The Physical, Psychological and Environmental Consideration of the Patient with Dementia - Case Study Example

DEMENTIA By Course Professor’s Name Institution Affiliation Date Dementia Dementia is a common condition that affects elderly patients. Its severity is due to the nature of the condition to pre-exist with other conditions such as delirium and depression. It also contributes to changed human behaviour through raising aggression, depression and even leading to death. The paper will carry out an analysis of a case study describing the possible treatments and the physical, psychological and environmental consideration of the patient under study. Introduction There have been many cases where mental illnesses have been detected among the aged. The prevalence has led to the belief that mental disorder is part of the normal ageing process. There is no association of ageing with mental illness and therefore any sign of distress among the elderly should be treated as any other illness. The common way that the disorder may present itself is through dementia, delirium, depression, aggression and even suicidal attempts (Budson & Solomon 2015, p. 30). Each of the disorder may occur as a singular condition or else act as co-morbidities exposing the patient to several illnesses relating to mental health. Common co-morbidities that have been prevalent among the aged include dementia and delirium, dementia and aggression and even dementia and depression (Budson & Solomon 2015, p.46). Identifying the type of mental condition a patient is suffering from either in singular or as a pre-existing condition is primary to devising the right treatment. Previous research has identified difficulties in treating a condition as co-morbidity when comparing to treating a singular condition. The case study present an elderly patient, Mr Wish who is 88 years of age and have been presented to the hospital to receive care regarding mental conditions he has been suffering from lately. The paper will analyse the treatment for the patient by carrying out an evaluation of the physical and psychological needs of Mr Wish. Case Study of Mr Wish History of the Presenting complaint Mr Wish is an 88 year old man who has been admitted to emergency nurses demanding treatment to the mental condition he has been facing. The grandson, who has been taking care of him and also speaks for him, claims that Mr Wish has become increasingly confused and incontinent with faeces and urine. The grandson also states that faeces and urine has been frequently found on the floor at an increasing rate creating a perception that the grandfather has a mental disorder. Other behaviour that Mr Wish has been showing that is inconsistent with his behaviour is him hitting out at the person who was trying to shower him. Family history He currently resides with his wife and grandson where they assist in provision of care. The wife who is 86 years of age has been finding it as challenging to continue caring for her husband although she is in reasonable health as outlined in the case study. The grandson is therefore the one in charge of providing essential care to Mr Wish. He is limited in the activities he carries spending most of the time sitting in the chair while watching television, where he falls asleep. Alternatively most of the time is spent in bed when he is not seated in his chair. The family has hired a person who also offers care to Mr Wish by showering him twice in a week. Medical history Mr Wish has experienced many health problems including being previously diagnosed with a mental condition, dementia. He also suffered from cerebrovascular accident approximately twenty years ago that can be associated with the declining health. The accident is also related to other medical conditions that have been observed to occur from that period. The decline in his speech is as well due to experiencing other communication disorders such as aphasia that began since the accident occurred. The accident he suffered several years back is believed to have been the cause of aphasia, commonly caused by stroke, head injury and brain tumour. Another communication disorders includes bilateral deafness that has subjected him not to wear his hearing aids. He as well has a history of atrial fibrillation and Diabetes 2 increasing the range of possible conditions he could be suffering from. Another condition that Mr Wish has suffered from in his life is glaucoma. Allergies There is no allergy that Mr Wish is Known to have. Medications At emergency nursing, the nurses discovered that Mr Wish was alert from any trauma and later he was admitted to the medical ward. He is then treated of urinary tract infections that increase his dependency on the nursing staff on all of his daily activities. Mr Wish is admitted to residential care for further care as evaluated by the aged care assessment team. His discharge medication includes Metformin is administered orally in treatment of type 2 diabetes. It also enables the reduction of insulin intake in the body. It is an anti-diabetic agent that helps in reducing macrovascular outcomes in the body. Oxidative stress in the human brain is associated with causing mental conditions such as Alzheimer’s disease. Metformin helps in offering neuroprotection thereby favourable for treating dementia. Insulin that contain acetylsalicylic acid that reduces pain through interference with compounds in the body that lead to the production of pain. It is also used in preventing heart attack that is common among people with high blood pressure and those who are highly stressed. It can be offered in a dose