbeing.org/http://www.alzheimers.org.uk/http://www.alzheimers.org.uk/http://www.independentage.org/http://www.independentage.org/http://www.independentage.org/http://www.independentage.org/http://www.alzheimers.org.uk/http://www.niamhwellbeing.org/http://www.alzscot.org/http://www.samh.org.uk/mailto:[email protected].8/12/2019 9 Memory Loss Depression Confusion and Dementia
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Contents
1 Memory loss................................................................ 4
2 What is depression?.....................................................5
Depression in care home residents................................... 6
3 Treatments for depression...........................................7
Counselling.................................................................... 7
Psychotherapy, psychology and psychiatry....................... 8
Cognitive behavioural therapy........................................ 9
Medication................................................................... 9
Combating loneliness................................................... 10
4 Confusion................................................................. 13
5 What is dementia?....................................................... 14
6 Symptoms of dementia................................................ 15
7 Diagnosis of dementia................................................. 17
8 What help is available for people with dementia?........18
Support from the NHS................................................... 18
Support from your local council social services................ 19
Independent advocacy.................................................. 20
Support from the voluntary sector.................................. 20
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1 Memory loss
Although older people may sometimes experience memory loss it is not an
inevitable part of getting older. Short-term memory loss may be prompted by
a difficult time, such as bereavement, or being worried about something.
Once this period has passed, concentration and memory difficulties should
also improve.
However, if symptoms begin suddenly or they persist or increase, it is
important to speak to a GP about your concerns. It may be that the
symptoms are being caused by something that is treatable, such as an
infection, a thyroid gland problem, depression or stress. If your memory loss
is affecting your ability to cope with everyday tasks, or if you feel you are
putting yourself or others at risk, you can request a full assessment of your
needs from your local council social services. This assessment should identify
what difficulties you are experiencing and what support could be provided to
meet your needs. For more information about needs assessments, see our
guideAssessment and services from your local council (Guide 12).
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2 What is depression?
Depression can affect anyone and it can manifest in different ways.
Symptoms may include:
ongoing sadness or feeling low feelings of worthlessness, low self-esteem, or low self-confidence tearfulness not sleeping at night or sleeping more than usual waking very early in the morning poor concentration poor memory problems with eating and appetite not feeling like eating, or eating
too much as a way to comfort yourself
feeling anxious and worried unexplained aches and pains lacking energy, not wanting to go out or do things that you normally
enjoy.
Although its not always recognised, depression affects older people just as
much as younger people. This may be due to older people having to deal with
bereavement, retirement, loss of social networks, health problems or sensory
loss, which can result in them becoming isolated and lonely. Sometimes the
symptoms of severe depression are mistaken for dementia. If you think you
may be suffering from depression you can ask your GP to carry out a health
assessment or refer you to a suitable medical practitioner. If you are
diagnosed with depression you should ask your GP to explain to you the
range of treatments available. You should not automatically be prescribed
anti-depressant medication without consideration being given to treatment
through other forms of therapy. If you would prefer to seek help from a
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counsellor or a psychologist for your depression, you should discuss this
with your GP.
Depression in care home residents
Depression among residents in care homes is often poorly recognised or
goes undiagnosed. If you think that someone living in a care home is
depressed, you can ask for the care home manager to arrange a GP
assessment so that it can be diagnosed and treated. You can also enquire if
a care package which will provide more activities, social interaction and
stimulation can be arranged.
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3 Treatments for depression
Therapy can help because it addresses the causes or reasons for the
depression, rather than just the symptoms. If you are diagnosed with
depression, there are a number of treatments you could consider.
Counselling
Counselling gives you the opportunity to talk freely and in confidence to a
person who is not a friend or relative. The counsellor is trained to listen to
you so you can tell them how you are feeling and they then can assist you to
resolve the problem. Counselling can help you become more aware of why
you are feeling or behaving the way you do, and help you to become more
accepting of your feelings and more satisfied with your life. The counsellor
should not judge you in any way or try to tell you what to do.
