Jean’s Case and Healthcare Needs
Discuss about the Dementia Care across Settings.
The healthcare needs of the elderly have continued to change with a continued decrease in the mortality rates of this patient population. This group of individuals comprising people above the age of 65 has been faced with a number of medical conditions that have often proved to be incurable. For instance, the prevalence of dementia, a psychological condition that deteriorates the emotional status of individuals has risen to alarming levels thereby presenting considerable challenges not only to the patient, but also to the caregivers of these individuals (Gilleard & Higgs, 2014, p. 242). As such, this condition has raised major public health concerns with various studies attempting to investigate the best forms of interventions that could enhance the recovery process and ease the daily living conditions of these patients.
Jean is 67 years old and she has recently been identified as an individual with diagnosis through her diagnosis. The specific condition is Alzheimer’s disease. Jean has admitted that this condition has significantly affected her social life since she has found it difficult to associate with her friends let alone her husband and her two boys. Even though Jean’s condition is still in its early stages, the patient admitted that the condition is taking an emotional toll on her given the difficulties she experiences in her social and family relations. Taking ethical considerations into perspective and specifically the need to get consent from Jean as well as protecting her confidentiality, this paper analyses Jean’s condition and reviews the most appropriate intervention that can address Jean’s condition.
Jean has lived in the country side most of her life. Occasionally, Jean would relocate to different cities for education purposes and after finishing her college education, she returned home and focused on her career as a high school teacher. At that time, she also got engaged and married, as she says, the love of her life, Mark. The two have been happily married for more than thirty years where they also had two boys. Jean attests that her family is the most important thing in her life. Additionally, Jean has maintained a social life being surrounded by a lot of friends from her neighborhood and the town as well. In this case, she is well known as a friendly person, one who is always willing to help out and the students too have really warmed up to her during her years of teaching prior to retiring.
An Outline of the Healthcare Needs
After retirement, Jean remained affiliated with the school as she was nominated to be a special member of the board. All had been going so well for Jean until she began to experience the first symptoms of dementia. Jean began to forget simple things including names and places that she had grew fond of. Her husband closely observed as Jean’s condition was slowly revealed. At one time, upon Jean’s insistence, she forgot her favorite cooking recipe and she completely didn’t know how to cook the food. As these signs became more and more evident, the two decided to visit a medical facility where Jean was diagnosed with dementia. The decision however did not sit well with Jean as she initially refused to accept the diagnosis she became worried of the outcomes of this condition. Consequently, Jean became severely depressed necessitating the need to check in to a nursing home.
A dialectical analysis for Jean’s condition can be established based on Kitwood’s model that premises five main factors namely; personality, social psychology, neurological impairment biography, and health status (Kitwood, 1990, p. 178). These factors are essential in explaining the elements that contribute to the emanation and escalation of dementia.
Personality
Throughout her life, Jean has been sociable keeping her friends and family very close. She has further confided in her husband and friends her conditions and they have been willing to offer support to her. However, even though this support has been fundamental in helping Jean to cope with her condition, Jean has progressively felt withdrawn especially when she began to forget some of her friends during their visits. This forgetfulness has left Jean in owe of her condition thereby exacerbating her emotional trauma.
Biography
Aside from being sociable, Jean maintained deep fondness for her husband, their two children, and her daughter in law and her grandchild. They would often stay indoors and read stories or alternatively listen to old country songs that they loved. The condition has however deprived Jean and her family this happiness given that Jean began to forget these stories as well as the name of these songs.
Health Status
Jean’s condition has been detrimental to her mental status given that she has continued to experience psychological distress. Recently, she would often stare through the window for hours wondering what would happen if she completely forgets her family and friends. Based on these effects, the formulated treatment plan should therefore focus on addressing the emotional trauma that has impacted Jean by enhancing Jean’s togetherness with her family.
Literature Review
Neurological impairment
Jean has emotionally detached herself from friends and family leading to mood and behavioral changes as evidenced by Jean’s sadness and gloomy character. Her cognitive functioning has also been significantly disrupted causing sufficient impairment in her everyday life (Dewing, 2008).
Social Psychology
Jean has maintained a crucial role in taking care of her family and to the community where she her input in the board of the school has greatly been valued. Her family and the community as well have therefore been supportive by allowing Jean to maintain her roles. For instance, she is allowed to cool for her family and attend the board meetings. Relieving Jean of these duties could further worsen her condition.