of 325 mg to 650 mg that can be offered at a short span ranging from four to six hours. Digoxin which is an important medication in treating heart failure is also administered to Mr Wish. Stroke is also known as a contributing factor to heart attack. Mr Wish had been previously diagnosed with stroke. Enteric coated Aspirin is administered as a pain reliever by also blocking substances that cause pain in the body. Reducing pain is essential in addressing the aggressiveness shown by Mr Wish towards the nurses. Other medications offered while in the residential nursing care include: Zinc cream applied on the groin as an antifungal to reduce groin rash. Antidepressant for depression. The doctor is also considering administering respiridone to address the aggression shown towards the staff as a last option alongside with physical restrain due to its side effects. Physical assessment He is unsteady when standing on his feet as he wants to get out of his chair. He is also capable of recognising his children when they visit and also respond correctly to close-ended question with a yes or no answer. He also requires assistance when feeding from the nursing staff presenting physical body weakness. The physical mobility is limited due to the illness subjecting him to either being seated in the chair bought by his children or else in the bed. Even after spending weeks under the care, his movement is limited. The caregivers lift him into a chair that they use to push him to the television room. Several evaluative tests are carried to detect other possible conditions he may be suffering from. One such test is the Mini Mental Sate Examination where he scores 19/30. Another urinalysis test is carried out by the general practitioner to assess the growing aggressiveness. It reveals the he has a urinary tract infection and also a groin rash. Urinary tract infections are caused by bacteria such as E.Coli in the digestive system. The bacteria then head to the urethra causing the infection. The movement can also occur by bacteria at the anus affecting the urethra. The most common groin rash is tinea cruris caused by fungal infection. He is placed on some antibiotics to help reduce the pain and zinc cream is applied on the groin to help reduce the groin rash. The zinc cream contains antifungal cream that helps in killing the bacteria reducing the rash. The antibiotics that were administered are essential as short term plan in reducing the itch brought about by the groin rash. Aggression was also another character M Wish shown towards the nurses. It is common to persons suffering from dementia. It is known to be a major reason for seeking advanced care for the aged in nursing homes in Australia and the United States. Several researchers have tried to explain the causal factors and some have identified the frustration brought about by incapability to engage in communication. The use of medicine is yet to be recommended due to the number of side effects brought about by the act putting the patient in more danger. The aggression shown towards the staff led to the doctor considering prescribing respiridone as an antidepressant for suspected depression. Respiridone is not recommended as it presents many side effects including nausea and vomiting that may worsen the condition for the geriatric patients. It should be a last result including physical restraint. The inactive nature of Mr Wish when his children and grandchildren are not around makes him to always be asleep even when in the television room. The doctors assesses the patterns and holds the view that the geriatric patient may be depressed making him to lose interest with life. He is also incapable of feeding himself due to his physical structure weakening and is therefore assisted by the staff of the nursing home. Psychosocial needs Apart from medical assistance, every patient has other psychosocial needs. The geriatric patients are more vulnerable to mental problems with the most common ones being dementia and depression according to the World Health Organisation (Cash & Glass 2014, p.159). They however plays an important part in the society just like people from other age groups. The common roles include acting as pillars of the family and as well contributing a vital part to the workforce of the nation (Cash & Glass 2014, p.130). The likelihood of the aged to be affected by mental disorder does not rule out the fact that they are in need of psychological and social care just like people of other age groups. Some of factors that come about by aging such as retirement that result in a drop in the socio-economic status increase the likelihood of mental health problems among the aged (Cash & Glass 2014, p.87). The elderly were used to catering for most of their expenses during their productive life. The deteriorating health as well as the old age rendered them incapable of engaging in productive activities resulting in them leaving their socio-economic class. The change in the class that they were used to results in distress, a form of mental disorder. Another factor that comes about by old age is the feeling of being isolated. The geriatric patients are limited not only in their movements but also in their daily interactions. The ability to associate with family members and friends at a daily basis is affected by immobility. The loneliness creates a feeling of isolation and since they are no longer productive, they may feel irrelevant in the society (Cash & Glass 2014, p.87). Aging is greatly associated with loss of independence. The elderly not only need financial assistance from family and relatives, but are