There are many different types of counsellor, depending on the training they
have had. It is important to find one you can feel comfortable with it may
even be worth finding one who has experience of working with older people,
although you may have limited choice if your counselling is through the NHS
or a voluntary organisation. Counselling can be conducted over the telephone
or face-to-face. It can be a one-off session or regular meetings over a
period of a few weeks or several months. Self-help support groups also can
give you an opportunity to talk with others who are feeling the same way or
going through similar problems.
Counselling through the NHSYour GP may be able to refer you to an NHS counselling service.
Counselling through the NHS is free of charge, though there can be long
waiting lists. Although it is not available everywhere, many GP practices
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employ counsellors or can refer you to a psychotherapist or a clinical
psychologist. If your GP does not mention counselling, you can ask them
to refer you.
Counselling through voluntary organisations or charitiesSome charities offer counselling for specific problems. For example,
Cruse Bereavement Care (0844 4779400,crusebereavementcare.org.uk)
provides counselling for people who have experienced bereavement.
Mind (0300 123 3393,mind.org.uk) provides counselling for people with
mental health issues. Your local branch of Age UK or Age Concern (0800
169 65 65,ageuk.org.uk)may have information on local charities which
provide counselling in your area. Services may be free or there may be a
small charge, possibly based on a sliding scale depending on your
income.
Private counselling
Another option, if you can afford it, is to see a private counsellor. Details of
individual counsellors are available from the British Association for
Counselling and Psychotherapy (BACP) (01455 883 300,
itsgoodtotalk.org.uk/therapists/). It is important that the counsellor is
qualified and registered with the BACP. Many private counsellors or
psychotherapists will offer an initial consultation free of charge to enable
both parties to decide if a programme of counselling will be helpful.
Psychotherapy, psychology and psychiatryIf you are diagnosed with severe or chronic depression, you may be
referred to an NHS psychotherapist, psychologist or psychiatrist. A
psychiatrist who is working with patients aged 65 and over is known as a
psycho-geriatrician. They will be able to provide intensive long-term
Guide 9: Memory loss, depression, confusion and dementia, August 2013August 2013
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http://www.crusebereavementcare.org.uk/http://www.crusebereavementcare.org.uk/http://www.mind.org.uk/http://www.mind.org.uk/http://www.ageuk.org.uk/http://www.ageuk.org.uk/http://www.ageuk.org.uk/http://itsgoodtotalk.org.uk/therapists/http://itsgoodtotalk.org.uk/therapists/http://www.ageuk.org.uk/http://www.mind.org.uk/http://www.crusebereavementcare.org.uk/8/12/2019 9 Memory Loss Depression Confusion and Dementia
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therapy in order to analyse and help you to understand the origins and
roots of the depression. In some areas, there can be long waiting lists for
psychotherapy and psychology treatments on the NHS.
Cognitive Behavioural Therapy (CBT)
CBT is increasingly the treatment therapy most favoured by the NHS. It can
be beneficial in the treatment of a variety of mental health problems such
as depression, anxiety, panic disorder, phobias, post traumatic stress and
obsessive compulsive disorder (OCD). CBT can help you to change negative
thought patterns that lead to certain feelings or behaviour patterns. A NHS
patient is usually offered between six to eight sessions of CBT, although this
can be extended. If you think you may find CBT helpful, discuss with your
GP whether a referral for CBT is appropriate for you.
Medication
Sometimes depression can be caused or aggravated by an imbalance of
chemicals in the brain. Anti-depressant medication could help to correct the
imbalance.
Anti-depressants can only be prescribed by your GP or a psychiatrist. You
may have to take them for six months or longer to treat the depression
properly. There can be side-effects from taking anti-depressant medication,
for example, you may feel sick or you may feel more agitated. If this
happens, contact your GP promptly, but do not stop taking the medication
until you have spoken to your GP and they have agreed you should stop.
