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Translating knowledge into practice underpins advanced practice. Developing leadership skills and the ability to advance positive change is essential to improving current models of dementia care provision.
Conduct a literature review exploring the international and national evidence that relates to a person, service, or care delivery model for dementia. Identify one of these models that you could, or would like to introduce into your workplace.
Drawing on this evidence and other relevant information write a proposal for the implementation of this model. This could include demographics, socio-cultural, environmental factors, and ethical considerations, and demonstrates your role leading this change.
Dementia – Requirement of rehabilitation wards in hospital
Dementia is one of the broad categories of brain disease. It causes a gradual decrease in ability to remember and think. The disease starts with the decrease in motivation, language problem and other day to day common problems. More than the affected person dementia has a significant effect on the caregivers.( - Flicker, L. 1999)
The common cause of Dementia is Alzheimer's Disease .There are a lot of other causes of dementia like vascular dementia, Lewy body dementia and frontotemporal Dementia
The most common form Dementia is Dementia due to Alzheimer’s disease.
Before we study the need of rehabilitation wards for dementia patients we need to study what is dementia and what its effects on a person’s life are. Now different types of dementia show its sign and symptoms.
Aetiology
Alzheimer's Disease is a type of dementia that causes problems with memory, learning and judgement of a person.Dementia is caused when brain cells are damaged . The brains cannot communicate with each other normally. Hence affecting the day to day function. Different regions of brain carry different functions. When brain cell of a particular area is damaged then the function of that area is impaired .( Ghafouri, M., Amini, S., Khalili, K., & Sawaya, B. E. (2006).
It gets worse with time and interferes with daily tasks
Prevalence of Dementia worldwide
In current scenario 47.5 million people of the world have dementia. Most of them are living in low and middle-income families. The their family may not be able to take proper care of them. There is a huge requirement of hospitals with wards for rehabilitation of dementia patients. (Ferri, C. P., Prince, M., Brayne, C., Brodaty, H., Fratiglioni, L., Ganguli, M., ... & Jorm, A. (2006)
Causes of dementia
Dementia is due to damage of brain cells. The brains cells are not able to communicate with each other. When the control and coordination of brain are affected than the daily simple tasks like thinking, behaviour and feelings are affected. The human brain has many regions . Depending on the region where the cells are affected symptoms are produced. Different diseases cause different areas of the brain to be affected. For example, in Alzheimer’s disease, the hippocampus of the brain is affected.
Let’s discuss two most important causes of dementia this will help us to decide the factors we need to reconsider while establishment of rehabilitation centres
Solution
Prevalence of Dementia due to Alzheimer's Disease
The prevalence of dementia due to Alzheimer's Disease in an individual of age above 60 is 40.2 per 1000 persons. It is clear that a substantial population was affected by Dementia due to Alzheimer's Disease .Future studies should be carried out to recognise the biomarkers for Dementia so that the global burden of Alzheimer's can be reduced.( Margallo?Lana, M., Swann, A., O'Brien, J., Fairbairn, A., Reichelt, K., Potkins, D., ... & Ballard, C. (2001).
The diagnosis of dementia in a patient with Alzheimer's Disease
The symptoms appear gradually over years. In starts with Impairment of learning and in this patient is not able to recall recently added information. In Alzheimer's Disease Dementia the most difficult part for the person is word finding. It becomes difficult to find the correct word. Another prominent feature is Visual agnosia . (Kitwood, T., & Bredin, K. 1992). It is impairment in recognition of objects due to low memory or intellect. Slowly as the disease progresses person is also subject to impaired face recognition. The most prominent feature is impaired judgement, problem-solving ability and judgement.( Finkel, S. I., e Silva, J. C., Cohen, G., Miller, S., & Sartorius, N. (1997).
