Category: Dementia

Background on Frontotemporal Dementia

Frontotemporal Dementia is characterized by degeneration of the frontal lobe which lead to behavior and executive function changes. Researchers consider that hereditary factors are important in the etiology of Frontotemporal Dementia. The matter has been continuously investigated ever since. These investigations showed that children adopted away from their biological parents at birth are at significantly greater risk of later developing Frontotemporal Dementia if there is dementia among their biological relatives, but not if it is present among their adoptive relatives (Baddeley et al, p. 98). These findings demonstrate that the enhanced tendency to develop Frontotemporal Dementia in these people is not due to a shared environment but to shared genetic material. “One of the major criteria used for distinguishing frontal variant dementia is the existence of executive deficits as shown by performance on frontal tasks” (Ward, p. 120). The boundary between normality and Frontotemporal Dementia is not clear-cut. It has been known for a long time that abnormal features can be observed before the onset of a clear-cut psychotic episode, and so it has generally been assumed that these transient or partial forms would always evolve into clear-cut and sustained psychotic features. However, this is not always the case.

The theme of the relationship of mental disorder to brain abnormality (neuropathology) was pursued in a particularly successful way in relation to what we would now recognize as neurosyphilis (then termed general paralysis of the insane). This was shown to be a single disease that presented as a sequence of clinical syndromes. “Recent studies in the literature claim to meet this criteria if performance is impaired on several such tasks, e.g. Trails version B and the Stroop. Lough, Gregory, and Hodges (2001) presumably defined their sample of frontal variant patients some other way since they were described as having intact performance on executive tasks but an inability to perform “theory of mind” problems” (Ward, p. 120). The order of appearance of these syndromes depended on the progress of lesions in the brain. Neuropathological approaches to dementia were also successful. Dementia praecox had a specific pathology in the brain and a specific cause, even though essentially nothing was known of either the pathology or the cause during his lifetime. The symptoms that he emphasized included auditory and tactile hallucinations, delusions, incoherent speech, blunted emotions, negativism (resisting suggestions and doing the opposite), stereotyped behavior, and lack of insight. Nonetheless, he appreciated that the condition was diverse and difficult to classify (Baddeley et al, p.98).

Overall Question

The question is whether executive deficits are the main signs and medical manifestations of Frontotemporal Dementia. The goals of the experiment is to extend the studies and differentiate between Alzheimer’s disease and Frontotemporal Dementia.

Alternatives and Logic

The hypothesis to be tested is based on the idea that executive deficits is a remarkable feature of Frontotemporal Dementia rather than Alzheimer’s disease. The concept of Frontotemporal Dementia as an essentially psychological and physical disorder, possibly with a psychogenic basis, rather than a pathological condition of the nervous system is attractive to psychiatrists. This view fitted in well with the psychoanalytical tradition that prevailed. As a result, psychiatrists had a very broad concept of Frontotemporal Dementia, one that included patients who would have been regarded as having depressive or manic psychoses, or even as suffering from non-psychotic neurotic states (Garrison, p. 781).

Method

The theory of mind will be used to test the hypothesis. It is assumed that some events happen to one person remain unaware for another person during the experiment. Theory of mind suggests that patients with Frontotemporal Dementia will be unable to perceive and understand events while another person (a testee) will be able to identify and explain the event. It is suggested that executive functions are distinct and disconnected but in some patients they can be associated with adjacent parts of the frontal lobes. From within the broad class of illnesses not associated with a demonstrable underlying brain lesion, he had set out to define a cluster of symptoms and signs that predicted a characteristically poor outcome. It is expected to test 25 patients (20-50 years old) with Frontotemporal Dementia. A special attention and care will be paid to possible cases of Alzheimer’s disease. The control group will consist of 25 people (from 20—50 years) without psychological problems.

Anticipated Results

One test of executive function on which patients with Frontotemporal Dementia often perform badly is ‘verbal fluency’, particularly in the form where the patient has to give all the words she can think of beginning with the letter A (or S, or F). the executive processes located in the prefrontal cortex can be seen as being near the top of a hierarchy of control. The executive processes control the function of lower centers located in posterior regions of the brain. The researcher will present a list of words and then asking patients to repeat back the words a few minutes later. This is a typical memory test. Researchers could just listen passively to the words and hope that we will remember them. Researchers could repeat the words over and over in our heads, but the psychologist will probably prevent this by giving another task to distract us. The best way to remember a list of words is to think about what the words mean. The patient with ‘executive problems’ fails to use strategies like this when trying to remember a list of words, and as a result, her memory for the words is poor. If she is specifically instructed to use a good strategy, her memory improves (Stuss and Levine, p. 401).

It is clear that problems with executive functions will have a pervasive effect on the performance of a whole range of tasks. For almost any task there will be an optimum strategy that could be adopted, including, of course, the strategy of abandoning the task altogether because enough time has been spent on it or it is too difficult. Tasks that depend least on executive functions are those that have been well practiced so that optimum strategy is adopted as a matter of routine. Alternatively, the need for executive functions is minimized if the experimenter tells the subject precisely how the task should be performed and which strategy should be adopted. On tasks like this patients with Frontotemporal Dementia perform reasonably well. The results obtained from the experimental and control groups will be compared (Stuss and Levine 401). It is also suggested that these ‘lesser’ executive functions superficially resembling Frontotemporal Dementia but with a good outcome should be considered ‘psychological’ rather than ‘physical’ disorders – in other words, these disorders do not have abnormalities in the brain and are appropriately treated with psychotherapy.

Inferences

The obtained results will prove that executive functions depend upon the prefrontal cortex. Different aspects of executive functioning probably rely upon different regions of prefrontal cortex, although precise relationships are yet to be determined (Selkoe, p. 58). Once a suitable strategy has been selected by processes acting in the prefrontal cortex, it will be implemented in posterior parts of the brain. For example, the word store that must be accessed in a verbal fluency task is probably located in the left temporal cortex. Thus, the executive processes located in the prefrontal cortex can be seen as being near the top of a hierarchy of control. The executive processes control the function of lower centers located in posterior regions of the brain. In patients with known brain lesions, impairment of executive function is associated with lesions in the frontal lobe, although these often have to be quite large for the impairment to be detected using standard neuropsychological tests. If executive function depends not only on the prefrontal cortex but also on interactions between the prefrontal cortex and other brain regions, then problems could arise if something went wrong with these interactions (Maj and Sartorius 109). The interactions depend upon long-range connections between brain regions and also on loops involving structures beneath the cortex, such as the basal ganglia. This problem frequently occurs with patients who are seriously ill, since a severe mental illness can cause a breakdown in family relationships. Sometimes, for reasons related to stigma, family history is concealed from doctors, and indeed we have come across cases where the family history is concealed from some family members. Since modern methods of genetic research were developed, these have been applied with enthusiasm to the study of psychiatric disorders (Garrison, p. 781).

Works Cited

1. Baddeley, A.D., Kopelman, M. D., Wilson, B. A. The Handbook of Memory Disorders. Wiley, 2002.
2. Garrison, M, The Empire of Illness: Competence and Coercion in Health-Care Decision Making. William and Mary Law Review, 49 (2007), 781.
3. Maj, M., Sartorius, N. Dementia. Wiley, 2002.
4. Selkoe, D. T. The Aging Mind: Deciphering Alzheimer’s Disease & Its Antecedents. Daedalus, 135 (2006), 58.
5. Stuss, D. T., Levine, B. Adult Clinical Neuropsychology: Lessons from Studies of the Frontal Lobes. Annual Review of Psychology, 2002, p. 401.
6. Ward, A. Attention: A Neuropsychological Perspective. Psychology Press, 2004.

Introduction

Stroke is a serious condition that affects patients’ health and quality of life. After a stroke, patients face the risk of both short-term and long-term neurological consequences (Perna & Temple, 2015). Consequently, patients with a history of stroke require specific attention, and clinical practitioners must understand their health risks to address them successfully. Clinical outcomes may depend on a variety of factors, including the type of stroke suffered, patient demographics, and medical history (Corraini et al., 2017). Research into variations in risk factors based on the type of stroke experienced is thus vital to providing high-quality care to patients. The present paper will review a research article by Corraini et al. (2017), which reports on the findings of original research into long-term risks of dementia among patients following ischemic or hemorrhagic stroke. The methods and results of the study will be discussed, including their relevance and significance to clinical practice.

