Mr. W was referred for an evaluation, and the current outcomes provide a few important details. Firstly, one should draw attention to the fact that the diagnosis of dementia was made in 2011, and the patient did not experience any evident symptoms of the condition for the next three years. Secondly, a decent medication list is also significant because drugs can significantly affect Mr. Ws cognitive functions. Thirdly, specific test results also indicate that dementia may not be an appropriate diagnosis for the patient. In particular, Mr. W was fully oriented and could provide specific details of his life. The patients speech was also fluent, while most tests of sustained attention showed normal results. However, the area of complex visuospatial processing was a weakness. This information demonstrates that dementia may not be the case for Mr. W, but it is reasonable to administer additional assessment instruments to ensure whether the patient has this condition.
Discussion
The Abbreviated Mental Test (AMT-4) is the first suggested instrument. According to Carpenter et al. (2019), it is an effective tool to diagnose dementia because its positive likelihood ratio was assessed as 7.69 at a 95% confidence interval. This data demonstrates that if a person has dementia, the selected instrument offers a high probability of identifying this diagnosis. It is possible to state that the tool is ethical because it does not subject individuals to harmful effects and is appropriate for professionals since it usually takes five minutes to administer the test (Carpenter et al., 2019). In addition to that, it is worth admitting that the instruments reliability was assessed as 0.90, while the validity was close to 0.75 (Tanglakmankhong et al., 2021). These figures demonstrate that AMT-4 can be applied to assess Mr. Ws conditions.
Simultaneously, the Brief Alzheimers Screen can be used to conclude that the patient does not have dementia. Carpenter et al. (2019) stipulate that this instrument has the lowest likelihood ratio of diagnosing a patient with this condition when it is absent. It is possible to claim that the given instrument offers high validity scores because its sensitivity is estimated at 95% (Carpenter et al., 2019). As for reliability, it is challenging to find the specific statistical value of this construct, but it is possible to expect good results. The rationale behind this statement is that the test only includes five activities that ask a patient to say the current data, remember words, spell a word backward, and others. It is possible to expect that the results can be reproduced under the same conditions. The description above also demonstrates that no ethical issues are present, and professionals can easily implement the instrument.
Conclusion
Finally, the Clock Drawing Test can be used to assess Mr. Ws conditions. This brief neuropsychological test is requested because it is an effective screening instrument to diagnose dementia on its own or as part of a test battery (Hwang et al., 2019). The given tool offers a few advantages since it is free of charge and easy to administer (Hwang et al., 2019). According to Emek-Sava_ et al. (2018), the test reliability can be assessed as 0.72-0.98. Approximately the same figures describe the instruments validity, and Emek-Sava_ et al. (2018) state that this phenomenon can be estimated at 0.72-0.92. Numerous articles confirm the fact that the selected tool is professional and ethical (Hwang et al., 2019; Emek-Sava_ et al., 2018). Consequently, it is reasonable to use the three instruments to assess Mr. W and make a final diagnosis.
Over recent times, Dementia has been increasingly reported as a worrying health problem across the world. According to Hickman et al. (2007), approximately 24.3 million people in the world had dementia in 2005, and an estimated 4.6 million new cases are reported every year. This scholarly study by Hickman and his fellow researchers further reports that going by the current trends, by 2040, this number will rise to about 81.1 million peoplewhich really is a perturbing figure, to say the least.
In another study by Wotton and Crannitch (2008), it is believed that Dementia will be experienced more in the developing countries which are already experiencing rapidly-growing life expectancy rates. In the UK alone, 700,000 out of 61 Million people are reported by Alzheimers Society (UK) to have dementia. By 2021, researchers are expecting this number to reach 940,000 people (International Longevity Center UK, 2009). These grim statistics have raised global concerns across the world with a good number of researchers coming up, slowly but surely, to try finding ways of curbing Dementia before it reaches unmanageable levels. But before delving into such intricacies, what really is Dementia?
Dementia is a health condition which is defined by Bidewell & Chang, (2011) as the progressive decline in cognitive function or, simply, the worsening of a persons ability to process thought. Dementia is mostly prevalent in old people (Barnes et al., 2004). Nonetheless, Hickman et al. (2007) argue that it may affect adults of any age.
In Residential Aged Care Facilities (RACFs), Bidewell & Chang (2011) say that nurses tend to face various issues in the care of patients with dementia. In solving these challenges, many approaches have been proposedas will be explicatively detailed later in this paper (Brown, 2002). A detailed analysis of these issues is embodied in the discussion given below.
Malnutrition and dehydration issues in patients with dementia in RACFs
In older adults, malnutrition is defined by Gaskill et al, (2009) as inadequate dietary intake that leads to the insufficient nutritional condition, weight loss and muscle wasting. According to Turner (2005), approximately 85% of nursing home residents suffer from malnutrition while 60% suffer from malnutrition.
In explaining the high percentages of dehydration and malnutrition in patients suffering from dementia, Barnes et al., (2004) support Reed et al., (2004) by saying that Dementia is a syndrome normally caused by a variety of diseases that produce disturbance of cortical functions with severe loss of cognitive ability and functional capacity. As a result, this leads to malnutrition and weight loss because of increased energy demand due to factors such as wandering, food refusal due to agitation, lack of appetite and declining capacity to chew, swallow (dysphasia) or feed independently (Reed et al., 2004).
Additionally, malnutrition is caused by difficulties with eating due to loss of ability to recognize food, eating low amounts, refusal to get involved or cooperate during feeding time, or forgetfulness about food and (Hines et al., 2008).
Moreover, the shortage of staff to attend to each one of the patients is cited as a cause of poor health and malnutrition. Chewing and swallowing problems make it difficult for them to eat their meals well. These swallowing problems make them easily prone to aspiration of fluids into the lungs and consequently water restrictions are set in place for certain patients. This restriction on fluids leads to the risk of dehydration in patients with swallowing disorders suffering from dementia (Reed et al., 2005).
Recommended Solutions
According to Gaskill (2009), nurses should consider soft or vitamised meals as a solution to chewing and swallowing problems. Reed et al, (2005) further say that poor oral hygiene, lack of teeth, infections in the gums, teeth decays and poorly fitting dentures may prevent them from having enough food to make up a nutritional value. In these cases, oral nutritional supplementation may be a solution (Levi, 2005).
In a study conducted by Levi (2005) in aged care and assisted living facilities, it was remarkably revealed that food and fluid intake increases among residents if they are monitored by staff during meals, have their meals in public dining areas rather than in their bedroom, the facility provides an environment with no institutional features, free of environmental distractions and there is enough staff to provide assistance in the room. For this reason, it is advisable for nurses and the management in RACFs to inculcate such endeavors and programs into their facilities so as to orient these positive results.
