Advance Dementia Care - Essay Example

Case Study: Advanced Dementia Care Number Department Introduction Dementia is a medical condition whichrefers to a significant loss of global cognitive ability in a person who had been impaired beyond the dynamics and characteristics of normal ageing processes or reality. Dementia may happen in a manner that is static or progressive. The former results mainly from a unique global injury in the brain, while latter results from a long-term decline that may be a culmination of a disease or damaging of the body. While dementia has been found to be far more common among geriatrics, cases where it occurs before 65 are also not very rare. Such cases are referred to as early onset dementia. The reality, diagnosis, treatment and effects of dementia are therefore to be discussed, in light of the aforementioned patient, Andy, as shall be seen forthwith. Diagnosis of Dementia Diagnosing dementia is somewhat complex, given that there is no single test that can clearly show that someone is suffering from dementia. Because of this, the need to apply a multifaceted approach cannot be sidestepped. This multifaceted approach will help establish the symptoms that are consistent with dementia. The first step in this case may be running a battery of home screening tests. First, it may be important to engage Andy in a meaningful conversation, since this step will go a long way in helping determine the state of his cognitive ability and memory. It is obvious that a person suffering from dementia is likely to exhibit symptoms such as the loss of mental recollection, inability to appreciate the physical reality around him, lack of vivacity and a general detachment from the environment. The above mental status test can be made more practical by ascertaining whether Andy: is aware of time, date and situational context (such as his location); can recall short lexicons (vocabulary); and is aware of the symptoms of the illnesses besetting him. In this case, the mini-cog test (MCT) and the mini-mental state exam (MMSE) may be used. In the case of MMSE, the consultant psychiatrist, at the Community Mental Health Nurse (CMHN) can use a scale of score points that start from 1 to 30. A score of 20 to 24 in this case suggests mild dementia. 13-2- may be indicative of moderate dementia, while any score that is below 12 denotes severe dementia. The above approach can be closely followed with a brief examination of the patient’s medical history. This study will involve looking at Andy’s present and past illnesses and the kind of medication that the patient is on. Herein, the consultant psychiatrist may also consider the medical conditions that accost Andy’s family members (Mary, Barry and John) and whether these medical conditions may have any connections with dementia or not. Conversely, an MCT may be used, in which Andy will be asked to: take mental note and repeat the names of three dominant objects afterwards, and to draw a clock with its 12 numbers and show the time that is to be specified. This step may be followed with mood assessment. Assessing Andy’s mental status may be in order herein; as such an undertaking may lead to the disclosure of his wellbeing, in respect to depression, mood disorders, loss of interest and enthusiasm in life, memory lapses. In case considerate extents of vestiges of these traits are visible, it may be important to proceed to other steps and forms of diagnosis since suppressed cognition and meta-cognition do not readily imply dementia (Bourgeois and Hickey, ?2009, 11). The effort above may also be complemented with a neurological examination, where Andy can be evaluated for problems akin to brain disorders. In this case, the consultant psychiatrist may test his reflexes, eye movements, muscle coordination, strength and tone, sensitivity and speech. If the evaluation is not explicitly indicative of dementia but the symptoms continue to fester over time, more tests may have to be run. It may also be helpful to run genetic testing on Andy, given that researchers such as Waite and Harwood (2009, 43) have shown and identified clearly specific genes and other rarely occurring deterministic genes that propound chances for the contraction of dementia. This form of examination may involve the running of blood tests for APOE-e4, the strongest risk gene for dementia. A test may also be run for the deterministic gene, ADDD (autosomal dominant Alzheimer’s disease). In light of the foregoing, it is important to take stock of the fact that it is unnecessary to run all the aforementioned diagnoses just to determine the presence of dementia. On the contrary, this battery of tests may only be run if the detection of the illness does not readily come by. As a matter of fact, the very last form of dementia discussed should be the very last option to be considered, due to its high affinity to ethical issues. Nevertheless, in the case of Andy, the aforementioned efforts were sidestepped through the use of brain imaging. This involved the use of Magnetic Resonance Imaging (MRI) scan to rule out mental conditions that may have close association with the dementia. The usefulness of MRI is meaningful for structural imaging to reveal evidence of large or small strokes, tumours, damage from severe head trauma or/ and even an accumulation of fluids in the brain. How the dementia is affecting the person and any previous/current therapeutic interventions It is important to note that the diagnosis that is to be conducted greatly considers the symptoms and signs of dementia. These signs and symptoms in turn come about as a result of the illness taking its toll