Background

Stroke is a severe threat to public health globally since it contributes to the burden of disease, disability, and mortality. According to Katan and Luft (2018), stroke is currently the second leading cause of death globally, with 15.2 million deaths from ischemic heart disease and stroke worldwide in 2015. In the United States, 795,000 people suffer from stroke every year, and more than 140,000 people die as a result of it (Perna & Temple, 2015). The incidence of stroke is the highest in older adults, and this condition is also among the leading causes of long-term disability in the country (Katan & Luft, 2018). As reported by Katan and Luft (2018), among sufferers of stroke, “26% remain disabled in basic activities of daily living (Framingham cohort), and 50% have reduced mobility due to hemiparesis” (p. 208). Other frequent causes of disability following stroke are aphasia and depression (Katan & Luft, 2018). In addition, stroke contributes significantly to healthcare costs. Studies report that approximately 3-4% of healthcare spending in the United States is attributable to stroke, and the lifetime cost per person is $140,048 (Katan & Luft, 2018). Therefore, stroke is a serious concern for care providers and patients alike.

The main subtypes of stroke considered in the literature are ischemic and hemorrhagic. In ischemic stroke, thrombi and/or emboli develop, leading to deficiencies in blood flow and oxygenation (Perna & Temple, 2015). Intracerebral hemorrhage (ICH), which is a term used to denote hemorrhagic stroke, cerebral vessels rupture, typically due to a combination of high blood pressure and atherosclerosis, aneurysm, or arteriovenous malformation (Perna and Temple, 2015). Although hemorrhagic strokes only comprise 10-15% of all strokes, they lead to more severe consequences and account for about the same number of patient deaths as ischemic strokes and for nearly 1.5 times more disability-adjusted life years (Katan & Luft, 2018; Perna & Temple, 2015). Hence, the long-term risks faced by patients vary depending on the type of stroke they experience, and providers have to understand these differences to support future care and rehabilitation.

Methods

The chosen study focused on the differences in the long-term risk of dementia among patients who had suffered an ischemic or hemorrhagic stroke. The methodology applied for the study was quantitative, and the selected design was a longitudinal population-based cohort study (Corraini et al., 2017). The research was conducted in Denmark, which did not limit its scope due to a substantial sample. The total sample included over 200,000 patients who had suffered a stroke, including 84220 ischemic stroke survivors and over 25,000 hemorrhagic stroke survivors, with 104,303 patients presenting with an unspecified type of stroke (Corraini et al., 2017). Additionally, the scholars included over 1 million patients who never suffered a stroke, and their data was used to compare the outcomes in dementia prevalence and risks (Corraini et al., 2017). The data used by the scholars were obtained from Danish medical databases, and the reporting period was over 30 years, from 1982 to 2013 (Corraini et al., 2017). Patients from the two groups were matched by age and sex, thus accounting for these factors while determining dementia prevalence and risks. Data analysis followed a simple process of constructing hazard ratios through statistical calculations, followed by sensitivity tests to verify the ratios.

The methods used by the authors were appropriate to the goals of the study. Using quantitative data allowed identifying common trends and analyzing them to determine the relationship between patient outcomes and stroke history. Additionally, this methodology enabled the researchers to gather longitudinal data and include a very large sample of patients in the analysis. This, in turn, contributed to the reliability of the findings. The fact that the authors rely on data from national hospital databases is also a strength of the study since it ensures the accuracy of the information gathered. One potential limitation of the research is that it did not consider non-demographic factors that could have contributed to dementia, such as family history, lifestyle, or overall health condition.

Results

The results of the study are presented both in written form and using visual aids, such as graphs and tables. On the whole, the researchers found stroke survivors to have a higher risk of dementia in comparison with patients without a history of stroke (Corraini et al., 2017). The comparative hazard ratio for stroke survivors was 1.80, 1.72 for ischemic stroke survivors, and 2.72 for hemorrhagic stroke survivors (Corraini et al., 2017). For hemorrhagic stroke survivors, the hazard ratio of dementia was 2.70 and 2.74 after intracerebral and subarachnoid hemorrhage, respectively (Corraini et al., 2017). Age was negatively associated with hazard ratios of all stroke survivors, with younger patients facing a higher risk of dementia than older ones (Corraini et al., 2017). Hence, three main conclusions can be made from the study. Firstly, stroke increases the risk of dementia regardless of patient characteristics and type of stroke suffered. Secondly, patients with a history of hemorrhagic stroke are at a higher risk of dementia than those who suffered an ischemic stroke. Lastly, a young age increases the risk of dementia in stroke sufferers even further.

Discussion

The results of the study have important practical implications for care providers. Based on the outcomes of the study, it is evident that patients with a history of stroke have increased chances of developing dementia, and thus it is crucial for care providers to identify these patients and screen them for signs of dementia regularly. This can help to develop management strategies as soon as possible, thus mediating the damage to the patient’s quality of life. Patients who had suffered a hemorrhagic stroke at a relatively young age are of particular concern to practitioners since their risk is even higher. These patients should be assessed more frequently to identify early-onset dementia, which poses a significant threat to their quality of life and health.

Patient education is also crucial to supporting patients who face increased risks of developing dementia. According to research evidence, up to 35% of dementia cases in the general population can be prevented by addressing modifiable risk factors (Yaffe, 2018). Hence, care providers should pay particular attention to educating stroke survivors about their risks of developing dementia and how these risks can be modified or managed. This could help to reduce the occurrence of dementia among stroke survivors or postpone its onset, particularly in younger patients.

Lastly, the study also shows the need to address the growing incidence of stroke and the prevalence of severe cases, which lead to the most significant consequences. As in the case of many other severe conditions, the risk of stroke can be reduced by addressing modifiable risk factors (Katan & Luft, 2018). Providing education to patients on the importance of a healthy lifestyle, weight management, smoking cessation, and reduced sugar intake could help to reduce the incidence of stroke in the general population, leading to decreased healthcare expenditures and improved patient outcomes. Encouraging patients to monitor their blood pressure and cardiovascular health can also assist in preventing hemorrhagic strokes, which lead to more deaths and dementia cases (Corraini et al., 2017). In this way, the study could also support improvements in clinical practice aimed at reducing the burden of stroke.

Conclusion

Overall, the study is relevant to clinical practice since it focuses on one of the most threatening conditions in the modern world. The methods utilized by the researchers were appropriate to the aims of the research and ensured that the information collected was reliable and accurate. The results of the study highlight differences in dementia risks between the general population and the survivors of two types of stroke: ischemic and hemorrhagic. The results can be used to support the clinical practice by improving screening and patient education.

References

Corraini, P., Henderson, V. W., Ording, A. G., Pedersen, L., Horváth-Puhó, E., & Sørensen, H. T. (2017). Long-term risk of dementia among survivors of ischemic or hemorrhagic stroke. Stroke, 48(1), 180-186.

Katan, M., & Luft, A. (2018). Global burden of stroke. Seminars in Neurology, 38(2), 208-211.

Perna, R., & Temple, J. (2015). Rehabilitation outcomes: ischemic versus hemorrhagic strokes. Behavioural Neurology, 2015(891651), 1-6.

Yaffe, K. (2018). Modifiable risk factors and prevention of dementia: What is the latest evidence? JAMA Internal Medicine, 178(2), 281-282.

Introduction

‘Knowing Residents with Dementia’ is a research study conducted by J. Kasin and D.D. Kautz (2007). The aim of the research is to examine and evaluate the kinds of knowledge applied to patients with dementia and used by caregivers in assisted living facilities. The relevance of the critique is to analyze the importance of different kinds of knowledge and their impact on the patience audience.

Summary

The research is a qualitative study that examines two main types of knowledge: behavior-centered knowledge and person-centered knowledge, and their role in gerontological nursing practice. “This is an explanatory qualitative study using focus groups as the method of data collection” (). The study was based on 5 focus groups and involved 23 caregivers from small and large facilities. Thus, different selection criteria were applied to small and large facilities. This study was based on in-depth personal interviews with a stratified sample. Although time-consuming, this type of interview allowed deeper exploration of key issues. The main unit of analysis was a focus group. Each interview lasted for one hour. Kreuger’s guidelines (2000) were applied to date analyses. “The researchers met during group sessions and identified areas from the interview guides that needed further exploration” (Kasin and Kautz 2007, 33).

