Dementia and Frailty Impact on Older Adults

Introduction

Ageing is the biological process in which the functional and structural changes occurs within the body such as decline in physiological functions, lowering of fertility, hindered psychological state and others. The changes mainly occur as a result of decline in the division ability of the existing cells to form new cells to replace the damaged cells in the body with ageing that has caused the hindered body function. In this essay, the key area to be explored is regarding older adults who are suffering from dementia and the way frailty is inter-related with the condition. For this purpose, a brief overview regarding ageing is to be provide by explaining key factors influencing it and the theories that describe the ageing process. The discussion is to further morbidities and co-morbidities present in older age and the way chosen health condition that is dementia and frailty are inter-related in affecting the health and life of older age people. The assessment of the health needs of older people with dementia and frailty is to be explored. Moreover, the intervention along with strategic support to enhance the health condition is to be discussed. Finally, evaluation of the professional care and a professional reflection is to be discussed in regarding to care and supporting of elderly with dementia and frailty.

Context

The theories of ageing explain the process and situation that leads individuals to age. One such theories of aging is Wear and Tear Theory of Ageing which explains that damage and destruction of cells and tissues on reaching their end life with passing time and inability of the cells to multiply and divide results individuals to develop ageing (Boccardi et al., 2017). This is because well-structured and effectively functional cells are required to be present in vital parts of the body for it enhanced function which on damage with ageing leads individuals to develop hindered health condition. In elderly people, it is mentioned that dementia and frailty increase with ageing as result of presence of damaged nerve cells which are not replaced by new cells causing hindrance in reaching of the brain signals to body parts for its effective functioning (Dyrba et al., 2018). Thus, it proves the theory of wear and tear working within the body leading to ageing and additional health issues among elderly. In contrast, the Programmed Theory of Ageing informs that ageing is essential and innate part of the human biology that lead to cause depletion of body functioning which in case not happens would led the individuals to live forever (Chmielewski, 2019). According to Programmed Theory of Ageing, the three key systems or factors which are responsible to promote ageing are genetic condition, endocrine system and immune system (Chmielewski, 2019). The study by Koch et al. (2020) mentioned that presence of apoliprotein E (APOE) gene in the body is responsible in making individuals experience dementia as they become elderly. This is because APOE causes impaired clearance of Aβ leading it to get accumulated in parenchyma cells of the brain which initiates formation of Aβ oligomers of neurotoxic nature and amyloid plaques. It invades the perivascular region of the brain leading to case blood vessel disruption and gradual development of dementia with age (Rasmussen, 2016). Thus, genes being one of the key factors in causing ageing related health issue is ensured as mentioned by Programmed Ageing theory. In contrast, the study by van der Willik et al. (2019) informed that innate immunity with age becomes degraded which leads the worsen the neurodegenerative disorder such as dementia among elderly. This is because hindered performance of the immunity leads the body cells unable to protect neurological cell degradation and faster the process making elderly to develop increased symptoms of dementia.

