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Introduction
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“Integrated care management” can be described as the multidisciplinary approach to collaborating care delivery services by cost, activity, and quality. It focuses on evaluating problems with a processed approach and outcome-based care delivery. In this aspect, patients and their careers are also involved in determining the process of care delivery and its outcomes. This, in turn, assists in improving communication and patient as well as staff satisfaction, thereby upgrading the overall quality of care. This report would shed light on the potential problems and their assessment for Mrs B. The discussion will be done on the diagnosis process, treatment and management of Mrs B;
Discussion
The potential evolving problems for Mrs B
The case study has highlighted that Mrs B is generally suffering from behavioural and mental health problems. Along with this, she has also been suffering from physical issues, which have worsened due to ageing. It can be observed that she has been struggling with increased paranoia, visual hallucinations as well as agitation. Agitation and major depressive disorder have been the major concern in relation to Mrs B because she gets easily frustrated and feels threatened. Moreover, due to ageing, her problems are difficult to manage. She has also been diagnosed with Alzheimer’s dementia which has been associated with depressive mood and delusions. This leads to paranoid ideation, breathlessness and restlessness. The increased intensity of these problems has resulted in irritation, pain and frustration in Mrs B. Isolation from society due to frustration and feeling of being threatened can be observed in Mrs B.
Appropriate assessment tools for Mrs B
A comprehensive assessment is related to evaluating the entire health status of the individual. It is important to analyse the complete health history and past medical complications of the patients for effective and upgraded care (Zeng et al. 2019). The case study highlighted that the patient suffered from mental and behavioural problems. In this regard, it is important to evaluate the condition of the patient with appropriate assessment tools in order to amplify the quality of care being provided to Mrs B. It has been observed that Mrs B suffers from Alzheimer’s dementia. In this regard, cognitive assessment of the patient is important as it would help in determining the cognitive impairment of the patient (Petrie et al. 2018). It would also help in the evaluation of depression and experienced problems by Mrs B. In this regard, the use of a “six-item cognitive impairment test” and “mini-mental state examination” can be done for Mrs B. The “six-item cognitive impairment test” is a kind of cognitive function test that is widely used in the primary healthcare setting. It consists of 6 questions and is of higher sensitivity that helps in understanding the situation of the patient.
This can be conducted within 3-4 m minutes, which would not irritate or agitate Mrs B. Considering the behavioural problem, the use of a “mini-mental state examination” can also be done. It would help in evaluating the communication and memory problems of Mrs B. The examination consists of 11 questions and assists in monitoring deterioration over time (Aafp.org, 2022). Mrs B also suffers from hallucinations, and in this regard, the use of a “multi-modality unusual sensory experiences questionnaire” can be done. It would assist in determining the sensory experiences experienced by Mrs B. Thus, the use of the stated assessment tool would help in providing comprehensive treatment to the patient.
Physical and physiological factors affecting assessment
Mrs B has been found to be suffering from a number of physical and physiological factors. This can be the result of her ageing and the associated diseases experienced by her. The presence of these physical and physiological factors might affect conducting of an effective assessment of the patient. Mrs B suffers from breathlessness, pain and restlessness, which can impact the assessment as she can be restless while answering the questions (Clevelandclinic.org, 2022). Moreover, being an aged woman of 85 years, she might interrupt the assessment process with her restless behaviour and deny answering the questions. This would impact the quality of results and, thereby, a comprehensive assessment of the patient.
On the other hand, Mrs B has also been found to behave physiological problems. She shows behavioural problems, increased frustration, extreme agitation and hallucinations. These factors might interrupt the effective assent of the patient (Hwang, Foley & Trollor, 2020). It has been found that older adults experience hallucinations in multiple contexts, such as physical, social and mental health contexts. According to statistics, 16% of people above age 65 will experience hallucinations by 2050 (Badcock et al. 2020). Considering the condition of Mrs B, it can be said that her extreme agitation and hallucination can interrupt the assessment process. She might feel frustrated and irritated with the questions and demy to answer them, thereby restricting her accurate evaluation. She might also feel threatened and try to harm her or the GP, thereby creating a complex constitution to manage her and execute an effective assessment.
Models of successful ageing related to Mrs B
Successful ageing can be stated as a multidimensional concept that describes the quality of life. It is an important aspect as it assists in increasing the healthy and functional lifespan of an individual (Bodner, Palgi & Wyman, 2018). The models of successful ageing assist in determining the quality of life of an individual and imports to understanding the necessary factors for improved living [Refer to appendix 2]. The following four models of successful ageing can be applied to the condition of Mrs B:
“Rowe and Kahn model”: This model evaluates successful ageing on the basis of three main factors “being free of disability or disease, interacting with others in a meaningful way, and having high cognitive and physical abilities” (Torregrosa-Ruiz et al. 2021). In order to improve the quality of living of Mrs B, there is a need to improve her behavioural aspect and pain problems.
- “Social functioning model”: This model illustrates the social engagement of an individual. It summarises the social activities and contacts being performed. Mrs B has been found socially isolated due to her depressive problems. Therefore, it is necessary to increase the social engagement of Mrs B to make her happy and improve her condition.
- “Physiological model”: This model sums up the self-efficacy of an individual in terms of overcoming difficulties or coping with them. Mrs B is found to get frustrated and irritated easily. She also feels threatened at times and experiences hallucinations, resulting in worse agitation. Therefore, it is required to improve this aspect to increase the successful ageing and quality of life of Mrs B.
- “Lay model”: This is a multidimensional model that focuses on predicted quality of life and assists in evaluating the health promotion outcome of the older population. This model would help in focusing on the entire aspect of Mrs B and thus treat her condition.
