Managing Alzheimers isease

Introduction

The dementia is referred to the term that is implemented for certain nature of symptoms which creates negative effect on the memory of a person. However, Alzheimer’s is referred to the progressive disease which damages the brain cells to slowly lead the individual to lack cognitive functioning and develop impairment of memory. In this assessment, the case study of a person named Mrs Z would be informed who is 70 years of age is currently suffering from Alzheimer’s disease. The patient’s case scenario is to be explained to inform her needs and a care plan is to be framed based on the identified needs where she is allowed independence, self-determination and purposeful activity.

Patient Scenario

A patient named Mrs Z who is 70 years old and a single mother is recently taken to a mental health clinic due to her inappropriate behaviour and improper mental state. The NMC code mentions that the confidentiality of the patient is to be maintained to avoid them from any form of harm or abuse (NMC, 2015). Thus, the pseudonym of the patient is mentioned as his name so that his identity remains confidential. The son took Mr Z because she was showing inability to remember her name as well as fails to recognise her friends. Moreover, she in the past 4 months has reported forgetting his way home 4 times and it has led her to get humiliated many times in the society making her avoid leaving home. Mrs Z’s son reports that her mother for the past few days was forgetting to take meals and has shown decline in the weight. Mrs Z’s son on visiting found that she was seen to be unable to keep proper hygiene and was wearing dirty clothes. (Refer to Appendix 1)

Assessment of patient needs

The key areas of person needs that are to be assessed for Mrs Z are physical status, cognitive ability, social, environmental condition and legal rights. The physical status assessment is referred to determining the efficiency of physical health of the patient (Kim et al. 2016). The physical status assessment of Mrs Z is to be done through physical assessment by the nurses to identify her physical needs. As mentioned by Warmling et al. (2016), maintaining hygiene is one the key physical need of a patient as lack of hygiene leads the individual gets infected by various disease-causing agents. In this context, it is seen that Mrs Z does not maintain proper hygiene and thus one of her physical need is that she is to be supported to wash and bath for maintaining proper hygiene. Mrs Z also expresses physical need to having assistance for cooking and eating which is evident as it is mentioned that she avoids eating often that has resulted her to lose weight. The patients need to maintain a healthy weight through the intake of proper food so that they remain healthy (Cova et al. 2016).

The Mini-Mental State Examination (MMSE) leads to develop a cognitive efficiency score of the patients by using a set of questions to screen the cognitive function of the patients. The MMSE score of 10-18 indicates the person has the moderate cognitive ability (Trzepacz et al. 2015). Mrs Z’s score was 16 which indicate that she has moderate cognitive disability and needs support. The cognitive ability is referred to the mental capability of the person to reason, resolve problem, plan, execute abstract thinking, develop complex idea and learn from experiences (Chapman et al. 2016). In relation to cognitive ability, it is seen that Mrs Z lacks effectively the ability to reason and think. It is evident as she often forgets everyday facts such as way to her home, family and friends she has known for ages and others as well as expresses difficulty in resolving problem with her speech. Thus, it indicates she needs support with memory skills and language development ability.

The social needs of the patient include love, belongingness, friends, family and others (Burgio et al. 2018). The case study of Mrs Z informs that she has faced humiliation in the society due to her recent issues with memory that has led her to remain at home. It indicates that she lacks belongingness and requires support to be socially active. This is because social isolation of Alzheimer’s patients leads them to develop depression which more adversely affects their mental health (El Haj et al. 2016). However, it has been found that Mrs Z’s son is supportive of her condition and this indicates her son needs to be included in her to ensure proper love and respect is shown towards her. The surrounding environment of Mrs Z indicates that she lives alone and requires effective assistance in executing her daily chores. This is evident as her son lives abroad and she is left alone at the home with no one to care for her. Thus, she needs a personal carer who can help in meeting her everyday needs. The Mental Health Capacity Act 2005 informs that the patients suffering from mental health issues are required to be included while planning their care where their preferences are to be considered as well as respected in framing the care plan (legislation.gov.uk, 2005). The Act mentions that Mrs Z is needed to be included in framing her care where her preferences and opinions are to be respected.

