Health Promotion for Dementia

Introduction

Health Promotion is referred to the behavioural social science which is drawn from the psychological, environmental, biological, medical and physical sciences for promoting and preventing diseases through the education-based voluntary change of behaviour. In this assignment, the health promotion for Dementia is to be discussed. The health promotion for Dementia is to be designed by initially providing a brief background of the syndrome and the way it affects the individuals. The health issues related to Dementia is to be discussed further and the assessment methods used for the disorder are to be explained. Further, the goal of health promotion for Dementia is to be mentioned and intervention to prevent it is to be critically assessed. In the end, the evaluation of the health promotion care plan for Dementia is to be evaluated to understand the changes to be made further for its improved success in future.

Brief background of Dementia

Dementia is referred to as the syndrome in which continuous decline in brain functioning occurs that leads the individuals to experience difficulties in performing everyday activities and face memory loss (Livingston et al. 2017). Dementia is seen to mainly occur among people of older age but it is not to be considered as the inevitable part of ageing. This is because with age the natural deterioration of brain occurs among the elderly but the people affected with dementia show quicker and improper deterioration of brain function which is different from the normal degradation of brain functioning with age (Lowe et al. 2017).

In the UK, there are 850,000 people who are affected by Dementia and it is projected to rise to 1.6 million by the year 2040. At present, there are 225,000 people who have developed dementia in 2018. The statistics inform that 1 in 6 people in the UK who are above 80 years of age are suffering from dementia and only 42,000 people who are under 65 years of age are suffering from the syndrome (alzheimers.org.uk, 2018). This indicates that Dementia acts as a health risk for most people who are aged 65 years and more as well as it becomes more risky for people with progressing age. The key symptoms of dementia include memory loss, experiencing difficulty in planning and solving problems, facing hindrance in executing everyday tasks, developing confusion regarding time and place, having problem with speaking and writing, memory loss, poor decision-making, withdrawal from the society and wide changes in mood and personality (Feast et al. 2016).

The key risk factor for Dementia is ageing as the ability of the brain to function effectively is lost making the person prone to develop the syndrome. However, age is not the sole risk factor for Dementia as combination of various other risks along with ageing is responsible in causing the syndrome (Lafortune et al. 2016). The genetic or hereditary factor acts as risk for development of dementia among people with age. This is because researchers mention that mutated genes can be passed by the parents to their offspring which increases the risk of dementia among the people. Further, studies have mentioned that presence of certain mutated genes such as CLU, CR1, Bridging Integrator 1 (BIN1), ATP-binding cassette transporter (ABCA7) and others are responsible for the development of dementia among individuals. This is evident as BN1 is regarded to influence the formation of neurofibrillary tangles in the brain which are seen in increased amount among people with dementia (Paulson and Igo, 2011). Moreover, the CLU C allele is linked with impairment of the integrity of the white matter which leads to affect individuals to develop dementia (Paulson and Igo, 2011).

The smoking is one of the risk factors for dementia as it increases the risk of development of vascular problems such as strokes or small bleeds in the brain that raises the risk for development of dementia. In addition, smoking leads to raise oxidative stress as well as inflammation in the brain as a result of the impact of toxic products present in the smoke which leads the individuals to develop risk of dementia due to smoking (Stirland et al. 2018). The health condition such as atherosclerosis acts as risk factor for dementia as it causes deposition of fatty substances in the blood vessels which interferes with the blood flow to the brain leading the individuals to develop improper functioning or stroke in the brain (Hughes et al. 2018). The diabetes is another risk factor for the development of dementia as excess sugar in the blood leads to cause damage to the brain which eventually leads individuals to show symptoms of the syndrome (Chatterjee et al. 2016).

Health Issue

Mr J who is a 78-year-old individual is found to be living alone and weekly visited by his daughter who is married and living in the town. Mt J is seen to show various symptoms of dementia such as forgetfulness, inappropriate behaviour, lack of performing everyday activities and others. Mr J was reported to forget his way back home for three times in the past month when he went out for a walk in the outskirts at morning. As mentioned by Sampson et al. (2018), people having dementia face difficulty with emotionally responding to changes and situations. They show lower control over their feelings and the way to express them. For instance, in the case of Mr J, it is seen that the person shows irritable or aggressive behaviour regarding simple activities along with rapid changes in mood by overacting to certain situations. This has led Mr J to be regarded as vulnerable person as his unusual behaviour makes the people in the society feel the individual is mad as well as aggressive and may cause harm to them.