They will advise you how to reduce the level of your medication safely, or
change it to another sort of medication. You must let your GP know if you
are taking any over-the-counter medications or any herbal remedies, as
anti-depressants can sometimes have an adverse effect on other
medications.
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Combating loneliness
Feeling lonely happens to most people at some time. It may occur if you
live on your own, you find it difficult to meet people or you have recently
been through a big change such as a divorce, retirement or bereavement.
Loneliness can be both a cause and consequence of depression.
Suggestions to combat loneliness include:
trying a Homeshare scheme. This will allow you to remain in yourhome with live-in help at no additional cost to you. This arrangement
could provide you with some companionship and help with basic
household chores. The scheme works by you offering accommodation
in your home to a tenant in exchange for an agreed number of hours
of support per week. SharedLivesPlus (sharedlivesplus.org.uk)
coordinate homeshare schemes in the UK. There are only a few
schemes at present. The contact details for homeshare schemes in
London, Bristol, Cumbria and East Susssex are available on the
website.
asking your local council social services or your local branch of AgeUK or Age Concern (0800 169 6565,ageuk.org.uk) to tell you about
social clubs, day centres and social activities in your local area. They
may also be able to provide you with transport or know of local
community transport schemes to get you there. Befriending schemes
provide trained volunteers to visit you in your own home, join you on
an outing, or telephone you for a chat. Contact Independent Age
(0845 262 1863,independentage.org)for details of befriending
schemes in your area. Getting in contact with Contact the Elderly (0800 716 543,contact-
the-elderly.org), which is a charity which organises monthly Sunday
afternoon tea parties for people aged 75 or over who live alone.
offering a home to an unwanted pet for companionship. The RSPCA
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http://www.sharedlivesplus.org.uk/http://www.sharedlivesplus.org.uk/http://www.ageuk.org.uk/http://www.ageuk.org.uk/http://independentage.org/http://independentage.org/http://independentage.org/http://www.contact-the-elderly.org/http://www.contact-the-elderly.org/http://www.contact-the-elderly.org/http://www.contact-the-elderly.org/http://www.contact-the-elderly.org/http://www.contact-the-elderly.org/http://independentage.org/http://www.ageuk.org.uk/http://www.sharedlivesplus.org.uk/8/12/2019 9 Memory Loss Depression Confusion and Dementia
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(0300 1234 555,rspca.org.uk)and local pet rescue organisations
may be able to help you find a suitable pet. The Peoples Dispensary
for Sick Animals (0800 731 2502,pdsa.org.uk)and the Blue Cross
(0300 777 1897,bluecross.org.uk) run subsidised veterinary services
if you are on a low income and your pet is unwell.
considering volunteering at a charity in your local area. Most areashave a local Volunteer Centre which will be able to put you in touch
with useful organisations. Contact Volunteering England
(0845 305 6979,volunteering.org.uk) for details of your nearest
Volunteer Centre or have a look at the volunteering database, Do-it
(do-it.org.uk)for local volunteering opportunities. Charity shops in
the high street are often seeking volunteers to help. The Retired and
Senior Volunteer Programme (RSVP) is a national organisation that
supports people aged 50 and upwards to find voluntary work (020
7643 1385,csv-rsvp.org.uk).
