Health Issues for Older Adults - Article Example

Health Issues For Older Adults Name: Roll No: Class: Teacher: Subject: February, 18, 2008 University: Previous Medical and Social History Joseph Williams an old age adult was admitted in our hospital for treatment of his agitation behavior. In this paper we shall discuss briefly the previous medical and social history of Joseph and his major health issues. The care received by Joseph and appropriate decisions that were made during his care period will be presented. At the end we shall discuss the overall care received by Joseph and will suggest the measures aimed at improving the case that Joseph received. In Joseph’s case one of the major impacts on his quality of life and for his family was the existence of agitation behavior right in the middle stage of his disease. He exhibited some particular type of agitation behavior for the last few years. Moreover he was also a patient of psychosis or depression. Medical experts suggested the best way for managing his disease was through atmosphere and environmental changes instead of medication which was termed as last resort. (Allen MH. 2007) All the proper changes in the environment and circumstances were made to provide proper care and cure to Joseph. Agitation some times occurs with the patient of dementia. Related behavior includes combativeness, hyperactivity and aggressions. Along with behavioral problems the initial step for treatment is to recognize the precipitants. Evaluations for Joseph included assessment for common type of systemic causes, for example dehydration, constipation, infection and types of illnesses. (Enida. 2000) Family of Joseph was well informed about the probable causes of agitation like excessive stimulation along with the need to execute educated guesses regarding environment that provoke inadequate behavior. As Joseph was initially the patient of dementia, he often became agitated when he was rushed, as such time-critical events were avoided that proved useful to some extent. His daily activities were re-structured to provide such a routine that was predictable to him. (Janicki, M.P, 2000) Orientation materials such as clock, family pictures and calendars were prominently displayed in his room and his living environment was well lit, even when there was daytime, for the purpose of avoiding misperception and misconception of stimuli. Behaviors that are mostly disruptive but not considered as harmful must be tolerated. Physical restraint is hardly necessary and generally serves to provoke the degree of agitation. (Gandelman K. 2007) Major Health Issues of Joseph Behavioral problems mostly occur in the early stage of disease event before a care provider is aware that person like Joseph in the old age is afflicted. For example patients such as Joseph may become angered easily when there is a mistake made because of memory loss. (Gandelman K. 2007) Joseph could have lash out verbally at the care provider when he was pointed about the loss of memory. He mostly became angry when he inquired about the reason of non-visit by any relative and was told that the visit was made just a day before. (Enida. 2000) With the progression of disease, behavioral problems became more severe and frequent. He was transformed and became suspicious and paranoid, accusing family members with different allegations like being faithful or stealing his personal things. He also had sleep disturbances and started wandering from home. Later on, as the disease developed, he yelled or screamed inappropriately and even resisted the attempts of family members for helping in his daily routine like dressing and other kind of personal care. (Janicki, M.P, 2000) Care Received by Joseph & Appropriate Health Care Decisions Made During Treatment Joseph was later on admitted in our hospital to receive the necessary care and treatment of his behavior problem with complex agitation behavior. A variety of behavior problems often are associated with dementia. The severity of such complexities may differ within a group of people at different phases of dementia that are the major cause of embarrassment and present problems for caregivers. A comprehensive and careful assessment of all probable contributing elements of behavioral problems provides support to caregivers in managing such complexities more effectively. (Janicki, M.P, 2000) At the hospital we tried out best to see from Joseph’s perspective to analyze the premises for the agitation behavior and then evaluated the scenario. We also set the objective and goals, and recognize such measures that were workable. We as caregivers at hospitals recorded the behaviors for instance frequency, intensity and the categories of behaviors, as to determine the manners and suitable methods in the treatment of behavioral problems of Joseph. (Enida. 2000) We analyzed the antecedents that trigger the elements for behavior, including circumstances, time, person, activities and emotion. Behavior was targeted for instance incontinence and wandering and the consequences were recorded which were the scenarios being outcome of behavior, its impact on other and the consequences for Joseph having dementia. (Gandelman K. 2007) It was accepted that the behavior of Joseph was caused by disease and that Joseph having dementia often is unable to control his behavior. We were patient and caring with Joseph and motivated appropriate behavior. (Keck PE Jr, 2004) At the end we were successful in managing the challenges presented by dementia of Joseph as it was vital for his well-being. Inappropriate or undesirable behaviors mostly reflect emotion of a person, expressive desires or intentions. Some of the factors that were identified in the case of Joseph being cause of such inappropriate behaviors were as follows: (Keck PE Jr, 2004) Excessive stimuli resulting from environment caused anxiety for Joseph as he was an old age adult. The large space also caused anxiety and confusion for Joseph. As for those factors that were associated with the emotional and physical health, Joseph was having difficulty in expressing his physical uneasiness that included agitation and emotional disturbance. The cognitive decline also caused spatial disorientation of place, time and person for Joseph. He was having difficulty in understanding and receiving the message in the phase of communication that lead to anger and ultimately agitation. (Enida. 