Causes of Dementia
Discuss about the Principles of Education for Health Professionals in Management of Dementia in Ageing Populations.
Dementia is a sudden form of confusion in which the brain undergoes rapid changes because of mental and physical illness. The condition is caused by a reduced supply of oxygen and nutrients from the blood supply. Conditions such as asthma are known to hinder the supply of blood to the brain. The forms of characterization are based on severity, causes, and characteristics (Balas et al., 2012). Causes include sedative drug or alcohol withdrawal, drug abuse, poisons, surgery and infections such as pneumonia and urinary tract infections. Imbalances in the body chemical compositions and electrolyte disturbances may also cause dementia. Disruption of chemicals in the brain may result from intake of certain medications such as blood pressure management drugs.
In reference to Inouye (2006) diseases such as pneumonia that trigger inflammation or an infection may change the brain function. There occurs loss in recall or short-term memory, disorientation about place and time, disorganized thinking, personality or emotional changes, problems in concentrating, inconsistency and movements caused by variations affecting the nervous system. Christensen (2014) argues that human beings experience loss of neuron functions but in people suffering from dementia, this comes at a greater impact. The signs and symptoms come about when nerve cells lose connections with other cells of the central nervous system.
Alzheimer’s disease is the most common type of dementia that affects individuals above the age of 65. It involves the loss of cognitive functioning thus loss of memory and other behavioral abilities. Among the persons diagnosed with dementia, they usually have a mixed kind of dementia that may involve several disorders (Zheng, Mulvenna, & Martin, 2012). In tauopathies, the tau protein clumps together within the neurons in the brain. As a result, nerve cells lose their functioning abilities and eventually die. The tau protein aggregates thus forming bundles referred to as neurofibrillary tangles within the nerve cells. Plaques of the amyloid protein from within the brain cells intracellular spaces form the hallmark of tauopathies. Corticobasal degeneration (CBD) is another form of dementia in which there is the loss of nerve cells and atrophy of certain areas of the brain such as basal ganglia and the cerebral cortex. CBD undergoes gradual progression when individuals attain an age of around 60 years. Some of the signs and symptoms include focused movements (apraxia), involuntary muscular jerks (myoclonus) and dystonia. Corticobasal degeneration may also impair the visual interpretation properties (Engdahl, 2013).
Types of Dementia
Clinical competency is one of the factors that impact on the ability to ensure integration of affective, cognitive as well as psychomotor skills that are key when delivering healthcare. The learning environment cannot be affected by the age, experience as well as expectancy of the nursing profession. In reference to Zheng, Mulvenna & Martin (2012) the older people are usually at a greater risk of malnutrition which is a major health problem that resulting in enormous morbidity and mortality. It has also been linked to diminished cognitive and physical performance and a reduced overall sense of physical and mental wellbeing. Forty percent of older people admitted to hospital are already malnourished and more than sixty percent of older people have been found to have challenges maintaining their nutritional status during their hospital stay. This has been attributed to poor recognition and monitoring of nutritional status and inadequate intake of nutrients in the inpatient setting. As a result, it acts as the major factor for non-elective hospital re-admission.
The three pillar strategies that can be deployed to improve health education for persons with dementia as well as other stakeholders involved in the care processes are discussed below. The points are further broken down and supported with real-life scenarios to assert applicability of these recommendations: –
- Come up with an approach that is person-centered to ensure that the critical needs are served during the provision of care and services
- Ensure proper understanding the multiple causations of major health problems affecting the older people.
- Ensure there is an improvement in the manner the community-based programs and organizations integrate appropriately to ensure appropriate care provision.
The age-related functional decline of physiologic systems means that older people are less able to prevent and recover from illness. In addition, they are easily affected by deconditioning. The decline in cognitive function is a leading complication of hospitalization of the aged which may reflect in the form of malnutrition, decreased functional mobility, decrease in the skin integrity of the patient, incontinence, the development of delirium, poor self-care, in addition to depression. In responding to the specific care issues of older people, it is essential that health providers and policy makers are aware of and apply practice based on best evidence.
Additionally, Engdahl (2013) states that skin breakdown is caused by moisture, pressure, shear or friction. Mary and other patients suffering from dementia should not stay in the wheelchair for too long since the wheelchair cushion may leave a pressure ulcer on the skin. The patient shouldn’t be left to take a shower for too long since moisture over-hydrates the skin thus weakening it. Patients such as Mary, therefore, should also consume adequate amounts of fluids to keep her skin well hydrated. As seen in the previous section, Mary and many other patients with dementia present with signs of pain owing to a condition such as constipation, pressure ulcers as well as urinary incontinence and other urinary tract infections. As part of the health professional’s education principles, the nurses ought to pay attention to certain behaviors such as agitation or shouting.