The presence of dementia leads people to develop insecurity and lack confidence in them due to their inability to perform everyday task. Moreover, the lack of control over person activities leads the individuals to doubt their judgement and become dependent on others for their everyday care (Robinson et al. 2015). Thus, dementia leads people to develop low self-esteem which in turn deteriorates the well-being and healthy living of the individuals in the society. This is evident as in the case of Mrs J it is seen that he is unable to remember things and have shown inability to perform everyday activities such as bathing, cleaning and cooking due to forgetfulness. It has led Mr J to lose weight and wear dirty clothes when he was reviewed by the social care provider. Moreover, Mr J is found to feel lack of self-esteem and have stopped socialising with people and friends in the society.

The social stigma regarding dementia informs that people experiencing the disorder show improper personality changes and the presence of such individual in the family are disrespectful for the family members (Robinson et al. 2015). This stigma has lead Mr J's daughter to stop visiting him which she used to do previously as she feels is known to be related to him would bring shame to her in the society. Therefore, this has led Mr J to develop hopelessness in receiving proper care for his health condition. Thus, to resolve Mr J's condition an effective assessment of his health condition is to be made so that proper healthcare interventions can be identified for promoting his health.

Assessment of Dementia

The existence of dementia in Mr J is to be assessed by using the Mini-Mental State Examination (MMSE), Mini-Cognitive Test and General Practitioner Assessment of Cognition (GPCOG) Test. The General Practitioner Assessment of Cognition (GPCOG) Test is referred to a screening examination used by the health professional for assessing the cognitive impairment level of individuals. The test includes nine key items which are clock drawing for time orientation, spacing and numbering, placing hands in correct manner, current news awareness, first name, last name, street, number and suburb where the person live. The total score for the test is 9 and the score from 5-8 indicates the person is suffering from cognitive impairment (Hunt et al. 2017). Mr J in the GPCOG test scored 7 which inform that the person is suffering from cognitive impairment.

The Mini-Mental State Examination (MMSE) is a technique in which a health professional asks an individual a set of different questions to examine and assess their everyday mental ability. The maximum points to be received in the MMSE are 30. The score from 20-24 indicates the person is suffering from mild dementia, 13-20 indicates the individual is suffering from moderate dementia and the score less than 12 indicates the individual is suffering from severe dementia (Stein et al. 2015). The MMSE score of Mr J was 16 which indicate that the person is suffering from moderate dementia. The advantage of using MMSE score for assessment of dementia is that it allows easy and brief examination of the presence of the syndrome. However, the limitation of using the test is that it offers narrow scope in assessing the ability of individuals and the health professional through the test are unable to determine the extent of memory loss and cognition of the person (Creavin et al. 2016). Therefore, an additional Mini-Cognition Test is being performed for Mr J to assess his condition regarding dementia.

In Mini-Cognitive Test, a person is asked to remember three common objects and mention them few minutes later. In addition, in the test, the person to be assessed for cognition is asked to draw a clock with number to indicate a time to be mentioned by the healthcare assessor. In the test, the score from 0-3 is provided to the individual for recalling the test. After adding the recall and clock drawing test score if the score is 0-2 then it indicates positive screening for dementia but the score of 3.5 indicates negative screen for dementia (Galvin, 2018). In the case of Mr J, it was seen that he failed in the recall test as well was unable to properly draw the clock as per mentioning timing making him get a 0 score for the test. This indicates that Mr J is suffering from dementia and has the low cognitive ability to perform his daily tasks.

Health Promotion Goal

The goals of health promotion for Mr J are as follows:

To maintain Mr J’s mood and emotional responses so that he is able to show proper feelings towards the situation

To provide support to improve Mr J’s memory skill to make him be able to remember important things

To enhance Mr J’s hygiene skills

Healthcare Intervention for Dementia

The care intervention arranged for Mr J includes making him involved in executing mental exercises so that he is able to manage his fluctuations in mood and behaviour. This is because mental exercise helps to enhance the stimulation of brain functioning and lower the rate of cognitive decline allowing individuals to think and analyse to control mood and behaviour in a better way (Telenius et al. 2015). In addition, Mr J is to be made to socialise with friends and relatives where he can talk and share his emotions to avoid being depressed and stressed with his health condition. This is because sharing emotion and talking helps individuals with dementia feel emotionally supportive for their condition from friends and family members making them gradually avoid being anxious and irritable that is caused due to burden of emotion and isolation (Donnellan et al. 2017).

