Dementia in older adults - Essay Example

 Dementia in older adults Introduction: Dementia is a condition that is generally prevalent among adults over the age of 75 and produces cognitive impairment that makes it increasingly difficult for them to communicate effectively with others. However, this is a condition that is developing among adults in lower age groups from 40 to 60 as well and has become an issue of concern because it is so widespread. Individuals suffering from dementia require long term nursing intervention and care. In the United Kingdom in particular, there is a negative perception associated with dementia which makes individuals who are suffering from it reluctant to report their condition to anyone, while the progressive levels of cognitive impairment further inhibit the reporting of symptoms. This study examines dementia in older adults and the role of nursing interventions in the disease, as well as measures that can be implemented in order to improve the provision of services to adults with dementia. Dementia: nursing interventions: Dementia has become a source of increasing public health concern, because it has become more widespread in both the United States and the United Kingdom, with associated costs of 100 billion dollars in the United States and 10 billion in the U.K.(www.physorg.com) . Dementia is more common among older adults and causes cognitive impairment leading to a progressive loss of memory and associated behavioural symptoms such as depression, with attendant pain. Patients may also suffer neuro- psychiatric symptoms which causes disturbance sin visual, motor and mental functioning(Sefton et al, 2008). A study was carried out in Sao Paolo, Brazil in order to examine the prevalence of dementia among the 65 plus age group.(Scafuza et al, 2008). This study showed that the prevalence of dementia generally increased when the age increased to 75. But on an overall basis, the study showed that there was an increased risk for the development of symptoms of dementia among lower socio economic groups. Lower income levels and belonging to a lower socio economic group appeared to increase the risk of individuals developing dementia. The conclusions reached in this study were that adverse socio economic conditions could be partly the cause of higher incidence of the disease arising out of a failure to compress morbidity into the latter stages of life. The study also suggests that the increasing levels of poor adults in developing countries who are afflicted with dementia may be increasing the incidence of dementia worldwide. Another study was carried out to compare attitudes in two countries on the issue of dementia. Participants in the study included 125 older adults from Indianopolis and 150 adults from Kent in the U.K. These adults were surveyed on the issue of screening for dementia, to determine what they perceived to be the harms and benefits of the practice(www.psychorg.com). This study found that fewer adults in the United Kingdom are willing to undergo screening for dementia, despite the existence of a universal health care system that facilitates early screening and diagnosis of the disease. The study also took into account differences in race and education among the participant samples, but on an overall basis, the findings still showed that a majority of Britons expressed concern about the stigma associated with a diagnosis of dementia, as well as the loss of independence and the degree of emotional suffering that would result from such a diagnosis. Dementia patients may require long term nursing and one of the issues to be considered is the maintenance of quality of life of these patients. Residential care facilities or assisted living arrangements may be beneficial in the case of some patients who suffer from less cognitive impairment and demonstrate a higher level of social functioning. But in the case of patients with advanced dementia, nursing homes may offer greater benefits, because they offer the facility of physical care and treatment of attendant symptoms of pain and depression.(Sefton et al, 2008). In a survey carried out on patients suffering from dementia to examine the quality of life of these patients, most of the participant sample appeared to be suffering from some limitation in mobility as a result of the disease but treatment in nursing homes appeared more beneficial for patients suffering from severe dementia (Sefton et al, 2008). Cholinesterase was being used to treat some of the dementia patients examined in the study and this appeared to be beneficial in the case of patients with milder symptoms, because they postponed the need for the patient to be admitted into a nursing home. Another major issue to be taken into consideration in caring for adults with dementia is the maintenance of patient integrity, which is also important from an ethical perspective since these patients need to be cared for on a long term basis.(Kilghren and Thorsen, 1996). Maintaining the integrity of a patient means that patients are treated with dignity and respect and are given a sense of being in control of their own lives with their individual needs and wishes being satisfied. But where adult patients with dementia are concerned, problems may arise out of the limited cognitive skills that dementia patients possess. They are unable to effectively communicate their wishes, express themselves or make the necessary choices. As a result, during everyday nursing situations, problems may arise because nurses may experience uncertainty about how to act in the most appropriate way, because it is difficult for them to construe the patient’s will and wishes.(Teeri et al, 2006). Dementia produces cognitive impairment and one of the results of such impairment is that patients are less likely to report if they are suffering from pain, and nurses are less likely to be able to identify pain in patients and treat them. Some of the most vulnerable adults in England can be found in the nursing homes and care homes, but these are generally understaffed and the few nursing staff members working there are underpaid and overworked, which results in a deterioration in levels of service that are provided. The potentially supportive role of carers from among family members is also largely being ignored and this is also borne out in the results of one study which showed that staff pay little, if any attention to the role of family carers in supporting the care of adults with dementia.(Buffum, 2007). Family carers could however play a very important role in helping nurses in their job of assessing the probability of pain in adult patients with dementia, in order to effectively devise remedies to alleviate such pain and provide higher levels of comfort to dementia patients. In order to effectively assess pain in patients suffering from dementia, behavioural assessment tools have been developed in recent years. One of these tools, known as the Dolphus scale, was originally developed in Europe and has been translated into five languages so that it can be used cross culturally across nations. (Pautex et al, 2007). A pain assessment tool has also been developed, specifically for use in nursing homes that provide long term care for patients with dementia and this is referred to as the Mobilization-Observation-Behaviour-Intensity Dementia pain scale, (MOBID) which is an aid to nurses in arriving at more accurate estimates of the pain that is being suffered by a dementia patient (30). Another tool used is the Pain Assessment in Advanced Dementia scale (PAINAD), which has been validated in countries such as Germany and Australia. It has been reported to be a good indicator for nurses and medical staff on assessment of the probability of pain in dementia patients.