taking up physical exercise as it is good for your health and providesan opportunity to meet new people. The National Institute of Health
and Clinical Excellence (NICE) recommends that older people should
be advised on how to exercise safely for 30 minutes a day, broken
down into 10 minute sessions on at least five days a week. Ordinary
everyday activities can be included in this exercise, such as shopping,
housework, gardening and cycling. If you want to improve your
exercise routine, you may wish to join a local walking group. Your GP
surgery, local library or local council may provide you with information
about local walking schemes. Alternatively, you could have a look atthe Walking for Health website (whi.org.uk) and use their Walk
Finder. Regular swimming is also recommended, and many local
councils offer concessionary rates at swimming pools to people aged
65 and over. Exercise classes and aerobic water activities, some of
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http://www.rspca.org.uk/http://www.rspca.org.uk/http://www.rspca.org.uk/http://www.pdsa.org.uk/http://www.pdsa.org.uk/http://www.pdsa.org.uk/http://www.bluecross.org.uk/http://www.bluecross.org.uk/http://www.volunteering.org.uk/http://www.volunteering.org.uk/http://www.do-it.org.uk/http://www.do-it.org.uk/http://www.do-it.org.uk/http://www.csv-rsvp.org.uk/http://www.csv-rsvp.org.uk/http://www.whi.org.uk/http://www.whi.org.uk/http://www.csv-rsvp.org.uk/http://www.do-it.org.uk/http://www.volunteering.org.uk/http://www.bluecross.org.uk/http://www.pdsa.org.uk/http://www.rspca.org.uk/8/12/2019 9 Memory Loss Depression Confusion and Dementia
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which may be specifically targeted at older people, may be available
at your local swimming pool or leisure centre.
Eating a good, nutritious diet and eating regular meals, which canhelp to counteract the effects of mild depression.
speaking to your GP if you are suffering from poor sleep patterns oranxiety, in order to seek treatment or solutions.
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4 Confusion
Symptoms of confusion can include dizziness, not being able to think with
your usual clarity or speed, not recognising where you are or feeling tearful
and agitated. Confusion can be temporary or permanent.
If these symptoms develop in a short space of time they may be caused by
a physical illness, such asa chest or urinary infection, or not eating or
drinking enough. Medical help should be sought from your GP as soon as
possible so that the condition can be diagnosed, treated and brought under
control.
The symptoms of confusion could also be a result of a reaction to any
tablets or medicine you are taking. If you are prescribed any new
medication, your GP should check that it will not react with something you
are already taking. If you do experience side-effects, speak to your GP
immediately.
Older people with dementia are also often described as confused.
However, it is more likely that someone with dementia will have other
symptoms as well, such as behaviour which is unusual or out of character.
If you are worried that you or someone you know may have dementia,
speak to the GP as soon as possible.
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5 What is dementia?
The term dementia is used to describe conditions that cause the progressive
decline of mental ability. Dementia will often affect the ability to remember,
learn, think and reason. It may also cause a gradual loss of social and daily
living skills. There are many different types of dementia.
Sometimes the symptoms of dementia develop slowly and the start of the
condition is difficult to pinpoint. In other cases, dementia can develop
suddenly and progress quickly. In either case, the effect on the person with
dementia, their family and carers can be very distressing.
Dementia can affect people at any age, but it is more likely to happen the
older someone becomes. One in six people over the age of 80 will have some
form of dementia. At the moment, there is no cure for dementia, although
treatments and medication are available that can help slow the development
and symptoms of the disease.
It is important to remember that dementia is not an inevitable result of old
age; most older people will never suffer from any type of dementia.
For more information about dementia, see our guideLiving with Dementia
(Guide 9a).
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6 Symptoms of dementia
Although dementia usually develops over a long period of time, not everyone
will be affected in the same way. Some people may experience a rapid decline
in their mental ability. However, dementia caused by Alzheimer's disease can
take 10 to 15 years to develop and may only become apparent if the person
experiences a trauma, such as moving home, or a bereavement. Dementia
may affect:
learning the ability to learn new skills, for example, difficulties withlearning how to use a new piece of equipment
memory many people become more forgetful, particularly about therecent past, for example, whether they have taken their medication or
not. They may forget faces and names, even of familiar people
communication speech is often affected as people may find itdifficult to remember certain words, names of people or objects,
express themselves or to understand other people
personality and behaviour some people experience significantmood swings, for example, they may become suddenly tearful or angry,
while others may become withdrawn and delusional and believe things
are happening which are not, and others still may walk around, but
forget their purpose, sometimes called wandering
disorientation some people find they have a problem understandingtime and place and, because of this, may get lost or do things at an
inappropriate time
depression this can affect a person's ability to concentrate and copewith life
personal care people with severe dementia may find it difficult tocomplete tasks in the correct order. They may need assistance
preparing meals, washing, dressing and going to the toilet
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judgement as the dementia progresses, the persons ability to makejudgements about the risks to themselves from hazards may diminish,
for instance, they might not be able to use the cooker safely but are
unaware of this
mobility as the illness progresses the persons ability to keep theirbalance and walk steadily may deteriorate
continence a person with dementia may experience problems withcontinence because they may not recognise the need to use the toilet.
