Dementia as a Progressive Disease - Case Study Example

Student name: Student number: Course code: Term/ year: Name of course: Coordinator name: Name of assignment: Date for submission: Contents 1.0 Introduction 3 2.0 Case study Analysis 4 3.0 Recommendations and strategy implementation 7 4.0 Conclusion 9 5.0 References 10 1.0 Introduction Dementia is a clinical term that is used to refer to a medical condition that individuals suffer from which lead to cognitive failure of a patient. As a result patients suffering from dementia tend to experience memory loss leading to behaviour change and a decline in their ability to perform daily activities that they previously were used to. Due to the effects of dementia, scientist attribute its main cause to be the Alzheimer’s disease (Stubendorff et al. 2012). The Alzheimer’s disease is characterised with social and behavioural change that is commonly witnessed among dementia patients. This is because, Alzheimer’s disease causes memory deterioration and the inability to perform simple tasks which makes a patient to be frustrated with themselves and consequently acts aggressively. Alzheimer’s disease greatly affects the nervous system in the brain which explains the anomalous behaviours that dementia patients exhibit. According to Stubendorff et al. (2012) patients who have been diagnosed with dementia and are under treatment survive for a maximum of 8 to 10 years. Clinicians are able to diagnose dementia through conducting a cognitive test on a patient. According to Kuntz (2012) when a patient exhibits unusual mental behaviours that are recurrent in significant areas of their lives which require their intellectual ability, these symptoms represent a decrease in a patient’s cognitive abilities. Dementia is a progressive disease that advances as the symptoms of a patient gets worse. Therefore it is important for clinicians to have an in depth understanding of the type of dementia he or she is treating since the symptoms vary from one king to the next. According to Ferman (2011) with the growing interest in treating the Alzheimer’s disease, medics argue that practioners must be able to distinguish the different subtypes of dementia. Additionally, understanding the differences in the nature of different types of dementia, a clinician is able to determine the level of side effects that certain drugs have on different patients depending on their symptoms. This essay will be evaluating a case study on a dementia patient. Joan is a clinically diagnosed dementia patient who recently started staying at health facility, however in recent times the patient’s behaviour has continued to change and she has been very aggressive. The essay will conduct an analysis on her behaviour and discuss the dementia disease as well as evaluate what might be contributing to the adverse in the patient’s symptoms. Further, in this essay recommendations will be suggested on how the facility can improve its infrastructure in order to accommodate dementia patients. As part of the concluding remarks, essay will provide a summary on the findings as discussed in the case study. 2.0 Case study Analysis In the case of Joan Taylor a dementia patient at the clinic, Joan is exhibiting behaviour symptoms by being aggressive and anxious which are evident in the Alzheimer’s disease. According to Husebo et al. (2011) the change in behaviour of a patient may be accelerated by an internal or external stimuli. Internal stimuli include; the feeling of fear, excitement, pain, anger, hunger or desire to do something. External stimuli on the other hand refer to the responses to ones surroundings, events, people or structures. These factors may agitate a dementia patient to react through psychomotor behaviours such as; running, wandering off, banging on things, undressing or anxiously pacing from one end to the other. The internal and external stimuli consequently results to a change in social behaviour whereby the patient in question, tends to attack people around them, breaks and destroys things, refuses to eat, drink or take medication (Husebo, et al. 2011). In Joan’s treatment it is important for the clinician in charge of her to first carry out an assessment test to determine what is causing her to be agitated and act anxiously. In this case the test is meant to identify the contributing factors to Joan’s behaviour as it is already clear that she is a dementia patient. Therefore during the assessment test, the main aim is to define how the immediate environment, associations with people affect Joan’s cognitive behavioural change as well as the level at which her symptoms are advancing (Maher et al. 2011). An assessment test or procedure will help the clinician in understanding what factors triggers aggressive behaviours in Joan. According to Brooker et al. (2011) change in behavioural symptoms of dementia patients, are closely associated with functional and relationship dependency, depression, delirium and cognitive deficiency. As part of the intervention strategy to reduce Joan’s recurrent behaviours, a physical and blood examination is needed to examine her behavioural change. Moreover Joan requires to undergo a closely monitored antidepressant therapy which are accompanied with effective nursing strategies. This will help in suppressing the high levels