The Antidepressants and Anxiolytics are antipsychotic medications provided to the dementia patients for treatment of anxiety and depression. They are usually provided for short-term use as long-term use may cause adverse side-effects and make patients become addicted to drugs (Jacquin-Piques et al. 2016). Thus, Mr J is to be provided with the medication for short-term use so as to immediately control his anxious behaviour to promote his well-being and effective interaction with people in society. The Cognitive Behaviour Therapy is referred to as the technique in which people are allowed to understand the way they can behave properly by changing their pattern of thinking (Spector et al. 2015). The CBT is to be provided to Mr J to make him realise the way he required to change his thinking to allow him to control his mood changes and anxiety. The advantage of using the therapy for health promotion of Mr J is that it would help him to overcome his emotional distress and manage negative thoughts as well as feelings that are raised as a result of dementia which is currently responsible for his unnecessary behaviour and mood. The limitation of CBT use is that it is time-consuming and may not work for people with complex mental health condition (Charlesworth et al. 2015). In case of Mr J, he is found to be suffering from moderate dementia and still have ability to use proper cognitive ability to some extent and therefore the use of CBT would be effective to promote his health.

The assistive technology promotes independence and empowers dementia patients to be able to take then own care (Kenigsberg et al. 2019). This is evident as by offering assistive technology such as interactive clock, communication aid, alarms, home monitoring devices and others would help Mr J develop ability to determine things kept at places, time, remember charts, medications to be taken and others. The Reminiscence Therapy is referred to the treatment in which through use of senses individuals suffering from dementia are made to remember things, people, places and other from their past life (Mileski et al. 2018). This therapy would be able to help Mr J to get assistance in remembering things and places which he has forgotten as a result of dementia. Thus, the therapy would help Mr J to enhance his memory helping him to lead a better life. In addition, Memantine is to be provided to Mr J to improve his memory skills.

Mr J through the help of assistive technology is to follow instruction of the care provider to remain clean and maintain hygiene. In addition, a separate care provider is to be allocated to Mr J who bath and clean his clothes to ensure proper hygiene is maintained. Moreover, the assistance of the care provider is required for Mr J to cook and have meals. The care provider is to ensure that the meals taken by Mr J are according to the diet chart mentioned by the dietician to ensure healthy weight and nutrition for the individual is maintained. The proper body weight is required to be maintained to remain physically strong and intake of proper nutrition through food is required to assist effective functioning of the body (Koyama et al. 2016).

Evaluation of the care plan

The goal of care mentioned for Mr J is able to be achieved to most extent by following the planned care intervention. This is evident as effective steps are taken to ensure mood changes and behaviour of Mr J is managed which is deteriorating as a result of dementia. Moreover, the side-effects of antidepressants to b used are considered due to which they are offered for short-time to ensure no negative impact on the health of Mr J occurs as a result of the use of the medication. In addition, the CBT which is the most effective cognitive improvement therapy for dementia patient is used for Mr J to improve his behaviour ensuring effective steps are taken to improve his mood and behavioural issues faced as a result of the disorder.

The memory improvement goal for Mr J is also effectively achieved through self-care actions and use of therapy. However, the side effects of the medication which is Memantine used to support memory improvement for Mr J is not considered. The side-effects of Memantine include constipation, headache, confusion, backache and others (Alizadeh et al. 2015). The side-effects may lead Mr J to not cooperate to take the medication leading to care issues for proper management of his memory problems. The use of dieticians and care providers to maintain proper weight and hygiene for Mr J which are the tow care goals is able to be achieved. However, the involvement of family members of Mr J in supporting his care is not achieved through care intervention. The inclusion of family members in caring for dementia patients makes the patients feel valued and develop trust in accept care without creating any hindrance (Deist and Greeff, 2015). Thus, the care interventions mentioned are to be improved so that the daughter of Mr J can be included in caring for him to make Mr J feel trusted in accepting care. In addition, it would make him feel being valued by the family which would boost him psychologically towards enhanced well-being. Moreover, education to Mr J’s daughter regarding cause and effect of dementia is to be included in the care plan so that she can be made to support her father in self-care actions without getting influenced by any social stigma that is presently barring her from meeting his father.