on the patient. Therefore, in mentioning the symptoms of dementia, it is important to remember that the effects of dementia on the patient are substitutable. The manner in which this illness has affected the patient follows forthwith. For one, because of the illness, Andy has an atrophied memory span. He misses appointments and forgets to pay his bills. It also emerges somewhat clear that Andy is giving in to depression. This is exemplified by his knack for short temper. At the same time, Andy’s attention and memory span having been reduced is a matter that is clearly shown by him not being able to concentrate on what he is doing for long. The culmination of all these negative developments was strained social interactions and increased dependency on others. Over time, the patient lost the war with depression and thereby leading him to lose his psycho-social predisposition. How Dementia Affected Andy, the Patient The illness also started to undercut the patient’s cognitive abilities. This is exemplified by his inability to concentrate on what he is doing. This is because the waning of the patient’s cognitive skills causes him to become gradually insensate towards his environment. In like manner, this detachment from the environment takes on an emotional angle. The patient became unable to appreciate humour and is less patient. This is underscored by Andy becoming highly predisposed to short temper. The culmination of all these impacts of dementia is the patient becoming increasingly and overly dependent on others. Andy, as the patient in this case had to rely on his family members to have virtually everything done for him. If Barry his son is not around, he forgets to pay his bills. In the long run, if the illness is not brought under control, Andy will have to be fed, bathed, dressed, walked and taken to bed. At this point, only the patient of family members can go the length (Bryden, 2005, 24). Any Previous/Current Therapeutic Interventions The patient had been being treated through the use of biomedical model. The biomedical approach believes in diagnosis, carrying out investigations on the illness and administering the most appropriate form of medical intervention, as the best panacea for dementia. This is seen in the fact that the General Practitioner had previously referred Andy to the CMHN. The consultant psychiatrist at the CMHN in turn had recommended and prescribed Donepezil, also known as Aricept for Andy. Aricept is an acetyl cholinesterase inhibitor which the National Institute for Clinical Excellence recommended in 2009 as the most inappropriate drug for treating moderate Alzheimer’s disease. Medically, one of the reasons for the recommendation of the Donepezil is that it (the drug) it easily and readily crosses the blood-brain barriers. Secondly, Donepezil is known to have an oral bioavailability of 100%. At the same time, Curran and Wattis (2004, 72) point out at the fact that the drug has half-life of 70 hours, meaning that it can be taken once in a day. These are the very reasons that may have definitely inspired the CMHN to recommend Donepezil for Andy. Ideologically, the reason for CMHN’s recommendation of Donepezil is premised on the rationale that the best approach to treating dementia is by following the biomedical model of medical intervention. The biomedical model sees dementia as a biomedical illness which can best be treated through the application of biomedical approaches. Before this, there has to be proper diagnoses of the sickness before it is treated. This is because, this model believes in the rationale that all manner of sicknesses have a particular cause or aetiology, and as such, they must also have a solution or antidote. In this respect, adherents of the biomedical model assert that medicine has technological solutions for everything, and as such, is the only credible and valid perspective and approach for understanding diseases. Section Impacts of Different Models of Care It is a fact that every one of the models of care for dementia patient has its strengths and flaws, as shall be seen forthwith. For one, the biomedical model of dementia has proven to be very useful because of its structural and empirical approach to dementia. This is because the biomedical model has largely seen dementia as a biomedical disease which is not only accompanied by degeneration and loss of abilities, gradually, but also as a loss of normality. Because of this, this approach makes concerted efforts towards understanding and controlling experiences that are usually hard to decipher or bring under control. As such, the biomedical model and its adherents have made meaningful inroads in coming up with dementia drugs and in searching for a more potent cure, in lieu of concentrating on the exercising of care towards the dementia patient. The positive impact of this is the emergence of drugs such as Prozac, which have been relatively useful in treating dementia and alleviating its ravages. Because of this rationale, CMHN recommends Donepezil for Andy (Waite, Harwood and Morton, 2008, 66). Again, according to the postulation that Downs and Bowers (2008, 22) make, the biomedical model has played a positive aspect in treating dementia patients by developing the importance of diagnosis and investigation. This is because this model believes that every disease has a particular cause or aetiology. For this cause, dementia patients such as Andy will have been succoured from an array of experimental interventions of which some have mainly been based on superstitions and the extension of emotional and instinctive care. This same value which propounds the need