Dementia Care & Management Research Paper
The development of dementia leads to consistent changes in the lifestyle of people and affects the elderly population. At the same time, the development of dementia affects not only patients but also their family members. At this point, it is possible to refer to the case of Mr. and Mrs. H. The latter suffers from dementia and her husband is the primary caregiver supported by their children, who help them from time to time, by doing shopping and some other activities which are difficult to perform for Mr. H. Mr. H is the primary caregiver because he is the husband of Mrs. H and he is not willing to give up taking care of his wife. He cannot even think of other people taking care of her. However, he experiences difficulties with handling Mrs. H, who becomes more and more aggressive as her health problem keeps progressing. Children push on Mr. H since he cannot always handle Mrs. H properly and manage her aggression. Children insist on sending Mrs. H to the nursing home, where she will be handled by professional nurses, who can and know how to manage patients with dementia. However, Mr. H cannot agree with such offer and refuses to let Mrs. H go to the nursing home. Instead, he takes the full responsibility over her and looks for options to take care of the patient all by himself. In such a situation, Mr. H faces the dilemma: on the one hand, he cannot manage Mrs. H and her dementia properly and has difficulties with handling his wife, while, on the other hand, he does not want to let her go and let other people to take care of her. Therefore, the plausible solution for Mr. H and his wife requires the development of the proper strategy of the dementia care and management so that Mr. H could stay with Mrs. H and provide her with the proper treatment that means that Mr. H may probably need training and assistance of nurses and health care professionals in terms of the proper management of Mrs. H’s condition, progressing disease and related changes in her behavior. Dementia Care & Management Research Paper
The case of Mr. H and Mrs. H and their family, including their children, is the example of the family unprepared for the mental health problem in Mrs. H. To put it more precisely, family members were not well prepared for their decision-making roles. In this regard, family members experienced substantial burdens and loss in caring for institutionalized elders. For example, children help Mr. and Mrs. H but their involvement is minimal with regard to needs of Mrs. H and current capabilities of Mr. H. In other words, children do not provide care for Mrs. H or help Mr. H to care and manage dementia in Mrs. H directly. The lack of such support leads to the different perspectives on the further treatment and management of Mrs. H condition. Children, who do not spent much time on care for Mrs. H prefer to send her to the nursing home, whereas Mr. H, who conducts all the care and management of the disease for Mrs. H prefers her to stay at home.
At the same time, family members have limited understanding of the natural progression of dementing conditions. Neither Mr. H nor their children know how to respond to the progress of dementia in Mrs. H. As she become more and more aggressive, Mr. H faces difficulties with handling her, while children are also unaware of possible management strategies that could help to handle her effectively.
Also, family members are uncomfortable in setting goals for their relatives’ end-of-life care since neither Mr. H nor their children are competent to provide Mrs. H with the proper care and treatment. Mr. H and other family members have little experience with death, and were ambivalent about the anticipated death of their relative.
In addition, family members have little substantive communication with health professionals regarding end-of-life care planning. In this regard, Mr. H needa to have such communication to learn from health care professionals how to deal with Mrs. H and her condition to address her problems. The assistance of health care professionals can help Mr. H to develop effective caring strategies that can facilitate the end-of-life care issue and the treatment of dementia in Mrs. H.Dementia Care & Management Research Paper
In this regard, the effective planning of care and management of dementia performed by family members is very important and Mr. H should have the training to be able to address needs of Mrs. H and cope with his own problems too. Many of the needs of such families could be addressed through improved application of the principles of advance care planning, including regular structured discussions, involvement of surrogate decision-makers, and anticipation of clinical decisions (Iadecola, 2013). Health professionals should take the lead in ‘normalizing’ the discussion of death (Iadecola, 2013).General recommendations on the dementia care and management involve the provision of essential aid to patients. More specifically, the management of dementia starts with the full assessment of the patient and the accurate and adequate diagnosis of the patient’s current condition. In this regard, CT scan imaging and MRI imaging are very helpful. Therapists should understand adequately what issues exactly are disturbing the patient at the moment, how his/her behavior has changed within the last five – ten years, what behavioral patterns are disturbing for the patient, whether the patient can live independently or need the care and assistance, and other issues that are relevant to the current condition of the patient and his/her well-being. As the patient’s condition is fully assessed, dementia is properly diagnosed; therapists start the treatment by developing the strategy of the treatment and start implementing that strategy.