Potential psychiatric diagnosis for Mrs B
Psychiatric diagnosis includes the subjective experiences and description of the behavioural aspect of the person. The case study encounters multiple mental problems in the patients. In regards to Mrs B, the doctor can evaluate her condition by interviewing her in an appropriate manner to avoid agitation. The conduction of physical examination and psychological evaluation can also be done for the patient (Mayoclinic.org, 2019). The doctor can make use of appropriate questions and use the experiences of Mrs B to understand her condition and perform her diagnosis. Effective and smooth communication with the patient regarding the symptoms, feelings and behavioural patterns experienced by her can helps in a better diagnosis of Mrs B.
Treatment and management plan for Mrs B
Mrs. B has already been in the hospital and has been prescribed medications to treat her condition. Considering the condition and behavioural issues of Mrs B, it can be said that behavioural management is important with increased family time. This would help in making the patient happy and thus improving her condition. The use of “cognitive behavioural therapy” can be done.
This would help in managing the agitated behavioural problems of Mrs B. Moreover, the use of “hydrotherapy” can also be done. This would help in using water in a therapeutic manner and improve the mood of Mrs B as she can spend more family time. Considering the dementia state of the patient, the use of “reminiscence therapy” can also be done as it would help the patient in recalling happy times and thus treat increased agitation (Park et al. 2019). The use of music therapy can also work well with the patient by lifting her mood. [Refer to appendix 1].
Conclusion
This report concludes the various problems and associated treatment for Mrs B. the discussion on the problems such as increased agitation, dementia and hallucination experienced by the patient have been done. The explanation of the appropriate assessment tool, such as the “six-item cognitive impairment test”, "mini-mental state examination", and "multi-modality unusual sensory experiences questionnaire", has been done. It has illustrated the four models of successful ageing in relation to Mrs B. A discussion has been done on treatment processes such as “CBT, hydrotherapy, reminiscence therapy and music therapy” that can be used for the patient.
Reference list
Journals
Annele, U., Satu, K. J., & Timo, E. S. (2019). Definitions of successful ageing: a brief review of a multidimensional concept. Acta Bio Medica: Atenei Parmensis, 90(2), 359. DOI: 10.23750/abm.v90i2.8376
Apóstolo, J. L. A., Paiva, D. D. S., Silva, R. C. G. D., Santos, E. J. F. D., & Schultz, T. J. (2018). Adaptation and validation into Portuguese language of the six-item cognitive impairment test (6CIT). Aging & mental health, 22(9), 1190-1195. DOI: https://doi.org/10.1080/13607863.2017.1348473
Badcock, J. C., Larøi, F., Kamp, K., Kelsall-Foreman, I., Bucks, R. S., Weinborn, M., ... & Sommer, I. E. (2020). Hallucinations in older adults: a practical review. Schizophrenia bulletin, 46(6), 1382-1395. DOI: https://doi.org/10.1093/schbul/sbaa073
Bodner, E., Palgi, Y., & Wyman, M. F. (2018). Ageism in mental health assessment and treatment of older adults. Contemporary perspectives on ageism, 241-262. : https://doi.org/10.1007/s10803-018-3596-8
Hwang, Y. I., Foley, K. R., & Trollor, J. N. (2020). Aging well on the autism spectrum: an examination of the dominant model of successful aging. Journal of Autism and Developmental Disorders, 50(7), 2326-2335. DOI: https://doi.org/10.1007/s10803-018-3596-8
Park, K., Lee, S., Yang, J., Song, T., & Hong, G. R. S. (2019). A systematic review and meta-analysis on the effect of reminiscence therapy for people with dementia. International psychogeriatrics, 31(11), 1581-1597. DOI: 10.1002/gps.4980
Petrie, K., Milligan-Saville, J., Gayed, A., Deady, M., Phelps, A., Dell, L., ... & Harvey, S. B. (2018). Prevalence of PTSD and common mental disorders amongst ambulance personnel: a systematic review and meta-analysis. Social psychiatry and psychiatric epidemiology, 53(9), 897-909. DOI: https://doi.org/10.1007/s00127-018-1539-5
Torregrosa-Ruiz, M., Gutiérrez, M., Alberola, S., & Tomás, J. M. (2021). A successful aging model based on personal resources, self-care, and life satisfaction. The Journal of Psychology, 155(7), 606-623. DOI: https://doi.org/10.1080/00223980.2021.1935676
Zeng, W., Chen, R., Wang, X., Zhang, Q., & Deng, W. (2019). Prevalence of mental health problems among medical students in China: A meta-analysis. Medicine, 98(18). DOI: 10.1097/MD.0000000000015337
Websites
Aafp.org, (2022). CLINICAL DEMENTIA RATING (CDR). Retrieved on: 31st October, 2022. Retrieved from: https://www.aafp.org/dam/AAFP/documents/patient_care/cognitive_care_kit/cdr-chart.pdf
Clevelandclinic.org, (2022). Delusional Disorder. Retrieved on: 31st October, 2022. Retrieved from: https://my.clevelandclinic.org/health/diseases/9599-delusional-disorder
Donvito, T., (2020). Cognitive Behavioral Therapy for Arthritis: Does It Work? What’s It Like? Retrieved on: 31st October, 2022. Retrieved from: https://creakyjoints.org/mental-health/cognitive-behavioral-therapy-for-arthritis/
Mayoclinic.org, (2019). Mental illness. Retrieved on: 31st October, 2022. Retrieved from: https://www.mayoclinic.org/diseases-conditions/mental-illness/diagnosis-treatment/drc-20374974