Current treatments of Dementia due to Alzheimer's Disease
For the treatment of Dementia, the most important factor is the cause. In cases where the cause is
Alzheimer's disease there is no treatment. There are medications which can relief the symptoms temporarily but there is no medication that slows or stops the progress of symptoms. (Speck, C. E., Kukull, W. A., Brenner, D. E., Bowen, J. D., McCormick, W. C., Ten, L., ... & Larson, E. B. (1995).
There are various non-drug approaches for Dementia
There are many behavioural changes in patients. In early stages, there is Irritability, depression, anxiety and later there is anger, agitation, aggression etc. Along with this there infections and other conditions which worsen the situation of patient.
There are many situations which can act as a trigger to aggravate the symptoms. Like Moving to a new place or house. The changes in the family environment.
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Non-drug approaches
To understand that the person is not acting but suffering from a disease condition we need to identify the cause of aggravation of symptoms .Changing environment if required by the patient for its comfort and ease of mind. We also need to Avoiding being confrontational with the patient. Also, it’s important to Look for reasons behind the various behaviour and allow the patient adequate rest. Training the patient in terms of the impaired speech.
Changes in patient’s communication style and needs?( Rovner, B. W., Steele, C. D., Shmuely, Y., & Folstein, M. F. (1996)
A person behaves differently due to dementia. The difficulties include problems related to memory loss, language or orientation problems.
The behaviour pattern can be divided into three categories
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1) Biological – Dementia causes a state of confusion and memory loss. The person might be in pain but not able to express it to others
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2) Perceiving threat-Dementia patient has a high degree of disorientation. This creates confusion which causes distress, anger and a feeling of threat.( Mahendra, N., & Hopper, T. 2013). Dementia makes the world a confusing and freighting place for the patients which others need to understand.( Lyketsos, C. G., Sheppard, J. M. E., & Rabins, P. V. (2000).
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3) Social-At time the behaviour of a dementia patient is a result of frustration or the way others behave with them or a feeling of not being heard or understood. In later stages behaviour may be an attempt to meet any urgent need( Ex-need for food)
All the above factors cause variety of changes in the person
Memory being one of the chief symptoms. Forgetting things which are recently learned. Increased need of depending on memory aids ( e.g. reminder notes) or family members. The situation also impacts problem-solving ability especially involving numbers. Like keeping a record of the monthly bill. There is a great difficulty in completing the familiar task at home or work. The person may find troublesome in driving to a frequently visited place. People with dementia lose track with date and time. They do not understand something happened recently or a few days back. People also suffer visual problems. They have difficulty in reading, determining the colour or judging distance. There are problems in joining conversations. They at times don’t know where to start or continue or repeat themselves. People may place thing at unusual places and not find it later. (Brooker, D. (2005).
Managing the behaviour of Dementia Patient’s
For managing person with dementia, it is important to continue the social relationship. So that the person should not feel lonely or frustrated. It is important to encourage the person in meaningful activity. Unnecessary noise and clutter have to be reduced. It is essential to maintain a comfortable sleeping environment. It is also important to have a daily routine. It will keep the patient occupied.
Also tracing the pattern of abnormal behaviour and providing comfort is also important. Keeping the patient away from unpleasant places It is possible to find ways to support a person with dementia to live well
Lewy Body Dementia
Aetiology
Dementia with Lewy bodies leads to decline in independent functioning, thinking and reasoning of the brain. In this, there is abnormal microscopical deposition on brain cells over time.
Prevalence
This is the third most common dementia after Alzheimer’s disease and vascular dementia.
In total 10-25 percent of dementia fall under the category of Lewy body dementia.There is an overlapping of symptoms of Alzheimer's disease and Parkinson’s disease.
Changes in client’s communication style and needs
There is a significant change in thinking and reasoning. The symptoms of Parkinson’s also reflected for example-Hunched posture, balance problems and muscle rigidity. Recurrent visual hallucinations. The person is more confused. They might not be frightening .There is a marked variation in patients attention and alertness. There is autonomic dysfunction which causes fluctuations in body temperature or blood pressure etc, The patient faints repeatedly hence it should be someone around all the time. There are many psychiatric symptoms like aggression and depression .( Volicer, L., Hurley, A. C., & Blasi, Z. V. (2003).