In case of dementia, psychological therapies are essential because often patients with dementia have serious psychological problems because dementia causes the de-socialization and irrevocable changes in their personal and professional life that can cause negative psychological conditions, including depression and other states, which have a negative impact not only on the psychological condition of patients but also on their physical health. Psychological therapies may vary and depend on the therapist’s choice and specific needs of each client. Researchers (Cunningham, 2006) point out that care givers may and often do need psychological therapies too. They should come prepared to provide care for patients with dementia and the effective interaction between patients with dementia and their care givers is very important for the effective treatment of the disease and maintenance of the high standards of living of patients.
Medication is an integral part of the treatment of dementia. In fact, the treatment of dementia is virtually impossible without medication because the destructive impact of the disease in the patients’ brain and nervous system lead to irrevocable changes. Medication can help to treat patients but does not actually lead to the full recovery of patients. Instead, medication helps to slow down the progress of dementia consistently and create conditions for the maintenance of the patients in the physical and psychological condition, which they have used to, and prepare them to the life with dementia. Dementia Care & Management Research Paper
Therefore, medication focuses on the treatment of symptoms of dementia. More specifically, researchers (Tombaugh, 2004) insist that the modern medication treats behavioral and cognitive symptoms mainly to minimize negative effects of dementia on the behavior of patients, their social relations, prevention of memory distortions and minimization of their negative effects, and other issues. At the same time, often the medication for the treatment of dementia is based on the medication used for the treatment of other health problems, which dementia accompanies, such as the Alzheimer disease, or Parkinson’s disease, for example. In some cases, antipsychotic drugs are prescribed to patients with dementia (Jorm, 2004). However, such medication is rather exceptional than normal and is used only in cases of substantial behavioral dysfunction in patients, when their behavior becomes too aggressive and dangerous for their social environment. Moreover, antipsychotic medication is used only when non-drug therapies have failed. For example, psychological therapies, such as music therapy, can help to treat patients with dementia and prevent the emergence of psychotic conditions in those patients. However, in the most severe cases non-drug therapies may not work. In such cases, antipsychotic drug treatment is prescribed but the medication is conducted under the full control of therapists.
Dementia is a serious health condition, which involves the pain management, which emerges along with the need of patients for medication and psychological therapies. In fact, patients with dementia are as vulnerable to diseases and health problems that cause pain as other elderly patients. However, the pain and its cause may not always be diagnosed accurately in case of patients with dementia. This is why health care professionals working with elderly patients with dementia and their care givers, including family members, should assist to make accurate and adequate diagnosis and find out whether patients with dementia have some pain problems. If such problems are identified, patients will need pain management. The difficult related to the pain management in patients with dementia is the difficulty of the identification of the pain and its source. Dementia Care & Management Research Paper
Diet and overcoming of eating difficulties are also important issues in the management of patients with dementia. Often patients with dementia have eating difficulties. For example, they may just forget to eat and miss meals. Moreover, they may be just unable to cook or order the food for themselves. They may simply be unable to serve food for themselves. Therefore, they often need assistant, who can feed them and control their nutrition to check whether they eat regularly. The diet is also important for elderly patients because they may develop other health problems, in case of poor nutrition. Therefore, the diet can help them to maintain higher standards of living.
Finally, patients with dementia often need palliative care because they are elderly and cannot cope with their health problems, while dementia increases the risk of de-socialization of patients. As dementia affects the elderly population mainly, especially after the age of 85, they are just unable to lead their normal lifestyle without the assistance of others and they need palliative care. Moreover, patients with dementia cannot cope with their health problem because dementia cannot be cured so far that makes palliative care essential for these patients, to face end of life issues being surrounded by reliable care givers.