2000) Agitation behavior is defined by the experts of behavioral management as inadequate motor or verbal activity. Non-aggressive behavior is incoherent babbling, repetitive questions is mostly frustrating for the care given and also for the family members, particularly as a symbol that a loved one is being lost. (Enida. 2000) Non-aggressive Physical behavior is wandering, pacing and repetitive body motions, or shadowing ways for love one in order to communicate fear, boredom, confusion and search for security or incapability to verbalize a help request of ultimately a pain feeling. (Antonangeli J.M. 2003) On the other hand aggressive verbal behavior comprises abusive language or cursing that can be shocking when the patient was proper and upright previously. Aggressive physical behavior is like scratching, hitting or kicking and that can not only be dangerous but life-threatening to the family members and the patient. (Keck PE Jr, 2004) Some of the categories suggest that aggression or agitation behavior seems to occur more if the patient was calmer and cooler when they were well; that it was in fact the disease that causes them to act in other or opposite manner different from their original behavior. Some of the researchers have not supported that assertion up. There exists some opinions that men are mostly twice as possibly to show aggressive behavior, particularly in the last stage of disease or if they have some kind of major depression. The degradation of various parts of brain is the cause of deviant behavior. Other premises like pain can also be its cause. (Allen MH. 2007) Although one of the measures adopted by some caregivers is to ignore the agitation behavior, this was not adopted in the case of Joseph as it could have made the things worse not only for Joseph but for us being caregivers and for his family members. The stress that is caused to the caregivers in hospital by such agitation behavior could had forced a premature placement in the case of nursing facility, health complexities for caregiver and also might had lessened quality and standard of life. (Keck PE Jr, 2004) All categories of behavior are in fact forms of communication. It was identified that Joseph was trying to communicate something event though his diseases has robbed his of other ways of expressing in a lucid way. He was depressed and was not able to communicate properly to narrate his problem. We believed that his agitation behavior was the incapability to deal with pain. (Warrington L. 2006) The key to recognize the behavior of Joseph was event-related for example when a visitor arrived at the time when dinner was served that caused the sudden escalation. To tackle the issue in the beginning for confronting the agitation behavior of Joseph comprised; the environment was modified for reducing known factors that created stress for him like shadowy lighting and loud noises. We noted the patterns of Joseph’s behavior and delicate clues that were the cause in the increasing of anxiety and tension such as incoherent vocalization or pacing. It was also identified while tackling the health issue of Joseph that his dysfunctional and arrogant behavior often increased at the end of day. (Gandelman K. 2007) Some of the measures that were adopted to treat the health issue of Joseph are discussed below. We used all of our senses to understand the circumstances and arrogant behavior of Joseph. It was in fact not an easy stuff and is also not fool proof, yet proved successful in the case of Joseph. As already mentioned above that mostly the arrogant behavior of Joseph increased at the day end we also suspected that fatigue could had been one of the factor. We tried to rest Joseph and provided quiet periods for mostly two times a day at similar time. In his nap he was not made to get beneath the bed covers or rest on the top of bed. Joseph was encouraged to have physical exercise curing the day but was prepared shorter version of activities with appropriate calm periods. If Joseph awaked confused during night, rest was increased during his day. (Gandelman K. 2007) To tackle the issue of Joseph’s health his environment was also changed. Routing and sameness was successful in minimizing the stress of Joseph with Alzheimer’s disease. As such it was considered appropriate to have a routine for Joseph with few changes in environment such as no extensive decorations inn holiday. Although some of the hospitals and nursing homes discourage visits of family but it was not felt appropriate in the case of Joseph. Visits by the family members were encouraged in the stay of Joseph to provide him a feeling of home. His day care was scheduled for four days a week as Joseph was not adapted it into his routine. (Warrington L. 2006) Joseph having Alzheimer’s disease had perceptions and memories of activities he used to enjoy and had affective responses to loss of perception. He missed the routine of driving a car or care for children. Safe activities were substituted that satisfied him and necessary for