Dementia and Older Adults

Use of Restraints: Ethical or Unethical
April 5, 2017

Dementia and Older Adults

Cognition is the cornerstone of life for older adults, whether they are in a long-term care setting, acute care setting or in a community setting. With the amplified expectancy of life among older adults, the prevalence of chronic and progressive diseases has reached its maximum. One of these progressive and persistent diseases is dementia. It is a cognitive disorder among older adults that is characterized by a progressive decline in cognitive functions such as memory loss, aphasia, agnosia, apraxia, and impaired executive functions. In addition, personality and behavior changes are the advanced symptoms of dementia (Miller, 2009). The resident that we refer to for this essay is Mrs. A.D., who is a 90 year old female client that lives in a in a long-term care facility. Mrs. A.D is totally dependent for her transfers from the bed to the wheelchair since last summer. The information used in this essay has been collected from the staff, the client’s chart and some of the information has also been collected directly from the client. The resident has been diagnosed with unspecified dementia, hypertension, acute renal failure and non-insulin dependent diabetes mellitus. The client had been working as a cashier and later on was a teller at a bank for about 27 years. This essay gives insight of the behavioral changes among people with dementia, benefits of early detection of the disease, some nursing interventions for the psychosocial wellbeing of the clients and the role of nurses in regards to communication and the prevention of dementia.

Behaviors and symptoms change are a normal process among people with dementia and these symptoms get even worse with the passage of time. The advanced manifestations of dementia cause problems, not only for the clients but also for the friends, families and staff.  These changes of symptoms are the loss of physical activities, loss of memory, delusions, hallucinations, depression, appetite changes and the change in communication behavior. Clients with dementia take more time to process the information and cannot store new information (Williamson, 2008; Miller, 2009). The client has been observed and interviewed for the manifestation of dementia. The symptoms that have been observed and discussed are sleep and mood disturbances as well as the inability to process, store and recall new information. The resident is unable to perform her activities of daily life on her own. During an interview, the client mentioned “she felt as if she was lost” (A. Duffy, personal communication, June 8, 2010). The mini-mental state examination was performed and rated as poor, which is more evidence of mild to moderate dementia (Jarvis, 2009).

Mrs. A.D. lost her physical abilities because of dementia and became dependent on her family for activities of daily life. This is one of the major reasons that the client had to move to a nursing home. In a conversation with Mrs. A.D. about residing at a nursing home with diagnosed dementia, the client mentioned “I don’t like it very much but I have no other option to…my kids have their own life, I don’t want to bother them, though, I would love to live with them” (A. Duffy, personal communication, June 8, 2010). The statement by the resident is consistent with Williamson (2008).

Williamson says that there is an utmost need to create awareness among the general public and the medical staff about dementia. This awareness can help in the early detection of dementia, where preventive measures can be taken before the actual manifestations of the disease appears and ultimately makes a big difference in the nursing outcomes. The role of knowledgeable and trained healthcare staff cannot be minimized because clients with dementia need special care and a unique way of communication. A knowledgeable nurse understands clients’ feelings and experiences (Williamson, 2008).

In order to prevent or delay the onset of advanced symptoms, we need to improve our nursing homes by introducing new therapies, outdoor physical activities, and maximum involvement of the clients and finally, invite their families for suggestions to improve our nursing homes (Williamson, 2008). At my clinical placement, I have noticed that there is a plan of activities and therapies for the whole month to keep the residents active, encourage mobility, brain storm, and enhance social interactions among residents. These activities include wax classes, group exercises, yoga, garden parties, ball exercises, bingo, patio socials, mind joggers, and physiotherapies.

All the nursing interventions are equally important when it comes to psychosocial wellbeing and safety of clients with dementia. Quality of life can be made better with early diagnosis of dementia and early interventions (see appendix for more details). Physical exercise and outdoor activities substantially improve one’s cognitive ability; therefore, such actions should be included as part of the plan of care for clients with dementia (Thomas, 2010). According to a study by Rappe and Topo (2007), therapeutic horticultural activities should be planned for the care of clients with dementia because these are familiar, creative, provide physical exercise, and enhance meaningful social interactions (Rappe & Topo, 2007). At the nursing facility, the clients are encouraged to participate in activities such as horticulture and observe nature that ultimately enhances their cognitive abilities. They are also provided with flowers and plants in their rooms to observe nature. Miller (2009) suggests some nursing interventions for the psychological wellbeing of clients with dementia. The author talks about environmental modifications for clients with dementia such as reducing physical and mental stressors, regular resting periods during physical activities, using a clock and simple calendars, placing non-glossy pictures of familiar people in visible places, and using night lamps while the client is sleeping at night (Miller, 2009). Residents at the nursing home have bigger clocks, calendars, televisions that help them to see without stress on their eyes. Family pictures are mounted on the walls to help them recall their memories. Clients with dementia are at greater risks of harming themselves because of their mental disorientation. To promote safety among clients with dementia, the following techniques should be considered such as providing identification tags and contact information, using alarms on doors to prevent wandering, and keeping poisonous substances away from the reach of the residents. This is consistent with Miller (2009) on a discussion of “safety for people with dementia”.

The nursing profession goes beyond clients’ ambulation and medication. In order to develop a transpersonal caring relationship, nurses are required to have knowledge of therapeutic communication skills and the ability to take care of clients’ mind, body and spirit (Watson, 2006). At the nursing home, I always centered my thoughts before going into the client’s room, and conveyed warmth and care in the conversation. I gave the resident enough time to think and respond during our conversation. Clients with dementia have a slower information processing system; therefore, they need more time to process the information and respond. For effective communication, it is recommended to give older adult clients more time to think and respond while keeping in mind that care is more important than cure (Miller, 2009).

Early detection is the key to prevention of dementia. Lack of information and certain myths about aging keep the general public and healthcare professionals away from assessing the older adults’ cognitive abilities that ultimately hamper the prevention and early detection of dementia in older adults. The role of knowledgeable nurses cannot be denied in this respect. As healthcare professionals, nurses need to create awareness among the general public about the benefits of early detection and preventive measures of dementia. There is a further need to conduct blind studies to explore how these nursing interventions and the outdoor physical activities are actually implemented for the improvement of cognition.

References

Jarvis, C. (2009). Physical examination and health assessment. Toronto: Elsevier Canada.

Miller, C. (2009). Nursing for wellness in older adults. Cleveland: Wolters Kluwer| Lippincott                   Williams & Wilkins.

Rappe, E., & Topo, P. (2007). Contact with outdoor greenery can support competence among                   people with dementia. Journal of Housing for the Elderly , 21(3/4), 229-248.

Thomas, H. (2010). Attitudes of primary care team to diagnosing dementia. Nursing Older                       People , 22(3), 23-27.

Watson, J. (2006). Jean Watson’s theory of human caring. In M. Parker (Ed.),  Nursing theories and nursing practice (pp. 295-308). Boca Raton: F.A. Davis Company.

Williamson, T. (2008). Dementia–Putting people at the centre. Working with Older People , 12(4), 38-41.

 

These articles have been written by Nasir Ahmad BSc. (HONS) Nursing, a graduate from York University Toronto, Ontario, Canada. The writer of these articles authorize Peace In-Home Health Care Services Inc to use these articles on their website as an additional resource for their clients. However, any unauthorized copying or distribution of these articles will be dealt strictly by the laws of the state. Please contact author for any queries at 416-648-2717 or email: 23.ahmad@gmail.com