Alzheimer’s disease is the manifestation of dementia. Alzheimer’s disease (AD) is one of the most dangerous diseases that mainly affect the elderly population. At any rate, specialists argue that Alzheimer’s disease progresses with age and the risk of the development of the diseases increases with age: aging, the passage of time, does contribute to the development of dementing diseases in at least two broad ways. First, over time, the brain accrues molecular and cellular defects in neurons and glia, which reduce its physiological reserve, just as occurs in muscle cells with age… Second, some of the specific diseases that cause dementia require great time to produce enough brain abnormalities, or lesions, to compromise function. (Selkoe, 2006 p.58)
In such a way, aging is accompanied by the increased risk of the development of Alzheimer’s disease but, nevertheless, it is important to focus on the prevention and early diagnosing of the disease in order to minimize its negative impact on patients’ health.First of all it is necessary to point out that “AD is the most common type of dementia and the fourth leading cause of death for those over the age of 65” (Keltner and Williams, 2004, p.124). At the same, studies show that many people are vulnerable to the development of disease: Although most people age without substantial loss of intellectual powers, 11% of U.S. citizens over 65 show a mild to severe mental impairment. The major cause of dementia, accounting for or contributing to about 70% of all cases is Alzheimer’s Disease. In addition, specialists warn that “Alzheimer’s Disease is progressive and incurable; patients’ health status will inevitably deteriorate, and clinical research is focused on delaying progression” (Gray and Brookmeyer, 2000, p.396).Dementia Care & Management Research Paper
In such a situation, it is important to understand causes and risk factors of the disease. Specialists argue that Alzheimer’s disease can be provoked by multiple factors: disease may in fact be caused by the abnormal processing of the so-called amyloid precursor protein and the accumulation of the protein [beta]-amyloid. Other brain abnormalities in people with AD include nerve cell death in specific areas that are vital to memory and other mental abilities, as well as lower levels of certain neurotransmitters. (Phelps, 2005, p.31)In this regard, it is important to lay emphasis on the fact that aging increases the risk of the development of Alzheimer’s Disease. In this respect, it is possible to dwell upon the factors that influence the course of Alzheimer’s disease, such as hippocampus. Hippocampus contains the information about episodic memories. These are short-term recollections from the near past.They are replaced by new memories in a short period of time. Functional disorder of hippocampus can be explained by patients’ disorientation.
Specialists argue that Known risk factors for neurodegenerative disease include certain genetic polymorphisms and increasing disease. Other possible causes may include gender, poor education, endocrine conditions, oxidative stress, inflammation, stroke, hypertension, diabetes, smoking, head trauma, depression, infection, tumors, vitamin deficiencies, immune and metabolic conditions, and chemical exposure. (Brown, et al., 2005, p.250)
On the other hand, it does not necessarily mean that the disease will progress if an individual is exposed to some of these risk factors. In fact, individual peculiarities and heredity influence the development of Alzheimer’s disease.
In this regard as a main characteristic of Alzheimer’s disease, memory impairment is caused by lack of neurons uptake of glucose. The low insulin responses explain the growing blood glycaemia in the primary stages of the disease.Dementia Care & Management Research Paper
Furthermore, it is important to clear out the symptoms of Alzheimer’s disease on the basis of clinical researches. As a matter of fact the first symptoms of Alzheimer’s disease are memory disorder and speech disturbances. Patients are not able to recollect a necessary word, and are trying to replace it with an unsuitable one. They also loose coordination and forget the way home. Moreover, they find it difficult to read the clock and sometimes they don’t even recognize their relatives and friends.
Finally they even loose such habit patterns as taking shower, getting dressed and eating. It leads to depression, personality changes and psychotic malfunctions. Such patients loose independent living skills and need constant care. In some cases it can also result in partial cerebral seizures. As a rule such patients suffer from lack of movement and eventually die of bronchial pneumonia. The average life time of such patients is up to 8 years.
In this respect, some specialists point out that “the distinct qualities of the illness substantially influence the way that caregiving is performed” (Martison and Muwaswes, 1993, p. 225). Remarkably, often spouses are major caregivers to patients with Alzheimer’s Disease. At this point, it is possible to refer to the study conducted by Cahill, which revealed that the majority of respondents provided care to their wives diagnosed with Alzheimer’s Disease and most women had a significant cognitive impairment. The majority of caregivers were partners in long-term marriages, had enjoyed happy and fulfilling relationships and were retired (Cahill, 2000, p.61).
In such a way, the support of spouses is very important in the treatment of Alzheimer’s Disease.A careful analysis of obtainable data showed that nowadays the treatment of Alzheimer’s disease is no longer a myth. During latest years it turned into clinical reality. In this respect, it is worth mentioning the fact that some studies revealed trends which are not commonly accepted, but which may be taken into consideration in the treatment of Alzheimer’s Disease. For instance, according to Tas, “Moderate drinking has been reported to have some beneficial vascular effects (NIAAA 2000), which could possibly reduce the risk of AD” (Tyas, 2001, p.301).Dementia Care & Management Research Paper
In actuality, active therapy became an effective way of treatment of various emotional and psychic disorders of the patients. The main part of pathogenic therapy is a compensatory therapy that aims at improving the function of neurotransmission in the neural systems that are under pressure during the Alzheimer’s disease. In this regard it should be admitted that one of such systems is a glutamatergic system that plays a significant role in the learning process and memory. Once this system is damaged it becomes harder and harder to avoid further disorders and ultimately Alzheimer’s disease.
