Decision Making In Dementia

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Dementia is considered to be as a cognitive disease, which arises due to neurodegeneration of the nerve cells of brain. In these specific condition neurons of the central nervous system has been reported for their neural coating with different kinds of proteins. As a result, an unexplained neural damage has occurred. This condition is prevalent in older age when body is immunologically suppressed for several reasons. Dementia is characterized by loss of memory function, lesser decision-making capacities even with limited social skills and thinking abilities. This paper aims to focus about the fact that whether the older patients having dementia should be allowed for taking of their health care associated decision or not. First part of this paper discusses about some functional assessment that has been performed on older people with dementia. after that the very next segment describes how dementia affects the decision-making capacity of an individual and lastly it further addresses some facts about contemporary nursing related to this condition. This writing is a literature review, which addresses two or even more supportive articles in order to conclude about this topic.

The main focus of any biomedical ethics revolves around some of the crucial domains which has to be maintained by any health care expert or organization. Those ethical principles are beneficence, non-maleficence, autonomy, justice and trustworthiness. Beneficence defines the act of maximizes preferable benefits while minimizes possible harms during a treatment or ongoing diagnosis. On the other side, non-maleficence stated to precede a treatment while maintaining negligible harm to the patient. In other word, an expert for any medical treatment that can harm the resign cannot force a patient. In addition to that, biomedical ethics also discusses that for any medical procedure patient’s autonomy there should be considered that means patient should allowed to make own decisions regarding their treatment (Wied et al, 2019). Now, the treatment consent capacity can be considered as the preliminary aspect of patient autonomy. In other words, the emotional and cognitive capacity of a resign to select among treatment approaches or to refuse for the same can be regarded as the treatment consent capacity. The distinction of this consent with others is that it arises in medical terms and not associated with any kinds of legal settings where it generally involves psychologist, physician and other health care professional but not the legal experts. In addition to that, these judgments are rarely subjected to judicial review. This patient consent capacity consists of four major domains. First and foremost domain in this consent is expressing a choice in which patient’s ability to convey a consistent treatment choice is tested. The second is the understanding of the risks and benefits of the proposed treatment whereas; appreciation of the relevant diagnosis and information of the treatment is listed as the third domain. Last but not the least reasoning or the ability of comparing the treatment alternative is considered as the fourth domain of this consent. Studies suggested that, above 60% consent capacity impairment could be observed for older adults with dementia compared with healthy individuals. Finding also suggests that older patients with dementia particularly impaired on measures of understanding followed by reasoning as well as appreciation. A study was conducted involving 106 individuals, which was further subdivided into two groups. The first group contains 53 individuals aged above 65, who were suffering from dementia while the other group consisted of 53 normal individuals with no cognitive impairments (Mariani et al, 2017). Between these two groups, a standardized MacArthur Competence assessment tool-treatment was applied in order to detect for four legal standards for consent capacity. The study was conducted for nine months and at the end of this period, it can be clearly concluded that group one with cognitive impairments had lesser consent capacity compared with the second group.

Apart from that, in another study were performed using four groups of individual as a sample. In which people having chronic schizophrenia are listed in the first group, the second group consists of individuals with learning disability while in the third group patients with developmental disabilities can be observed. These all three groups were compared and tested against the fourth group of normal healthy individual taken as control. Sample number of each group were twenty-one (N=21). These four groups were subjected to various decision-making tasks, which were simplified with enough information. After this study, finding suggests that people with chronic schizophrenia in the first group had been reported for severe impairment in decision making capacities in comparison with other three groups along with this they are also had observed for verbally non-expressive (Dening et al ,2017).

Likewise, several studies suggested that, the decision-making capacity for health care or any other serious issue is impaired in older persons with dementia. This potent finding further supported by a palliative and harmonization model which provides an idea that frail older adults face dramatically reduced capability of making complex and critical health care decisions (van de Pol et al, 2017). Study discusses that, persons who were undergoing through several medications and had multiple commodities only able to make health care related decisions when guided by a substitute decision maker (Pel-Little et al, 2019). In addition to that, people with dementia especially at old age were more likely to choose less-aggressive treatment options.

However, older persons with dementia are observed for a better condition in terms of health care decision making if guided with a proper health care expert especially with the help of a caregiver or enrolled nurses. In order to support this, a multi-case study had been performed in which a group of thirty participants was taken as a sample along with their family members and caregivers (Miller, Whitlatch, & Lyons, 2016). Participants were chosen according to some criteria such as they must have clinical symptoms of dementia along with this the age criteria of inclusion should be sixty-seven and above. Apart from that, all the participants should possess clinical dementia rating score of two, and be efficient to communicate verbally. Followed by this, triad had been formed consisting ten individuals in each group and their family members and caregivers were asked to join that study later. After performing this study, it could be observed that persons with dementia or any other mental disorders had been reported for better decision-making capacities in presence of the family and caregivers in compare with when they subjected to those tasks alone. This study proved the importance of contemporary nursing in order to manage the health care decision making capacities in older dementia patients. Nursing theory is defined as a creative and rigorous structuring of ideas that project a tentative, purposeful, and systematic view of phenomena. Experts are involved in educating the patients about the condition while making them understand the necessity of treatment approaches and medications (Martin et al, 2019). This practice seems to be very crucial in terms of dementia patients for improving their decision-making capacities (Davidson et al, 2015). As a enrolled nurse the personal learning goals revolves around many domains including understanding of clinical placement objective, making my clinical perception even more strong, work on my attitude towards patient party, enhance the collaborative work and last but not the least working on my communication skills (Arnott et al, 2018). During the placement and even these are some vital aspects that should be maintained by a registered nurse. A clear understanding of learning objective that is why this course is essential, why one should choose it, why it is important in the health care, is considered to be as a potent step in order to establish personal learning goals (Rosa, et al 2019). Apart from this, strengthening of critical thinking and evaluation is also very important in order to assist in various critical future case studies. These goals are critically evaluated during the treatment of dementia patient crucially at old age (Tang et al, 2019). Therefore, decision making capacity can be improved by an appropriate treatment by a caregiver following contemporary nursing.