Conclusion

The above discussion informs that dementia is a syndrome which mainly affects the elderly leading them to show improper behaviour and experience memory loss. In the current case study, Mr J is found to be suffering from dementia which has become a health issue for him as he is unable to manage his emotions, forgetting things, unable to execute everyday activities and others. In order to assess the health condition of Mr J regarding dementia, the Mini-Mental State Examination (MMSE), Mini-Cognitive Test and General Practitioner Assessment of Cognition (GPCOG) Test are used and the tests revealed that Mr J has impaired cognitive health along with moderate dementia. The care interventions provided to promote the health of Mr J includes self-care actions, medication and psychological therapies. The goals of care for Mr J are found to be met but the care intervention is to be changed further so that the family members of Mr J can be involved in providing him better and trusted care to ensure his well-being and healthy living.

Continue your journey with our comprehensive guide to Health Promotion and Public Health Addressing Wellbeing and Inequalities in a Case Study Context.

References

Alizadeh, N.S., Maroufi, A., Jamshidi, M., Hassanzadeh, K., Gharibi, F. and Ghaderi, E., 2015. Effect of memantine on cognitive performance in patients under electroconvulsive therapy: a double-blind randomized clinical trial. Clinical neuropharmacology, 38(6), pp.236-240.

Charlesworth, G., Sadek, S., Schepers, A. and Spector, A., 2015. Cognitive behavior therapy for anxiety in people with dementia: a clinician guideline for a person-centered approach. Behavior modification, 39(3), pp.390-412.

Chatterjee, S., Peters, S.A., Woodward, M., Arango, S.M., Batty, G.D., Beckett, N., Beiser, A., Borenstein, A.R., Crane, P.K., Haan, M. and Hassing, L.B., 2016. Type 2 diabetes as a risk factor for dementia in women compared with men: a pooled analysis of 2.3 million people comprising more than 100,000 cases of dementia. Diabetes care, 39(2), pp.300-307.

Creavin, S.T., Wisniewski, S., Noel‐Storr, A.H., Trevelyan, C.M., Hampton, T., Rayment, D., Thom, V.M., Nash, K.J., Elhamoui, H., Milligan, R. and Patel, A.S., 2016. Mini‐Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database of Systematic Reviews, (1). pp.29-45.

Deist, M. and Greeff, A.P., 2015. Resilience in families caring for a family member diagnosed with dementia. Educational Gerontology, 41(2), pp.93-105.

Donnellan, W.J., Bennett, K.M. and Soulsby, L.K., 2017. Family close but friends closer: exploring social support and resilience in older spousal dementia carers. Aging & mental health, 21(11), pp.1222-1228.

Feast, A., Orrell, M., Charlesworth, G., Melunsky, N., Poland, F. and Moniz-Cook, E., 2016. Behavioural and psychological symptoms in dementia and the challenges for family carers: systematic review. The British Journal of Psychiatry, 208(5), pp.429-434.

Galvin, J.E., 2018. Using Informant and Performance Screening Methods to Detect Mild Cognitive Impairment and Dementia. Current geriatrics reports, 7(1), pp.19-25.

Hughes, T.M., Wagenknecht, L.E., Craft, S., Mintz, A., Heiss, G., Palta, P., Wong, D., Zhou, Y., Knopman, D., Mosley, T.H. and Gottesman, R.F., 2018. Arterial stiffness and dementia pathology: Atherosclerosis Risk in Communities (ARIC)-PET Study. Neurology, 90(14), pp.e1248-e1256.

Hunt, H.A., Van Kampen, S., Takwoingi, Y., Llewellyn, D.J., Pearson, M. and Hyde, C.J., 2017. The comparative diagnostic accuracy of the Mini Mental State Examination (MMSE) and the General Practitioner assessment of Cognition (GPCOG) for identifying dementia in primary care: a systematic review protocol. Diagnostic and prognostic research, 1(1), p.14.