also believed to be incapable of making crucial decisions (Williams & Wold 2016, p.269). The loss of independence that one has been having for quite a long period affects them psychologically. Even when they visit healthcare facilities for check-up or treatment, they are always accompanied by a caregiver who even answers questions asked by the doctors on their behalf (Cash & Glass 2014, p.360). It creates a feeling that they no longer matter and may affect them psychologically. In the case study, Mr Wish becomes dependent on the nurses for all the aspects of his daily activities. He has lost any independence he previously had while engaging in his activities. The deteriorating health that comes about with old age is another stressor creating the need for psychological care. The weakening of the body limits the mobility of the aged subjecting them to limited movement around the house and the facility where care is being provided (Edelman et al. 2014, p.125). The illness has affected Mr Wish to an extent he has to be assisted when so as to eat. He is also pushed around with a comfortable chair as he has lost physical mobility. Another psychological condition that affects the elderly is the awareness of one’s own mortality. The decline in health accompanied by the mortality of close ones such as friends, family and other relatives who may be the same age group or even younger create a mental fear that they will be the ones to pass next (Loehr & Malone 2014, p.36). What the aged patient need is some inspiration and motivation so they can feel alive again (Loehr & Malone 2014, p.47). They have lost a purpose to live and fail to enjoy their life. It reaches a point where they perceived themselves as burden to other who now has to incur financial expenses so as to ensure their well-being and even pay for their medication. Physical and Psychosocial support The residential aged care where he is transferred to is near the wife’s house so as to address his psychological need knowing that he is close to his wife’s home and is also easily accessible by the family. The distance from home is always an important factor to consider when taking the aged to care homes. A long distance creates a feeling that they have been isolated and are no longer needed by the family members (Loehr & Malone 2014, p.49). The family is the most important unit of a society and is important in showing care and support to the elderly (Loehr & Malone 2014, p.47). It provides love, care and companionship that no other unit can offer to the aged. Placing the aged at the center of the family is important as it enables them to play multiple roles within the unit and feel appreciated. In the case study, the family of Mr Wish recognizes the role they play in offering mental support to the geriatric patient. The children pay him a visit regularly so as to offer psychological support to the aged patient. The aged may feel as if they are no longer important in the society as they do not contribute any productive activity but instead increases the dependency group in the community. The feeling is popular with the retirement where the society places the importance of someone in the contribution they make to the community (Loehr & Malone 2014, p.53). When one retires, the society no longer treats them as important and so their social contacts decline. The number of interaction they were making greatly reduces as people no longer believe that they can add value to them. Others even view them as a burden thinking that they are will only ask for assistance, either financial or non-financial. The family of Mr Wish recognises the value he contributes and makes him an integral component. The children and the grandchildren values him even making time frequently to not only visit him but also engage him in playing time. The son plays with him poker whereas the grandchildren involve him in cards. Despite remaining eminent of urine and faeces, Mr Wish plays poker with the son whenever he visits. It helps in addressing issues that may come about due to hospitalization such as distress. The regular visits by the children and grandchildren where he even play card with them also makes him happy addressing the psychological needs. It also shows the support the family has provided in helping Mr Wish get well. Discussion After being hospitalised for several weeks, Mr Wish starts to become aggressive prompting the general practitioner to carry out a urinalysis test. The practitioner realises that he is suffering from urinary tract infection and groin rash. He is also diagnosed with dementia and memory loss, some common conditions associated with aging. The general practitioner also suggests that he may be depressed after observing him for a while. He is only interested in eating and sleeping even when in the television room he does not pay a lot of attention to the television and only extend his sleep there. Aging is known to contribute to some adjustments that should be taken into considerations when dealing with them. The most popular conditions that are associated with aging include dementia, memory loss, delirium, depression, and aggressiveness (Budson & Solomon 2015, p.46). These conditions can occur singly or can occur alongside each other making it hard to treat the geriatric patient. At the extreme, they have even resulted in suicidal attempts by the elderly. Dementia has become increasingly common nowadays with the growing number of the aging population (Budson & Solomon 2015, p.112). Several factors have led to the increase in the population including better health facility that has increased the