Discussion

AThe morbidity is characterised by unhealthy and abnormal health condition present among individuals leading them to experience hindered health issues and at times fatal consequences (Price et al., 2017). The co-morbidity is referred to the state of multiple medical condition in individuals that leads them to remain sick and unhealthy (Hithersay et al., 2019). As asserted by Ticinesi et al. (2018), frailty is increased vulnerability of health condition as a result of hindered homeostasis in elderly. This is because of the increased emotional and physical stress faced by elderly with ageing. In elderly, dementia and frailty are found to be present as comorbid condition among individuals. This is evident as in 2019, it is reported that in the UK there are nearly 850,000 people who are mainly 65 years and above are affected by dementia and has frailty condition (alzheimers.org.uk, 2019). The people with dementia due to their hindered mental status are often seen to forget eating and drinking on their own. It leads them to experience frail condition of muscle weakness and weight loss as a result of inadequate presence of nutrient in the body (Abdelhafiz et al., 2016). The elderly with dementia express symptoms of memory loss as the key issue as a result of progressive damage in the brain cells which leads them to develop confusion regarding reality. The confused behaviour often leads the elderly to face emotional disruption making them how frail condition regarding mental performance and cognition (Lim et al., 2018). In the study by Shimada et al. (2018), it is mentioned that people with dementia are seen to have higher risk of developing depression. This makes them less active and influences the way they drink, sleep and eat. It leads the elderly with dementia face frail condition in which they experience fall out of distraction from the reality and physical ability to effectively maintain body balance. Thus, it informs that dementia is related to cause physical and cognitive frailty among elderly in which they experience hindrance with managing everyday living n their own. The presence of dementia among individuals leads them to develop weakness of developing effective and clarified speech as the condition of frailty. This is because dementia cause destruction of the brain cells and damage to the frontal lobe of the brain which is responsible for managing speech formation among individuals. As a result of the damage, neurons in the area are unable to ensure enhanced flow of signals for effective speech formation (He et al., 2018). In the study by Osawa et al. (2020), it is informed that left parietal lobe allows people to tell left from their right and when is limb is in the front of the body. For instance, in dementia patient, the damage to the parietal lobe causes individuals to develop clumsiness in executing activities which slower their actions in performing everyday tasks indicating presence of frailty. Therefore, dementia is found to be related with physical and emotional frailty among elderly leading them to become dependent for care on others.

Assessment and Identifying health needs

The health practitioners can contribute to the identification, assessment and supporting plan for meeting the needs of elderly with dementia and frailty by use of enhanced healthcare approaches and tools. The identification and assessment of the needs regarding dementia in elderly can be determined by the health professionals by the use of Mini Mental State Examination (MMSE) tool. The MMSE tool is widely used technique in identifying cognitive needs of the patients suffering from mental disorder such as dementia and assess the extent of their existing cognitive performance. The cognitive factors assessed with the help of the tool are orientation knowledge, registration, attention and calculation, recalling ability, language performance and copying ability (NHS, 2019). The tool allows a maximum score of 30 points to be scored by patients in which a score between 20-24 indicates presence of mild dementia, 13-20 indicates presence of moderate dementia and less than 12 indicate presence of severe dementia (Pinto et al., 2019). The advantage of using MMSE tool for diagnosis and assessment of dementia patients is that it acts as easier tool to be used by health practitioners in identifying the needs of patients in concise manner (Devenney and Hodges, 2017). Thus, MMSE tool is to be used for assessing dementia as it provides clarified and brevier information regarding the specific needs of the elderly patient.

The laboratory test to be used by health practitioners in assessing and identifying the presence of dementia is CT scan. This is because in the CT scan the brain structures are detected to determine the evidence of any brain atrophy, changes in blood vessels, presence of stroke and others that are related with occurrence of dementia (NHS, 2019). The other tool to be used by health practitioners in detecting frailty regarding memory and cognitive performance among elderly individual is Mini-Cog test. The Mini-Cog test contains two key components in which one is a memory recall task and another a clock drawing test used in assessing the cognitive condition of the patients like language, cognitive function, execution function and visual-motor skills (NHS, 2019). The score between 0-2 in Mini-Cog test indicates the person is suffering from dementia (Yang et al., 2016). Thus, both the MMSE tool and Mini-Cog Test is to be used so that enhanced screening and identification of the care needs of elderly with dementia can be determined by the health practitioners.