It should be mentioned that memantine is an antagonist of glutamatergic receptors. It prevents their excessive activation and has protective effects on neural systems, stimulating cognitive functions. With the help of drug treatment good results can be achieved in case of mild memory disorders. Many researches pointed out visible improvement of memory, intellectual functions and behavior. We are not referring to complete recovery, but we can observe significant improvement of mental functions and general condition of the patients. Another method of Alzheimer’s disease treatment is MRI which helps to diagnose brain atrophy in its initial stages. It is important to analyze the effects of MRI on the example of practical researches. Thus, a group of scientists in Mayo Clinic, Rochester, investigated brain atrophy of healthy senior people, patients with mild cognitive disorders and suspects of Alzheimer’ disease. The research included MRI data on the condition of 160 patients compared to results of several cognitive tests. The atrophy factors correlated with the progress of the disease. The changes of MRI were more distinct in healthy patients who suffered from mild cognitive disorders. We may come to a conclusion that it is advisable to use MRI data in diagnosing the condition of the patients. It is also important to consider patients first complaints about memory malfunction. A minor reduction of cognitive functions can already be defined as memory disorder.
Also, it is possible to refer to the study conducted by Phelps, who revealed another possible treatment of Alzheimer’s Disease: transthyretin may block the progression of AD by inhibiting the effects of [beta]-amyloid. This discovery suggests that it may be possible to develop a drug that increases the production of transthyretin and thus protects people at risk for AD, such as those with a genetic predisposition. The findings may also improve the chances of detecting potential environmental factors in the development of AD by allowing scientists to identify agents that upset the balance between transthyretin and [beta] -amyloid proteins. (Phelps, 2005, p.31) Dementia Care & Management Research Paper
Finally, it is necessary to point out a number of preventative measures against age-associated memory disorder. As the course of Alzheimer’s disease does not depend on genetic susceptibility, it is more important to take into consideration the life style of a person. Patients with minor symptoms of the disease should first of all avoid stress, as it may lead to further memory problems. Stress has a negative influence on cognitive processes and may cause depression. That is why it is important to combine work and relaxation, trying to avoid stress. What is more, physical activity also improves cerebral blood flow and accordingly stimulates intellectual functions. Furthermore intellectually active people have less chance to become ill. Latest scientific researches on people with high mental work load proved that they have more neurons in hippocampus and memory centers. In senior age mental activity can be maintained with the help of various logical quizzes and crosswords. Traumatic brain injuries and loss of consciousness increase the probability of Alzheimer’s disease. Smoking also falls into this category. In general, everything that maintains brain health can postpone mental deficiency.
In case of Mr. and Mrs. H it is possible to suggest the following action plan that Mr. H has to execute:
First, taking into consideration issues Mr. and Mrs. H confront under the impact of dementia and deterioration of the condition of Mrs. H, Mr. H need the training to be able to manage dementia successfully. He should be aware of the effective models of behavior and coping strategies to manage the condition of Mrs. H successfully. In this regard, Mr. H should try to accommodate the behavior, not control the behavior. For example, if the person insists on sleeping on the floor, place a mattress on the floor to make him more comfortable (Phelps, 2005).
Second, Mr. H as the caregiver can change his behavior or the physical environment. Changing the caregiver own behavior will often result in a change in the patient’s behavior (Nasreddine, et al., 2005). Mr. H should focus on the development of positive behavioral patterns and supportive behavior that helps him to cope with his problems. The behavior of Mr. H should minimize the resistance from the part of his wife or pressure on his wife because such behavior is stressful for his wife and may cause outbreaks of aggression and inadequate behavior from the part of Mrs. H.
