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COMPLEX CARE NEEDS ON DEMENTIA
| Subject | Nursing | Pages | 18 | Style | APA |
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Abstract
Dementia is one of the serious mental health concerns affecting the older population, particularly people aged 65 years and more. This paper explored the complex care needs on dementia with a primary focus on the Leicester and the Leicestershire communities. To have a proper understanding of the topic, a definition of dementia as a long-term condition was provided. It was established that dementia is a mental health condition associated with other concerns such as the Alzheimer’s disease. It was also revealed that dementia is increasingly becoming a major health concern since it is associated with increased death rates in comparison to heart disease. A demographic and epidemiological profile was also completed on dementia with a primary focus on the Leicester and Leicestershire regions. It was established that Leicester is mainly composed of people aged below 35 years while Leicestershire has a population of mainly older people. As a result, it was revealed that the cases of dementia are higher in Leicestershire than in Leicester. The epidemiological profile established that the prevalence rate of the condition is mainly higher among the older people. The study also revealed that the community and different agencies have a role to play in caring for the dementia patients. Evidently, when different agencies collaborate, the carers are offered with support on how to offer effective care to the affected population for a better health outcome. The study also pointed out that patients with dementia have varied met and unmet needs which were established after Maslow Hierarchy of Needs framework was implemented. As a result, the nurses roles in caring for the patients were revealed with one of the strategies identified include the use of holistic nursing approach to care. Patient education was identified as an effective strategy and recommendation which should be implemented to offer care to the people with dementia for a better patient outcome.
Keywords: Dementia, Holistic Approach, Alzheimer’s disease
Contents
Long Term Condition Definition. 5
Demographic and Epidemiological Profile. 6
Importance of Community Services. 8
Health Needs Assessment of Dementia Patients. 10
Nurses Roles and Interventions. 11
Self-Managing Long-term Conditions. 12
Current Legislation and Partnership. 13
Appendix 1: Chart: Dementia Cases in Leicester and Leicestershire. 21
Appendix 2: Figure: The Estimated number of people living with Dementia. 21
Introduction
Dementia is one of the mental health conditions affecting mainly people in their old age. The condition is the leading cause of death and hence regarded as a factor of national priority (Naharci, Buyukturan, Cintosun, Doruk & Tasci 2019). Dementia is increasingly growing to be a significant health concern. The condition, which is also inclusive of Alzheimer’s disease, is considered serious since the situation has now overtaken heart disease cases and has now become the leading factor resulting to death in Wales and England (Hae-Young, Ji-Won, Song, Sohn & Jin-Won 2017). Different health organisations such as the World Health Organisation (WHO) has established strategies focused on controlling the impacts of the disease and encouraging those affected to live better (West Leicestershire Clinical Commissioning Group 2019). Different reforms have been established with a primary aim of achieving this functionality by the end of 2020 (West Leicestershire Clinical Commissioning Group 2019). The strategies included in the reforms detail the shared vision and offers support to people living with the disease as well as those focused on offering care to the affected (Mogi 2019). This paper presents a report on the complex care needs of the people with dementia. To achieve this functionality, Maslow’s Hierarchy of Needs framework will be included to establish the met and the unmet needs of the people in the population. However, to generate a better understanding of the topic, several definitions of dementia as a long-term condition will be provided. Subsequently, demographic and epidemiological profile of dementia will also be explored with the context of the Leicester and the Leicestershire population. In addition, the importance of the community services in addressing the challenges associated with dementia will also be provided. Later, a health needs assessment is completed on the population of the patients diagnosed with dementia. Other factors such as the role of the nurses in offering care to the dementia patients is also explored and the recommendations to improve of self-care and proper management strategies documented.
Long Term Condition Definition
Dementia is one of the long-term mental health conditions affecting a patient’s mental health. Dementia is characterised by loss of memory, problem-solving, language and other thinking abilities which becomes severe to a point that it interferes with a person’s daily life (Alzheimer’s Association 2020). Dementia is a general term such as heart disease that includes a wide range other specific medical conditions including Alzheimer’s disease (Alzheimer’s Association 2020). The disorders falling under the term “dementia” arise from abnormal changes in the brain which further results to a decline in the thinking skills capabilities of the affected person. The abilities are severely affected to a point that they could influence a person’s independent functionality in the daily life (Gronewold, Haensel, Kleinschnitz, Frohnhofen & Hermann 2019). Moreover, the changes can also be severe to a point that the affected person’s feelings, behaviour and relationships are also negatively affected (Alzheimer’s Association 2020).
