Assessment, Management And Challenges Of Dementia In Older People – A Critical Analysis

Background

Dementia can be defined a mental health disorder, that has a huge impact on the health and well-being of the patients, and this progressive disease targets the elderly population. There are various different risk factors that are predominating in case of dementia include age, family history, heavy alcohol use, hardening of the arteries, high blood pressure, diabetes, high cholesterol, and smoking. Elaborating more, intrinsic damage to the neurons leads to the loss of communication network among the neurons and results in the clinical manifestations associated with dementia (Brooker and Latham 2015). Hence, undoubtedly, dementia is a healthcare complexity that is associated with various different implications on the lifestyle and living conditions of the patient and there is a need for specialized care planning and implementation program in order to address the different concerns that are caused by dementia in the patient; taking into consideration the overall concepts of health including physical, emotional, spiritual, physical and cognitive health and wellbeing. Although, it has to be mentioned in this context that in most cases, early, quick, and effective assessment structures are very important for the care plan to be effective and patient-centered (Gauvin and Lavis 2013). This assignment will attempt to discuss a case study including the assessment procedure and tools utilized, the rationale for the assessment procedure and techniques chosen for the case study, the care interventions planned and implemented, the rationale for their choice and effectiveness of the care provided for the dementia patient.

The case that will be discussed in the assignment is a 70-year-old woman who had recently received a diagnosis of dementia. In order to honor the privacy of the patient and confidentiality of the information that the patient has shared, the patient will be addressed as Sharon in the assignment. It has to be mentioned in the context that while designing the care plan and the assessment program for a dementia patient, it is crucial for the care team to explore and analyze the background, lifestyle, and past history of the patient (Robinson et al. 2013). Sharon had been a widow who used to live with her only daughter in her house; her daughter is named Sarah who had recently moved upstate after her wedding a year and a half ago. The patient stated that she had been in touch with her daughter over phone, however, the physical distance from her only daughter and the loneliness she lived with after the demise of her husband 25 years ago, her depression and insecurities caught up with her and she soon started to neglect her health and started excessive smoking and drinking. The past medical history of the patient revealed that she had been diagnosed with hyperlipidemia a decade ago and along with that ever since her daughter’s moving away, he had forgotten to diligently take her medication and go for checkups in the past year. According to the subjective and objective data shared by the patient, she confirmed to be having mild memory problems from 6 months ago, which started with forgetting her car keys, forgetting to take her medications. However, the patient resented to the healthcare facility with the symptoms of lack of memory, inability to focus and be attentive and Confusion and disorientation.

Assessment of Dementia

Assessment is a very important aspect of planning and implementing dementia care. According to the Sabbagh et al. (2010), the progression of the disease can be very different in different individuals. While the disease can progress at a fairly rapid pace and for certain others, the progression of the disease can be more time taking and gradual. As a result it has to be mentioned that for proper diagnosis and care planning for a patient it is very important for the healthcare provider to employ assessment techniques and tools to assess the exact stage that the patient is in so that the care provider can employ care activities and interventions that will suit the exact needs of the patient (Machiels et al., 2017).

In this particular test, two particular assessment tools or techniques were used in case of Sharon. The preliminary assessment test that was performed was the 6 item cognitive impairment test or the 6-CIT test which is a very commonly utilized test for the dementia settings, and along with that this particular type of test is very common assessment tool used in conjunction with the MMSE test to assess the level of organization and planning in the patient according to the UK national Dementia Strategy (Abdel-Aziz and Larner 2015). The second assessment tool utilized is called Mini-Mental State Examination (MMSE) test. It has developed as a screening instrument which helps in the diagnosis of dementia symptoms such as memory, language, and visuoperceptual function..