In order to prevent the escalation of dementia, studies indicate that cognitive impairment should be focused upon comprehensively since its clinical significance is easily distinguishable. As such, several approaches that are based on prevention trials therefore comprise enrichment strategies. These strategies are further based on genetic risk factors or biomarkers (Solomon et al, 2014, p. 229). However, the effectiveness of such strategies has come under much scrutiny given the adverse side effects that are associated with these pharmacological interventions (Feldman et al, 2014).
Available research indicates that music therapy is both inexpensive and a safe intervention method for people with dementia. Most importantly, this intervention method has proven to yield credible benefits for the treatment of dementia. Unlike drug therapy which is in most cases used for the treatment of dementia, evidence further indicates that music therapy has limited side effects compared to drug therapy which produces severe complications that arise from hypersensitivity of the brains of demented persons (Du, 2017, p. 1).
Another similar study aimed to review the effects produced by group music intervention on the psychological and behavioral signs of AD. In their findings, the authors of this study illustrate that the available date evidences an improvement in regards to agitation and also improvements in the emotional well-being of both the patients as well as their caregivers. From the 15 sessions of music therapy conducted over a five week period, the study concluded that music improves the psychological signs and behavioral symptoms in patients with dementia (Choi et al, 2009, p. 472).
A similar study also indicates that the benefits of music therapy are realized by both the patient as well as the caregivers. Hence, caregivers should be wary of not using music as a form of intervention given the barriers that could emanate from such an action. Such barriers could involve hearing loss problems, functional disabilities and unmet needs of elderly individuals (Logsdon, McCurry & Teri, 2007, p. 310). Another peculiar study indicated that music therapy is majorly important since it elevates the mood of elderly persons diagnosed with dementia. In this study, it was further revealed that music therapy enhances positive emotions and also brings remote memories to the patient (Besha, 2015). In addition, evidence also indicate that leisure activities that encompass music activities can provide social as well as cognitive benefits to individuals with dementia or rather those suffering from cognitive functioning disabilities (Rakesh et al, 2017, p. 121).
Implementation of the Intervention
Given that dementia is viewed as both an individual and family problem, Jean and her family were included in the decision making process. Furthermore, the family’s responsibility to take care of Jean was essential in promoting Jean’s independence as a demented individual. The economical essence and moral value of Jean living in their home was also realized. In this case, allowing Jean to stay at her home was viewed as being economically feasible for the family. Also, this environment was assumed to be familiar to Jean, comforting and secure (Golden, 2010, p. 15). Hence, it was conclusively decided that the music be played in Jean’s room early in the morning allowing Jean to feel comfortable, secured in her own way and familiarize with the environment.
Jean was also to spend most part of her day in her room surrounded by a number of novels. As she read, it was proposed that a soft soothing music would play in the background. In the afternoons, Jean would be allowed to see visitors most of whom were her friends and socially interact with them. Later in the afternoon, an inclusive music listening session was scheduled for Jean and her family. Ideally, this session would comprise listening to some of Jean’s old favorite music at her own will. Group singing was also emphasized upon during this session (Gotell, Brown and Ekmam, 2009).
For observation of Jean’s behavioral changes, it was decided that Jean’s son maintain a journal or rather diary which would document the changes in mood that were exhibited by Jean during these sessions. The information would then be discussed with a medical professional on a two week basis during their visit to monitor Jean’s progress and how she was responding to the intervention (Moyle et al, 2007). In addition, it was essential that the careers be taught coping strategies since it was expected that during the provision of care, it was likely that they would face physical as well as emotional difficulties.
Impact of the Intervention
The availability of family including Jean’s husband, son and daughter in law as carers for Jean proved to be essential in reducing the likelihood of Jean being admitted into the care home. Although this was the initial plan, financial constraints raised a major concern thereby warranting alternative form of treatment plan. Hence, by assigning the family members the primary role of caring for Jean, the healthcare cost associated with the treatment of dementia was significantly reduced thereby easing the financial burden associated with health and social workers. Moreover, the use of music therapy was also less costly compared to pharmacological treatments which could further result to side effects (Whitehouse, 2014, p. 678).