The National Institute of Aging (NIA) defines dementia as the loss of the cognitive functioning capacities, such as reasoning, remembering and thinking (NIA 2020). Dementia is also considered as the loss in a person’s behavioural abilities to a point that the individual’s daily life and activities are drastically affected. The functions include visual perception, self-management, problem solving, and the ability to pay attention and focus (NIA 2020). Some of the people diagnosed with the condition find it difficult to control their emotions and they may experience a change in their personalities (NIA 2020). The presenting symptoms of the disease determine its severity range. For instance, at the mildest stage, the person’s functioning is still intact with slight pointers on the changes experienced on this skill. At the most severe phase, the affected person has lost almost all of the basic activities and functioning of life (NIA 2020). According to Gkioka, Tsolaki, Papagianopoulos, Teichmann and Moraitou (2020), dementia is considered as a significant public health concern as a result of its longer life expectancy as the limited scope of efficient therapeutic strategies established to address the condition.
Demographic and Epidemiological Profile
Demographic Profile
In Leicester, approximately 991 males and 1,835 females aged 65 or more are estimated to have dementia at a provided time (Leicester City Council 2016). Out of this, 1,794 are likely to suffer from Alzheimer’s disease, 492 likely to be diagnosed with vascular dementia, and 289 assumed to suffer from a blend of vascular dementia and the Alzheimer’s condition. The statistics presented by the Leicester City Clinical Commissioning group provides that there are approximately 2,340 present on general practice registers available in Leicester who have been diagnosed with dementia (Leicester City Council 2016). Moreover, it is projected that approximately 790 new dementia cases are reported on an annual basis in Leicester (Leicester City Council 2016).
West Leicestershire Clinical Commissioning Group reports that in Leicestershire and Leicester combined, approximately 13,372 people live with dementia (West Leicestershire Clinical Commissioning Group 2019). The number is expected to rise by the end of 2025 to 16,969. Out of the presented number of people with dementia, 269 are known to have an early onset of the condition (West Leicestershire Clinical Commissioning Group 2019). In Leicestershire, one in every 14 people in the population of people aged more than 65 years suffer from dementia. In Leicestershire alone, 9,642 people are known to be living with the condition (West Leicestershire Clinical Commissioning Group 2019). Out of this value, 9,458 are individuals aged more than 65 years which constitutes approximately 6.78% of this population. In Leicester, 3,026 people are believed to be suffering from dementia. Out of this figure, 2,951 are aged more than 65 years thus constituting 7.07% of the population (West Leicestershire Clinical Commissioning Group 2019).
Looking at the demography of Leicester, it is evident that the average age of the people is 35 years with a median age of 31 years (Local Stats UK 2011). The larger percentage of the population is composed of people aged less than 35 years. The demography of Leicestershire provides an indication that the average age of the people is 39.5 years. The largest portion of the population is more than 70 years (Plumplot 2018). This suggests that the prevalence rate of dementia will be higher in Leicestershire than in Leicester since old age is one of the risk factors of the disease (Rizzi, Rosset & Roriz-Cruz 2014). The Chart in Appendix 1 below provides an illustration showing that the cases of dementia are higher in Leicestershire than in Leicester.
Epidemiological Profile
The prevalence rates of dementia increases swiftly rises by about 3% among people aged 70 to 75 years to approximately 25% for those aged more than 85 (Rizzi, Rosset & Roriz-Cruz 2014). Above the age of 85, a limited data exists to provide an affirmation whether the prevalence rates of the condition continues to rise or remains constant after the age of 85. In old age, it is highly likely that women will suffer from dementia in comparison to men (Eriksson et al. 2018). This value is reflected by the fact that there is an age adjusted increased risk of the development of Alzheimer’s disease (Akinyemi, Allan, Oakley & Kalaria 2017). Cultural and economic factors are some of the considerations which influence the prevalence rates of dementia. Looking at the projections provided by the World Health Organisation, it is evident that by 2025, approximately 75% of the population of people aged more than 60 years will be living in developing society and that the people affected with dementia will have doubled between 2020 and 2040 (Rizzi, Rosset & Roriz-Cruz 2014). In this case, it is evident that age is the primary risk factor for dementia. Figure 2 in Appendix 2 below provide an outlook of the estimated number of people who will be living with dementia on a global basis.