(32). It is however significant to note that none of these tools have been developed in the United Kingdom and there has been very little research in this country into the question of pain in older dementia patients. While this may be the result of underfunding and low levels of staff who are overworked, there is clearly a need for further research to be carried out in the U.K. This is especially relevant because of the perceived higher levels of stigma that are associated with the disease in the United Kingdom as opposed to other countries.(www.psychorg.com). The prevalence of such negative perceptions on the stigma associated with dementia may only serve to further inhibit patients in discussing their symptoms, or revealing if they are suffering from pain, while the concomitant cognitive impairment may further exacerbate this condition. Nurses may sometimes not be in the best position to provide the necessary care and attention that dementia patients may require. This could be caused by a variety of factors, such as staff shortages which result in less time being available for individual patients, (Irurita et al, 2001) or the kind of health care routines that are practiced at the medical facility (Powers, 2001). For example, where meals for patients are concerned, the kind and nature of meals supplied at institutional facilities is strictly controlled according to organizational routines and under these circumstances, it may be difficult for nurses to take into account the personal preferences, personal choices, habits and customs of individual patients.(Kayser-Jones, 1996). Another factor that may impact negatively upon the quality of nursing care provided at institutions includes the negative perceptions and stereotypes that are associated with elderly people.(Nordam et al, 2003). Cutbacks in health care budgets may also impact first upon care for the elderly, since they are generally too weak to press for their own interests. In specific relation to dementia in older adults, Jolley (2004) has drawn attention to the findings of the Rowan report that highlighted failures in the institutional ward facility at Rowan, Manchester. Inadequate staff and low supervision levels at the facility had led to allegations of physical and emotional abuse of the patients. In commenting upon the failures at Rowan, Jolley(2004) points out that such failures only highlight need for good management practices in nursing . When dealing with older people with dementia, there are hazards posed for families, nurses and families in caring for such individuals because dementia is a severe mental illness and good management is necessary in order to ensure that these older people are not taken advantage of in order to ensure that their will is not overridden so that they may become susceptible to physical or emotional abuse. Conclusions: On the basis of the above, it may be concluded that dementia is a disease that is likely to afflict a large percentage of the population above 75 years of age, both male and female. But individuals in the age group of 40 to 70 years are also vulnerable to dementia and the increasing incidence of the disease among poor socio economic groups, as well as among individuals in the United States and the European countries indicates that this is increasingly becoming a pressing health problem worldwide. While compared to the United States, people in the United Kingdom may be more reluctant to report symptoms of the disease condition, due to the perceived stigma associated with it. Patients with milder symptoms may benefit from cholinesterase, because it improves cognitive function and social function. But patients with more severe symptoms of dementia may need to be treated at nursing homes, where physician care is available, together with treatments for the attendant pain and depression. Some of the problems being experienced in the United Kingdom in relation to nursing intervention for dementia patients include shortage of nurses and a lack of available funds for medical facilities. Where nursing alternatives exist at residential medical facilities, there may be other associated difficulties, such as the problem of ascertaining the patient’s needs in the absence of optimum cognitive functioning. Maintaining patient integrity is also important in order to ensure ethical nursing treatment. Since the cognitive impairment in dementia patients inhibits their ability to express themselves and communicate effectively with those in their immediate environment, it becomes difficult for nurses to determine when these patients are suffering from pain and depression. On this basis, it may thus be concluded that there is a need for more funding for nursing homes treating patients with dementia, as well as recruiting more nurses to provide them the service they need. Since dementia patients often require long term care, the quality of nursing is a vital factor to ensure that the quality of life of these patients is maintained. In view of the cognitive impairment that dementia patients suffer from, the most important factor that plays a major role in nursing interventions is determining patient needs and concerns despite their difficulties in communication. Some assessment tools have been developed for this purpose and have been found to be efficacious in determining when patients are suffering from pain. While these tools have been tested out in other countries however, they have not been tested in the U.K. and there appears to be a need for more research into this area within the United Kingdom. This is especially relevant in the context of the existing environment in the United Kingdom, where those potentially suffering from dementia are reluctant to report their symptoms for fear of the public stigma associated with the disease. On this basis, it may thus be concluded that there is a need for more funding for nursing homes treating patients with dementia, as well as recruiting more nurses to provide them the service they need. Since dementia patients often require long term care, the quality of nursing is a vital factor to ensure that the quality of life of these patients is maintained. In view of the cognitive impairment that dementia patients suffer from, the most important factor that plays a major role in nursing interventions is determining patient needs and concerns despite their difficulties in communication. Some assessment tools have been developed for this purpose and have been found to be efficacious in determining when patients are suffering from pain. While these tools have been tested out in other countries however, they have not been tested in the U.K. and there appears to be a need for more research into this area within the United Kingdom. It is important to ensure adherence to ethical standards in providing nursing care for dementia patients, and it would not be ethical to override a patient’s will and wishes in providing nursing intervention and treatment. In order to cope with some of the difficulties that nurses experience in arriving at an accurate assessment of patient needs and wishes when they are suffering from dementia, it may be necessary to ensure that nurses undergo sufficient training in the use of behavioural assessment tools. It may also be beneficial for nurses to work in association with family members in treating dementia patients, because this may be beneficial in accurately determining what the patient’s wishes are. There is also a need to increase funding available for nursing interventions, so that nurses can be well trained and recruited in numbers sufficient to prevent overwork and a deterioration in levels of service provided. Within the United Kingdom in particular, there may also be a need to promote programs to educate the public about dementia, in order to gradually remove the public stigma that is associated with the disease. 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