In order to describe the procedure, first and foremost, the patient had been informed regarding the both of the assessment procedures performed and their benefits. In the beginning, Sharon was a little nervous regarding the type of assessment and sharing personal information, however, when she was informed about the need of the assessment procedure and how it will benefit inefficient and correct diagnosis and a patient centred and targeted care plan that will help her significantly. Along with that, she was also informed about the confidentiality and privacy protection policy of the healthcare facility and soon she was comfortable and convinced enough to share her woes. The preliminary test was the 6 item cognitive impairment test where the patient is asked 7 different questions and the patient is required to answer all the different questions and on the basis of the answers that the patients is going to be scored. In case the patient attains a score from 0-7, then the patient is considered to be having no cognitive impairment, at score 8-9 the patient is considered to be having mild cognitive impairments and at score 10-28, the patient is considered to be having significant cognitive impairment. The patient scored 8 in the 6 cognitive impairment test (6CIT) indicating the fact that the patient had only mild cognitive impairment however she still will require intervention for it (Jefferies and Gale  2013). The second and more advanced assessment that was performed was the MMSE test which began with asking her 12 questions in total and two diagrams. The entire questionnaire took close to 15 minutes to complete and after this test was completed the patient was given 5 minutes to relax before commencing with the second test. The patient scored 19 on the MMSE test indicating that she is suffering from mild to moderate dementia.

Case Study Analysis

In rationale for the type of assessment tools utilized in case of the patient, it has to be mentioned that Sharon had been exhibiting the signs of cognitive impairment. The first performed test was 6CIT, a brief and simple cognitive screening instrument that emphasizes on the cognitive status of the patient particularly and is used mostly in the primary care setting. According to Jefferies and Gale (2013), this particular test had been designed and in use to assess the global cognitive status of the dementia patients. This test utilizes the combination of one memory oriented question, 2 calculation based questions, and three orientation based questions; and the brevity of this test makes it simple and easy as a primary assessment taking only 2 minutes or lesser to complete and provides a valid preliminary assessment for more extensive screening to be employed (Upadhyaya, Rajagopal and Gale 2010). The most detailed and useful assessment tool for judging the exact state of cognitive impairment is MMSE is a very important tool for diagnosis of dementia. As per the NICE guidelines the result of an MMSE that assists in the determination the appropriateness of pharmacological interventions (Nice.org.uk. 2018). The combination of tools is recommended for use in acute, primary, community and residential Care (Price et al. 2011).

In order to evaluate the assessment and intervention followed in the case scenario, it has to be mentioned that the care professionals were able to establish a therapeutic relationship with Sharon and were able to employ effective communication skills to help her understand the need for the assessment and intervention activities and contribute to the entire care program (Ihpa.gov.au. 2018). Along with that, the two assessment programs utilized MMSE and 6CIT tests are two very abundantly used and NICE guideline approved diagnostic tools which were successfully utilized in the case scenario (NICE, 2018). Although, one major mistake that occurred in the care scenario was the fact that when the patient becomes somber and sad, effective compassionate and empathetic communication was not performed. In case of interventions, the use of medication administration education has been a fundamental step to help Sharon understand the need for the medication. Although, the medication remembering routine was not prepared for Sharon, which is another fundamental error in the care scenario. The nonpharmacological interventions included both cognitive behavioral therapy and tailored interventions  which will help the patient overcome the impact of dementia. In the future, the nurse will need to focus on compassionate and empathetic communication with the patent and perform inclusion so that the patient can feel valued and empowered (Aguirre et al. 2013). Along with that, as both malnutrition and depression are major concerns for the patient care should be taken to include different activities to make routines and reminders for eating regularly, taking medicines, and other related care activities (Azheimers.org.uk 2018).

Conclusion:

Dementia can be defined as the amalgamation of a few healthcare adversities that mostly target the elderly population. This disease is an amalgamation of different neurotic disorders that lead to clinical manifestations such as memory loss, word-finding difficulties, impaired judgment, and problems with activities of daily living. There are two most common types of dementia, Alzheimer’s and vascular dementia. On a more elaborative note, dementia can be defined as the collective term that describes the use of different correlated cognitive disorders such as memory loss, word-finding difficulties, impaired judgment, and problems with activities of daily living. The most common type of dementia is Alzheimer’s disease which constitutes almost 50 to 70% of the cause. This essay was able to explore and evaluate a complete care scenario and the different aspects associated with future recommendations for improved care quality and better health outcome for the patient.

Care Interventions for Dementia

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