of agitation exhibited by the patient. According to Brooker et al. (2011) dementia patients are very sensitive to the relationship they have established with their caregivers. Therefore, the new staff member at the hospital is required to first understand why Joan is being aggressive in the first place. Husebo et al. (2011) affirm that agitation and anxious behaviours among dementia patients, is not random or unpredictable, but rather it is aimed at achieving something. Therefore when Joan is aggressive or anxious it shows that she needs something or requires attention but instead of speaking up she acts out by being aggressive. Therefore the new staff can aid Joan’s aggressive behaviour by first trying to calm her down through asking her why or what she needs. According to Husebo et al. (2011) by addressing the feelings or needs that are expressed by agitated dementia patients, the clinical staff at a given hospital is likely to reduce the level of agitated behaviours exhibited by patients in the institution. Joan’s disease is worsening because she is getting more aggressive and anxious since her arrival at the hospital. This means that her Alzheimer disease is progressing, therefore her dementia is getting worse. As a result Joan becomes really aggressive and at times refuses to take her medication. It is important that the nurse in charge of Joan is able to understand the factors that agitate Joan and make her refuse to take her medication. In a situation whereby Joan behaves this way, the nurse first needs to calm her down and make her feel comfortable. This is achieved through nonpharmacologic strategy by engaging the patient in a conversation which will distract them from what is agitating them. Additionally, this strategy will enable the patient forget what is upsetting them and the nurse is in a better position to feed them their medication or convince them to take their medication (Rhodes-Kropf et al. 2011). Gauthier et al. (2010) affirms that in some cases a patient may be too aggressive and completely refuse to take their medication, during these circumstances the nurse is required to ask for assistance from higher care levels. This means that the patient needs a pharmacologic solution to calm them down. This is because when a patient is aggressive and fails to conform to the non-pharmacologic solution of speaking and listening he or she is likely to harm themselves or others therefore a nurse can employ the use of an acetyl cholinesterase inhibitor. According to Seitz et al. (2013) an acetyl cholinesterase inhibitors may include donepezil, galantamine, rivastigmine which are commonly used in clinical facilities to calm patients down. In such circumstances the nurse may administer the prescribed medication to the patient when they are asleep through drip form or wait until they wake up. According to Gill & Seitz (2013) dementia is associated with a number of risks. This is because the disease is accompanied with psychological, cognitive as well as behavioural factors that eventually interfere with the wellbeing of a patient and his or her immediate surroundings. For instance the lack of proper and secure structures for dementia patients at Joan’s facility, exposes the patients and staff members to health and safety risks. Unmonitored dementia patients are likely to harm themselves or others within their reach since they are in most circumstances delusional. The increased levels of aggressive behaviour of dementia patients tend to impose a lot of stress to caregivers, therefore having an effective support system in a facility is important for the safety of the staff and patients (Brooker et al. 2011). 3.0 Recommendations and strategy implementation In an effort to provide secure environments for dementia patients and caregivers, health facilities need to implement policies that are well aligned with the national clinical and the local NHS policy guidelines (Brooker et al. 2011). Therefore, the management at Joan’s facility, should put in place mechanisms that ensure the care administered at the facility meet the national and local NHS policy guidelines as well as the needs of the patients. Additionally, before the installation of new structures open discussions should be held by both the clinic staff and management to ensure that the needs of the patients are addressed in terms of unit architecture and facility practices. Improved infrastructure that are well aligned with the needs of dementia patients not only facilitate a quick recovery process from the symptoms of dementia but also ensures that an institution is secure. The dementia institution within the health facility should be separated from the rest of the facilities. This means that dementia patients should have infrastructures that are tailored to meet their needs. For instance, each new patient like Joan should have a ward that has a personalized touch, the decoration in the room should be familiar to the patient. According to Brooker et al. (2011) the primary setting of a dementia patient directly impacts their behaviour, because it changes the environment that a patient is already accustomed to at their homes. As a result this will ensure that the patient feels comfortable and is not agitated in any way. Through the inclusion of a separate wing within the facility, which