lifespan enabling many people to reach 60 years or above. The awareness of the factors that lead to the decline in the health of a person such as unfavourable lifestyle alongside with the adopting of healthy activities such as engagement in exercises can also be attributed to the increase. Dementia is known to contribute to other related conditions that make it challenging to deal with the geriatric patients (Loehr & Malone 2014, p.103). One of the conditions exhibited by Mr Wish that include aggression when dealing with the nurses is contributed by dementia. It is known to put a lot of pressure on the caregivers making it hard for to interact with the patients. Dementia may occur singularly or in conjunction with other conditions such as memory loss. It is known to be a big contributor to the loss of memory that was an evident condition shown by Mr Wish inciting his children to seek further assistance. Dementia can occur in several forms such as vascular, Parkinson and with other conditions. The most common type of dementia is the one brought about by Alzheimer disease. It is projected that half of the people suffering from dementia also suffer from Alzheimer disease (Budson & Solomon 2015, p.156). Vascular is a type of dementia that involves the decline in the thinking skills triggered by the decline in the blood flow in the brain. The flow of blood is essential in ensuring the survival of the blood cells by enhancing the delivery of oxygen and other vital nutrients. It is the second most prevalent form of dementia globally. Another type of dementia that occurs alongside other diseases is the one caused by the Parkinson disease. It involves the tampering of thinking capacity hence the reasoning of many people suffering from the disease. Its prevalence is due to the widespread of Parkinson disease among the aged (Loehr & Malone 2014, p.15). Other effects reflected in people suffering from Levy Body type of dementia such as the loss of cognition as well as increased hallucination have increased its awareness. Each type of dementia demands the application of specific strategies in order to apply the right strategy to treat it. For the Alzheimer’s triggered dementia, it is essential to treat the disease while in its early stages so as to prevent the exhibition of its symptoms such as the loss of memory. Vascular dementia, on the other hand, involves controlling of the amount of the blood that flows into the blood thus influencing the condition of the brain cells (Mane & Rabins 2011, p.69). Key to treating the type of dementia is controlling the blood pressure by avoiding its causal factors such as high cholesterol, high sugar intake and even indulgence in drugs (Mane & Rabins 2011, p.89). Depression is another primary mental disorder that is prevalent among the aged as reflected by Mr Wish. The general practitioner projects that the patient may have lost interest in life from the activities that he indulges in. He has adopted a pattern where he shows loss of interest in other activities and is only excited by food. The patient also becomes aggressive while dealing with the nurses to an extent the general practitioner is considering physical restraint if the medication prescribed fails to address the medical issue. Depression is highly believed to contribute to aggressive behaviours and addressing the condition in turn helps reduce the aggressiveness (Mane & Rabins 2011, p.130). The use of medication in treating aggression is not recommended as it presents several side effects to the patient such as vomiting and nausea. They also present severe threat to the patients where antipsychotic is largely known to expose the patient to a much higher probability of death. Treatment can be addressed by using non-medicinal methods of reducing depression through such acts as showing love and compassion. Providing support by the family members as applied by the children and the grandchildren of Mr Wish is also an important strategy. Other medications that help reduce depression include the use of antidepressants in turn reducing the aggressiveness. The later can also be solved directly by use of respiridone and antibiotic. Other non-medicinal strategies include physical restraints that should act as a last option in addressing extreme aggressive behaviour. Conclusion The strategies used by the carers, general practitioners, nurses and the relatives of Mr Wish can be adopted to help treat patient suffering from dementia occurring singularly or alongside other mental conditions such as aggressiveness and depression. The caregiver are responsible in ensuring the mental problems are detected during their early period of development to ensure that the subsequent intervention is timely to help address the symptoms that can independently result into distinct mental disorders. In future, strategies that empower the caregivers to detect and seek the right care at the appropriate time are central in ensuring autonomy of the patient as well as reducing the burden on the former. References Budson, AE & Solomon, PR 2015, Memory Loss, Alzheimer's Disease, and Dementia A Practical Guide for Clinicians. Elsevier Health Sciences, London. Cash, JC & Glass, CA 2014, Family practice guidelines. Edelman, C, Mandle, CL & Kudzma, EC 2014, Health promotion throughout the life span. Loehr, J & Malone, ML 2014, Here's how to treat dementia. Mace, NL & Rabins, PV 2011, The 36-hour day a family guide to caring for people who have alzheimer disease, related dementias, and memory loss. Baltimore, Johns Hopkins University Press. Williams, P & Wold, G 2016, Basic geriatric nursing. Read More