to stick to empiricism is also underscored by this approach’s insistence on the notion that medicine should help develop technological solutions for everything, and that medicine is the only credible and valid perspective and approach for understanding illnesses and diseases. One can therefore wax poignantly that the biomedical model has extensively played a pivotal role in setting the path for the observation of evidence-based practice in the treatment of dementia. According to Whitman (2009, 66), the downside of the biomedical model is that its insistence on the notion that medicine is the only credible and authentic perspective that can help bring about understanding on illnesses and diseases and that medicine should develop the technological solution for all (health) problems. The crux of the matter herein is that with this kind of approach, the biomedical model will have significantly succeeded in ruling out the emotional, when treating dementia. This can not be gainful since Andy as a dementia patient seriously needs love and emotional care from Barry, Mary and John- that his emotional senses and cognitive abilities are continually atrophying, notwithstanding. This drawback is further reinforced by adherents of the biomedical model’s belief that the mind and the body can be (effectively) treated separately. Since the emotional is always conveyed in the soul, this approach has largely not been factoring the emotional into consideration. Another approach that has made considerable contributions to the treatment of dementia is the one that has medicalised it. The medicalisation of dementia is emphatic on expert control, with medical professionals being considered the experts who should solve this problem. Again, medicine is seen as an institution of social control. The impact that this model has had on patients is the reduction of the stigma that comes with dementia. This is because, the medicalisation of dementia depoliticises behaviour, so that there is the deliberate ignoring of the meaning behind an individual’s behaviour. Again, medicalising dementia has helped this healthcare services provision more patient-based. This is particularly because the medicalisation of dementia lays emphasis on the individual, the diagnosis and treatment of his illness. The gravity behind this development is that because of the medicalisation of dementia, dementia patients have been saved from the ill-advised approach of treating them collectively, and not as individuals. The only pitfall that accosts the application of medicalisation of dementia is the failure to acknowledge the dynamics of dementia. This is because the depoliticisation of dementia ignores the essence of an individual patient’s behaviour. The magnitude of the matter at hand is that as dementia progresses, so does its ravages, symptoms or effects become more pronounced. The import of this is that by not factoring extent and relevance of an individual’s behaviour, this approach either disregards the progressive stages of dementia, or fully dismisses these stages as irrelevant. However, it is very clear that the determination of the degree of illness or infection is sacrosanct to the administration of treatment. For instance, proper dosage cannot be administered if a patient who has been taken ill for eleven months is treated the same as his counterpart who has been in the same predicament for three weeks, even if the two patients should be suffering from the same illness (Humphrey and Nicholas, 2010, 75). Other drawbacks of the biomedical model stem from the side effects that the drug being administered may bring. For instance, Donepezil is bound to subject Andy to bouts of gastrointestinal upsets. This may subject Andy to bouts of nausea and regurgitations. As if these consequences may not be enough, with continual use, Donepezil will leave Andy susceptible to nausea, diarrhoea, bradycardia, hallucinations and abdominal cramps. Brooker (2007, 56) divulges that, that there are other methods that are based on the socio-psychological approach to treatment is a matter that cannot be gainsaid. These socio-psychological methods to treatment and management of dementia are in turn divided into the Sabat’s 3 forms of self; Kitwood’s approach, Brooker and McCormack’s approaches. Like their predecessors, these approaches have both positive and negative impacts on the exaction of care. The approach taken by Sabat and Kitwood is important in fostering a more objective and comprehensive approach since both confirm the dangers of destructive social psychology. Similarly, both confirm the beneficiary nature of the notion of wellbeing. The acknowledgement of the dangers of social psychology is important since it incorporates the environmental reality as being significant in the treatment of dementia and how the environment can also exacerbate dementia. The confirmation of the notion of wellbeing as a beneficial factor is important because it stresses all the facets of the self (self 1, 2 and 3). Carilus and Michael (2009, 46) contend that the flipside of Kitwood and Sabat’s approaches is that they can easily entrench despair and guilt among the caregivers who may fail to achieve the ideals that are envisioned in the concept of personhood. This is because both approaches are highly idealistic, to the point of making the PCC a utopia. The glaring reality behind this is that emphasis on the PCC may leave the caregivers apprehensive towards extending this care, and thereby placing much concern on prerequisites to effective care giving, instead of plunging headlong into the art of care giving. According to Dick (1999, 16), the