Third, Mr. H should consider the medication of Mrs. H and consult the doctor. Behavioral problems may have an underlying medical reason: perhaps the person is in pain or experiencing an adverse side effect from medications. In some cases, like incontinence or hallucinations, there may be some medication or treatment that can assist in managing the problem. Therefore, Mr. H should also consider the proper administering of medication to Mrs. H. This is why he should know what medication Mrs. H should take to conduct the treatment and to recover from her health problems or, which is rather the case, to address symptoms of dementia and suppress them. Dementia Care & Management Research Paper
Fourth, Mr. H should study the behavior of his wife to understand its purpose beacsue behavior has a purpose. People with dementia typically cannot tell us what they want or need. They might do something, like take all the clothes out of the closet on a daily basis, and we wonder why. It is very likely that the person is fulfilling a need to be busy and productive. Always consider what need the person might be trying to meet with their behavior — and, when possible, try to accommodate them. This is why Mr. H should be patient and understand the behavior of his wife rather than interfere. The understanding of her behavior will help Mr. H to respond adequately and help his wife to reach her ends and to make her behavior more purposeful and productive. In such a way, they will interact more effectively than they do now.
Fifth, behavior is triggered that means that Mr. H should understand why Mrs. H acts in the particular way, for example, why she becomes aggressive. It is important to understand that all behavior is triggered — it occurs for a reason. It might be something a person did or said that triggered a behavior, or it could be a change in the physical environment. The root to changing behavior is disrupting the patterns that people create. Mr. H should try a different approach, or try a different consequence. The change of the behavior can help to find a different and more effective response from the part of his wife that may help to improve her condition and relations with her husband.
What works today, may not work tomorrow. The multiple factors that influence troubling behaviors, and the natural progression of the disease process, mean that solutions that are effective today may need to be modified tomorrow—or may no longer work at all. The key to managing difficult behaviors is being creative and flexible in strategies to address a given issue. This means that Mr. H should try different approaches, when he realizes that the approach he has already used does not bring desired effect. Dementia Care & Management Research Paper
Sixth, Mr. H should try to get support from others. For example, the support of children could be very helpful. Moreover, the condition of Mrs. H could improve too, if they received help from the part of children more. Children could spend more time with Mrs. H that would ease the pressure on Mr. H and help him to cope with his problems which accumulate as he grows more and more exhausted while managing the condition of his wife.
Seventh, the daily socialization is essential to prevent the feeling of isolation experienced by the old aged persons. This helps to maintain the sense of liveliness. The elderly persons have a feeling of being caught by others in the course of social interaction for not equipped cognitively. They avoid social activities and consider it to be distasteful experience. This causes loss of self-esteem. The aged also consider the social participation demands higher mental abilities, so they become insecure and secluded in the social gatherings.
Eighth, the physical exercises will provide following benefits: the exercise will help in improving joints and muscles. It also gives the person a sense of independence. These benefits can prevent the onset and further progression of the disease. A nutritional diet is the most promising form of preventing the progression of dementia. The nutritional diet strategy can be applied to “prevent, halt and slow” the process of progression of dementia.
There is evidence to show that “metabolic derangements” are caused due to inadequate nutrition in dementia (Cardoso, Cominetti et al. 2013). Further the nutritional supplements and modified diets can affect the pathological state of the person with dementia. Mediterranean diet is recommended in some epidemiological cohort studies.Dementia Care & Management Research Paper
In addition, it is possible to use the assistive technology for Mrs.H, such as daily living activities which can help her to manage her mental health problems. In this respect, it is possible to recommend her to do some conventional and easy tasks, such as having a walk every morning along with her husband or washing dishes after the meal. Such activities may help her to stay focused on regular activities and slow down the progress of dementia. As she suffers from dementia and becomes quite aggressive in relation to her husband, mutual activities, such as walking together, can help them to establish positive relations and cope with problems they may experience now. She may also use medication aids which can help her to take medication in time and on the regular basis. Medication aids will help Mrs. H to take medicaments she needs to suppress the development of dementia and to cope with her problems.
The effects of being a family caregiver, though sometimes positive, are generally negative, with high rates of burden and psychological morbidity as well as social isolation, physical ill-health, and financial hardship. Caregivers vulnerable to adverse effects can be identified, as can factors which ameliorate or exacerbate burden and strain. Psychosocial interventions have been demonstrated to reduce caregiver burden and depression and delay nursing home admission. Comprehensive management of the patient with dementia includes building a partnership between health professionals and family caregivers, referral to Alzheimer’s Associations, and psychosocial interventions where indicated.Dementia Care & Management Research Paper