On another note, Barrat (2004) outlines interventions such as fortified food, supplements and meal planning as other solutions to RACFs. In addressing malnutrition and dehydration, nurses and other staff education programs need to be designed on nutrition assessment procedures and early nutrition intervention methods (Manthorpe & Watson, 2002). This is, in order, to equip them in awareness, screening and assessing the residents nutritional status (Gaskill et a., 2009).
In solving the problem related to the aspiration of fluids caused by dysphagia, Hines et al., (2008) proposes increasing the viscosity (thickness) of drinking fluids. This idea is supported by Manthorpe & Watson (2002) who found out that thickened fluids were easily accepted by older people compared to dilute ones. Barrat, (2004) however, refutes this by saying that thickened fluids were not accepted by patients in his study since thickening agents were thought to suppress flavors of drinks. Debates on this issue are still ongoing and a decisive solution (through research) is yet to be found.
Other general solutions proposed to solve malnutrition include reducing noise in the RACFs (since patients consider it distractive), increasing light in the facilities (because patients love to see what they are eating), and providing meals on time. As for dehydration, nurses promoting fluid consumption in their daily meal routines is additionally encouraged.
Communication with aged care residents with dementia
Communication is very important in all human relationships and, in people with dementia, it is extremely critical to their well-being (Hickman et al., 2007). Patients with dementia are believed to experience numerous communication challenges. In most cases, they cannot express themselves coherently, and in worst cases, they may lose the communication function completely (Kohn & Surti, 2008).
As we all know, communication is a broad concept and can happen in a myriad of ways. The most common categories are verbal and non-verbal communication. Regardless of the category, caution and professionalism should be taken when communicating to these patients since they are normally very delicate and any wrong communication can be very detrimental to them. The fact that old people tend to slow to understanding complex issues, utmost professional discretion and patienceas was already mentionedshould be adherently observed.
Recommended Solutions
To have a quality life and receive the care they need, dementia patients just need to be consulted consistently, but in a loving and patient way. This might see seems difficult, but it is realistically achievable.
Moreover, intervention measures have been developed at individual and group levels to help the patients directly and indirectly with family members, friends and healthcare professionals (Borbasi et al., 2011). This is aimed at mainly improving the communication between the victims and those around them.
In order to improve communication for quality care, nurses should use communication that enhances decision making. Here, the nurse should show genuine interest and engagement of the patient in making everyday simple decisions such as what to wear, in bathing and even what to do (Tilly & Reed, 2004). This is supported by Harding, (2005) who says that cheeriness and warmth towards the patient as well as concern and seriousness display the same responses interest and engagement. This will make the patient to recognize familiar pattern around the facility for care without apprehension of the next activity.
Another way of encouraging communication with patients with dementia could be less focus on routine and obsession with time while intermittently giving them monitored freedom to do things like walking and reading. When the nurses display a manner of communication that shows his/her focus on finishing with one resident so as to get to the next one or follow procedures, this is felt by the patient and may not be able to take care of the needs of the patient neither allow him/her to make decisions on the same (Hickman et al., 2007; Harding, 2005).
Dementia agitation in people with dementia living in RACFs
Agitation in dementia is recognized as a common and difficult issue among aged care residents. Nguyen et al. (2008) explicates this by estimating that 80% to 90% of patients with dementia develop at least one distressing behavioral problem at some point in the course of the disease.
Agitation is such a symptom and is characterized by inappropriate verbal, vocal or motor activities that result from unmet needs or confusion in the patient. Agitation can be displayed by several types of behavior as outlined by Nguyen & Paton, (2008). These include; verbal non-aggressive where the patient just complains, voices a lot of negativity, repeats questions or statements and regular uncalled for requests for help. Verbally aggressive behavior such as screaming, strange noises, cursing etc, physical non-aggressiveness characterized by doing inappropriate things and physical aggressiveness such as sexual advances, throwing things and grabbing among others (Levi, 2005).
Recommended Solutions
Agitation needs to be diagnosed properly in order to rule out delirium and appropriate intervention measures to be applied. Besides pharmacological interventions, non pharmacological measures should be administered first as (Detweiler et al., 2008). These could include providing an environment that is as close to a home environment as possible in the facility.
In addition to this, bright lighting could be used in the surroundings even during the day so as to avoid a misconception of stimuli (Neugroschi, 2002). Moreover, the environment should also be calm and with familiar things to soothe the patients (Bidewell & Chang, 2011).
A daily plan of activities, which the residents can engage in, will also help calm down and reduces stress. It is also important to provide adequate training to nurses on skills such as communication, managing behavior without confrontational manner and other support techniques and the planning and engaging the patients in activities in their care (Vink et al., 2003).
For patients with sleep disturbances, lack of enough sleep may cause agitation and intervention should involve addressing the underlying causes of sleeplessness (Hickman et al., 2007). First, there should be no excessive sleep expectations since, daily sleep requirements do not increase with age. This is echoed by Wilkes et al. (2005) who say that, daytime napping should be limited by engaging the patients in activities that are specially designed for dementia patients and physical exercises. In order to prevent agitation, Wilkes and his colleagues suggest a structured day should be provided so that a predictable routine is maintained. This should be done by providing orientation materials such as calendars, clocks and family pictures which should be kept in prominent places. Care should be taken when structuring a day so as to avoid rushing the patient because as it may result into agitation (Turner, 2005).
Pain in people with dementia
Research has shown that pain prevalence in elderly people is a common problem with 60 years and above adults experiencing twice as much pain as younger persons (Smith, 2007). Further, Smith says that 50% of institutionalized elderly people in the US have dementia and in European countries such as Austria and UK, 60% of institutionalized people have dementia. This is an indication of how pain assessment in RACFs is a challenge to the nurses.
Pain assessment in dementia patients is further complicated by unique barriers such memory loss, language problems, abstract thinking, loss of personality and judgment among others (Harding, 2005). Moreover, absence of behaviors associated with pain or difficulties in interpreting them make assessment even worse.
In pain assessment among patients with dementia, self reporting which is considered a gold standard may not work since it will require the patient to understand the task and communicate about the patient (Brown, 2002).
Recommended Solutions
Primarily, agitation and other behaviors displayed by dementia patients may be an indication of pain (Maslow, 2004). Care should be taken though not to interpret these symptoms as pain indicators thereby complicating pain assessment even further (Harding, 2005).
In instances where the gold standard (mentioned above) does not work; other assessment tools will come in handy. This will require developing non-verbal assessment tools that will base their assessment on behavior observation (Maslow, 2004). One such tool nurses should use could be an observation chart for changes in the sleep patterns, appetite, physical activity, mobility and body/facial language of the patient at a given period of time (Harding, 2005).
Nurses or caregivers at the facility could also use physiological charts where the details of a patients especially those identified with problems in the first measure, such as heart rate, blood pressure will be recorded and monitored (Maslow, 2004). Though this has not been researched fully due to limitation validity and practicality, as reported by Fallon et al. (2006), with more research and a mixture of other interventions, it can significantly lessen pain.