treating his agitation behavior and depression. As noted above that one of the cause for agitation behavior of Joseph was excessive noise that ultimately triggered his agitation behavior. It was noted that mirror image or even television also represented extra people for Joseph in the environment. As such these environmental factors were also considered before the start of medicating with specific anti-psychotic drugs. (Gandelman K. 2007) We as care givers accepted the fact that Joseph had lost mental function. There were not quantity of reality orientation, quizzing, brain exercises pushing or retraining him to try harder improved his mental capabilities, yet they caused some sense of futility or stress for Joseph. He was provided understanding and support, encouraged assisting and independence when he was not able to perform a particular task. (Daniel DG. 2001) After minimizing the behavioral and environmental stressors, Joseph still exhibited agitation behaviors that caused pain not only for his family members but also for us being caregivers. We understood that Joseph wanders for some specific reasons although it was difficult task to determine the reasons of wandering. Nevertheless it was felt inappropriate to lock him in a room or even restraining him in a chair. We implemented activities and later on adjusted the environment in order to relive agitation. (Gandelman K. 2007) To decrease the habit of pacing Joseph was burning off many calories. Foods with high calories were given to him for solving this problem. We also reduced pacing by providing particular inviting places to relax and sit. Too much pacing also produces pains and aches. (Allen MH. 2007) Pacing also inadvertently transform into wandering that could result in loosing the patient. For minimizing illusions and hallucination we removed confusing stimuli such as shadowy lightings and at times television also. Joseph was also examined for the symptoms of an atypical dementia like Pick’s disease or Lewy Body Dementia. These required a variety of behavioral and psychiatric interventions. As such a simple and effective approach adopted to manage the agitation behavior of Joseph could be concluded as ‘alter the environment, alter the behavior and adopt medication as a last resort’. It was found successful to adopt some basic interventions to ease out the agitation behavior of Joseph. The health care decisions that were made during the period included different significant factors. (Gandelman K. 2007) Calm music was played to Joseph being part of Music therapy and it ultimately led to a decrease in agitation. It was also used in the course of meals as it was felt that soothing music had a significant impact to increase food consumption. Also during relaxing or bathing favorite music was effective to give bath. (Warrington L. 2006) Another health decision made during the care period was to provide light exercise like chair exercise recommended by a physical therapist or such activities that supported function of limbs and ultimately minimized problem behaviors. (Daniel DG. 2001) Joseph was also motivated for a walk up to one and half hour particularly after dinner many times a week that also helped in reducing aggression. Joseph was also inspired to go for walk with three or four people and it ended up in Joseph socializing with the group with interaction like talking or signing. The health a professional of Joseph was also consulted on routine basis for ensuring that there existed no circumstances that preclude walking and exercise. It was also ensure that Joseph did not over do wall or far away from hospital. The habit of walk was built gradually and ensured to maintain the same. (Antonangeli J.M. 2003) Safe activities also proved good for Joseph for reverting to his earlier life and search meaning throughout the process of disease. We also searched for activities that Joseph used to enjoy in the past. Human interaction is also significant for individuals having Alzheimer’s disease and large groups particularly strangers are absolutely out. (Daniel DG. 2001) As a health decision to cure some high school students serving as volunteer were also introduced to Joseph as new friend for spending their time with him. They conversed, reminisced and performed activities together. Cassettes and videos were also provided at the later stages. These products proved to be mimic not only a dialogue but a sing-along. (Keck PE Jr. 2004) It was decided that in case bathing proved a problem for Joseph being an old age adult it was skipped for a day or so as needed. We were aware that Joseph had lost the capability to determine a suitable temperature that made the water too cold or tool hot. Proper care was ensured to safeguard hot water so that Joseph could not get burned. His baths and showers were supervised and particularly when his balance was unsteady. The door lock of bathroom was removed for safety. Yet too much concern on modesty can result in increase of agitation so we remained reassuring. (Enida.2000) Another significant measure adopted was associated with the fact that loss of control by Joseph on appetite could have occurred and he might not have remembered having just eaten. The measure adopted to manage this complexity was that food was kept out of sight of Joseph in the non-meal times. Pre-cut food was served in the times when utensils became difficult. We positively responded to the emotions of Joseph by reassuring him that he was being well fed. He was distracted with a different activity. (Antonangeli J.M. 2003) For the dementia patients dressing is also difficult. Loose fitting dresses were chosen for Joseph and comfortable clothes ere provided with easy snaps or zippers having