This research values context-sensitivity, that is, understanding phenomena in all their complexity and within a particular situation and environment. The study analyzes two types of knowledge, behavior-centered and person-centered knowledge, in the focus groups. The research works to eliminate all of the unique aspects of the environment in order to apply the results to the largest possible number of subjects and experiments. Finally, one would expect different contributions to a body of knowledge given the intricate connection between and among the postulates. Each type of knowledge was evaluated and analyzed in relation to the main symptoms of dementia. Four out of five groups used person-centered knowledge. In this study, the knower and the known were interdependent; then there was integrity between how the researcher experienced the participants in the study, how the participants experienced the situation and their participation in it, and how those results were presented (Kasin and Kautz 2007). Using interviews also enabled us to adopt an inductive approach whereby we were not testing part of a theoretical model (deductive reasoning) but identifying patterns in data that might lead to the development of grounded theory based on the actual travel experiences of the women themselves.

It was found that the group used behavior-centered consisted of young employees who did not have experience in this sphere. In other groups, person-centered knowledge was associated with a personal attachment to residents. The majority of respondents who used the person-centered approach were from small facilities, while the person-centered approach was typical for large facilities. The main limitation of the study was limited sample groups and bias. The researchers suggest that individual behavior analysis can help to increase residents’ quality of life.

Critique

I suppose that the study is well conducted and designed, which helps the researchers to examine and analyze the hypothesis. The task of qualitative research is to capture this process of interpretation. Many patients, particularly with chronic disabilities, live in nursing facilities, and the role of nursing staff is to help them to function. Some caregivers may be biased in their feelings about the expectations for the chronically disabled, but they tend to know the habits and functioning of the disabled person more intimately. The person-centered approach helps caregivers to be intimately involved with that person after hospitalization or therapy. Therefore, decisions about and particularly results of treatments, therapies, and procedures are important for them. If family caregivers are excluded either inadvertently or deliberately, if their questions are not considered seriously, they may also either inadvertently or deliberately thwart or undo the progress that was made by the formal caregivers. The research can be applied to home care because disruptive behaviors are a major obstacle in the care of a person suffering from dementia. They bring challenges to caregivers both in the home and in the nursing home. Frequently, it is because family members are not able to cope with these behaviors at home that they are then forced to institutionalize their relative (Rovner et al., 1996).

In nursing facilities, higher staff-to-resident ratios are often required in order to control the agitated behaviors of residents. Informed by the knowledge that the demented person has a longstanding tendency to react strongly and negatively to particular circumstances, caregivers and researchers might be able to interpret better their signals of emotional distress. A consideration of these challenges in translating the demented person’s message reveals the vital role of careful assessment in understanding their self-reported inner experience (Rovner et al., 1996).

I suppose that this study vividly portrays that the need to translate dementia patients’ oftentimes distorted communication constitutes one of several methodological obstacles to accurate interpretation of self-report information. The ability to “read” a patient is facilitated by assessment efforts that emphasize attention to complementary sources of information, including verbal, facial, postural, vocal, and contextual cues, as well as by the establishment of rapport, which serves to allay patients’ fears and mistrust, thereby minimizing emotional barriers to self-revelation. Further, given the extreme fluctuations in dementia patients’ levels of lucidity or self-awareness, the usefulness of self-report information might be maximized by making every effort to interview a patient at what is a “good time” for him or her. The person-centered approach proposes great opportunities to improve service quality and quality of life in assisted nursing facilities.

The main limitation of the research is that it does not take into account considerable cognitive and social skills to observe one’s own state, compare it to internal and social standards regarding what is desirable, assess the feelings associated with the state, and report such evaluations to an outsider. The person with the dementing illness is typically severely limited in observational, conceptual, and reporting ability.

I agree with the authors that the person-centered approach should be the core of nursing practice because it proposes nurses’ wide opportunities and effective interaction with patients. For instance, cerebrovascular accidents can lead to drooping of half of the face and paralysis of an arm or leg. Tardive dyskinesia can produce strange mouth, tongue, and body movements. Chronic obstructive pulmonary disease in severe cases can produce shortness of breath and wheezing even with limited movement. Resting tremors in the hands are very common in many neurological conditions. Impairments in vision or hearing may reinforce an impression of unreactivity. Wrinkles may give an impression of permanent anger, worry, or mirth if the observer has no previous knowledge of how changes in expression occur. Knowledge of these conditions should be used to help interpret apparent effects and inform the human observer about the relative usefulness of its cues. The apparent effect is usually thought of in terms of a state the individual is experiencing at the moment, one that comes and goes depending on a variety of internal and external situations. However, difficulties arise when one is confronted with individuals who appear to have an emotional state etched permanently into their face and body. Is this depression or the result of many years of simple aging or of a disease process loosening the elasticity of the facial skin, osteoporosis of the spine, and osteoarthritis in the joints? This gets us back to the importance of having a sense of the baseline of apparent effect for a given individual. Minute movements of the face and changes in the intensity of expression become crucial in rating an individual’s apparent effect.

I would suggest that the method of observations would help to improve the study and overcome bias. Observation is a method employed by qualitative researchers. Although case-study research rarely uses more than a handful of cases, the total number of observations is generally immense. It is therefore essential to distinguish between the number of cases and the number of observations (Byman and Burgess 1999). The former may be of some interest for some purposes, but only the latter is of importance in judging the amount of information a study brings to bear on a theoretical question (Byman and Burgess 1999). Further research is needed to analyze the personal motives and professionals skills of the caregivers careering for people with dementia.

References

1. Byman, A. and Burgess, R. (eds) (1999). Qualitative Research, London: Sage.
2. Kasin, J., Kautz, D.D. (2007). Knowing Residents with Dementia’
3. Rovner, B. W., Steele, C. D., Shmuely, Y., & Folstein, M. F. (1996). A randomized trial of dementia care in nursing homes. Journal of the American Geriatrics Society, 44, 7-13.

Executive Summary

The purpose of this report is to investigate the causes of dementia and explore the role of a mental health nurse in helping patients to manage the condition. In this document, dementia is presented as a public health concern in the United Kingdom because it is a poorly understood cognitive condition and the population at risk, which is mostly comprised of elderly people, is increasing as people live longer in the United Kingdom. Therefore, dementia is a public health concern because of its surging prevalence and low levels of community awareness regarding its impact on patients, families, and society. From a background of a high prevalence of dementia in the United Kingdom, due to a growing aging population, this report suggests that early diagnosis of dementia should be improved and its occurrence minimized through behavioral changes. The theory of reasoned action and the health belief model are presented in this document as supportive frameworks for implementing the aforementioned objectives. The role of community healthcare nurses is pivotal in accomplishing these goals because they are important caregivers. This report recommends that their services should be complemented by the provision of home-based care, which may be provided by well-resourced family members. Lastly, it is advised that local and national health data should be used to track progress in health promotion and in identifying new requirements in disease management.

Introduction

Dementia is a mental health condition characterized by a decline in cognitive reasoning, loss of memory, and poor judgment. The World Health Organization (2019) posits that mental health condition is among the leading causes of disability among older patients throughout the world. Based on the importance of cognitive functions to human life, dementia causes significant disruptions to a person’s daily activities and, by extension, their quality of life through a manifestation of the aforementioned symptoms (Honig et al., 2018; Clarkson et al., 2017). Its effects on patients are dire because the condition has physical, psychological, and economic costs to their wellbeing and that of their families.

Dementia commonly affects older persons because of their declined cognitive functioning. Global estimates suggest that 50 million people suffer from the disease and 10 million new cases are reported annually (World Health Organization, 2019). In the United Kingdom (UK), about one in every 14 people, aged over 65 years, suffer from the disease (Alzheimer’s Society, 2020). This ratio is expected to increase as the population of elderly people increases (Dementia UK, 2020; Wauters and Van Broeckhoven, 2019; Olney, Spina, and Miller, 2017)). Therefore, the rising cases of dementia in the UK pose a serious public health risk. Consequently, it is important to understand its causes and management. To this end, key issues that will be covered in this report include an appraisal of key mental health concepts relating to dementia, the use of local and national health data to formulate appropriate health policies, and a critical evaluation of theories and policies to develop effective health programs aimed at increasing people’s awareness of the disease. The findings of this report will help to improve the efficacy of collaborative public health interventions for addressing dementia in the UK and promote the use of evidence-based practices in its management.

Concepts of Mental Health and their Implications in Care Management

Reasons for High Prevalence of Dementia

As highlighted in the introduction section of this report, dementia is a cluster of several types of diseases that cause a decline in cognitive functioning. There are many causes of the disease but Alzheimer’s is leading because it accounts for up to 70% of all cases diagnosed (Schols and Kardol, 2017; Marie, Hannigan and Jones, 2017). In most cases, the disease is associated with age, childhood trauma, and the presence of a head injury (Honig et al., 2018). A history of unskilled work and alcohol abuse are also other risk factors contributing to the high incidence of the disease (Farina et al., 2017; McShane et al., 2019). Smokers and patients who suffer from high blood pressure have the highest exposure to dementia because of their poor health. Early symptoms might consist of hallucinations and difficulty in measuring distances (Mueller et al., 2017; McKeith et al., 2017; Kane et al., 2018; Jellinger, 2017). Broadly, the reasons for the high rates of dementia are genetic and socioeconomic.