Care Planning

The care plan is referred to the documentation of the process of actions that are to be followed to provide effective healthcare assistance to the patients for improving their health and well-being (van der Flier et al. 2017). In order to develop the care plan, the person-centred care approach is to be followed. In the study of Fazio et al. (2018), it is mentioned that person-centred dementia care approach considers six key domains that are holistic care, respect, choice or independence, dignity, self-determination and purposeful living. The independence to the patients suffering from dementia or Alzheimer’s in choosing their care can be provided by explaining them in details the process of different types of care available for them and which would be beneficial for them. This is required as it makes them feel dignified and respected, in turn, helping them live a purposeful life without shame from the illness (Samus et al. 2017). Thus, Mrs Z’s independence of choice in framing the care plan is to be ensured by the nurses by allowing her to choose from care options that are explained in details to her by the nurses so that she can frame informed decision and provide proper consent regarding her care. In order to appoint a carer for Mrs Z, she is to be asked about her preference regarding whom she wishes to deliver her daily care so that the particular person can be appointed.

The self-determination is referred to the process in which the person has their own control of life (Vergallo et al. 2018). In order to ensure Mrs Z achieves self-determination in taking her own care, various assistive technologies are to be included in the care plan by the nurses so that she can take her own care. Moreover, she is to be trained in using the assistive technology so that effective self-determination is reached by her. The devices which allow setting reminders are used for Alzheimer's patients so that they can be able to take their own care without assistance as the devices play alarm and messages to inform patients when to execute which task that they often forget (alzheimers.org.uk, 2018). For example, providing remainder devices that play messages would lead Mrs Z to avoid forgetting when to bath or eat as through messages she can remember when to execute which task. In addition, it would lead her to achieve self-determination of taking her own care without or minimal assistance from carer.

Alzheimer’s Research UK informs that rivastigmine is the medication to be provided to the patients suffering from Alzheimer's to help them develop the controlling cognitive ability and proper memory skills (NICE, 2019). Since Mrs Z is showing lower cognitive ability, she is to be provided rivastigmine to improve her cognitive and memory skills. The medication is to be provided by the carer allocated to Mrs Z and through the use of remainder messages, she is to be informed when to take medication to ensure her self-determination of being able to take own care. The service provider requires interacting with the neighbours and family members of Mrs Z to explain them in details about the reason behind her improper activity. This is because proper education regarding Alzheimer’s would help neighbours and family members understand the impact of the disease as well as show cooperation to interact with Mrs Z which they previously avoided as they though Mrs Z was showing inappropriate behaviour of getting lost purposely. This, in turn, would lead Mrs Z to be able to interact socially making her live a purposeful life where she can share her emotions with others. The nurses require developing a diet chart for Mrs Z to ensure her weight issues as it would lead her to take proper meal to live a healthier life.

Anticipated outcomes of the Care Plan

The care plan being developed for Mrs Z would lead to stabilise and improve her cognitive and memory skills as the medication provided would help in this purpose. Moreover, educating her neighbours and family regarding her condition would lead to resolve her social isolating helping her to live a happy and purposeful life. The care plan would also help her improve her physical health as well as assist her in being able to take her own care through the use of assistive technology.

Conclusion

The above discussion informs that Mrs Z is being currently taken to the mental health clinical by her son as she was showing forgetfulness, inability to maintain hygiene, showing weight issuers and others. The health assessment of Mrs Z informed that her physical needs include weight issues, social needs include improving social and cognitive needs include improving memory and analysis skill. The care plan developed for her is made with a person-centred approach where her self-determination, independence and purposeful living values are focussed.

Looking for further insights on Management of Mental health patient and Discharge planning? Click here.

References

alzheimers.org.uk 2018, How technology can help, Available at:

Arai, T., 2017. Diagnostic Criteria for Alzheimer’s Disease. In Neuroimaging Diagnosis for Alzheimer's Disease and Other Dementias. Springer, Tokyo.

Baker, K.G., 2016. Evaluation of DSM-5 and IWG-2 criteria for the diagnosis of Alzheimer’s disease and dementia with Lewy bodies. Diagnosis, 3(1), pp.9-12.

Burgio, L., Allen-Burge, R., Stevens, A., Davis, L. and Marson, D., 2018. Caring for Alzheimer’s disease patients: Issues of verbal communication and social interaction. The Gerontological Prism: Developing Interdisciplinary Bridges: Developing Interdisciplinary Bridges, p.103.