minimal buttons. We also reduced the choice of Joseph by removing those clothes from his close that were seldom-worn. For facilitating in the process of dressing, articles of clothing were laid at some times that were to be worn. Soiled clothes were removed from the room and it was ensured that there were no arguments in such time when he was insisting on wearing same things once more. (Daniel DG. 2001) At times when hallucinations proved a problem, the room was well lit for minimizing shadow effects that could prove confusing. Joseph was reassured after a loud noise like storm or airplane by providing a truthful elaboration of noise yet avoiding convincing him. Distractions were eliminated by turning radio of television off during conversation and an eye contact at all times was maintained with him. Sentences phrased particularly in the negative were also avoided such as instead of saying a sentence ‘don’t go outside’ the sentence was restricted by saying ‘stay inside’. The tone and voice level was monitored while talking with Joseph having dementia. Gestures, pictures and pantomime also supported the point across. Non-verbal cues such as a nod or exaggerating smile were also used and he was engaged in the conversation about his interests, familiar places and past experiences. (Warrington L. 2006) Overall Care Received and Suggestions for Improving Care Received by the Person A caregiver with an old age adult having Alzheimer’s disease is aware that the most difficult part in the process of caring of such person stems from the problem behavior that can happen as a consequence of the disease. In some persons, problems start at early phase of the disease and continue till death. Others appear to live in their little world and mostly are passive and easy in dealing. Sometimes an old age adult with agitation behavior is in fact in the eye of beholder. A behavior that could be termed as problematic for a particular caregiver might not concern other. The tool of dealing with agitation behavior is that caregivers should be flexible and have a positive attitude. (Daniel DG. 2001) Some of the suggestions are provided hereunder to deal with the person having agitation behavior as was the case of Joseph presented in this paper: Everything that encompasses a person particularly an old age adult could be the cause of behavioral problem. A thorough evaluation of the old age adult, the circumstances and environment and also the care-giving by a trained professional is considered necessary for the purpose of planning for intervention. Planning for situations should be made that could ultimately result in agitation behaviors. Trying to reason or argue with an old age person having Alzheimer’s disease can only create frustration not only for the patient but for caregiver also. It is almost impossible to win a debate with person having Alzheimer’s disease. Divert and distract whenever it is possible. Routine should be kept same. Changes made in routine can upset person with Alzheimer’s disease and can cause agitation behavior problems. Sense of comfort and security should be promoted when agitation behavior occurs. Agitation behavior often occurs due to the reason that a person is scared but not able to establish sense out of the circumstances. Positive reinforcements like smiles, food or a gentle touch, lots of praise and personal attention should be used. These methods have more impact than negative reactions. The person with Alzheimer’s disease should be allowed some sense of authority and control. Being capable to save face is significant even in an individual who is confused. A clam manner should be maintained when threatening behaviors are confronted. This can resolve a stressful scenario and assist a person not becoming scared and frightened. References Allen MH. (2007).Efficacy of ziprasidone in hospitalized bipolar patients with severe mania. Presented at: New Clincial Evaluation Unit Meeting; June 11-14, 2007 Boca Raton, Fla. Antonangeli. J.M. (2003) The Alzheimer Project: Formulating a Model of Care for Persons with Alzheimers Disease and Mental Retardation. The American Journal of Alzheimers Disease, 1995, 10(4), 13-16 Daniel DG. (2001) ziprasidone 20 mg is effective in reducing acute agitation associated with psychosis: a double-blind, randomized trial. Psychopharmacology. 2001;155:128- 134. Davis, D.R. 2002. A Parent's Perspective. In Dementia, Aging, and Intellectual Disabilities. pp. 42-50 Philadelphia: Brunner-Mazel Enida . (2000). Face to Face: Respectful Coping with Dementia in Older People with Intellectual Disability 52 minutes. Working Group on Coping with Dementia in Older People with Intellectual Disability, European Network on Intellectual Disability and Ageing [ENIDA - c/o Patricia Noonan Walsh, Ph.D., Director, Centre for the Study of Developmental Disabilities, University College Dublin, Belfield, Dublin 4, IRELAND Gandelman K. (2007). Impact of meal size and fat content on ziprasidone bioavailability. Presented at: American Psychiatric Association 160th Annual Meeting; May 19-24, 2007; San Diego, Calif. Janicki, M.P, (2000). Supporting People with Dementia in Community Settings. In Community Supports for Aging Adults with Lifelong Disabilities. pp. 387-413 Baltimore, Maryland: Paul H. Brookes Publishing Keck PE Jr, (2004) Ziprasidone in bipolar mania: efficacy across patient subgroups. Presented at: American Psychiatric Association 56th Institute on Psychiatric Services; October 6-10, 2004; Atlanta, Ga. Warrington L. (2006) Early onset of antipsychotic action in the treatment of acutely agitated patients with schizophrenia. Presented at: American Psychiatric Association 159th Annual Meeting; May 20-25, 2006; Toronto, Canada. Read More