Hygiene for people with dementia living in residential aged care facilities
Dementia often affects a persons hygiene in that, they may loose interest or forget to wash or change their clothes and also bathing. This presents a different kind of a challenge to nurses in RACFs as the patients may require help toileting, getting dressed, brushing their teeth and general grooming (Kohn & Surti, 2008).
In addition to this, nurses face problems such as resistance or confrontations from patients to be assisted in caring for them due to the embarrassment of losing their privacy (Tilly & Reed, 2004). If at all the well-being of this patients is to be facilitated, these issues should be addressed as detailed below.
Proposed Solutions
In order to assist such patient, the nurse should exercise patience and avoid confrontations. The nurse should also try to maintain a level or a feeling of privacy by closing doors and pulling the blinds down. If the patient does not recognize himself/herself, cover the mirrors in the room and show a great deal of reassurance and patience while approaching the patient (Borbasi et al., 2011).
Another thing to address is the environment in which bathing or dressing is taking place. This can be bettered by making the room warm and attractive, providing adequate light and playing soft music in the background to get a calming and relaxing environment (Fallon, et al., 2006).
Conclusion
Dementia has become an increasingly common health problem that healthcare providers have to deal with in Residential Aged Care Facilities (RACFs). Patients of dementia have problems ranging from lack of attention, ability to tackle problems, language, ability to concentrate, ability to recall, think and behavior among others which become obstacles to living a normal social life. This is made worse by other medical and psychiatric conditions associated with dementia such schizophrenia, anxiety disorders, bipolar affective disorder and agitated depressive disorder.
However, by blending all the solutions discussed above, great improvements can be made not only by the dementia patients but the entire constitution of RACFs. In turn, the medical world will be monumentally bettered thus making the world a much better place than it is now.
Reference List
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Barrat, J. (2004). Editorial: Nutrition and Older People with Dementia. Clinical gerontology, 5(4), pp. 247-251.
Bidewell, J., & Chang, E. (2011). Managing Dementia Agitation in Residential Aged Care. International journal of generiatrics, 9, pp.299-315.
Borbasi, S., Emmanuel, E., Farrelly, B., & Ashcroft, J. (2011). Report of an Evaluation of a Nurse-led Dementia Outreach Service for People with the Behavioral and Psychological Symptoms of Dementia Living in Residential Aged Care Facilities. Perceptives in public health, 16, pp.124-130.
Brown, S. (2002). Systematic Review of Nursing Management of Urinary Track Infections in the Cognitively Impaired Elderly Client in Residential Care: Is there a Hole in Holistic Care. International journal of nursing practice, 11(8), pp.241-253.
Detweiler, D., Murphy, P., Meyers, L., & Kim, K. (2008). Does a Wander Garden Influence Inappropriate Behaviors in Dementia Residents? American journal of alzheimers disease and other dementias, 44(7), pp.31-45.
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Care planning is a legal process that ensures the continuity of care (Chinn & Kramer 2008). According to Aggleton and Chalmers (2010), care planning portrays the care delivery pathway in a systematic and logical manner. This method facilitates collaboration among health professionals, patients and families during the decision-making processes (Ratheet et al. 2015). Patients assume an active role in the development of care plans based on the subjective identification of needs and preferences (Watson 2010). As such, personalised care is essential to meet the distinctive requirements of each patient.
The stages of the Care Planning Process
The process of developing a care plan follows a definitive cycle of four components: assessment, care planning, implementation and evaluation (Dwamena et al. 2012). According to Ratheet et al. (2015), each of the four steps mandates the health and social care professionals to provide holistic care. Although each stage requires the application of different skills, none of them supersedes the other (Fullbrook 2007). Dwamena et al. (2012) have argued that the four components provide unique contributions to the care planning procedure. According to Chinn and Kramer (2008), the failure to address the requirements of each phase undermines the quality of care.
The care planning process begins with the assessment of the clients needs and preferences (Brotherton & Parker 2013). The use of various assessment tools is essential to generate an in-depth analysis of the care needs (McCormarck & McCance 2010). Efficient communication within the multidisciplinary team is of the essence during the assessment process. Ratheet et al. (2015) have also highlighted the significance of communicating adequately with the patients and their relations. The sources of information include non-verbal observations, written records and verbal communication (Dwamena et al. 2012).
The second phase entails setting short and long-term goals based on the findings from the initial evaluation (Aggleton & Chalmers 2010). McCormarck and McCance (2010) have indicated that practitioners should collaborate appropriately to formulate feasible goals. For example, a caregiver cannot design a care plan for a diabetic patient before conducting a rigorous assessment of needs (Brotherton & Parker 2013). In addition, the monitoring of vital signs requires the continuous collection of accurate baseline data. This information helps the health care provider to determine deteriorations in a timely manner (Chinn & Kramer 2008).
The third stage of the process entails the implementation of the interventions. This phase involves monitoring the patients progress to ascertain if the selected therapies are effectual (Dwamena et al. 2012). The assessment of needs is a critical aspect in each of the four stages. The appraisal of these phases provides feedback about the performance of the interventions (Brotherton & Parker 2013). Evaluation constitutes the final step of this procedure, and it determines whether the decisions taken during assessment, planning and implementation were practical (Aggleton & Chalmers 2010).
Nursing Care Models and Approaches
Patient-centred care (PCC) assumes a holistic approach, which views individuals as composed of the body, spirit and soul (Watson 2010). As such, PCC moves beyond meeting the patients immediate needs to addressing their social, spiritual, emotional and psychological needs (Watson 2008). The application of PCC in mental health care requires health professionals to value and respect individuals regardless of their limitations (Brotherton & Parker 2013). PCC also incorporates the patients family members and friends in the care planning process (Aggleton & Chalmers 2010).
Although PCC is crucial in the development of the care plan, a myriad of challenges undermines its implementation and promotion. First, it is difficult to implement the PCC in the absence of family members or advocates. This situation is particularly problematic when the client does not have a family (Dwamena et al. 2012). In addition, PCC emphasises the issue of quality but fails to provide evidence-based guidelines to realize this objective (Chinn & Kramer 2008). McCormack and McCance (2010) have indicated that the lack of conclusive evidence regarding the PCC philosophy is hindering the implementation of this model.
Secondly, the participation of patients and their families in the care planning process can be either non-existent or limited (Brotherton & Parker 2013). Aggleton and Chalmers (2010) have noted that the inferior position of family members or patients in care planning prevents them from participating actively in the care planning process. Other health and social care providers may perceive a debilitating condition as preclusion to meaningful participation (Dwamena et al 2012). On the other hand, Ratheet et al. (2015) have found out that most people are not aware of the need to take part in the care planning processes.