However, in a recent finding it can be observed that medications decision is unaffected in persons having dementia. To support this finding seventy-one video recording were analyzed from approximately nine memory clinics. Conversations were categorized as pronouncement in which experts were already made them aware about their treatment plans without the consent of the patients or proposal in which patients’ autonomy were considered, offers and lastly assertions (Palmer & Harmell, 2016). Study finding suggested that over 80% of patient resisted medications through passive resistance, which further indicates that medication-decisions are completely independent of cognitive disorders, and those people with dementia can take decisions in terms of the health care efficiently. However, remaining in proper medicines could even more improve their capacity significantly.

Henceforth, from this paper it can be interpreted that, health care decision-making capacities are impaired in old persons with dementia. However, the family members and caregivers can significantly influence their capacity or ability. Thus, from this view it can be said that clinically they should not allowed taking serious decisions about their health care without the consent of the family depending on the condition and state of dementia.

References

Arnott, N., King, C., Bromley, P., & Hoffman, K. (2018). Contemporary nursing education. The Road to Nursing, 29. https://books.google.co.in/books?hl=en&lr=&id=MHaIDwAAQBAJ&oi=fnd&pg=PA29&dq=contemporary+nursing&ots=hcXJsQsTvE&sig=ku3LfU92tRonieZAODscPJw4JF8&redir_esc=y#v=onepage&q=contemporary%20nursing&f=false
Davidson, G., Kelly, B., Macdonald, G., Rizzo, M., Lombard, L., Abogunrin, O., … & Martin, A. (2015). Supported decision making: a review of the international literature. International Journal of Law and Psychiatry, 38, 61-67. file:///C:/Users/hp/Downloads/Pathare-Shields2012_Article_SupportedDecision-MakingForPer.pdf
Dening, K. H., King, M., Jones, L., & Sampson, E. L. (2017). Healthcare decision-making: past present and future, in light of a diagnosis of dementia. International Journal of Palliative Nursing, 23(1), 4-11. https://doi.org/10.12968/ijpn.2017.23.1.4
Mariani, E., Vernooij-Dassen, M., Koopmans, R., Engels, Y., & Chattat, R. (2017). Shared decision-making in dementia care planning: barriers and facilitators in two European countries. Aging & Mental Health, 21(1), 31-39. https://doi.org/10.1080/13607863.2016.1255715
Martin, C., Shrestha, A., Burton, M., Collins, K., & Wyld, L. (2019). How are caregivers involved in treatment decision making for older people with dementia and a new diagnosis of cancer?. Psycho‐oncology, 28(6), 1197-1206. https://doi.org/10.1002/pon.5070
Miller, L. M., Whitlatch, C. J., & Lyons, K. S. (2016). Shared decision-making in dementia: a review of patient and family carer involvement. Dementia, 15(5), 1141-1157. https://doi.org/10.1177%2F1471301214555542
Palmer, B. W., & Harmell, A. L. (2016). Assessment of healthcare decision-making capacity. Archives of Clinical Neuropsychology, 31(6), 530-540. https://academic.oup.com/acn/article/31/6/530/2237509
Pel-Littel, R. E., Buurman, B. M., van de Pol, M. H., Yilmaz, N. G., Tulner, L. R., Minkman, M. M., … & van Weert, J. C. (2019). Measuring triadic decision making in older patients with multiple chronic conditions: observer OPTIONMCC. Patient education and counseling, 102(11), 1969-1976. https://doi.org/10.1016/j.pec.2019.06.020
Tang, F. W. K., Ling, G. C. C., Lai, A. S. F., Chair, S. Y., & So, W. K. W. (2019). Four Es of caring in contemporary nursing: Exploring novice to experienced nurses. Nursing & health sciences, 21(1), 85-92. https://doi.org/10.1111/nhs.12561
van de Pol, M. H., Fluit, C. R., Lagro, J., Slaats, Y., Olde Rikkert, M. G., & Lagro-Janssen, A. L. (2017). Shared decision making with frail older patients: proposed teaching framework and practice recommendations. Gerontology & geriatrics education, 38(4), 482-495. https://doi.org/10.1080/02701960.2016.1276014
Wied, T. S., Knebel, M., Tesky, V. A., & Haberstroh, J. (2019). The Human Right to Make One’s Own Choices–Implications for Supported Decision-Making in Persons With Dementia. European Psychologist. https://doi.org/10.1027/1016-9040/a000372

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