Role of Community Mental Health Nurse

Although almost all forms of dementia are treatable, it is difficult to reverse the mental health decline caused by the disease. Therefore, community mental health nurses have a role in helping patients to take medication that would alleviate symptoms (Stokes, 2017). In this regard, post-diagnostic care and support is important component of care management. In the UK, this type of intervention has been spearheaded by the National Health Service (NHS) through the “Well Pathway for Dementia,” program, which encourages nurses to help patients prevent dementia and live well with it (NHS England, 2020). These initiatives highlight the importance of community mental health nurses in providing post-diagnostic care.

Use of Local and National Data to Improve Health Policies

The effective management of dementia as a public health concern depends on the use of reliable data to formulate effective health policies and programs to manage it. Particularly, data obtained from different levels of healthcare management, such as local and national data in the UK could be instrumental in developing collaborative public health interventions (Woods et al., 2018; Wu et al., 2017). The goal is to create synergy across various levels of healthcare management. Such data, if well aggregated, could be used to develop health guidelines and proposals that would improve the prevention of the disease (Nordström and Nordström, 2018; Langa et al., 2017). The use of epidemiological data relating to dementia in the UK could also be relevant in predicting healthcare needs and resources needed to manage the condition in specific communities.

Theories and Ethical Principles Relating to Health Promotion

Addressing the healthcare needs of dementia patients requires the use of effective theoretical frameworks for designing public health interventions. To this end, the theory of reasoned action could be used to formulate public health programs for managing dementia because it highlights the link between people’s behaviors and health outcomes (He, Wan, and Luo, 2019). The “behavioral” component is integral to this analysis because the management of dementia is largely a product of people’s actions aimed at preventing, diagnosing, and managing the condition (Schols and Kardol, 2017). Particularly, since patients lose their cognitive abilities and depend on receiving care from family members or healthcare providers, it would be possible to use the theory to predict behaviors that would improve or worsen the quality of care provided. From this analysis, the theory of reasoned action largely suggests that people’s health behaviors are products of their behavioral intentions (He, Wan, and Luo, 2019). Therefore, the aforementioned theory portends several positive outcomes in the management of dementia because it helps healthcare workers to predict people’s behaviors that would ultimately affect the quality of their health outcomes.

Based on the need to undertake collaborative programs to increase people’s awareness of dementia, the health belief model could also be used to design effective interventions and health promotion programs for preventing or managing the disease. The theory presupposes that people’s health outcomes are products of their belief systems (McLean et al., 2019). Therefore, its proponents suggest that it is difficult to realize positive health outcomes if no strong belief supports them (McLean et al., 2019). This theory highlights the need to develop health interventions and programs that are centered on aligning positive health behaviors for preventing dementia with people’s beliefs. The opposite is also true because health behaviors that are inconsistent with people’s beliefs in the UK may fail to achieve their objectives.

Lastly, it is important to observe strict ethical guidelines when implementing health programs in the UK aimed at preventing or managing dementia among older adults. For example, there should be a keen emphasis on protecting the privacy of patients and families involved in care management to prevent social stigma (Kontos, Miller, and Kontos, 2017). Similarly, participants of healthcare programs should give their consent to partake in such initiatives. The goal of observing these ethical guidelines is to maintain the integrity of proposed health interventions.

Conclusion and Recommendations

This report has highlighted key concepts in mental health care relating to the management of dementia among older adults in the UK. The analysis has included a review of the use of local and national health data to formulate appropriate healthcare policies and develop synergy across different levels of healthcare management to provide the best possible care for patients. Lastly, a critical evaluation of health-based theories and policies has been provided to provide enough data for developing health promotion programs aimed at increasing people’s awareness of dementia. Broadly, the insights provided in this review could improve the quality of health interventions formulated at primary, secondary, and tertiary levels of care.

At a primary level, there is a need to evaluate the main causes of dementia, such as Alzheimer’s, and prevent their occurrence through early diagnosis and treatment. This means that more sensitization should be done within the community to increase people’s awareness of the disease-causing factors and encourage them to report suspected incidences. At a secondary level, families should be equipped with sufficient information on how to care for elderly patients suffering from dementia in their homes. The goal is to augment the primary healthcare plan provided at healthcare facilities with home-based care. This intervention should improve the synergy in care delivery between nursing professionals in the primary healthcare setting and family members in the secondary setting. Lastly, at a tertiary level, local and national data should be utilized to develop effective interventions using epidemiological and statistical data to determine the most affected demographics and the kind of resource requirements needed to manage the disease.

Reference List

Alzheimer’s Society (2020) Dementia UK report. Web.

Clarkson, P. et al. (2017) ‘A systematic review of the economic evidence for home support interventions in dementia’, Value in Health, 20(8), pp. 1198-1209.

Farina, N. et al. (2017) ‘Vitamin E for Alzheimer’s dementia and mild cognitive impairment’, Cochrane Database of Systematic Reviews, 9(1), pp. 134-166.

He, J., Wan, L. and Luo, B. (2019) ‘Intentions and influencing factors regarding natural childbirth among urban pregnant women in China, based on the theory of reasoned action and structural equation modeling’, Journal of International Medical Research, 7(2), pp. 4482-4491.

Honig, L. S. et al. (2018) ‘Trial of Solanezumab for mild dementia due to Alzheimer’s disease’, New England Journal of Medicine, 378(4), pp. 321-330.

Jellinger, K. A. (2017) ‘Dementia with Lewy bodies and Parkinson’s disease-dementia: current concepts and controversies’, Journal of Neural Transmission, 125(4), pp. 615-650.

Kane, J. P. M. et al. (2018) ‘Clinical prevalence of Lewy body dementia’, Alzheimer’s Research and Therapy, 10(1), pp. 112-119.

Kontos, P., Miller, K. L. and Kontos, A. P. (2017) ‘Relational citizenship: supporting embodied selfhood and relationality in dementia care’, Sociology of Health and Illness, 39(2), pp. 182-198.

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Abstract

Nurses and professionals consider the Lazarus and Folkman Stress and Coping Theory as one the best models for dealing with stress. The theory is one of the widely acknowledged transactional models. It presents the best interventions and management strategies to help individuals change their perceptions about stressful conditions. The model helps people deal with their external environment in a positive manner. The Middle Range Theory can help members of a family provide the best care to patients suffering from dementia. This paper applies the Lazarus and Folkman Stress and Coping Theory to a family providing health support to a family member by the name Martin. Martin has dementia disease.

Middle Range Theory Paper: Application of Theory to Practice

Martin had just celebrated his 40^th birthday. He is currently staying at home whereby his family members are giving him the prescribed medicine for the disease. Martin’s dementia was diagnosed in its later stages of development. The members of the family were greatly concerned about Martin’s condition. As a nurse leader, I observed that the family members were depressed. This made it impossible for them to provide the necessary support to the patient. From the situation, I strongly believed that an appropriate Middle Range Theory would help the family. This would ensure Martin was getting the necessary support from them (George, 2010).

I decided to apply the Lazarus & Folkman Stress and Coping Theory since it is an effective transactional model for coping with stress. Whenever a family member has a serious condition like dementia, the relatives find it hard to cope with the situation (George, 2010). It was notable that the family members felt stressed because of they were unable to cope with the Martin’s condition. According to Lazarus & Folkman Coping and Stress Theory, stress can result from lack of resources or ability to cope with a situation. The family members found it hard to offer the best attention and care their patient. That being the case, I decided to design a stress management programme for the family members.

From the very beginning, I asked Martin’s relatives to list some of the factors affecting their relationship with the patient. From the exercise, I learned that the family members found it hard to cooperate with the patient’s situation. Most of them were unwilling to provide the needed care to Martin. The family indicated that the medication procedures were demanding. The relatives did not cooperate with each other in providing the needed care. Sometimes there was communication breakdown thus making it impossible to provide the best care to the patient (Hardy, 1998). The relatives were also uncertain about the future of the patient. This affected the healthcare regimes and practices for Martin.