The Orems self-care model of nursing supports patient-centred care because it considers the biological, social and psychological needs of a patient during the treatment process (Simmons 2009). The Orems approach is similar to the Watsons theory of caring, which mandates health professionals to provide holistic care (Watson 2010). The difference between these approaches is that the Watsons perceptive focuses on therapeutic relationships between patients and their caregivers (Watson 2008).
By contrast, the Orems model mandates nurses to assist patients to meet their self-care needs (Simmons 2009). On the other hand, care providers use the Roper-Logan-Tierney model to assess the effect of an illness or hospital admission on a patients life. The primary goal of the Roper-Logan-Tierney model is to enable an individual to gain maximum independence (Aggleton & Chalmers 2010).
Legislation and Social Policy
The provision of patient-centred care brings to the fore ethical and legal implications. One of the principal issues in the care planning process is the concept of informed consent (Dimond 2007). The point of argument is that patients with severe mental disorders cannot take part in the development of care plans (Probst 2009). For instance, most patients suffering from dementia or other mental limitations lack the cognitive capacity to provide the consent (Kilbourne et al. 2008). On the contrary, case managers, caregivers or family members make unilateral decisions on the behalf of these individuals (Probst 2009).
Despite the previous challenges, every individual has the right to make autonomous decisions. The Mental Capacity Act (MCA) contains provisions that protect people with mental limitations (Alonzi, Shear & Bateman 2009). The Mental Capacity Act (MCA) allows patients to make specific decisions even if they suffer from dementia, stroke, brain injury, learning disabilities and any other debilitating conditions (Bisson et al. 2009). According to Boyle (2008), it is essential to conduct a mental capacity assessment before judging the ability of these individuals to make independent decisions.
Patients with mental limitations may require third parties to provide informed consent (Dimond 2007). The Mental Capacity Act allows people to appoint the people who will act as their representatives when they become incapacitated in the future (Donnelly 2009). On the other hand, MCA necessitates the appointment of independent advocates with no affiliation with the NHS or social services (Bisson et al. 2009). The Human Rights Act is another UK legislation that requires health and social care workers to provide treatment while at the same time protecting the patients human rights (Alonzi, Sheard & Bateman 2009).
The persisting inequalities in the health and social care services are undermining the delivery of patient-centred care (Hoffman 2011). The main problem is that people from ethnic and racial minority groups do not receive optimal care because of language barriers and cultural differences (Saha, Beach & Cooper 2008). The Equality Act has mandated the NHS to reduce inequalities and eliminate discrimination by providing culturally sensitive care. The Equality Act supports these efforts by protecting individuals against discrimination because of their age, sex, race, disability or gender and other attributes (Bisson et al. 2009).
Care Planning and Dementia Flow Chart
The care pathway for patients with dementia begins when the patient arrives at the emergency department. The first step entails assessing the needs of the patient by communicating with them and their caregivers (Probst 2009). Probst has argued that all patients should have an equal access to the assessment procedure. The staff should use translation and interpreting services when handling patients from diverse cultures.
The knowledge about the Mental Health Act, the Mental Capacity Act and the human Rights Act is vital to facilitate decision-making processes. The involvement of other professionals is also essential during the assessment process to produce conclusive results (Mughal 2014).
The assessment process continues after the admission of the patient to the ward. The purpose of these activities is to prevent the exacerbation of symptoms. According to Dwamena et al. (2012), effective communication and collaboration with other professionals, caregivers, family members and friends improve clinical outcomes.
The development of the nursing plan during admission should emphasize patient comfort and safety (Ratheet et al. 2015). The most critical issues to consider include nutrition, physical activity and personal hygiene (Kilbourne et al., 2008). Communication and feedback are also fundamental aspects that professionals should incorporate into the assessment of needs and interventions (Probst 2009).
The final step of the care pathway involves the development of a discharge plan. This plan should include the patients preferences and needs, as well as procure community-based services (Bisson et al. 2009). The practitioner should also assess the emotional, psychological or social needs to facilitate the rehabilitation process. The evaluation of these needs helps the health and social care providers to refer the patient to appropriate services within the community. Community-based care facilitates the delivery of referral care, evaluation and assessment (Chinn & Kramer 2008).
Another crucial component of the discharge plan involves the formulation of strategies that will support the patient to live independently (Kilbourne et al. 2008). The majority of people suffering from dementia and other mental disorders often live in communities (Bisson et al. 2009). Probst (2009) has indicated that the multidisciplinary team provides support to patients and their caregivers.
Collaboration is particularly crucial since the Community Care Act requires the provision of mental and physical health services within the community (Boyle 2008). These services include social work and nursing interventions, supported accommodation, day centres and home care (Donnelly 2009). The goal of these strategies is to empower caregivers and families members (Bisson et al. 2009).
Conclusion
Care planning has increasingly become an integral component in the delivery of health and social care. The care planning process entails four aspects: assessment, planning, implementation and evaluation. One of the fundamental issues in care planning is the patient-centred care (PCC). The essence of PCC is to involve patients, as well as their caregivers and families in the decision-making processes.
Another aspect of PCC is the inclusion of the multidisciplinary team in the care process. The combination of these factors is essential in dementia care because of the debilitating symptoms of this condition. Thus, the development of patient-centred care will continue to assume a forefront position in health and social care.
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Group therapy is an evidence-based psychotherapy method that helps solve many problems, including relationship issues and personal difficulties. People come to the group to cope with grief, trauma, chemical addiction, anxiety, and depression. One of the most well-known and influential types of group therapy is the cognitive-behavioral therapy group. Compared to other theories, the cognitive-behavioral approach is preferable because it focuses on mental processes: how people perceive, think, remember, learn, solve problems, where they direct their attention.
According to the cognitive approach, working only with a persons behavior is inefficient in solving their psychological issues. First of all, you need to identify beliefs, ideas, and thoughts that make them act destructively or feel uncomfortable, get rid of them, and only then work on the behavioral aspect. Moreover, one of the basic concepts of behaviorism is positive and negative reinforcement. Positive reinforcement, or encouragement, is applied when the individual has done the right thing and helps to reinforce the desired form of behavior. Negative reinforcement implies an adverse reaction to the undesirable behavior of the trainee. As a rule, the first form of reinforcement is used in CBT: it works faster clearly indicates what needs to be achieved.
Group Counselor and CBT
As a group counselor, cognitive-behavioral theory influences the decision of the formal sessions. The therapy includes not only group exercises but also homework and visualization. Moreover, group therapy affects the counselor to take a direct part in the discussion. This makes it easier to work with patients who can be stiff and neutral towards other people. CBT is a technique that highlights a persons unconscious motivations, transfers them to a conscious level, helps to change beliefs and behavior that cause neurotic and other pathological conditions. CBT combines two scientific psychological approaches: cognitive and behavioral (behavioristic). The first states that thoughts and beliefs cause psychological problems and neuropsychiatric disorders, stereotypes of thinking acquired during life. The second argues that human behavior can be changed by encouraging desirable forms of action and not reinforcing undesirable behavior.