Challenges Faced by Older People
Within a period of three weeks, there was a significant change in the behavior of the patient in the case study meaning that the strategies proposed in the current study were workable. For instance, the clinician recorded a positive impact on Mary which has helped her to become more comfortable as well as secure. The care providers need to be sensitive in the manner they communicate with their patient if they need positive impacts during treatment. The section below will give recommendations on ways that the health professionals may interact with such patients. As the educational awareness programs will require reaching out to the masses, respecting the patients, as well as their knowledge, goes a long way in equipping them to sensitize others on the benefits of dementia management.
As reported by Shea (2012), dementia is known to reduce one’s ability to communicate with the patient. People important to the patient such as her family and caretakers ought to develop patience, good listening skills, and understanding. They should be patient and supportive in that they show her an interest in listening to whatever she has to say. The next method to enable good communication is to avoid correcting and criticizing. It is imprudent to discourage her from talking through unnecessary corrections and criticism to allow her self-esteem and confidence to grow.
The caretakers should cut down on Mary’s fluid consumption especially at nights to avoid involuntary urination at night and agitation. The patient should take walks during the day since these are good exercises for bowel movements. In conclusion, whenever patients such as Maty visit the toilet, enough time should be given to allow optimal emptying of the bowels. The toilets should be made easier for use by persons with mobility challenges. Imbalanced diets and lack of fluid consumption accompanied by the lack of exercises may result in constipation. The patient is therefore put on a schedule to consume about six glasses of fluids in a day. Before consumption of food especially after visiting the toilet, Mary and other demented patients need assistance where applicable in washing hands with mild soap. Observing personal hygiene is vital in avoiding parasitic infections. The healthcare providers also need to look out for hunger and starvation signs in the patients as they tend to have challenges in communicating the fact that they are hungry and as a result.
The masses can really benefit from learning new and innovative ways on how they can deal with their loved ones who suffer from dementia. Mary, for instance, has problems in memory and must use electronic devices or reminder notes. These are the warning signs for the condition whereby she cannot keep track of house chores she used to keep earlier on. The innovators of new technologies should however also come up with ways that educate the population on how to break the device usage as it is associated with the increasing incidence of dementia. The masses need to be aware of the warning signs regarding dementia which may include problems such as completing familiar tasks at home or work. For example, the suspected individual might have become slower at preparing meals, forgot how to set the table and uses recipes to prepare her favorite meals that they used to prepare off the head. Engdahl (2013) argues that misplacing things and inability to retrace steps is also another set of warning sign.
Care Strategies for Individuals with Dementia
The principles and processes for improving the care of older people have been identified. These include the expectation that health policy makers will have a clinical governance responsibility to provide care that reduces the risk of adverse events for older people and gives the accommodation to allow them to reach their optimal level of independent functioning besides upholding it. One of the major principles learned in the current write-up is the essence of involving older people in their own care. By doing this, they can better recognize and address issues that are central to the person’s recovery. If older people and their carer are involved in planning care and treatment, the health professionals are in a position to quickly identify the issues that may curb the return of the person home.
Treatment, therapy, and care for older people can be provided in many settings. The
boundary between the hospital and community care has changed over the last decade
with several conditions now safely managed in the community. In moving from
one care setting to another, it is important that the care is provided in an integrated
way that meets the needs of the patient and their loved ones. Care settings should be designed
and managed so that appropriate physical, social and environmental features relating
to the special needs of older people are provided.
Nurses can design the Nu-Desc five-points scale questionnaires and integrate it into the clinical practice and routine care in the form of bronchures. The questionnaire takes note of the underlying medical complications and any abnormal psychomotor retardation. A score of at least 2 identifies the presence of postoperative delirium correctly. These questionnaires can be carried out after every 6-7 hours and after 72 hours of the post-anesthesia period.
Conclusion
The five stages of dementia describe the patient’s ability to fulfill the six areas of cognition such as memory, orientation, home and hobbies, judgment, community and personal care. One of the major signs is the loss of memory that disrupts normal life. In the case study, for instance, Betty forgets things at a higher frequency and has to use recipes to prepare meals. Dementia is also characterized by difficulty in solving problems or planning. Patients will, therefore, seem to experience changes when trying to work with numbers or follow a plan. Difficulty when solving problems or planning is another key sign of dementia whereby individuals fail to complete routine tasks. Betty had become slower when it comes to preparing her favorite meals and even forgot how to prepare the table for dinner. The fourth symptom is confusion with place or time thus losing track of seasons, time and passage of time (Hardman, 2009). The older person’s care plan should be built on information gathered from the
References
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Fong, T.G., Tulebaev, S.R., & Inouye S.K. (2009). Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol, 5(4), 210-220.
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Shea, T. (2012). Dementia. New York: Rosen Pub.
Zheng, H., Mulvenna, M.D., & Martin, S. (2012). Pervasive care for people with dementia and their carers. International journal of computers in healthcare, 1(4).
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