If they have difficulty remembering learnt skills, they may not be able
to locate or use the toilet.
Many people who are in the early stages of dementia may only experience
slight forgetfulness and occasional out-of-character behaviour. People with
advanced dementia are often severely affected and may require 24-hour
care at home or in a care home which employs staff specialised in dementia
care.
The Alzheimers Society has published a best practice guide for health and
social care professionals to use in clinical and care home settings. It is called
Optimising treatment and care for people with behavioural and psychological
symptoms of dementia. It is available from
http://alzheimers.org.uk/site/scripts/download_info.php?fileID=1163
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7 Diagnosis of dementia
If you are worried that you or someone you know may have dementia,
speak to the GP as soon as possible - they will be able to check whether
you, or the person you are concerned about, is demonstrating signs of
dementia and will investigate the cause of the symptoms. Sometimes, the
symptoms are caused by other treatable conditions, such as depression,
thyroid gland disorders or a reaction to certain drugs. It is important that
other possible causes are investigated.
The GP will normally refer the person with dementia to a psychiatrist who
specialises in the care of older people a psycho-geriatrician - for a full
diagnosis. The person with dementia may be referred to a memory clinic
where professionals from a wide range of disciplines will carry out a thorough
investigation into the most likely cause of memory loss, and can then begin
the appropriate treatment. In order to be clear about the diagnosis, the
psychiatrist may ask the patient to visit the assessment unit or memory clinic
over the course of a few weeks, or a community psychiatric nurse (CPN) may
visit them at home.
If you, or someone you know, has been given a diagnosis of dementia which
you do not agree with, you should talk to the GP to understand the reasons
for this diagnosis, or you can ask for a second opinion.
Further specialist advice about dementia can be obtained from the
Alzheimer's Society (0300 222 11 22,alzheimers.org.uk).
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8 What help is available for people with
dementia?
Living with dementia or caring for someone with dementia can be difficult,
and can cause stress, financial hardship and a sense of isolation. It is
important to try to obtain as much support as possible.
Support from the NHS
If you have symptoms of dementia, your GP should refer you to the local
hospital's psychiatrist for older people, or memory clinic, if there is one in
your area. If you are diagnosed with dementia, the psychiatrist will provide
advice on medication that might help to control the condition or slow down
the development of the disease. You may also be provided with other
services, which could include:
seeing a community psychiatric nurse (CPN) who can give you adviceand support
a regular place in a day hospital (if you have severe dementia) whereyou can receive nursing care and therapy as well as lunch and leisure
activities. This support can also help carers by giving them a regular
break from their caring role
periods of regular respite care in a hospital or nursing home providedby the NHS and your local council social services
visiting district nurses who can come to your home to provide nursingcare, such as changing dressings or giving medication
NHS Continuing Healthcare Funding to pay for your care (if you havesevere dementia). For more information about this, see our guide
Continuing Healthcare: Should the NHS be paying for your care
(Guide 27).
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Support from your local council social services
The social services department at your local council must carry out aneeds assessment if it appears that you need support. If your needs
meet your local councils eligibility criteria, the council may be able to
provide support services such as personal and home care, meals to be
delivered to your home, a laundry service or cleaning. For more
information about services you may be eligible to receive, see our
guide,Help at home: What may be available in your local area
(Guide 14).
Occupational therapists can advise on and arrange for you to havespecialist equipment, such as a walker or hand rails to help you carry
on living at home. They can also arrange for larger adaptations to your
home, such as a walk in shower or a stair lift. For more information
about getting equipment or adaptations, see our guideHousing:
adapting your home to stay independent (Guide 28).