Features of CBT
A feature of CBT is its carefully developed theoretical basis, which was formulated based on the long-term follow-up of many patients. To date, the world has accumulated hundreds of studies, meta-analyses, and systematic reviews that confirm the effectiveness of this method for the treatment of affective disorders, personality disorders, various types of addiction, and some psychotic disorders. CBT can be used both as monotherapy and in combination with drug therapy. The structure of group sessions (classes) is usually defined in treatment protocols.
However, there are a number of its features that are not given enough attention. CBT groups should be closed, the composition of participants must be constant, and new patients cannot join after the first session. This is primarily because the CBT process involves teaching cognitive techniques and acquiring skills by patients in strictly sequential order with a frequency of meetings of at least one time per week (Carrion et al., 2018). It happens because learning cognitive techniques can only occur with a relatively short break between sessions, but the duration of the sessions should remain limited in time; the number of participants in the group should not exceed 8-10 people. After the intensive weekly psychotherapeutic work phase, it is important to continue holding more infrequent support sessions. These sessions are necessary to maintain the result and prevent relapse.
Development of Psychological Problems
When prescribing group treatment and its type, it is necessary to understand the nature of the development of psychological problems. The causes of problems can be divided into endogenous factors. Endogenous factors include genetic predisposition, intrauterine developmental disorders, early childhood developmental disorders, and immunological and metabolic disorders. Somatic diseases that affect the state of the brain due to insufficient blood supply, autointoxication, or hormonal imbalance are also the causes of difficulties in perceiving the world. The causes of mental problems are often combined, including stress, trauma, and adverse family history (Patel et al., 2021). Thus, the psychotherapist must evaluate the importance of each of these factors. Exogenous factors include intoxication, traumatic brain injury, infectious processes, radiation exposure, and acute or chronic emotional stress. Physicians consider mental and behavioral disorders as multifactorial diseases. Even if the root cause of a mental problem is a well-defined circumstance, a persons condition still depends on many factors.
Elimination of Psychological Problems
CBT is considered short-term therapy, but the course duration depends on many factors. About ten sessions are needed for a specific request, such as a phobia or difficulty falling asleep. However, this format involves the solution of only one problem within the framework of group therapy. The course will last from a few months to a year for multiple issues and more complex conditions. The treatment of personality disorders will require even longer work and will solve specific problems in terms of group work on fears. An indispensable component of therapeutic measures is psychological counseling. Regular meetings with a psychologist are aimed at helping the patient understand their disease and its causes, learn how to reduce stressful conditions, overcome emotional problems, control their thoughts and actions, and control behavior. The course of psychotherapy usually lasts several months, or more is prescribed individually in a group of patients or relatives.
The Role of the Group Process
Group processes within group CBT, playing a unique role, significantly affect its effectiveness. Such a phenomenon as self-disclosure of ones negative thoughts, interpretations of events, and peoples behavior, which is necessary for practical cognitive work, is possible in conditions of a significant level of group cohesion and trust (Schmidt et al., 2019). Some studies have also shown that patients perceive group processes as an essential therapeutic experience and that group process factors significantly affect the dynamics of improvement in the well-being of members of the therapeutic group (Goldberg et al., 2019). Typically, the implementation of CBT in groups begins by providing patients with a cognitive model of mental disorder, such as cognitive models of depression (Sunnhed et al., 2020). Particular attention is paid to the encouraging provisions that, with the help of psychotherapy, each of them will learn techniques with which they can change their thinking to a more adaptive one. Thus, it will positively affect the emotional state and help reduce symptoms of depression.
Thus, the method of CBT is effective and helps people to understand themselves better. It helps patients accept themselves and realize that they are not alone in their problems. Moreover, for many group members, there is a rare opportunity to share their deep feelings, which they were previously embarrassed to express or met with misunderstanding from family members or friends. In addition, often after the first meeting, participants experience surprise and a sense of relief from the fact that people of very different gender, ages, social statuses faced the same problem and turned to identical treatment methods. The emerging sense of cohesion creates a favorable atmosphere for proper cognitive and behavioral techniques and contributes to the development of mutual assistance, support, altruism between group members.
References
Carrion, C., Folkvord, F., Anastasiadou, D., & Aymerich, M. (2018). Cognitive therapy for dementia patients: A systematic review. Dementia and Geriatric Cognitive Disorders, 46(1-2), 1-26. Web.
Schmidt, I. D., Pfeifer, B. J., & Strunk, D. R. (2019). Putting the cognitive back in cognitive therapy: Sustained cognitive change as a mediator of in-session insights and depressive symptom improvement. Journal of Consulting and Clinical Psychology, 87(5), 446. Web.
Sunnhed, R., Hesser, H., Andersson, G., Carlbring, P., Morin, C. M., Harvey, A. G., & Jansson-Fröjmark, M. (2020). Comparing internet-delivered cognitive therapy and behavior therapy with telephone support for insomnia disorder: A randomized controlled trial. Sleep, 43(2), 245. Web.
Since the prevalence of dementia tends to increase globally, it is critical to understand its cognitive issues and related evidence-based interventions. The cognitive changes caused by dementia include disorientation, short-term memory loss, and personal care challenges. To cope with these ambiguous losses, people with dementia can be offered mindfulness training that aims at strengthening a patients ability to direct his or her attention at the moment and act with awareness (Berk et al., 2018). Training implies several sessions devoted to meditation techniques, such as breathing, as well as focusing on feelings, thoughts, and sensations. Mindfulness-based interventions for patients with dementia are expected to develop their flexibility and broaden their attention, leading to positive emotions and stress reduction (van Boxtel et al., 2021). In addition, not only patients but also their caregivers are expected to benefit from mindfulness training.
A plan for implementing meditation training should begin with a patient evaluation and explaining to him or her techniques to be practiced. Considering that the patient has memory impairments, reduced mental flexibility, and disorientation, an 8-week training program based on 90-minute group sessions and mindfulness-based cognitive therapy (MBCT) can be designed. The goals to be achieved are cognitive control, the ability to handle disorientation and confusion periods, and mastering the skills of breathing and being at the moment. Since the potential cognitive impairments may involve aging-related challenges and emotion regulation problems, the patient should also be provided with meditation techniques to prevent anxiety and depression (Berk et al., 2018). The studies show that patients receiving meditation training for cognitive issues of dementia improved their verbal memory, decreased perceived stress levels, and experienced a higher quality of life than before the intervention (Berk et al., 2018). Thus, the rationale for engaging this patient in mindfulness training is its potential benefits to mental health and a lack of negative outcomes.
References
Berk, L., Warmenhoven, F., van Os, J., & van Boxtel, M. (2018). Mindfulness training for people with dementia and their caregivers: Rationale, current research, and future directions. Frontiers in Psychology, 9, 982-992.
van Boxtel, M. P., Berk, L., E. de Vugt, M., & van Warmenhoven, F. (2020). Mindfulness-based interventions for people with dementia and their caregivers: Keeping a dyadic balance. Aging & Mental Health, 24(5), 697-699.