The use of music intervention provided the best alternative mode of treatment given Jean’s early diagnosis of the condition. This is mainly so since, music intervention was not only a non-pharmacological form of treatment, but it also resulted to no side effects and was pivotal in managing the distressing behavior that was exhibited by Jean (Feldman et al, 2014).
However, the caring role assigned to the family members progressively proved to be emotionally and physically challenging. In some way, the carers felt that they were put under pressure to care for Jean. They therefore required professional support from health professionals which primarily involved counseling and medical checkups to determine Jean’s emotional and physical well-being(Sung et al, 2011, p. 1778). Also, the coping strategies were emphasized upon and in this case, the carers were provided with skills and confidence to take on the task of caring as substitutes to home care workers.
In some cases and as anticipated, the family members would succumb to excessive grieving given the health deterioration of Jean as an individual with dementia. Ideally, the demented person would seem to be physically present but emotionally absent. Moreover, the interaction between the carer and the demented person would be distressingly incoherent thereby disrupting their daily relationships. Consequently, the carers would perceive themselves as being powerless and overwhelmed to make any decisions that would result in positive changes in the life of the demented individual. In these cases, professional monitoring was identified as the most efficient course of action where a medical professional would offer support for the carers thereby propping them up to continue caring for the demented individual.
How the Intervention Promotes Person Centered Care
It was imperative that Jean’s independence be respected and protected by the intervention plan. Jean’s caregivers primarily comprising of her husband, her daughter in law and one son were effectively advised on the form of communication that they should use while communicating with Jean. In this case, non-verbal cues as well as the use of certain terms were emphasized upon in order to enhance Jean’s comprehension. It was also decided upon that Jean’s favorite songs be played very early in the morning after she woke up in order to kick-start her days (Hammar et al, 2011, p. 971). This decision was made after realizing that Jean spent most of her mornings confused and worried as she often gazed through the window in utter oblivion of what was unfolding in her life.
By ensuring that Jean listened to her favorite songs every morning, this would relieve Jean of the distress of having to worry of what had become of her life (Gilleard& Higg, 2014, p. 242). Additionally, a music session late in the afternoon coupled with storytelling session would ideally promote Jean’s integration into the family and also enhance her emotional attachments to the individuals that she had grown fond of.
Evaluation Criteria
To evaluate the Jean’s progress, regular interviews were scheduled with Jean, medical professionals and Jean’s family. One of the interviews would comprise a session where the health professional would review the Jean’s diary and ask Jean’s family questions in relation to the progress that Jean would ideally be making. Another interview will involve all the three parties and which will be open ended thereby giving room for advice from the health professional as well as allowing for concerns or issues to be raised by the family members regarding Jean’s health status (Strooper & Karran, 2016). Additionally, the evaluation process would further involve education on coping skills and strategies for the family members thereby enabling them to carry on with the caregiving task and giving value to Jean as a person suffering from dementia.
Conclusion
Dementia condition is a major public health concern affecting predominantly individuals at an old age. This condition presents major challenges to the individual affected as well as their family members especially when taking into consideration the healthcare cost and, physical and emotional challenges that are experienced when providing care to the demented person. In regards to Jean, a 67 year woman recently diagnosed with AD, this condition has impacted negatively on the physical and emotional well-being of the individual given that she has become emotionally withdrawn from her family and friends despite valuing these two groups of individuals all through her life.
In order to provide care to Jean and subsequently improve on her health status, it was decided that music therapy be used as the most efficient form of intervention for Jean’s condition. This approach was implemented at Jean’s home where the environment was deemed to be secure, comfortable and familiar to Jean. During the implementation, Jean would primarily listen to her favorite song very early in the morning when she woke up. In the afternoon, Jean would be involved in group singing with her family and dance at her own will. A diary detailing Jean’s behavioral changes would be maintained by her son for evaluation purposes which would be conducted during visits that would be made by health professionals. Additionally, it was critical that Jean’s family as the primary caregivers be educated and trained on coping strategies in order to enable them deal with the overwhelming and distressing nature of their caring task
References
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Choi, A., Lee, M. S., Cheong, K. J., & Lee, J. S. (2008) Effects of Group Music Intervention on Behavioral and Psychological Symptoms in Patients with Dementia: A Pilot Controlled Trial. International Journal of Neuroscience. 119, pp. 471-481.
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