Telecare refers to technology products which can help older people,including those with dementia, to remain independent at home for
longer and can delay the need to move into residential care. For more
information on telecare and how to obtain it, read our guideTelecare
and telehealth: what it is and how to get it(Guide 6).
Social services must also look at the needs of carers of people withdementia and carers can ask for an assessment of their own needs,which is known as a carers assessment. Social services may be able to
provide respite care, a sit-in service or training to support you in your
role as a carer. For more information, see our guideCarers: what
support is available (Guide 10).
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Independent advocacy
People who lack capacity can often benefit from the assistance of an
independent advocate. This is someone who can act in the interests of the
person who may lack capacity, and can make sure their opinions and wishes
are taken into consideration. An independent advocate may be particularly
helpful in situations where there is dispute among family members as to the
best future care of a relative, or when there is conflict about future care
decisions between the older person and the professional or statutory care
services. An independent advocate can try to establish the wishes and needs
of the older person and represent their points of view to the professionals
involved. For more information about advocacy, see our guideIndependent
advocacy(Guide 25).
Support from the voluntary sector
In many areas, voluntary and charitable organisations provide services to
support people with dementia and their carers.
The Alzheimer's Society (0300 222 11 22,alzheimers.org.uk) is anational organisation set up to help and support people with dementia
and those caring for them. They produce a wide range of booklets and
guides on dementia and the caring of dementia patients. Their national
office can provide specialist advice and they have a network of local
branches throughout the country which offer a range of services, such
as advice and support groups for the carers of people with dementia.
Contact the central office for details of your local office.
Dementia UK (0845 257 9406,dementiauk.org) is an organisationwhich has developed Admiral Nursing in various parts of the country.
Admiral nurses work to promote good practice in dementia care and, in
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particular, to support the needs of carers and families of people with
dementia. Their helpline is open on Tuesdays, Thursdays and Saturday
mornings.
Carers UK (0808 808 7777,carersuk.org)is a national organisation
providing advice and support to carers. It also runs support groups
where you can talk to people in similar circumstances. The helpline is
open on Wednesdays and Thursdays.
Age UK (0800 169 65 65,ageuk.org.uk) is a national organisation with
local branches that often provide services such as good neighbour
schemes, handywork and gardening services, lunch clubs and advice
services. You can contact the national office to obtain details of your
local office.
Parkinsons UK (0808 800 0303,parkinsons.org.uk)provides advice
and information to people who have Parkinsons Disease and their
families and carers. It also can also give information about local support
groups.
There may be other services provided by other voluntary groups, depending
on where you live. Your local library or council social services should be able
to tell you about these.
Guide 9: Memory loss, depression, confusion and dementia, August 2013August 2013
21
http://www.carersuk.org/http://www.carersuk.org/http://www.carersuk.org/http://www.ageuk.org.uk/http://www.ageuk.org.uk/http://www.parkinsons.org.uk/http://www.parkinsons.org.uk/http://www.parkinsons.org.uk/http://www.parkinsons.org.uk/http://www.ageuk.org.uk/http://www.carersuk.org/8/12/2019 9 Memory Loss Depression Confusion and Dementia
22/22
Independent Age T020 7605 4200
6 Avonmore Road [email protected]
London www.independentage.org
W14 8RL Advice line 0845 262 1863
The Royal United KingdomBeneficent Association
I d d t A i th ti
This guide is not a full explanation of the law and is aimed at people aged
over 60.
If you would like free, personal advice on mental health or any
issue related to social care, benefits, loneliness or isolation, please
call our advice line on 0845 262 1863.
If you have found our advice useful, please consider making a donation. We
receive no state funding and rely on income from individuals, trusts and
other sources to continue providing our services to hundreds of thousands
of people in need. For further information on how to support us, please see
our website independentage.orgor call 020 7605 4288.
Independent Age, August 2013