REM Sleep Behaviour disorder is specific to Lewy body dementia. In this, there is confusing between dream and reality. There are strong fluctuations in the state of mind. Many times the person will be alert and suddenly there will be episodes confusion which may last for hours or days
Treatment
There is currently no treatment that can stop or slow down the damage to the brain cells by Lewy body Dementia
But as per the severity of the symptoms medication are given to relief particular symptom of patient
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1)Cholinesterase Inhibitors-These is mainly used in case of Alzheimer's disease and may also help in case of Dementia with Lewy body
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2) Antipsychotic drugs-This is used in case of Alzheimer's disease and Parkinson's. It can also work for Dementia Lewy body. But these drugs carry strong side effects such as acute confusion, impaired swallowing. Hence should be given with a lot of care.( National Institute of Neurological Disorders and Stroke
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3)Antidepressants- It is mainly used to treat depression which is common in Dementia Lewy body
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4)Clonazepam-Used for the treatment for REM sleep disorder .
Taking proper care of person with Lewy Body Dementia
Telling and educating family and friends about patient’s condition and problem. So that people in the surrounding can understand the problem. It is important to be prepared for emergencies as there can be a sudden decline in body functioning or any unpredictable behaviour. He is important to recognise limitations. The adjusting expectation is one way of doing it. Patient suffering cannot perform all the tasks as the person must be doing before the disease. The caregiver also needs to take care of them there is always an increased risk of poor sleep and depression as a result of added responsibility. The early and acute diagnosis of Lewy Body Dementia is important as the treatment line differs from Alzheimer's disease and Parkinson's. It is the duty of the physician to educate the family of the patient regarding the disease condition. The physician should prepare the family for emergency situations . Due to various autonomic changes like blood pressure, temperature regulation, bladder and bowel control it is important for the patient’s family to be ready for emergencies and mood swings caused by these dysfunctions. It is important for family and friends to understand that patient is not faking the conditions. Things generally go out of the patient’s control which has to be understood by the family.( Kitwood, T. (1993).
In this, till now we have discussed two different causes of dementia and how it affects the life of and sufferer and the caregiver. Hence it is necessary to have separate rehabilitation wards in hospitals for them. The behaviour of the dementia patient changes in a great way. We cannot blame the patient for this. It is very important for the caregiver to take constant care of the patient.
In all cases, if dementia there are few common symptoms, these symptoms are not only difficult for the patient to understand and cope with but also for the family members and the caregivers. There are few symptoms in practical which create lot of problems in life of the caregivers-
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1)The very early symptom of dementia is a loss of memory. It starts with loss of short term memory. It has a very adverse effect on individual as well as the family. The individual starts forgetting many things. It can be very important and very recent things. This causes lack of confidence in the individual. For the family, it has a very bad effect as they might not be able to understand this as an early sign of dementia and may think that the person might not be responsible enough to remember anything important. In this case, if rehabilitation of dementia patients in the hospital is provided then through proper diagnosis and treatment memory can be improved. It also becomes easy for the caregivers. (Kane, R. L., Keckhafer, G., Flood, S., Bershadsky, B., & Siadaty, M. S. (2003). As it may be very tiring to take care of dementia patient on a day to day basis.( Minkman, M., Ligthart, S. A., & Huijsman, R. (2009).