The first thing I considered necessary as a nurse was to design a workable programme for the family members. I applied the Lazarus & Folkman Coping and Stress Theory because it views the external environment as a major cause of stress. I encouraged the members understand that Martin would get well if he continued to receive the best support and care. I discussed with the members about the future of our patient and his health condition. I also offered myself to be part of the situation. I also responded to their questions accordingly. It was my duty to encourage them to consider dementia as a treatable disease (Altman & Wohlwill, 2001). It was my duty to inform the family members that the condition was manageable with proper communication, cooperation, and the right medication.

From the above clinical situation, it is clear that I embraced the idea of cooperation and attitude change. After a few months, I observed that the members of the family had already changed their attitude about dementia. They were also willing to support, encourage, and communicate with him. This is essential towards faster recovery. Since dementia can cause stress in a family setting, the use of an appropriate transactional model can facilitate the best lifestyle practices and encourage the family members provide the best care and support to their patients (Antonovsky, 2003). I emerged victorious and proud from the practice because I applied the theory successfully to Martin’s family.

Reference List

Altman, J. & Wohlwill, F. (2001). Human Behavior and Environment. New York: Plenum Press.

Antonovsky, A. (2003). Health, Stress, and Coping. San Fransisco: Jossey-Bass.

George, J. (2010). Nursing Theories: The Base for Professional Nursing Practice. Upper Saddle River, N.J.: Pearson.

Hardy, S. (1998). Occupational Stress: Personal and Professional Approaches. London: Stanley Thornes ltd.

Introduction

Dementia is a “syndrome caused by chronic and progressive brain diseases which lead to disturbances of higher cognitive functions” (Royston, 2004, p.71). The common behavioral changes noted in patients with dementia include difficulty carrying out familiar duties, misplacing things, changes in mood and personality, memory loss of recent events, and loss of initiative among others (“Learning how to cope…” 2010). In most cases, individuals living with dementia find it difficult to successfully cope with the situation mainly because they lose their autonomy and are forced to depend on their relatives and friends. This paper discusses dementia and it covers the common types of dementia, its impacts and how individuals successfully cope with this condition.

General Outlook of Dementia

Dementia is a condition that describes a group of symptoms caused by disorders that affect the brain. This condition is not a specific disease but it is a syndrome describing different symptoms affecting individuals’ memory, thinking as well as social abilities to the extent that it interferes with an individual’s normal functioning (Potocnik, 2013). Notably, dementia shows problems with brain functions including loss of memory and inability to perform daily activities accordingly. Apart from memory loss, other brain functions that are affected include reasoning and judgment, communication and language, mental agility, understanding as well as the ability to focus and pay attention.

Generally, individuals with dementia may lose interest in engaging in their usual activities, and may also not be able to control their emotions. More so, they lose interest in socializing and also some aspects of their personality may change as well. These individuals may not be able to understand or solve problems, become agitated or hallucinate, and say things that are not true. Since dementia interferes with an individual’s mental abilities, people with dementia may find it very challenging to maintain their independence, plan and organize things accordingly. This implies that they have to depend on their relatives or friends to assist them with decision making and also in doing certain activities. In most cases, dementia is noted among old people but this is not an indication that it is a condition that affects the aged and it is not a component of the usual aging process. Dementia is usually progressive and this implies that the symptoms begin to appear slowly and gradually worsen.

How Memories are Lost

Memory loss in the most common symptom of dementia but it is not the sole indicator that a person has dementia. Memories are lost if there is damage to brain cells affecting their ability to communicate with each other normally. Symptoms of memory loss include increased problems with duties that need focus and proper planning, and having problems getting the correct words to use among others. Early identification of dementia is important as it enable individuals with it to start engaging in psychological interventions such as memory retraining earlier enough to help them improve dementia symptoms (Royston, 2004).

Alzheimer’s disease

Alzheimer’s disease is one of the most common types of dementia experienced worldwide. It is commonly determined by symptoms such as memory loss and difficulty in planning and performing their usual activities. This type of dementia is known to start with memory loss. At first, the symptoms are mild but with time, they get worse and a person may become more confused, develop communication problems, show poor judgment, and have personality changes and so on. In the early stages, recognizable symptoms of this condition include repletion and getting lost frequently. Extended stress is also one significant factor that makes this disease worse because it leads to increased disappointment and depression.

Vascular Dementia

Vascular dementia is also common and it usually commence with poor judgment, problems with planning, organizing, and making decisions. Other symptoms of this type of dementia include being agitated, communication and language problems, memory problems, and difficulty in recognizing familiar sights and sounds among others. In addition, vascular dementia can result in fluctuating intellectual and changes in personality (Potocnik, 2013). This type of dementia is as a result of illnesses like stroke in the brain that interferes with the brain’s normal functions. Although there are various symptoms of this condition, its signs largely depend on which part of the brain has been interfered with. It is also caused by factors such as high blood pressure and high cholesterol (“Learning how to cope…” 2010).

Impact on individual and the family

Effects of Alzheimer’s disease include reduced self-esteem and positive self-image with in turn causes social isolation. This condition also forces individuals to lose independence and start depending on others in most cases because it greatly influences a person’s ability to function normally and carry out their familiar duties effectively. In addition, individuals with Alzheimer’s diseases experience mood changes. Moreover, those suffering from Alzheimer are not able to work as they used to and so they may find themselves having financial problems especially due to the rising costs of care. The changes in their lives make them feel a loss of control and increases anxiety about what awaits them in the future.

The family or the caregivers of patients with dementia face various challenges in their attempt to create a safe and supportive environment. According to Goodman (2005), relatives are the main care providers for individuals with dementia living at home. They experience burnout and depression in the process of providing care to their loved ones with this condition (“Learning how to cope…” 2010). In some cases, family members may not be able to take their patient to care centers because of financial problems and so they choose to stay with them at home and give them support they need to cope with the situation.

How individuals successfully cope with the condition

Some people find it very difficult to live with dementia due to its symptoms and impacts. However, there are various ways through which individuals with dementia can successfully cope with the condition. First, people with dementia cope with the condition by engaging in physical exercise. Being active in physical activities is very important for those individuals with this condition as it reduces the risk of other forms of dementia. Individuals should ensure that engage in activities that stimulate their brain so as to deal with certain symptoms of dementia (“Learning how to cope…” 2010). They should remain active and occupied by continuing enjoying their hobbies and interests to help them maintain their interest in life. Second, interacting with friends and relatives helps people with dementia to successfully cope with the situation. They should ensure that they maintain a social life because this will help them being active and stimulated. This is because they will be able to share with them about the condition and so the family members and friends would like to help and provide necessary support if they are not isolated. In some cases, individuals find it difficult to talk about their condition and this makes it very difficult for others to help them or to give them the support they need.

Managing stress is another way which individuals with dementia adapt to successfully deal with the symptoms of this condition. Reduced stress can help them maintain a positive emotional and physical perspective of life. Therefore, individuals with dementia can maintain a positive outlook of life by avoiding stress and getting enough sleep. Self care is an important part of daily life and so individuals with dementia should take care of their health and wellbeing, maintain good physical and mental health to reduce the risk of other types of dementia. Staying stress-free is one way to remain relaxed and successfully deal with the dementia and its symptoms. In addition, these individuals need to learn to control their cholesterol intake so as to stay healthy and reduce the risk of other forms of dementia. More so, consulting a mental health professional is important as it will assist individuals with dementia to successfully cope with the situation. A mental health professional can come up with a treatment plan to help these individuals meet their specific needs, regain a sense of control over their lives, and enhance their quality of life. In addition, people with dementia can make use of antidepressants and psychotherapy to help them cope especially if they are very depressed.

Further, individuals can maintain good general health and proper nutrition to improve their lives while living with dementia. They can also plan their daily activities and develop a routine with which they can become familiar. They can adjust to activities which allow them to participate as much as possible. In addition, individuals with dementia can successfully cope with the condition by joining a local support group or get individual or family counseling. Arguably, end of life care in dementia is suboptimal coping mechanism of this condition, and this normally happens if an individual is not able to successfully cope with the situation and the only opt for dying and freeing themselves from the demoralizing symptoms and effects of dementia.