As the worlds population grows, the number of people in late adulthood inevitably increases. Moreover, their percentage of the whole of humanity is increasing as the quality of life and medicine improves. However, several life-complicating illnesses prevent seniors from enjoying their retirement years at their actual value. One such disease is incurable dementia, which is one of the most dreaded diagnoses when all possible complications and related problems are taken into account.
Summary of the Problem
Dementia appears due to brain damage caused by organic or inorganic causes. In addition to physical trauma, causes may include an adverse medical history in the form of Alzheimers disease, vascular problems, Parkinsons disease, or Huntingtons disease (Russo-Netzer & Littman-Ovadia, 2019). Inorganic causes are generally considered to be exacerbating external factors that have affected the body over a long period of time: tobacco or alcohol abuse, poor diet, depression, and stress (Beyer & Lazzara, 2018). In a weakened human body in late adulthood, the consequences of such actions can become irreparable.
Not surprisingly, a great deal of research on the issue is being done by various organizations. In addition to treating the symptoms, methods are being attempted and developed to lessen or offset them (Russo-Netzer & Littman-Ovadia, 2019). Social organizations, the state, and the public, as well as relatives of patients, are interested, if not in curing the disease, then alleviating it as much as possible. It is why specific homes for the elderly have been developed and designed to make the mentally ill as stress-free as possible.
Reflection on the Major Points
It is hard to disagree with the findings that non-non-mental causes contributing to brain damage significantly impact the possibility of dementia. Beyer and Lazarra (2018) highlight depression as a cause. Statistics confirm that at least 10% of confirmed cases are due to depression or psychological problems (Beyer & Lazzara, 2018). From personal experience, it is possible to confirm that some of the older acquaintances have aggravated their mental health due to family problems and stress and have been diagnosed with dementia. In addition, few people give up the bad habits that have followed them throughout their lives. With more time at their disposal in retirement, some only make their health worse by using alcohol or tobacco.
Moreover, an essential condition directly related to dementia is delirium. This condition can also be called confusion, leading to unpredictable reactions (Beyer & Lazzara, 2018). Undoubtedly, creating the closest approximation to everyday life in nursing homes or hospitals is very important (van Amerongen, 2019). It reduces the degree of confusion in a sick person, and hospital rooms and staff in gowns can only frighten or anger the patient during the period of enlightenment. In the end, such content can only aggravate a persons mental state.
Deferred retirement for financial reasons also becomes unavailable when dementia develops. The need to earn money, the unwillingness to stop socializing, or the refusal to feel old often cause people in late adulthood to continue working past retirement age (Beyer & Lazzara, 2018). This decision is understandable, logical, and only commendable (van Amerongen, 2019). However, in the case of progressive dementia, it becomes impossible, and financial problems can leave a person on the sidelines of life. The state should pay more attention to protecting such citizens and provide opportunities for people of all genders and ethnicities to grow old with dignity.
Conclusion
Memory lapses, lack of control over ones actions, and decreased brain function do not let one underestimate the dangers of dementia. It prevents seniors from spending their retirement time with dignity, communicating with grandchildren and great-grandchildren, and living life to the fullest. The specific care provided in nursing homes does not always benefit the sick, frightening or confusing them. Attitudes are worth reworking and reconsidering the degree of freedom each person needs, especially in such a severe condition.
Dementia can lead to a wide variety of psychological disorders, including depression and anxiety. The symptoms of depression are apathy, isolation, social withdrawal, impaired thinking, and concentration on the negative side of life (Kitching, 2015). The symptoms can be managed both pharmacologically and non-pharmacologically. The usual pharmacological treatments include anti-depressants; however, they may contribute to the effect of poly-pharmacy (Kitching, 2015).
Additionally, medications may take longer to have an effect due to old age. Thus, pharmacological treatment should be used with caution. Non-pharmacological treatments include psychotherapy or cognitive-behavioral therapy, as well as electro-convulsive therapy, which can be used (Kitching, 2015).
Common types of anxiety disorders found in older adults include panic disorder, generalized anxiety disorder, and phobias (Balsamo et al., 2018). Common symptoms include shallow breathing, trembling, nausea, sweating, irrational and excessive worry or fear, and a racing heart (Balsamo et al., 2018).
Anxiety is better treated by combining pharmacological treatment s and therapy. For pharmacological approach, Benzodiazepines are usually used; however, they may have a negative impact on memory and should be prescribed with caution (Balsamo et al., 2018). There is also evidence that older anxiety patients can benefit from psychotherapy.
Delirium and agitated depression can occur with dementia. Delirium and dementia have similar symptoms; however, delirium is a confusion that occurs and goes away rather quickly (Laske & Stephens, 2018). However, dementia is a confusion that develops slowly, and the mental changes are mostly irreversible. When speaking of depression it is a mood disorder, and confusion is not a part of it (Laske & Stephens, 2018).
References
Balsamo, M., Cataldi, F., Carlucci, L., & Fairfield, B. (2018). Assessment of anxiety in older adults: a review of self-report measures. Clinical interventions in aging, 13, 573.
Laske, R. A., & Stephens, B. A. (2018). Confusion states: Sorting out delirium, dementia, and depression. Nursing made Incredibly Easy, 16(6), 13-16.
Kitching, D. (2015). Depression in dementia. Australian Prescriber, 38(6), 209.
The aging of the planetary population of human beings is a well-known fact for the public health institutions of most countries. Health professionals expect individuals with age-related diseases such as dementia to increase in the next few decades. Delgado et al. (2020) state that dementia defines a group of conditions involving irreversible neurodegenerative disease, leading to changes in cognition, communication and functional ability (p. 1). The current years are a window of opportunity to deeply analyze and evaluate existing pharmacological and non-pharmacological care for dementia patients to better prepare for upcoming challenges in the industry.
Pharmacological Methods of Care Provision for Institutionalized Dementia Patients
Judging by the current body of academic literature, while the pharmacological way of providing care for dementia patients in nursing homes is considered a conventional and practical intervention, it is widely criticized. Modern researchers highlight psychotropic drug treatment as the primary approach to delivering care for institutionalized people with dementia via medication (Mesquida et al., 2019). According to Delgado et al. (2020), polypharmacy is another widespread therapeutic practice. Pasina et al. (2020) also mention antipsychotics, laxatives, benzodiazepines, antiplatelets, and proton pump inhibitors as drugs used to alleviate dementia patients physiological and mental states (p. 1011). Healthcare researchers and practitioners criticize these because they carry several severe risks for those who take them. Mesquida et al. (2019) list impaired cognitive capacity, rigidity, somnolence, and other complications during the course of the illness as drug complications with a high risk of occurring (p. 1). The reasons lie beyond the need for complex medical treatment, the highly variable physiological characteristics of institutionalized people with dementia, and the inability to treat dementia completely.
