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Care and Management Plan for an Elderly Patient with Alzheimer's Dementia assessment 3
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Introduction
The social, emotional, and psychological well-being of a person depends on the mental health of a person. Some specific reasons can contribute to the imbalance of mental health. Loss of a loved one and being aged are one of the significant reasons, which has happened to Mrs. B. She had been admitted to emergency care with the symptoms of "visual hallucinations, paranoia, and agitation". In this assessment, a management and care plan is developed for Mrs. B.
Potential evolving problem
Mrs. B was presentedto the emergency department due to a mental health issue. It has been found that 2 years ago she was hospitalized and diagnosed with a moderate degree of mental illness. Depressed mood, behavioral disturbance, and delusion were seen from her side. The clinic stated that she was suffering from Alzheimer's type dementia. Besides, her husband died 5 years ago. At that time, she was suffering from a major depressive disorder. Behavioral management and medicine both were used to stabilize the condition of Mrs. B. However, in the present condition visual hallucination, restlessness, and paranoid delusion have increased by a considerable amount.
Mrs. B showed some strange behavior and did not take regular medicine to treat the problem. There is a high chance of developing potential risk factors, which can decrease her health further (Wiels, Baeken, &Engelborghs, 2020). As the brain starts to shrink, it reduces the ability to function properly. On the other hand, declining behavioral, social, and thinning skills increase the difficulty in life. Hence, the ability to function properly could be destroyed (Phanet al. 2019). Besides, at the age of 85, she needs physical support as well in order to function. Hence, an overall reduction in health could be seen.
Discussion and identification of appropriate assessment tools
Screening the disease properly is the first step in reducing the problem. As stated by Pessotti et al. (2018), one of the famous and widely recognized tools for the assessment of Alzheimer's type dementia is MMSE or “mini-mental state examination”. There are various techniques included in this process, which assess the cognitive ability of the person. These tools can be used for Mrs. B to find the problem in visual construction, word recall, orientation, and attention. However, as the age of Mrs. B is higher, the questions should be developed based on that. Besides, the clinic also asks questions to friends or family members, who have experienced some changes in the behavior of the patient (Liu et al.2020). In this case, the son of Mrs. B has experienced changes in behavior. The role of the clinical is to note down those symptoms for analysis.
Conducting some physical tests is also important in order to find any changes in the brain structure. These tests help to find the damage in the nervous system. As stated by Goudsmit et al. (2018), different types of brains scan such as CT or “computed tomography”, PET or “positron emission tomography”, MRI or “magnetic resonance imaging” help to diagnose the disease specifically and rule out other diseases.
Impacts of Psychological and physical factors on the assessment
The assessment of the disease involves the participation of the patient. As stated by Pessotti et al. (2018), when the patient is not properly functional psychologically and physiologically, this creates some constraints. In the case of Mrs. B, she is aged and not functional properly physiologically. However, in terms of conducting the brain scan, the participation of the patient is needed. It is challenging the staff to complete the test without any disturbance from her side. The staff also needs to carry her to the test room and help her with every part of the test. In addition, agreeing to do the test by the patient is also necessary.
It is seen in the case study that Mrs. B got angry and accused the GP of euthanizing her. It can be expected that she will not be going to perform the MMSE test as well. As these tests involved different questions and answers, the participation of the patient is fully needed (Liu et al.2020). Besides, there is a huge chance of denying any symptoms or problems as she is already suffering from the disease. In dementia, a common problem is forgetting things. Hence, she might not be able to tell the answer to each question. In that aspect, asking questions to her is more relevant to the problem.
Four models of successful aging
There are various models used by professionals, which can define the successful aging of a person. Here discussion is done in four successful aging models. The first model is the “biomedical model”. According to Rolfson (2018), this model discusses the biological and social dynamics, which are relevant to the aging process. Changes in body composition are common in old age. As per this model, in terms of successful aging, the elder must be disease free. Besides, they also need to be free from any kind of disability that has been caused by disease. On the other hand, the “Broader biomedical model” stated that engagement and activity with the community is a sign of successful aging. These both are biologically focused approaches; they posit that pharmacological treatment can target “presumed biological abnormalities” (Wahl, 2020). The current condition of Mrs. B does not follow any of these two models properly, as she is already suffering from serious mental illness due to aging.
“Social model of aging” discusses the role and responsibility changes due to aging in society (Rolfson, 2018). The changes are seenin both their friends and family life. Besides, changes in function and responsibility are seen in the workplace as well. When aging is successful, the social life of the person is maintained successfully. On the other hand, the "Psychological resources model" discusses the ability of a person to cope with different situations. The role of social and personal resources in proper functioning under high stress is measured in this model. As stated by Wahl, (2020), after critically analyzing all the models, it can be said that the proper physiological, emotional, and social function of the person instead of high age is the main criterion of successful aging. In Mrs. B's case, she was unable to maintain that as she is not properly functional physically, emotionally, or socially.
Potential psychiatric diagnoses
After the assessment, a psychiatric diagnosis of the patient is done. Mrs. B has shown some severe symptoms such as delusion, and paranoia. These are some common symptoms of dementia. The patient with dementia feels hallucination or fear of being threatened (Wiels, Baeken&Engelborghs, 2020). Hence, these develop anxiety or paranoia in the patient. Besides, the feeling of being attacked by some close member is also seen in this type of case. Hence, the psychiatric diagnosis of the disease could say that “severe Alzheimer's type dementia” is the disease, which Mrs. B is suffering from. However, performing the brain scan can be helpful to be sure about the disease and develop a care plan based on that.