Importance of Community Services
The fact that people with dementia lose their ability to handle daily their daily task especially in critical scenarios provides an indication that carers should be available to offer assistance to the affected. In most cases, the relatives of the people living with dementia take the responsibility of offering care which normally turns out to be highly demanding and stressful unlike when offering care to cognitive deficit patients (Bieber, Nguyen & Meyer 2019). Multi-agency working when offering care to the people with dementia is important. Notably, when the members of the family work together with other bodies, including the Alzheimer’s Society, they are exposed to an environment where they can achieve support and advice. This is fundamental towards ensuring that they offer effective care to the affected without jeopardizing their health or safety (Lee et al. 2020). Moreover, working alongside social workers as well as the continuing health care nurse assessor is also beneficial as it makes it easier to assess the patient needs and then determine where support should be offered for a better patient outcome (Renehan, Goeman & Koch 2017). Therefore, the multi-agency workings are beneficial since they offer support and advice which are effective towards improving the patient’s outcomes (Curie 2017).
A carer has several fundamental roles to play to improve the dementia patient’s outcome. For instance, it is the responsibility of the carer to assist the affected person with daily tasks. Mescal (2018) states that during the early stages of the condition, a person has the ability to enjoy life in the same manner as they did before their diagnosis. However, as the condition worsens, one may feel stressed, anxious and scared and may forget important things. In this case, the carer has the obligation of offering support to the affected to maintain their abilities and skills of an active social life (Seidel & Thyrian 2019). The carer is also expected to assist the patient with maintain a positive lifestyle such as eating a healthy balanced diet to avoid other secondary health concerns likely to arise in this case (National Health Society, 2018). Additionally, the carer has the responsibility of ensuring that the patient maintains a proper hygiene for improved outcomes (Wang et al. 20180. Over statutory, private and voluntary agencies, such as the Alzheimer’s Society can also play a fundamental role in this case. For instance, the Alzheimer’s Society can offer advice about the best course of action or support that should be offered to the patient to improve their life outcomes (National Health Society 2018).
Martin, O’Connor and Jackson (2018) show that the primary gap in the provision of care for dementia patients includes the non-person-centred care pathways which are fragmented, difficult to navigate and confusing. This has made the situation worse for the patients as most of them end up inappropriate care settings whereby they experience poor care services risking their health outcomes (Siobhan et al. 2017). Health care inequalities are also experienced due to ineffective policies whereby the low-income earners are excluded from insurance policy covers which prevent them from securing quality care services (Martin, O’Connor & Jackson 2018).
Health Needs Assessment
Maslow’s Theory of Need
Maslow’s Hierarchy of Needs’ theory provides that people have five levels of needs and they focus their effort on ensuring that their unmet needs are fulfilled. Physiological needs are established at the bottom of the hierarchy suggesting that they should first be satisfied before fulfilling the others. The psychological needs are followed by safety, social, esteem, and finally the self-actualization needs (Acevedo 2018). The Maslow’s hierarchy of needs theory was identified for the patients with dementia since it has a great potential of establishing the met and the unmet care needs of the old people in Leicester and Leicestershire.
Evidently, it is a fact that the needs of the people diagnosed with dementia are not always met, especially in acute care settings. This is mainly accrued to the fact that the needs of this population are under-recognised and unobserved mainly due to lack of effective communication (Greenwood & Smith 2019). However, through the implementation of the Maslow’s Hierarchy of Needs theory, it becomes simple to recognise the need since the framework makes it possible to categorise the needs at varied levels (Scerri, Scerri & Innes 2018).
Health Needs Assessment of Dementia Patients
Patients diagnosed with dementia in Leicester and Leicestershire have several needs. Mazurek, Szczesniak, Urbanska, Droes and Rymszewska (2017) report that the most common unmet needs of the members of this population include psychological distress, lack of company, and reduced daytime activities. The completed study reported that 31.9% of patients with dementia considered their psychological distress as one of the most common unmet need which affected their comfort and patient outcomes. Lack of company was reported by 29.8% of the patients and 25.5% complained that failure to experience daytime activity was also a primary factor which affected their outcomes (Mazurek, Szczesniak, Urbanska, Droes and Rymszewska 2017).
Scerri, Scerri and Innes (2018) relayed that the basic unmet needs displayed by patients with dementia includes lack of comfort, continence, drinking, feeding and toileting. Moreover, the greatest gap which was recorded between the met and the unmet needs was recorded in patients who were being observed constantly or those who were not able to engage in effective communication (Zwingmann, Michalowsky, Esser, Kaczynski, Monsees, Keller, Hertel, Wucherer, Thyrian, Eichler, Kilimann, Teipel, Dreier Wolfgramm & Hoffmann 2019). Further, Scerri, Scerri and Innes (2018) noted that greater emphasis was provided on what the staff members considered as safety needs at the expense of the needs of the other patients in the facility. However, the need for boosting the patient self-esteem levels and the improving their social contact was neglected such as the desire to enhance their respect and dignity. This factor resulted to an increased feeling whereby the patients felt devalued (Scerri, Scerri & Innes 2018). According to Maslow’s theory, when one level of needs is not satisfied, a person will always end up feeling demotivated. This explains why the failure to satisfy the dementia patient’s needs resulted in a situation whereby the patients felt devalued while in the critical care facility. Cohen-Mansfield, Dakheel-Ali, Marx, Thein and Regier (2015) established that the major factor that contributes to the unmet needs among the patients with dementia is lack of communication.