Conclusion

Dementia is a common psychological condition that affects the lives of individuals, and it is not a specific disease but a syndrome caused by illnesses that affect the brain and its abilities to an extent that the normal brain functions are impaired. The most common brain functions affected include memory loss, understanding, language, and judgment among others. Notably, individuals with dementia exhibit behaviors such as memory loss, problems performing familiar activities, changes in mood and personality, and isolation among others. Normally, memories are lost if the brain cells as disturbed or damaged and their normal functioning affected. Alzheimer’s disease starts with loss of memory as a common symptom during its early stages. In contrast, vascular dementia commences poor judgment and inability to make decisions accordingly. Dementia has various impacts on individuals living with it some of which include reduced self-esteem, increased dependency, and isolation. More so, it has effects on the family members of the patient because they have to take care of their patient and ensure that they create a safe and supportive environment. In overall, individuals living with dementia can successfully cope with the condition by being physically, mentally, and socially active as a way of improving symptoms of dementia and living quality life.

References

“Learning how to cope with dementia.” (2010). Healthy Years 7.10: 6.

Goodman, C. (2005). Dementia. Primary Health Care, 15(5), 8.

Potocnik F.C. (2013). Dementia. South African Journal of Psychiatry. 19.3 : 141-152.

Royston, C. (2004). Diagnosing early dementia — cornerstone for change. Pulse, 64(36), 70-72.

Introduction

Dementia is one of the most common disorders in society that is associated with the loss of cognitive ability in aged adults. The condition may stem from brain injury or disease, which may interfere with the mind of an individual. Dementia presents a wide range of syndromes that entail language problems, memory loss, difficulties in communication, and problem-solving ability. To solve the problem, different measures are used with various levels of effectiveness. It is in this regard that is study highlights the management of dementia condition concerning the question stated below.

Framing of the Question

How effective is reminiscence group therapy in eliminating symptoms of depression in dementia patients?

The above-stated research question can be analyzed using the PICO model as stated below.

• Patient or Population: Patients with dementia
• Anticipated intervention: Reminiscence group therapy
• Current standard: Non-Pharmacological tool
• Outcome: Reducing depressive symptoms

Search Strategy

Five scholarly articles were identified for the topic. The articles presented information that could be used for evidence-based practice since the information provided the correlation between reminiscence group and its effectiveness as a non-pharmacological tool for reducing symptoms of depression. The scholarly articles include the following:

Blake, M. (2013). Group reminiscence therapy for adults with dementia: a review. British Journal of Community Nursing, 18(5), 228-233.

Bohlmeijer, E. Kramer, J. Smit, F. Onrust, S, & Marwijk, H. (2009).The effects of integrative reminiscence on depressive symptomatology and mastery of older adults. Community Mental Health Journal, 45(6), 476-484.

Croucher, M. (2009). Effects of reminiscence group in elderly people with Alzheimer disease and the vascular dementia in a community setting. Geriatrics and Gerontology International, 7(2), 167-273.

Robinson L, Hutchings D, Dickinson HO, et al. (2009). Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic review. International journal of Geriatrics Psychiatry, 22 (1), 9–22

Van, P.J., & Maes, B. (2009). The Effect of Reminiscence Group Work on Life Satisfaction, Self-Esteem and Mood of Ageing People with Intellectual Disabilities. Journal of Applied Res Intellectual Disabilities, 22(1), 23-33.

Resources

Search Terms

To conduct an accurate search, appropriate guidelines were used as outlined in the table below.

Boolean Search Strings

The first step used in the search process entailed writing down the main phrase that was specific to the topic of the study. The phrase used in the search enabled the researcher to get the right information on the topic. The researcher typed the following phrase ‘Group reminiscence therapy for adults with dementia’ on the Google search engine. The next stage was the identification of a specific website that provided the required information. The researcher then proceeded to search for related terms from specific websites. Nice.Com was used as the website. The site provided information on other related issues of the topic such as non-pharmacological treatment. The search process can be justified as shown in the provided screen shorts.

Literature Analysis

History and Purpose of the Research Question

Reminiscence group therapy is one of non-pharmacological approaches that was developed in the late 1990s to replace the use of pharmacological methods. Early researchers in the field of dementia discovered that pharmacological methods were not very effective in eliminating certain problems that affected dementia patients such as depression, low esteem, and self-confidence. The researchers also discovered that depression was one of the key problems that affect dementia patients. The position, therefore, justifies the ground for this research question.

Existing Literature

Gaps in the Current Literature

Current literature does not provide information on how non-pharmacological approaches such as group reminiscence can be used to ensure evidence-based practice in the management of dementia. The current literature tends to overemphasize the use of pharmacological methods in the treatment of dementia. Moreover, the current literature tends to over-rely on systematic reviews, which cannot provide adequate information on a given topic of research (Blake, 2013).

References

Blake, M. (2013). Group reminiscence therapy for adults with dementia: a review. British Journal of Community Nursing, 18(5), 228-233.

Bohlmeijer, E. Kramer, J. Smit, F. Onrust, S, & Marwijk, H. (2009).The effects of integrative reminiscence on depressive symptomatology and mastery of older adults. Community Mental Health Journal, 45(6), 476-484.

Croucher, M. (2009). Effects of reminiscence group in elderly people with Alzheimer disease and the vascular dementia in a community setting. Geriatrics and Gerontology International, 7(2), 167-273.

Robinson L, Hutchings D, Dickinson HO, et al. (2009). Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic review. International journal of Geriatrics Psychiatry, 22 (1), 9–22.

Van, P.J., & Maes, B. (2009). The Effect of Reminiscence Group Work on Life Satisfaction, Self-Esteem and Mood of Ageing People with Intellectual Disabilities. Journal of Applied Res Intellectual Disabilities, 22(1), 23-33.

Introduction

Most aged persons suffer from dementia. A report by the Department of Health, Western Australia (2011) reveals that dementia affects 24% of persons aged 85 years. In Australia, dementia represents a noteworthy challenge due to the ageing population. Although the world is busy searching for ways to stop dementia, the present challenge is to exploit treatment and care opportunities.

Since assessment forms the main part of treatment and care of patients with dementia, this report gives several assessment tools that could be used in finding the degree of pain, depression and ability to feed in patients with dementia. The report first describes 3 assessment tools that could be used to assess a range of abilities of the person with dementia in scenario 3. These tools include the Abbey pain scale, Dysphagia screening tool and the Cornell Scale for Depression in Dementia (CSDD). The report then gives a critical review of three research articles on CSDD. Finally, the report summarizes findings and gives a recommendation for future practice.

Abbey Pain Scale

This is an observational scale that assesses pain in patients who have communication impairments. The scale measures five items including vocalization, facial expression, body language as well as behavioral, physiological and physical changes. All these items become rated on a scale of 0-3 (o-absent, 1-mild, 2-moderate, 3-severe) (Gruber-Baldini et al. 2005; Kallenbach & Rigler 2006). The sums of these items become calculated and interpreted on a scale of 0-14 (0-2-No pain, 3-7-mild, 8-13-moderate, 14-severe) (Eisses et al. 2005). Thus, this scale quantifies levels of pain in patients who have impaired verbal skills. In some cases, speech therapists aid in creating individual reports, and where need be pictorial rating scales become used.

Abbey’s pain scale is suitable for use in scenario 3 because dementia gets associated with pain and John refuses investigations. By using the Abbey pain scale, the assessor can assess the level of pain felt by John, through observation. Interpretation of these scales should describe the nature of pain experienced by John, in an effort to find a lasting solution to this problem.

The Cornell Scale for Depression in Dementia

The Cornell Scale for Depression in Dementia (CSDD) assesses signs and symptoms that become related to depression in dementia patients (Thakur & Blazer 2008). CSDD makes use of broad interviews to get information from patients as well as the informants since some patients tend to give false information (Baller et al. 2010; McAvay et al. 2004). Thus, CSDD uses two semi-structured interviews in data collection.

The interviewer determines scores through aligning preliminary scores, to scale items that are even, according to data collected from the informant. The assessor then asks the patient questions based on Cornell scale items (Lin & Wang 2008). The questions tend to find information about signs and symptoms that the patient might have experienced in the previous week (Kales et al. 2005). In case of any differences in ratings created after the two interviews, the assessor must interview the informant and the patient further, until differences disappear. Thus, the assessor influences final ratings obtained in CSDD.

Administration of CSDD takes only 20 minutes, and items become rated on a scale of 0-2 (0-absent, 1-mild, 2-severe) (Kroenke et al. 2001). The sums of all these scores become calculated. Scores that are less than six units show that the level of depression is insignificant. Scores cores that fall above 10 units show that depression is severe (Kroenke et al. 2001).

CSDD is suitable for use in scenario 3 because John appears depressed. As seen in the scenario, John lost his wife and since then, he has refused care and treatment. Besides, John is experiencing significant weight loss, which could be due to depression. Hence, the level of depression experienced by John should be assessed in efforts to manage his condition.