is mainly dedicated to dementia patients, the facility will be in a better position to assess and monitor each patient’s movements, progress and avoid some wondering off into the streets without the staff’s knowledge. This is because both the staff members, the management and the visitors are aware of the conditions of dementia patients and the risk that they pose to themselves and others therefore will be able to take the necessary precautions. As a result the management will need to build an additional dementia facility to reduce the increased numbers of dementia patients on the waiting list. This can be achieved by partnering up with the local NHS programs in order to gain financial aid to sponsor the expansion of the facility and ensure that the facility has an improved and secure system to meet the needs of patients. Moreover, in order to ensure that patients are not agitated by their immediate environment within the facility, the management is required to have in place a training program that enhances, the performance of the nurses and staff. De Deyn (2013) affirm that having a well-trained and educated care givers in the facility, means that patients are well taken care off and medication is administered appropriately. According to Brooker et al. (2011) it is vital that all nursing units and staff members that work with dementia patients, are equipped with the skills and knowledge that are needed in addressing behavioural change among patients. Moreover, these trainings will offer family members to be in a better position to understand the behavioural symptoms exhibited by patients and know how to cope with them. Brooker et al. (2011) further affirm that involving staff and family members in the training programs, enables a facility to avoid uncalled for misunderstandings. As part of the training and mentorship program for caregivers, the facility can participate in community based psychiatric nurse and group trainings. Nonetheless, an improved psychiatric facility within the dementia wing will ensure that patients have easy access to services and treatment. 4.0 Conclusion Dementia disease presents a number of mental disorders among patients. These disorder range from hallucinations, psychosis or delusions, as a results dementia patients tend to act out by being aggressive, anxious or come out as being agitated. This state of dementia patients puts everyone including themselves in danger due to the social and behavioural change exhibited by patients. Therefore it is important for health facilities to take the symptoms of dementia into consideration when they are employing new staff, admitting patients or in the structural management of the environment. Managing behavioural change among dementia patients in a facility is very important as this ensures the wellbeing and safety of the patients and staff. Dementia as a progressive disease presents social burdens for care givers therefore in order to manage its symptoms it is important for the primary caregivers and nurses at health facilities to undergo a training program. These trainings are aimed at educated them on proper care administration for patients and how to cope with dementia patients. 5.0 References Brooker, D. J., Argyle, E., Scally, A. J. and Clancy, D. (2011).The enriched opportunities programme for people with dementia: a cluster-randomised controlled trial in 10 extra care housing schemes. Aging Mental Health. 15:1008–17. De Deyn, P. P., Drenth, A. F., Kremer, B. P., Oude Voshaar, R. C. and Van Dam D. (2013). Aripiprazole in the treatment of Alzheimer's disease. Expert Opinion Pharmacother. 14:459–74. Ferman, T. J., Boeve, B. F., Smith, G. E., Lin, S. C., Silber, M. H., Pedraza, O., et al. (2011). Inclusion of RBD improves the diagnostic classification of dementia with Lewy bodies. Neurology.77:875–82. Gauthier, S., Cummings, J., Ballard, C., Brodaty, H., Grossberg, G., Robert, P., et al. (2010). Management of behavioral problems in Alzheimer's disease. Int Psychogeriatr. 22:346–72. Gill, S.S. and Seitz, D.P. (2013). Antipsychotics can be withdrawn from many older people with dementia, though caution is needed for people with more severe neuropsychiatric symptoms. Evidence Based Mental Health. 16:81. Husebo, B. S., Ballard, C., Sandvik, R., Nilsen, O.B. and Aarsland, D. (2011). Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial. BMJ. 343:d4065. Kuntz, K., Boeve, B., Drubach, D., Allen, L. and Drubach, D. (2012). Safety, tolerability, and efficacy of armodafinil therapy for hypersomnia associated with dementia with Lewy bodies. Neurology.78:P04.192. Maher, A. R., Maglione, M., Bagley, S., Suttorp, M., Hu, J. H., Ewing, B., et al. (2011). Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis. JAMA. 306:1359–69. Rhodes-Kropf, J., Cheng, H., Castillo, E. H. and Fulton, A. T. (2011). Managing the patient with dementia in long-term care. Clin Geriatr Med. 27:135–52. Seitz, D.P., Gill, S.S., Herrmann, N., Brisbin. S., Rapoport, M. J., Rines, J., et al. (2013). Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review. International Psychogeriatr. 25:185–203. Stubendorff, K., Aarsland, D., Minthon, L. and Londos, E. (2012). The impact of autonomic dysfunction on survival in patients with dementia with Lewy bodies and Parkinson's disease with dementia. PLoS One.7:e45451 Read More