Appropriate treatment & management plan
The condition of Mrs. B is severe and consistent treatment is necessary to control the symptoms. Both the combination of medication and therapy is essential to overcome the problem and reduce the severity of the disease. "Cholinesterase inhibitors' ' is a medicine which boosts the level of the chemical messenger of the brain (Jia et al. 2020). "donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne)" are included in this group. However, these medicines can temporarily improve the condition and have some side effects like diarrhea or vomiting. According to Ismail et al. (2020), another medicine is "Memantine (Namenda)", which regulates the activity of glutamate. This chemical messenger regulates learning and memory. Dizziness is a major side effect of the medicine. Besides, "aducanumab (Aduhelm)" is an emerging medicine, which helps to improve cognitive impairment in people (mayoclinic.org, 2022). However, studies are still going on the effectiveness of the medicine.
Therapy is also an important part of the treatment and management plan. Person-centered care is important so that the treatment can be more relevant and effective. Cognitive behavior therapy can also be used. As Mrs. B has some behavioral problems, this can help to solve all the behavioral problems. Besides, these prepare the patient for drug therapy. Reminiscence therapy can also be used, which helps the individual to remember events (Jia et al. 2020). Recalling the memory of Alzheimer's patients is the main function of this therapy. The goal is to help the seniors to feel valued, and peaceful by recalling the happy moments of their past life. Hence, an overall improvement of the situation is possible.
Conclusion
In this assessment, a care and disease management plan for Mrs. B is developed. It has been seen that the first symptoms of the disease appeared five years ago after her husband died. 2 years ago she was diagnosed with Alzheimer's type dementia. However, the condition becomes worse with severe symptoms of the disease. MMSE or brain scan can be used to assess the disease. Both combinations of therapy and drug are necessary for Mrs. B for reducing the symptoms.
Reference list
Journals
- Goudsmit, M., van Campen, J., Schilt, T., Hinnen, C., Franzen, S., &Schmand, B. (2018). One size does not fit all: comparative diagnostic accuracy of the rowland universal dementia assessment scale and the mini mental state examination in a memory clinic population with very low education.Dementia and Geriatric Cognitive Disorders Extra,8(2), 290-305. Retrieved on: 25th Oct, 2022. From: https://www.karger.com/Article/PDF/490174
- Ismail, Z., Black, S. E., Camicioli, R., Chertkow, H., Herrmann, N., LaforceJr, R., ...& CCCDTD5 participants. (2020). Recommendations of the 5th Canadian Consensus Conference on the diagnosis and treatment of dementia.Alzheimer's & Dementia,16(8), 1182-1195. Retrieved on: 25th Oct, 2022. From:https://alz-journals.onlinelibrary.wiley.com/doi/pdfdirect/10.1002/alz.12105
- Jia, L., Quan, M., Fu, Y., Zhao, T., Li, Y., Wei, C., ...&Jia, J. (2020). Dementia in China: epidemiology, clinical management, and research advances.The Lancet Neurology,19(1), 81-92. Retrieved on: 25th Oct, 2022. From: http://www.523cyts.com/docs/20190917192730176948.pdf
- Liu, I. T., Lee, W. J., Lin, S. Y., Chang, S. T., Kao, C. L., & Cheng, Y. Y. (2020). Therapeutic effects of exercise training on elderly patients with dementia: a randomized controlled trial.Archives of Physical Medicine and Rehabilitation,101(5), 762-769. Retrieved on: 25th Oct, 2022. From: https://www.researchgate.net/profile/Shin-Tsu-Chang-2/publication/339355899_The_Therapeutic_Effects_of_Exercise_Training_on_Elderly_Patients_with_Dementia_A_Randomized_Controlled_Trial/links/5eb3189845851523bd496fad/The-Therapeutic-Effects-of-Exercise-Training-on-Elderly-Patients-with-Dementia-A-Randomized-Controlled-Trial.pdf
- Pessotti, C.F.C., Fonseca, L.C., Tedrus, G.M.D.A.S. &Laloni, D.T., (2018).Family caregivers of elderly with dementia Relationship between religiosity, resilience, quality of life and burden.Dementia &neuropsychologia,12, pp.408-414. Retrieved on: 25th Oct, 2022. From:https://www.scielo.br/j/dn/a/tCNNGZWTdWVrHrk5MhR3QSS/?lang=en&format=html
- Phan, S.V., Osae, S., Morgan, J.C., Inyang, M. & Fagan, S.C., (2019). Neuropsychiatric symptoms in dementia: considerations for pharmacotherapy in the USA.Drugs in R&D,19(2), pp.93-115. Retrieved on: 25th Oct, 2022. From:https://link.springer.com/article/10.1007/s40268-019-0272-1
- Rolfson, D. (2018). Successful aging and frailty: a systematic review.Geriatrics,3(4), 79. Retrieved on: 25th Oct, 2022. From:https://www.mdpi.com/2308-3417/3/4/79/pdf
- Wahl, H. W. (2020). Aging successfully: Possible in principle?Possible for all? Desirable for all?.Integrative Psychological and Behavioral Science,54(2), 251-268. Retrieved on: 25th Oct, 2022. From: https://link.springer.com/article/10.1007/s12124-020-09513-8
- Wiels, W., Baeken, C., &Engelborghs, S. (2020). Depressive symptoms in the elderly—An early symptom of dementia? A systematic review.Frontiers in pharmacology,11, 34. Retrieved on: 25th Oct, 2022. From: https://www.frontiersin.org/articles/10.3389/fphar.2020.00034/full
Website
- mayoclinic.org (2022).Dementia. Retrieved on: 25th Oct, 2022. From:https://www.mayoclinic.org/diseases-conditions/dementia/diagnosis-treatment/drc-20352019