The drivers of complications are the frequently occurring potentially inappropriate prescribing and the lack of a standardized pharmacological methodology for the delivery of care in healthcare. However, there are practical measures that allow health professionals to prevent potentially inappropriate prescribing, avoid the emergence of new symptoms and comorbidities, and implement and promote pharmacological care initiatives more effectively. Some of these are reanalysis and applying multiple guidelines and instructions (Dijk et al., 2022). Experts also advise using multicomponent and interdisciplinary approaches to the design, implementation, and promotion of care strategies. For example, pharmacists contribute substantially to patient care in nursing homes, ensuring quality use of medication, resulting in reduced fall rates (Lee et al., 2019, p. 2668). Interventions based on multidisciplinary consensus result in efficient medication, the preservation of material resources in nursing facilities, and better care providers cooperation.
Non-pharmacological Methods of Care Provision for Institutionalized Dementia Patients
The non-pharmacological way of providing care for persons with dementia is an alternative that has snowballed over at least the last two decades in nursing homes and academic circles. It includes a multitude of standard and specially designed strategies, approaches, and techniques that target not only the condition but also the accompanying symptoms and problems that people with dementia experience. Among the comprehensive care models, the MACS intervention is one of the most interesting, as it is designed to treat severe cases. According to Diehl et al. (2020), the abbreviation stands for Motor stimulation, Activities of daily living stimulation, Cognitive stimulation, and Social functioning (p. 2). It represents an intriguing example of a high-quality, multicomponent care delivery technique that can be applied to many different populations of institutionalized individuals with severe dementia. Care delivery methods with such properties are much needed in mental and neurological healthcare. Moreover, Diehl and their colleagues research shows that emphasizing an interventions external validity is an effective tactic for promoting it among nursing theorists and practitioners.
There is also much literature on specific care interventions that aim to alleviate patients side effects and comorbidities and make minor aspects of their lives more comfortable. Most of them affect the behavior and psychology of affected individuals. Findings from a systematic review by Hayward et al. (2022) show that interventions to promote family involvement in the lives of their relatives at nursing homes positively influence their quality of life and overall mental state.
One of the most common concomitant pathologies in the case of dementia is sleep disturbances. Webster et al. (2022) state that this problem occurs in more than a third of people with dementia staying special nursing facilities. This comorbidity is exhausting and harmful to its bearers and the care providers who look after them. A group of researchers recently approached this problem through an intervention that includes many techniques and uses a multicomponent methodology (Webster et al., 2022). Their solution was found to be effective but demanding on human resources. Wandering is another adverse effect of dementia that makes the lives of patients and nurses more difficult. Like sleep disturbances, it is prevalent in about 40% of institutionalized persons (Wang et al., 2022). Wang et al. developed a practical care method for this specific group of suffering individuals by combining various categories of evidence. Methodological diversity and versatility, interdisciplinary and inter-professional perspective is the key to effectively promoting and implementing nursing pharmacological and non-pharmacological interventions for persons with dementia in homes for the elderly.
References
Delgado, J., Bowman, K., & Clare, L. (2020). Potentially inappropriate prescribing in dementia: A state-of-the-art review since 2007. BMJ Open, 10(1), 1-9.
Hayward, J. K., Gould, C., Palluotto, E., Kitson, E., Fisher, E. R., & Spector, A. (2022). Interventions promoting family involvement with care homes following placement of a relative with dementia: A systematic review. Dementia, 21(2), 618647.
Lee, S. W. H., Mak, V. S. L., & Tang, Y. W. (2019). Pharmacist services in nursing homes: A systematic review and metaanalysis. British Journal of Clinical Pharmacology, 85(12), 2668-2688.
Dementia is one of the most common brain dysfunctions that predominantly occur in older adults by diminishing their quality of life and chances for independent functioning. Since the worlds demographic situation is currently characterized by an aging population, the causes of dementia are expected to grow in number. Therefore, it is essential for health care professionals to develop and continuously improve the methods of care that would meet the needs of older patients with different types of dementia. The present paper discusses the implications of dementia care within the context of Ertha Williams case. The patients cognitive concerns, strengths, weaknesses, health care needs management, and prospects for professional care improvement are addressed.
Characteristics of Dementia
Among the geriatric-related health issues, dementia is commonly regarded as the most frequently observed one. Dementia is defined as a group of disorders characterized by brain dysfunction manifested through cognitive impairments, namely memory loss, language skills worsening, deterioration in thinking abilities and decision-making, and others (Alzheimers Association, 2021). One of the types of dementia is Alzheimers disease, which might develop in later stages of dementia and develop fast. While aging is one of the most commonly observed risk factors for dementia, it is not considered a normal attribute of aging.
However, such dementia symptoms as confusion, memory dysfunction, impairments with speech and cognition might be associated with depression, polypharmacy, excessive alcohol consumption, and other conditions (Alzheimers Association, 2021). Moreover, since different types of dementia, and Alzheimers disease, in particular, are progressive conditions that are irreversible, it is vital to identify and diagnose them at the early stages. Early diagnoses will ensure symptom treatment, cause elimination, and lifestyle adjustments.
Erthas Cognitive Concerns
A 74-years old patient, Ertha Williams, experiences some signs of cognitive deterioration. In particular, in her monologue, the patient reports often being anxious and having some bad days and some good days. Ertha gets confused and forgets things, and when she realizes that she forgot something important, she feels nervous and cries (Cleary, 2021). When telling about her professional life, the patient makes a long pause to remember the institution she worked for. The fact that the patient occasionally forgets some important information from her life indicates that she has early cognitive dysfunction.
After moving to their apartment at an assisted facility, Ertha struggles to find things claiming that they are not in their rightful places (Cleary, 2021). She is aware of her forgetfulness, but when she tries to write down some things, she forgets where she took notes; also, Ertha finds it difficult to recall if some of the recent events took place a week or a month ago. These indicators of memory losses related to long-term and short-term events signalize the development of the symptoms of dementia. Apart from memory loss, the patient has symptoms of confusion when she says that she has to cook for Henry although he is hospitalized. Similarly, she reports that noises tend to distract her, which illustrates difficulty concentrating.
Erthas Strengths
Despite an array of cognitive concerns that indicate early dementia symptoms, Ertha has several strong features that might be helpful in her management of the condition. Firstly, the patient is aware of her problem and is willing to manage it. This predisposition toward treatment is a very helpful element in further care. Secondly, the patient has developed a strong sense of belongingness to her family. Ertha has good supportive relationships with her husband, her daughter-in-law, and her grandson. These family ties keep her motivated to remain active and also provide her with adequate support and assistance. Thirdly, the patient attends church, which serves a two-fold purpose, namely group support of other church attendants and the faith that is empowering and very important for psychological wellbeing.