The health practitioner in detecting and assessing level of frailty among elderly with dementia are required to use PRISMA-7 questionnaire. The questionnaire includes total of 7 questions covering various factor regarding frailty and the presence of more than 3 positive answers indicates that the person is experiencing frailty (Higginbotham et al., 2020). The tool is preferred to be used as it provides easier identification of the presence of frailty among elderly as well as it is less consuming indicating delivery of faster result for diagnosis regarding frailty. The tool only indicates the presence of absence of frailty in elderly but does not detect the different nature of frailty present among elderly who are suffering from dementia or other diseases. In dementia patients, it is previously mentioned that they experience frailty such as muscle weakness and slower movement. Thus, to detect the level of this nature of frailty among dementia elderly, the health practitioners are to use Gait Speed Test. The Gait Speed Test is used to assess the functional mobility of individuals (Dumurgier et al., 2017). In the test, the person is asked to walk for 10 meters and values regarding their speed of walking and nature of walking are observed. The normal gait speed for men is 1.34 m/s and for women is 1.24 m/s who are 60-69 years whereas it is reduced to 0.97 m/ for men and 0.94 m/s for women above 80 years (Toots et al., 2017). Thus, on the basis of the speed, the frailty level regarding movement in dementia individuals is to be calculated. The dementia elderly is also seen to show frail condition of experiencing fall and to assess their risk regarding falling the AGS/BGS guideline is to be used. According to the guideline, the health practitioners are required to ask the dementia patients and their family members the number of previous falls been experienced by the patient in past year and if any fractures are present. The guidelines also mention the health practitioners to ask the patients if they feel unsteady during walking to determine their risk regarding fall (Hunter and Speechley, 2020). The health practitioner for supporting care plan of elderly with dementia is required to develop effective communication with the patients. This is because enhanced therapeutic communication leads the health practitioners understand the specific needs and demands of the elderly to fulfilled (Kontos et al., 2017). For instance, dementia patient due to frail condition are often seen unable to perform everyday chores such as bathing, dressing and others. The development of effective communication by the health practitioner with the dementia patients would help them to understand the nature of specific care support required in regard to bathing and dressing so that they have enhanced health condition (Thyrian et al., 2017). The health practitioners to support plan in meeting the needs of the dementia and frail elderly is required to evaluate the patients needs by using Roper-Logan-Ternary Model. This is because this model helps the health practitioners in making holistic assessment of patients in determining their needs regarding activities of daily living (Shen et al., 2020).

Intervention and Support

The role in integrated multi-disciplinary is that group of health professionals from different disciplines are to involve in providing specific integrated services to the patients so that their needs and demands are effectively fulfilled (Miele et al., 2020). In case of caring for the elderly with dementia and frailty, it is role of the multi-disciplinary team is to deliver various psychological and physical care interventions to ensure enhanced health of the elderly. The importance of coordinated person-centred care is that it helps to take specific intervention in regard to the patient in controlling their health as well as helps in creating independence and empowerment of the patient in deciding and keeping their own care (Miele et al., 2020). The NMC Code of Conduct mentions that nurses are required to develop effective communication with the patient and involve them in deciding their care. It also mentions that nurses are to be competent and deliver care specific to the patient in their best interest (NMC, 2018). Thus, the NMC Code Conduct is to be followed in accessing guidance regarding the way to deliver person-centred care. The coordinated person-centred care is important as it helps to create inclusion of the patients in deciding their own care as well as assist the nursing practitioners to access assistance from patients and other professionals in determining the specific care and changes in support to be maintained to ensure their enhanced well-being (Stolee et al., 2020). The coordinated person-centred care approach for preventing frailty in dementia elderly is important because it helps in including dementia affected elderly to decide the need of care they require to avoid frailty issues at the earliest. Moreover, the coordinated person-centred care helps the nurses to inform the family members of the patient about the actions to be taken from their part in preventing frailty in the adults (Rahman, 2017). It is also important as it led the nurses to include suggestion of care from psychiatrist and physiotherapist about the actions to be taken for elderly with dementia so that the progressing frailty as result of the disease can be prevented (Yamaguchi et al., 2019). The barrier such as ageism leads to create discrimination towards the patient because the elderly individuals are considered as burden of care for all and considered to lack effective decision-making ability out of their diseased state. It leads people to make decision on their behalf regarding health by ignoring their views and perception which makes them feel lack of dignity and autonomy in deciding their care (Chen et al., 2020). The Mental Health Capacity Act 2005 informs that the individuals with mental health issues are not to be discriminated under any condition and they are to be actively involved in deciding their own care if they are able to execute it (legislation.gov.uk, 2005). The NMC Code of Conduct mentions that family members are to be contacted in case the patients are unable to provide their view regarding care (NMC, 2018). Thu, the Mental Health Act 2005 and NMC Code of Practise is to be followed in overcoming barriers regarding ageism in caring for the elderly with dementia and frailty. In shared decision-making regarding care for elderly individuals with dementia and frailty, the role of the patient to explain their needs of care and way they wish it to be provided to be mentioned to the nurses. This is to provide their clarified opinion regarding care delivery to the nurses (Daly et al., 2018). The role of the family member in shared decision-making of care for dementia and frail elderly is to inform the nurses regarding the additional care approach required by the patients. Moreover, they are to avail education from the nurses regarding the way to care and support the frail and dementia elderly at home so that they can able to support their speedy recovery and healthy ageing (Seiger Cronfalk et al., 2017).