idea that Brooker puts across portends the acknowledgement of the reality of dementia in various care settings, and the fact that people with dementia are very susceptible to stigma and discrimination, strategically or individually, or both. To therefore solve this problem, Brooker proposes the consideration of 4 factors when providing the patient with care. These factors are: treating people as individuals; trying to view the world from the patient’s perspective; valuing the patient and their carers; and maintaining a social environment which is to enable relative well-being. The impact that comes with Brooker’s proposition is the assigning of care that is patient-centred. This is because the autonomy of the patient is respected since he is treated as an individual and valued together with his carers, as the physicians and healthcare services providing staff strive to see things, according to the patient’s perspective. It is a fact that there is a one-to-one relation between consistency in the administration of patient-centred and speedy recovery. Conversely, McCormack stresses fusses the ideas that Sabat and Kitwood advanced, to state that proper care giving for a dementia patient should be inclusive of 4 concepts which are being with self; being in a social world; being in place; and being in relation. The influence that McCormack’s approach has had on extension of care for dementia patient is the placing of emphasis on the individual patient, and not theories and models of CC as the realities and fundamentals of practice (Beck, 1975, 34 and Breitung, ?2004, 16). Section Critique Any Family or Carer Issues Related To the Person The family of Andy in point mainly used an amalgamated of approaches such as the one mentioned by Brooker. In this case, the family is presented by Barry, Andy’s brother and Mary, Andy’s daughter. John’s distance from Andy causes his inability to support Andy, though being his son. Thus, he cannot be considered part of this team. The family’s knack for considering this process was in turn necessitated by the fact that the approach is more patient-centred than other models. Another factor that underpinned the family’s preference to this approach is the constant need for the family, the carers and physicians to collaborate closely. Mary and Barry generally do well if they work closely with the patient and the physicians. Particularly, Mary’s constant presence and support can go a long way in revitalising Andy’s emotional awareness and trigger his mental recollection on the side of the patient. This is because she shares emotional sentiments and history with the patient and therefore is the party that is best placed to identify the milestones that form the bedrock of the Andy’s emotional composition. Because of this, the input of the patient’s family by all means remained commendable. Nevertheless, following the failure to tamper the care giving aspect with structural approaches to treating dementia such as biomedical model may take its toll on the family. The family’s work schedule may be negatively impacted as its members seek to strike the delicate balance between work and caring for the patient. Another shortcoming of the family is its failure to consolidate its efforts together. John’s absence need not be a perennial excuse of not taking care of his father. He has not exhausted other options such as asking for transfers, yet his father’s health is at stake. Conclusion As already mentioned, dementia affected the patient in multiple ways. First, this illness gnawed away at the patient’s cognitive abilities and mental recollection. Because of this, Andy had memory lapses, and was unable to sustain meaningful social constant. The culmination of this was the inability of the patient to maintain his social circle. Resultantly, the patient lost the company of his peers and was left only with Mary and his friend Barry to look after him. Psychological symptoms such as depression, withdrawal symptoms, indifference and acts of self-dereliction also set in. Interestingly enough, one of the most formidable challenges that arose when handling this illness was not even directly related to the complexity of dementia, but the patient’s perception towards the illness. When the consciousness of the patient came around, the feeling that patient saw the illness as a signal to his sunset days was very palpable. This perception was retrogressive because it sapped away Andy’s fighting spirit and denied him the ability to see the beauty of life. It is a fact that with this mentality, even medical intervention, no matter how well administered, fails to work. This perception differed from that of healthcare services professionals and staff. Physicians saw this condition as manageable and reversible. It is this assurance that served as the first step to Andy’s steps to healing. References Beck, A. T. 1975. Cognitive Therapy and Emotional Disorders. New York: International Universities Press. Bourgeois, M. S. & Hickey, E. ?2009. Dementia. Oxford: OUP. Breitung, J. C. ?2004. Understanding and Managing Dementia. Oxford: OUP. Bryden C. 2005. Dancing with Dementia: My story of Living Positively with Dementia. London: Jessica Kingsley. Brooker, D. 2007. Person Centred Dementia Care, Making Services Better. London: Jessica Kingsley. Carilus, J. & Michael, M. 2009: “Managing Dementia.” Journal of Psychology, 3 (3): 45-50. Curran, S., Wattis, J. P. ?2004. Practical Management of Dementia: A Multi-Professional Approach. Oxford: OUP. Dick, L. P. 1999. “Cognitive Behavioural Therapy.” Psychological Problems of Ageing. 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