By using broad interviews in CSDD, an assessor can find reliable information from both John and his informants. In this case, caregivers or John’s brother can act as informants. Caregivers can give suitable information because John has been in the hospital for the past year. His brother can also act as an informant because we find that he expresses his wishes, on antibiotics use, to his brother and thus, they must be open with each other. CSDD is also suitable for use in John’s case as it takes little time to administer.

The implication of John’s depression can be determined using CSDD, which should be followed by proper measures such as prescription of antidepressant treatment.

Dysphagia Screening Tool

This tool assesses any difficulties in swallowing. The tool becomes administered in 6 steps (Callahan et al. 2006). First, the tool assesses whether a patient is attentive and conscious when feeding. In case the patient is not attentive when feeding, the assessor repeats the procedure after 24 hours. If there is still no response, the assessor should consult the services of a medical practitioner or a clinical nutritionist.

The second step assesses whether a patient can control oral secretions. If the patient cannot control drooping, the assessor should aid the patient to do dry swallowing, and if the patient cannot carry out this, a medical practitioner should become alerted.

The third step assesses the strengths of a patient’s voice or cough. If the voice or cough is unclear, a medical practitioner should become alerted.

The fourth step assesses the working of the laryngeal. The assessor gives the patient one teaspoonful of water. If no laryngeal elevation occurs, or the patient tries to swallow water, the assessor should seek the services of a medical practitioner.

The fifth step involves giving a patient one teaspoonful of water three times, and then the assessor asks the patients to say the words “aaahh” following every swallow. In cases of choking, coughing, gurgling, or breathlessness, the assessor should repeat this step with more thickened fluid in place of water. If these problems persist, the assessor should tell the medical practitioner.

The last step involves giving patients 50 mls of water in sips. If the patient experiences problems, services of a clinical nutritionist or a medical practitioner should become sought, since the client may require a Dysphagia diet. If there are no problems, patients should be given a normal diet.

The dysphagia screening tool is suitable for use in scenario 3 because John appears to have difficulties in swallowing. Also, the staff reported that he often gags on his food and later refuses diet and fluids. All these issues need investigation using the Dysphagia screening tool. Through using the Dysphagia screening tool, the staff can realize why John has difficulties in swallowing. For instance, they can find out whether John is attentive and conscious when feeding. In case John is not attentive when feeding, the assessor should repeat the procedure after 24 hours, and where need be the assessor should consult clinical nutritionists. This tool can also assess whether John’s swallowing problems are related to the inability to control oral secretions. The strength of John’s voice and cough should also face assessment in an effort to find out why John gags when taking food. Lastly, this tool should assess the working of John’s laryngeal to find out why John refuses fluids and diet. This may involve giving John water in bits and assessing evident behavior. Problems such as choking, coughing, gurgling, or breathlessness, should face assessment in efforts to find out the most proper diet and feeding methods for John in efforts to stop weight loss. Using this tool for assessment is also significant as it can help find areas that require specialized attention from medical practitioners.

Article 1

Brown, EL, Raue, P, Halpert, KD, Adams, S, & Titler, M 2009, ‘Evidence-based guideline detection of depression in older adults with dementia’, Journal of Gerontological Nursing, vol. 35, no.2, pp. 11–15.

Brown et al. (2009) explain that CSDD is efficient for screening dementia in aged adults. He explains that CSDD assesses signs and symptoms of depression in several areas of cognition. However, he also argues that a Mini-Mental State Exam (MMSE) must precede the assessment using CSDD. In his opinion, the administration of CSDD should occur when the patient scores less than 15 on the MMSE (Brown et al. 2009). However, he does not consider that MMSE could be erratic since some clients may give false information (Brown et al. 2009).

Brown et al. (2009) further argues that CSDD obtains information from both an informant and the patient. In his opinion, an informant should come from a close person or family member, who knows the patient well. Some persons who could be close to the patient, apart from relatives, not relatives may include social workers, nurses, home health aides (Brown et al. 2009).

Lastly, Brown et al. (2009) recommends that assessors who find scores of 11 or more in patients should immediately inform medical practitioners for more assessment, treatment, treatment and referral. Besides, patients who have scores below 11 should continue with assessments after treatment, and if the situation persists, patients should face screening after 6 months.

Article 2

Burns, A, Lawlor, B & Craig, S 2002, ‘Rating scales in old age psychiatry’, The British Journal of Psychiatry, vol. 180, pp.161-167.

Burns et al. (2002) explain that CSDD become used in assessing depression in patients with dementia. He also explains that the administration of CSDD should be done by clinicians, who should administer the tool both to the ‘carers’ and the patient. Thus, Burns et al. (2002) only considers care givers as informants and leaves out other people such as relatives, who could be having more information about the patient.

According to Burns et al (2002), the main difference between CSDD and other depression scales lies in the method of administration but not in finding symptoms. He also explains that the CSDD scale has 19 items, which become related on a three-point scale (absent, mild and severe) (Burns et al. 2002).

Lastly, Burns et al. (2002) reveal that a score of 8 and above is an indicator of depressive symptoms. In his perspective, CDD is the most suitable tool to assess depressive symptoms when there is cognitive impairment. However, Burns et al. (2002) does not give a clear insinuation of scores that are below 8. Also, his explanation that a score of 8 and above is an indicator of depressive symptoms is too general. Rather, he should show the level of these symptoms by using words like mild, moderate and severe.

Article 3

Phillips, L 2012, ‘Measuring symptoms of depression: comparing the Cornell scale for depression in dementia and the patient health questionnaire-9-observation version’, Research in Gerontolological Nursing, vol.5, no.1, pp.34-42.

Phillips (2012) reveals that CSDD is a measure of depressive symptoms in patients with dementia. However, he argues that the degree of depressive symptoms varies depending on the instruments used in the assessment. For instance, PHQ-9-OV and CSDD have comparable reliability to internal consistency but different cut-off points in scoring.

The cut-off point of CSDD is 8, while that of PHQ-9-OV is 5. This brings the difference in assessing depressive symptoms.

Phillips (2012) also reveals that CSDD accommodates low degrees of some mood symptoms that are dementia-specific such as “agitation, anxiety, multiple physicals complains, diurnal variation of mood, lack of response to the joyous occasion and mood-congruent delusions” (n.p.).

Lastly, Phillips (2012) reveals that CSDD is an efficient tool for assessing depressive symptoms among patients with dementia.

Summary

In summary, assessing patients with dementia involves the use of different tools. In assessing scenario 3, we found the most suitable tools for use as Abbey pain scale, Dysphagia screening tool and CSDD. Abbey’s pain scale is suitable for use in scenario 3 because dementia gets associated with pain and John has refused investigations. By using the Abbey’s pain scale, the assessor can assess the level of pain felt by John, through observational scales.

The Dysphagia screening tool is also suitable for use in scenario 3 because John appears to have difficulties in swallowing. Through using the Dysphagia screening tool, the staff can realize why John has difficulties in swallowing.

CSDD could be as well used in scenario 3 because John appears depressed. As seen in the scenario, John lost his wife and since then, he has refused care and treatment. Besides, John is experiencing significant weight loss, which could be due to depression.

We also reviewed several articles on the development and use of CSDD. These articles revealed that CSDD is a measure of depressive symptoms in patients with dementia, and it uses broad interviews to get information from patients, as well as the informants. While other authors included both family members and caregivers in the interview process, Burns et al. (2002) only included caregivers. Also, Brown et al. (2009) recommended that a Mini-Mental State Exam (MMSE) must precede the use of CSDD, while other authors did not mention this issue. Lastly, all authors explained that the administration of CSDD should be done by clinicians.

Implications of the Research Findings and Recommendations

The findings of this report are essential as they can act as guidelines for administering assessment tools when handling patients with dementia. I would recommend any medical practitioner, or caregiver, use these tools to follow proper ways during administration to get the best results for use in the treatment and care of these patients. Also, any caregiver or nurse assessing patients with dementia should integrate different tools to assess different disabilities. This will make sure that different difficulties or patients’ needs become addressed.

References

Baller, M, Boorsma, M, Frijters, DH, Marwijk, HW, Nijpels, G, & Hout, HP 2010, ‘Depression in Dutch homes for the elderly: underdiagnosis in demented residents’, International Journal of Geriatric Psychiatry, vol. 25, pp.712–718.

Brown, EL, Raue, P, Halpert, KD, Adams, S, & Titler, M 2009, ‘Evidence-based guideline detection of depression in older adults with dementia’, Journal of Gerontological Nursing vol. 35, no.2, p. 11–15.