Evaluation and Professional Reflection

In delivering care to the elderly with dementia and frailty, the role of nurses working with the multi-disciplinary team is to inform about the physical and mobility needs of the elderly to the physiologist. This is because physiologist are professionals with experience to deliver physical therapies in enhancing the physical movement of individuals. Thus, by accessing the knowledge about physical efficiency and fall risk of the dementia elderly from the nurses, they can appropriately determine and deliver specific physical therapies to ensure well-being of the patients (Goeman et al., 2016). The nurse role in multi-disciplinary team towards psychiatrist in caring for elderly with dementia and frail is to inform the professional about the level of cognitive and mental efficiency of the patient. This is going to help them in determining the specific psychological therapies to be provided to the elderly in enhancing their mental health (Miele et al., 2020). In working with the multi-agency, the nurses are to inform the social workers responsible for caring of the elderly with dementia and frailty about the everyday care support to be provided to the patients. This is social workers are individuals who work to deliver social and everyday support to frail and dementia affected elderly and others (Jenkins et al., 2016). The professional skills required by me to deliver care to dementia and frail elderly is compassion, effective communication, patience and collaboration skills. This is because dementia elderly is often found to be abuse and neglected due to burden of care which hinder their dignity and respect (Bickford et al., 2019). The presence of compassion and patience to take their care supported by communication to include them in deciding care makes them feel dignified and accept care out of value (Treadaway et al., 2019). In future, I am going to implement coordinated person-centred care to support elderly with dementia and frailty. This is because it would lead me to deliver specific care with confidence to the service users. The current exercise would help me in future to practise more effectively with elderly as it helps me to understand the strategies, legislation and policies to be followed to avoid discrimination and deliver high-quality care.

Conclusion

The above discussion mentions that dementia among elderly is linked with frailty. This is evident as dementia people develop frail condition such as hindered mobility, prone to fall, depression and others. The development of dementia and frailty with age occurs as result of hindered innate immunity and presence of certain genes. The Wear and Tear theory of ageing informed that ageing occurs as result of damage and non-replacement of the damaged cells in the body. It is evident as due to brain cells destruction the elderly develop dementia and frail condition with age. The MMSE tool along with Mini-Cog tool is required to assess and identify the impact of dementia among elderly. The Gait speed test along with PRISMA-7 test are required to assess and identify frail condition of the elderly with dementia. As intervention to care for elderly with dementia and frailty, effective coordinated person-centred care is to be used. The social care services are top be included in delivering care to the elderly with dementia and frailty. The Mental Health Capacity Act 2005 and NMC Code of Conduct are to be followed in delivering proper care to the elderly without discrimination by the nurses.

Continue your journey with our comprehensive guide to Dementia among the UKs Black minority ethnic communities.

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