Nurses Roles and Interventions
Nurses have an effective role to play in caring for the dementia patients to ensure that their needs are met for a better outcome. For instance, it is the obligation of the nurse to engage in effective observation of the patient’s vital signs suggesting dementia. After observing, the nurse has a duty to report to the relevant professionals and agencies to ensure that the patient gets the requisite care required so that all fundamental needs of the patient are met (Bickford, Daley, Sleater, Hebditch & Banerjee 2019). Other than being observant, the nurses have the role of ensuring that they are empathetic to the patients and their families (Nursing Times 2016).
One of the effective strategies that the nurses can consider implementing in this case includes holistic nursing care approaches. In this case, the nurses will not only empathize with the patients but also educate them on the importance of self-care strategies, especially for the patients who are not yet in the critical phase (Zamanzadeh, Jasemi, Valizadeh, Keogh & Taleghani 2015). Under holistic care, the nurses can also consider management system strategies. In this case, the professionals will be in a position where they can consider assisting the patients by reminding them that it is time to clean up as most of them, especially those in the critical phase, forget about important activities which they should accomplish (Zamanzadeh et al. 2015).
Self-Managing Long-term Conditions
People can be empowered to engage in self-management of their long-term conditions through patient education. Evidently, when the patients or the immediate family members are trained about how they can manage long-term conditions, chances are higher that they will do it accurately and religious for a better patient outcome (Vassilev, Rogers, Kennedy, Wensing, Koetsenruijter, Orlando, Portillo & Culliford 2016). The education can be offered by nurses before the patients are discharged or by voluntary organisations seeking to train the members of the community about how to achieve this functionality (Ryan 2014).
Current Legislation and Partnership
In Leicester, different types of legislation have been established to encourage the administration of effective care to the people with dementia. The Equality Act of 2010, applicable in the Leicester and Leicestershire, is focused on supporting the carers who are at work as well as persons taking care of people with dementia. The legislation considers the fundamental role of the cares as well as the challenges they experience as they offer care to the dementia patients. The legislation safeguards dementia care by enhancing the protection offered to the carers against acts of discrimination in the healthcare environment as well as when accessing other societal services. Evidently, the Equality Act of 2010 prevents the carers from harassment and discrimination because of their caring responsibilities (People First, 2020).
Social care, local health and voluntary care organisations in Leicester and Leicestershire have established partnerships to ensure an improvement towards the delivery of a more personalised and integrated care as required by the Dementia Strategy 2019-2022. The NHS England Well Pathway for Dementia is an example of such partnership which focuses on ensuring efficiency in the delivery of dementia care in Leicester and Leicestershire (National Health Society, 2018).
Conclusion
Conclusively, dementia is one of the primary mental health conditions that affect mainly people in their old age. Dementia is associated with several signs such as the loss in memory and the ability to engage in critical thinking and effective problem solving capabilities. Dementia is not considered as a disease but as a medical condition which is associated with the development of other diseases such as Alzheimer’s disease. The disease can exist in different stages depending on its critical levels. The signs and symptoms presented by the patient will determine the phase of the disease in which a patient exists in and the type of intervention to be considered. In severe cases, the affected person lacks the ability to think and hence the independent functionality becomes disrupted thus calling for the need of a carer’s services. Demographic factors provide an indication that old age is one of the risk factors of the condition. Evidently, in places such as Leicestershire, the population is majorly composed of older people in comparison to Leicester. As a result, the number of dementia cases recorded in Leicestershire is significantly higher than in Leicester. Collaborating to offer care is regarded as an effective strategy which ensures that the needs of the people with dementia are effectively met. Evidently, through such collaboration efforts, the carers are advised about how to cater for the needs of the affected to improve the patient outcomes.
Despite the fact that families are carers always offer care to the members of the population, it is evident that not all needs are met effectively leaving the patients feeling devalued. Therefore, it is recommended that free training sessions should always be offered to the immediate family members and patients at the first stages of the disease of care strategies. This will be effective in empowering the carers to close the gap in the unmet needs for an effective outcome.
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References
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