Chapman, K.R., Bing-Canar, H., Alosco, M.L., Steinberg, E.G., Martin, B., Chaisson, C., Kowall, N., Tripodis, Y. and Stern, R.A., 2016. Mini Mental State Examination and Logical Memory scores for entry into Alzheimer’s disease trials. Alzheimer's research & therapy, 8(1), p.9.

Cova, I., Clerici, F., Rossi, A., Cucumo, V., Ghiretti, R., Maggiore, L., Pomati, S., Galimberti, D., Scarpini, E., Mariani, C. and Caracciolo, B., 2016. Weight loss predicts progression of mild cognitive impairment to Alzheimer’s disease. PLoS One, 11(3), p.e0151710.

El Haj, M., Jardri, R., Larøi, F. and Antoine, P., 2016. Hallucinations, loneliness, and social isolation in Alzheimer's disease. Cognitive neuropsychiatry, 21(1), pp.1-13.

Fazio, S., Pace, D., Flinner, J. and Kallmyer, B., 2018. The fundamentals of person-centered care for individuals with dementia. The Gerontologist, 58(1), pp.10-19.

Kim, M.J., Han, C.W., Min, K.Y., Cho, C.Y., Lee, C.W., Ogawa, Y., Mori, E. and Kohzuki, M., 2016. Physical exercise with multicomponent cognitive intervention for older adults with Alzheimer's disease: A 6-month randomized controlled trial. Dementia and geriatric cognitive disorders extra, 6(2), pp.222-232.

Lam, B., Kim, A., Honjo, K., Lam, I., Kiss, A., Freedman, M., Stuss, D.T., Black, S.E. and Masellis, M., 2016. Diagnostic Disagreement Among Major Consensus Criteria For Alzheimer's Disease When Compared To The NINCDS-ADRD. Alzheimer's & Dementia: The Journal of the Alzheimer's Association, 12(7), pp.P691-P692.

legislation.gov.uk 2005, Mental Health Capacity Act 2005, Available at:

NICE 2019, Final Appraisal Determination Donepezil, galantamine, rivastigmine (review) and memantine for the treatment of Alzheimer’s disease, Available at:

Samus, Q.M., Davis, K., Willink, A., Black, B.S., Reuland, M., Leoutsakos, J., Roth, D.L., Wolff, J., Gitlin, L.N., Lyketsos, C.G. and Johnston, D., 2017. Comprehensive home-based care coordination for vulnerable elders with dementia: Maximizing Independence at Home-Plus—Study protocol. International journal of care coordination, 20(4), pp.123-134.

Trzepacz, P.T., Hochstetler, H., Wang, S., Walker, B., Saykin, A.J. and Alzheimer’s Disease Neuroimaging Initiative, 2015. Relationship between the Montreal Cognitive Assessment and Mini-mental State Examination for assessment of mild cognitive impairment in older adults. BMC geriatrics, 15(1), p.107.

van der Flier, W.M., Kunneman, M., Bouwman, F.H., Petersen, R.C. and Smets, E.M., 2017. Diagnostic dilemmas in Alzheimer's disease: Room for shared decision making. Alzheimer's & Dementia: Translational Research & Clinical Interventions, 3(3), pp.301-304.

Vergallo, G.M., Cisale, G., di Luca, N., Marinelli, E. and Zaami, S., 2018. Informed consent to research trials on Alzheimer's disease: How to foster research without infringing upon the patient's right to self-determination. Pharmacological research, 132, pp.69-71.

Warmling, A.M.F., Santos, S.M.A.D. and Mello, A.L.S.F.D., 2016. Home-based oral healthcare strategies of elderly people with Alzheimer's disease. Revista Brasileira de Geriatria e Gerontologia, 19(5), pp.851-860.

Appendix 1:

The DSM-5 criteria were used to diagnose the condition of Mrs Z. The DSM-5 criteria are mainly used for identifying the mild neurocognitive disorder. The patient to meet DSM-5 criteria for Alzheimer's disease require to meet mild or major cognitive disability and need to show the onset of in at least two cognitive domain (Lam et al. 2016; Arai, 2017). The key signs seen in patients with moderate Alzheimer’s include mood swings, inability to form speech, memory issues, unable to maintain hygiene and others (Baker, 2016). In case of Mrs Z, it is seen that she expresses most of the signs related to Alzheimer’s disease and as mentioned in DSM-5 she expresses memory decline as well as inability to form speech as two key cognitive inabilities which indicates that she is actually suffering from Alzheimer’s disease.