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The evidence-based approach to treating dementia has its pros and cons. First, as mentioned above, this method requires some training of medical personnel, which requires time and resources. Second, the use of evidence presupposes a specific accumulation or classification of existing information on the issue. Nevertheless, the non-pharmacological treatment approach is seen as a comprehensive treatment option with positive results.

For example, psychosocial activities tailored to a person’s individual needs can help reduce pain in patients with dementia (Egan, 2019). Some of the evidence gatherings can be attributed to social activities, but several therapies will positively affect each case. Cognitive, biographical pieces of training contribute to the tone of memory and intelligence. However, their use is possible instead of as a preventive and preventive measure against dementia. Art therapy or pet therapy serves a variety of therapeutic tasks (Cations et al., 2018). Exercise, outdoor exercise, and journaling can also help keep you physically and mentally active.

In my opinion, evidence gathering as an approach would be better applied in the context of the above therapies. More patient data will allow nurses better to immerse themselves in the method and its understanding. In addition, most of the listed types of non-pharmacological treatment do not require financial investments, which is a clear plus. Furthermore, using these types of therapies will contribute to health education and a decrease in hospitalization. As a result, mortality from this disease and its severe consequences will decrease. Education will help reduce the burden on hospitals, which is vital in the face of the COVID-19 pandemic. Evidence needs to be collected in shared databases to help develop promising new treatments for dementia: gene therapy, new diagnostics, and vaccinations.

References

Cations, M., Radisic, G., Crotty, M., & Laver, K. E. (2018). What does the general public understand about prevention and treatment of dementia? A systematic review of population-based surveys. PLoS One, 13(4), e0196085.

Egan, N. (2019). Drug-free interventions. Australian Ageing Agenda, (2019), 52. Web.

Mr. Jake was presented to the facility with agitation and deterioration in cognitive function beyond the expected limit. He is an older man aged 75 years with a past medical history of coronary artery disease and dementia. Moreover, the patient had undergone an aortic valve replacement to treat the artery. A relative disclosed that he had occasionally been experiencing memory loss since 2010, which worsened after aortic valve replacement two years later. He could not utter coherent sentences when brought in, and he forgot his previous conversations. The family said that he forgot or confused their names sometimes.

He was presented to the facility with functional disorders in his daily routine, such as driving, preparing meals, and handling money. He would get agitated and irritable easily and often got aggressive with his wife and anyone close to him. The laboratory exams showed no defects, and the brain appeared to have no issue. As a nurse, I must observe the patient keenly and orient them into reality (James et al., 2017). The nurse should also explain and enforce positive feedback because the patient was disturbed by his state.

Pathophysiology

Mr. Jake had symptoms of depression which was associated with his dementia state. Secondly, he had agitation and irritability, which his wife noted. After examining him, a distressed mood and distant thoughts were detected. Moreover, he had slurred speech, difficulty expressing his thoughts, and understanding what others said. The symptoms of dementia are; memory loss, poor judgment, and confusion (Jha & Mukhopadhaya, 2020). Moreover, such patients have trouble handling money and often get lost within their neighborhoods. Mr. Jake’s wife confirmed that the patient experienced these characteristics.

The cause of dementia is damaged brain cells, which obstructs the brain cells from communicating with each other. When the brain fails to function normally, thinking, behavior, and feelings are affected. When specific brain regions are obstructed, their functionality deteriorates. For example, in Alzheimer’s disease, brain cells fail to stay healthy and communicate with each other because of high protein levels inside and outside the cells (Xiao, 2020). The hippocampus is the center for learning and memory, and the first brain cells to be damaged come from this region. Memory loss is one of the initial signs of dementia.

History

My patient, Mr. Jake, had been diagnosed with coronary artery disease and hyperlipidemia. He has a history of dementia, and he used to take medication until recently. These conditions were diagnosed in the hospital, and a prescription to manage them was given. He underwent coronary artery bypass grafting. The patient had also been given statins to manage hyperlipidemia. Statins help in lowering cholesterol levels in the body. The doctor had advised him to consume healthier fats and eat more omega-3 foods as a sustainable plan for the cholesterol issue (Xiao, 2020). Patient A has been taking foods with more fiber as advised by his doctor.

Nursing Physical Assessment

Mr. Jake recorded blood pressure of 117/78 mmHg, which shows that his blood pressure was not affected by dementia. Moreover, he had normal bowel sounds that clicked 15 times per minute. The patient could move around independently without a wheelchair or assistive devices. Apart from his agitation issue, the cognitive and neurological tests showed no anomaly. Nevertheless, psychiatric evaluation demonstrated that the patient had depression, the leading cause of his symptoms.

Related Treatments

For the symptoms of Alzheimer’s, Mr. Jake was given galantamine twice a day and donepezil once a day to reduce the symptoms. The two prescriptions are given to patients with this condition to help them restore comfort and independence (Jha & Mukhopadhaya, 2020). Moreover, the caregivers of the affected patients are encouraged and relieved of their worries. It can be devastating to care for a dementia patient who shows no signs of improvement. Donepezil prevents acetylcholine breakdown in the brain, whereas galantamine prevents both the acetylcholine breakdown and facilitates the release of more of it in the brain by stimulating nicotinic receptors.

Nursing Diagnosis and Patient Goal

The main problem for Mr. Jake is dementia accelerated by depression. It was established through the psychiatric evaluation, and the patient confirmed feeling depressed about his state. The depressed state caused him agitation and made him get violent. In order to help the patient, the depression needed to be addressed, and then treat dementia. Since the patient was on donepezil once a day, the dosage was increased to twice daily (Lam, 2018). Furthermore, psychotherapy was recommended to treat the symptoms of depression.

Nursing Interventions

As a nurse, I must care for the patient and provide patient education to the wife and his close relatives. I will accomplish these goals by helping him remain calm and talking to him to familiarize him with reality. I would advise the wife and family members to talk to him more so that his memory may come back. Stimulative and enjoyable activities are recommended to keep the patient active (Trivedi, 2019). It would help him forget his worries and trigger the brain to function. The family should help him by keeping familiar objects around him, such as photo albums.

I will advise my patient to have a simple activity schedule to help him stay on track. Mr. Jake needs to use reminders and notes of his daily tasks. Moreover, he should keep a list of routine tasks and directions for two weeks. When this period was over, Mr. Jake was advised to return to the hospital for a check-up. Nevertheless, I provided my contact to his wife and advised her to inform me of his progress. I would occasionally call in to check on him to ensure he followed the prescriptions and doctor’s advice to the letter.

Evaluation

Mr. Jake returned to the facility for evaluation after two weeks. He was cheerful and bubbly, and his speech had returned. He denied feeling depressed, and the wife added that he had stopped the violence. The patient’s brother, who had accompanied the two, commented that his brother had transformed into a more organized and cooperative family member. Nevertheless, Mr. Jake admitted that he was still using notebooks to record his daily tasks, although he could remember most things. He cited not wanting to leave room for mistakes, so he preferred following the written schedules. Initially, the patient would make poor financial decisions, so they had to prepare a budget to avoid overspending. The intervention had worked for this patient because he got better and regained his speech and socialization. He is more familiar with his condition and is determined to recover.

Recommendations

The patient needs to have a healthy diet and make it a routine. Hence, his meals should consist of whole grains thrice a day. He should eat vegetables and fruits at least once a day and avoid excess red meat. Furthermore, he should increase physical activity by exercising and challenging his mind (Gorman & Anwar, 2018). The patient should avoid smoking and alcohol as they are harmful to the brain. The idea is to keep the brain as healthy as possible. Cognitive exercises such as board games and crosswords are recommended to help the brain stay active. Nonetheless, the nurse has to monitor the patient’s progress and should check on him occasionally.

References

Gorman, L. M., & Anwar, R. F. (2018). Neeb’s mental health nursing. F.A. Davis.

James, J., Knight, J., Cotton, B., Freyne, R., Pettit, J., & Gilby, L. (2017). Excellent dementia care in hospitals: A guide to supporting people with dementia and their carers. Jessica Kingsley Publishers.

Jha, A., & Mukhopadhaya, K. (2020). Alzheimer’s disease: Diagnosis and treatment guide. Springer Nature.

Lam, R. W. (2018). Depression. Oxford University Press. 10.1093/med/9780198804147.001.0001

Trivedi, M. H. (2019). Depression. Oxford University Press, USA, 10.1093/med/9780190929565.001.0001

Xiao, J. (2020). Physical exercise for human health. Springer Nature.