Jacquin-Piques, A., Sacco, G., Tavassoli, N., Rouaud, O., Bejot, Y., Giroud, M., Robert, P., Vellas, B. and Bonin-Guillaume, S., 2016. Psychotropic drug prescription in patients with dementia: nursing home residents versus patients living at home. Journal of Alzheimer's Disease, 49(3), pp.671-680.

Kenigsberg, P.A., Aquino, J.P., Bérard, A., Brémond, F., Charras, K., Dening, T., Droës, R.M., Gzil, F., Hicks, B., Innes, A. and Nguyen, S.M., 2019. Assistive technologies to address capabilities of people with dementia: from research to practice. Dementia, 18(4), pp.1568-1595.

Koyama, A., Hashimoto, M., Tanaka, H., Fujise, N., Matsushita, M., Miyagawa, Y., Hatada, Y., Fukuhara, R., Hasegawa, N., Todani, S. and Matsukuma, K., 2016. Malnutrition in Alzheimer’s disease, dementia with Lewy bodies, and frontotemporal lobar degeneration: comparison using serum albumin, total protein, and hemoglobin level. PloS one, 11(6), p.e0157053.

Lafortune, L., Martin, S., Kelly, S., Kuhn, I., Remes, O., Cowan, A. and Brayne, C., 2016. Behavioural risk factors in mid-life associated with successful ageing, disability, dementia and frailty in later life: a rapid systematic review. PLoS One, 11(2), p.e0144405.

Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S.G., Huntley, J., Ames, D., Ballard, C., Banerjee, S., Burns, A., Cohen-Mansfield, J. and Cooper, C., 2017. Dementia prevention, intervention, and care. The Lancet, 390(10113), pp.2673-2734.

Lowe, V.J., Wiste, H.J., Senjem, M.L., Weigand, S.D., Therneau, T.M., Boeve, B.F., Josephs, K.A., Fang, P., Pandey, M.K., Murray, M.E. and Kantarci, K., 2017. Widespread brain tau and its association with ageing, Braak stage and Alzheimer’s dementia. Brain, 141(1), pp.271-287.

Mileski, M., Topinka, J.B., Brooks, M., Lonidier, C., Linker, K. and Vander Veen, K., 2018. Sensory and memory stimulation as a means to care for individuals with dementia in long-term care facilities. Clinical interventions in aging, 13, p.967.

Paulson, H.L. and Igo, I., 2011, November. Genetics of dementia. In Seminars in neurology. 31(4).pp. 449-460.

Robinson, L., Tang, E. and Taylor, J.P., 2015. Dementia: timely diagnosis and early intervention. Bmj, 350, p.h3029.

Sampson, E.L., Candy, B., Davis, S., Gola, A.B., Harrington, J., King, M., Kupeli, N., Leavey, G., Moore, K., Nazareth, I. and Omar, R.Z., 2018. Living and dying with advanced dementia: a prospective cohort study of symptoms, service use and care at the end of life. Palliative medicine, 32(3), pp.668-681.

Spector, A., Charlesworth, G., King, M., Lattimer, M., Sadek, S., Marston, L., Rehill, A., Hoe, J., Qazi, A., Knapp, M. and Orrell, M., 2015. Cognitive–behavioural therapy for anxiety in dementia: Pilot randomised controlled trial. The British Journal of Psychiatry, 206(6), pp.509-516.

Stein, J., Luppa, M., Kaduszkiewicz, H., Eisele, M., Weyerer, S., Werle, J., Bickel, H., Mösch, E., Wiese, B., Prokein, J. and Pentzek, M., 2015. Is the Short Form of the Mini-Mental State Examination (MMSE) a better screening instrument for dementia in older primary care patients than the original MMSE? Results of the German study on ageing, cognition, and dementia in primary care patients (AgeCoDe). Psychological assessment, 27(3), p.895.

Stirland, L.E., O'Shea, C.I. and Russ, T.C., 2018. Passive smoking as a risk factor for dementia and cognitive impairment: systematic review of observational studies. International psychogeriatrics, 30(8), pp.1177-1187.

Telenius, E.W., Engedal, K. and Bergland, A., 2015. Long-term effects of a 12 weeks high-intensity functional exercise program on physical function and mental health in nursing home residents with dementia: a single blinded randomized controlled trial. BMC geriatrics, 15(1), p.158.