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2) Also with dementia, there is memory loss. With memory loss, the confidence level goes down. The patient mood changes to a great degree. There are chances of getting depressed. If the family is also not able to understand it as a sign of early dementia then the chances of depression increase to a greater extent. (Weissman, D. E., & Meier, D. E. (2011)As the person does not receive any support from anyone. So the individual might feel worthless and gradually go in depression. In this case, if care is provided by rehabilitation centres then chances of depression will minimise. If the individual is in a dementia-friendly environment then it will give him higher chances of recovery.( Dröes, R. M., Boelens-Van Der Knoop, E. C., Bos, J., Meihuizen, L., Ettema, T. P., Gerritsen, D. L., ... & SchöLzel-Dorenbos, C. J. 2006).
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3) A person with dementia loses interests in everything. They do not show any interest in the outside world. They lose interest in any hobby , they don’t like any fun activity. For them spending time with family and friends are no more joyous occasions. They may sit idle in a corner. These things need to be discouraged. (Andrén, S., & Elmståhl, S. (2005)This can be done properly in a rehabilitation ward. This requires a lot of dedication and an organised programme. This becomes very difficult for the family member and friends. In the case of rehabilitation centres, they should have organised and trained staff for dementia patients. They should engage the dementia patients in various activities. There they can learn to engage themselves. They will learn to have a hobby and also it will keep them away from apathy and depression.( Arnold, E. (2005).
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4) As dementia cases, memory loss patient is not able to complete normal tasks. The person might feel it difficult to follow its own routine. The simple task of writing something which he has been doing since many years can be very difficult. In this case, rehabilitation centres play a great role they teach the simple technique of remembering things. They train the person again to do the task normally. These things are difficult to achieve at home.
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5) As a part of dementia, there is also difficulty in judgement . It becomes difficult for the person to take a decision or to choose something. For example- ordering food in a restaurant may be a simple task for all of us but for someone with dementia, it becomes difficult to judge or take a decision. There are many kinds of exercises which can be introduced in rehabilitation centres where a patient can be taught to take a simple decision with help of simple programmes. This will enhance their decision taking skills.
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6) Loss of sense of direction-In this patient loses the sense of direction. He may confuse left as right and right as left. Also, there is difficulty in remembering the well-known landmarks. The frequently used streets and roads become confusing. Patient is not able to make out where he is and what are the roads required to use to reach a particular place. In rehabilitation centres, there can be training focused on directions and maps so that the patient can develop a habit of remembering all these gradually.( Fossey, J., Lee, L., & Ballard, C. (2002).
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7) The dementia patients tend to repeat things again and again. As they don’t remember the things they just said. They keep on repeating their sentences. This becomes very difficult f or the family member to accept this as a kind of behaviour. Even if they understand that person is suffering from dementia with time it becomes difficult to tolerate this behaviour. Hence it is better for the dementia patients to stay at rehabilitation centres where everything is according to their need. In this case, a person may repeat daily tasks such as shaving or bathing.( Brooker, D., Foster, N., Banner, A., Payne, M., & Jackson, L. (1998).
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8) As the person starts forgetting things or doesn't remember where he is going or what was he about to say his day to day life becomes very difficult. He becomes very slow . Also, hesitates a lot to go out alone or do anything new. (Moore, M. J., Zhu, C. W., & Clipp, E. C. (2001)It is better for them to be in a rehabilitation centre. Where their problems can be understood and they can be encouraged for new things.
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9) There is a loss of ability to focus or perceive. A person does not understand what others are saying or what they intend to say. It takes time for him to understand others words. The world at times is not a friendly place for them. A dementia-friendly environment is very much required by them. Where there special needs are accepted.
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Place Your OrderThere are many risks associated with dementia, a rehabilitation centre will help in preventing them and in case the risk factors are already developed it will help them to prevent the progress. It may be difficult to achieve the amount of care required by a dementia patient at home. There are other factors which help in fighting with dementia. These factors are-
Cardiovascular Factor-Our brain is supplied by a very oxygen rich blood .In the case of vascular dementia the blood supply to the brain is damaged. The brain needs to be protected by avoiding the other external factor which damages it. Like no smoking or drinking and having a healthy diet.( Brooker, D., & Duce, L. (2000)
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