Fourthly, Ertha continues visiting the ladies circle, which is also a valuable platform for group support. Finally, the fact that the patient resides at an assisted facility increases her chances for adequate care and safe functioning while her husband is away. All these strengths contribute to the opportunities for helping the patient overcome the struggles of developing dementia and provide timely treatment that would minimize harm and prolong active and functional life.
Professionals Concerns for Ertha
Erthas symptoms indicate that she is incapable of taking good care of herself. Since she often forgets things and is easily distracted, she might be subject to incidents in her apartment when performing her daily chores. In addition, the symptoms indicate that the patient is experiencing the first signs of dementia, which requires particular attention from the professionals and specified treatment. Ertha does not take some memory medicine and pills for anxiety that her husband gives her. However, it might be necessary to introduce dementia-specific treatment. Another concern that arises in relation to medication is the potential for polypharmacy.
The patient is prescribed several medications, confusion and memory loss being some of the possible side effects (Davidson, 2017). Therefore, the concern for Ertha is that she should be assisted in her medication intake since she might be exposed to accidental overdose due to her forgetfulness.
Additional Information that Might be Required Concerning Erthas Condition
Despite the multifaceted data describing the patients condition, there are several issues that a professional should clarify for making informed decisions in terms of further treatment of the patient and care provision relevant to her needs. For example, it might be relevant to identify what medications exactly Ertha is currently prescribed. One should clarify whether her physician is aware of all the medications that the patient and her husband consider helpful in different situations of anxiety or confusion. Moreover, It is important to collect health history that would determine when the first incidences of memory loss and cognitive impairments occurred. This information would be helpful in identifying the severity and the level of the conditions development.
Life Changes and Health Care Needs Management
Several changes in the patients life have had a significant impact on her ability to manage her health care needs. In particular, at the time of the interview, the patient reported losing her son in a war, which had been a trigger of depression and emotional breakdown along with long-term grief that could intensify the severity of dementia symptoms. As for moving to an assisted facility, this change might have a positive effect since Ertha has continuous access to assistance provided by professionals. On the negative side, Henrys illness and hospitalization hinder Erthas independence from professional care since her husband cared for her all the time.
Moreover, the stress that the patient is exposed to due to the hospitalization and illness of her husband triggers more severe depression and anxiety that results in a weaker ability to take care of herself and manage her condition. Therefore, given all the difficulties that the elderly patient encounters, she is in need of timely and adequate professional care that would meet her health needs.
Beers Criteria Application
According to Croke (2020), the Beers Criteria help health care professionals in guiding proper medication management in patients with several concurrent conditions, especially in the elderly population. This tool might be helpful in Erthas case since it provides a basis for eliminating insufficient medications that could aggravate the symptoms related to dementia. It might be the case that the elimination of medications with harmful side effects might ease the severity of symptoms and help the patient lead a more effective life. On the other hand, the Beers Criteria might be applied in order to substitute her current medications with alternatives to understand the development of her cognitive impairments with time.
Conclusion
In summary, as the review of the case of Ertha Williams dementia demonstrates, older people are subject to brain impairments that result in memory loss, confusion, language- and thinking-related complications, and other issues.
These symptoms significantly obstruct normal everyday life and the ability to manage ones health care needs. Recent changes in the patients life trigger more stress and might cause worsening of dementia symptoms, which is why professional support and help with symptom management is essential. The strengths of the patient, namely active social life, close relationships with family, faithfulness, and the overall acceptance of her condition, might contribute to successful disorder management. One of the tools that are likely to mitigate the risks and clarify Erthas cognitive issues is the Beers Criteria.
References
Alzheimers Association. (2021). What is dementia? Alzheimers Disease and Dementia. Web.
Cleary, J. (2021). Ertha Williams. National League for Nursing. Web.
The client has chronic obstructive pulmonary disease (COPD), a progressive respiratory disorder characterized by difficulty breathing and inflammation of the airways. The client also has mild dementia, a decline in cognitive function that can affect memory, language, and decision-making skills. COPD can significantly impact the clients functional ability and cognitive status. The difficulty breathing caused by COPD lessen the clients ability to meet their basic needs, such as dressing, bathing, and eating. It can also affect the clients ability to carry out their activities of daily living, such as managing their medications, paying bills, and performing household tasks. Mild dementia can also contribute to a decline in the clients cognitive function, which can impact their ability to perform these tasks and make decisions (Arvanitakis et al., 2019). The clients condition affects the care that is required in several ways. The client may need assistance with activities of daily living and may require oxygen therapy to help with breathing. They may also need additional support to manage their medications and to make decisions about their care.
Pertinent assessment data related to the clients condition that should be collected and noted include respiratory rate, oxygen saturation levels, and the presence of a cough or sputum. It is also important to assess the clients cognitive function and memory, as well as their ability to perform activities of daily living. The clients cultural background can affect the care that is provided in several ways. For example, the clients cultural beliefs about health and illness, their preferred methods of communication, and their dietary preferences may all impact the care that is provided. It is important for the care team to consider these cultural factors and to provide care that is culturally appropriate and sensitive. An individuals social history and family relationships can also affect the care that is provided. For example, the clients support system and the availability of caregivers can impact the level of care that is required. It is important for the care team to understand the clients social network and to involve family members and other caregivers as appropriate.
There are several ways to promote independence while assisting with care for a client with COPD and mild dementia. These may include providing the client with the tools and resources they need to manage their care independently, such as medication reminders or assistive devices, and encouraging the client to participate in their care as much as possible. It may also be helpful to provide the client with education and training on how to manage their condition and to advocate for their own needs.
From a physical standpoint, the clients COPD and mild dementia likely have a significant impact on their overall health and wellness. The cognitive and psychological dimensions may also be affected by the clients declining cognitive function (Arvanitakis et al., 2019). The social dimension may be impacted by the clients reliance on caregivers and their reduced ability to engage in social activities. The spiritual dimension may be affected by the clients illness and the challenges they are facing. These dimensions are not in high-level wellness because they are all are worsened with the conditions. The strongest dimension can be social as caregivers help the ill person while the weakest one is psychological as the conditions affect the cognitive functions. To promote wellness in psychological dimension, the person can engage in cognitive simulation activities, for example, doing puzzles, writing or playing memory games. Another strategy is to participate in social activities, for instance, being involved in group outings or club meetings.
If I were this client, I would likely prioritize the quality of my physical care and the management of my COPD. Ensuring that my breathing is well-controlled and that I have access to the resources and support I need to manage my condition would be important to me. The clients overall quality of life can be enhanced by changing their diet and daily routine. The client can include cognitive games, spending time with their family and eating fresh food to their daily activities.
Reference
Arvanitakis, Z., Shah, R. C., & Bennett, D. A. (2019). Diagnosis and management of dementia. Jama, 322(16), 1589-1599.
