...Dementia and Palliative Care Thomas Edison State College Introduction According to the Palliative Medicine article “global prevalence of dementia is almost 36 million people and the numbers are expected to double every 20 years (Ryan, Gardiner, Bellamy, Gott & Ingleton, 2011). With this in mind, in seems dementia is just as prevalent as cancer but these patients do not seem to receive the same end of life care or palliative care. The World Health Organization defines palliative care as An approach that improves quality of life in patients and families facing problems associated with life threatening illness, through prevention and relief of suffering by means of early identification, impeccable assessment and treatment of pain and the problems with physical, psychosocial and spiritual. ("Who definition of," 2013) The two article summaries that follow will help healthcare staff understand the great need for palliative care in dementia, from the diagnosis to death. Annotated Bibliography Ryan, T., Gardiner, C., Bellamy, G., Gott, M., & Ingleton, C. (2011). Barriers and facilitators to the receipt of palliative care for people with dementia: The views of medical and nursing staff. Palliative Medicine, 26(7), 879-886. doi: 10.1177/0269216311423443 Tony Ryan and colleagues discuss how “people with dementia often receive too little care whereas end of life care is often characterized by too much” (Ryan, Gardiner, Bellamy, Gott &...
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...and/or demented patients and pain control. I believe this needs to be changed because although we have an initial assessment protocol, we do not have any kind of protocol to control a geriatric or demented patients pain. Since demented patients are quite often left unable to communicate their feelings, I believe there would be, less adverse effects and better patient outcomes for this group of people and better satisfaction with their families. B There are many people associated with proposing the change within the facility. First would be to go through the assistant nurse manager and nurse manager who would then bring the proposal to the nursing and medical directors for the ER. The ANM and NM would have to decide whether the proposed change would be beneficial for the patients and their outcomes and do further research which they would then propose to the directors. From there, they would decide whether the research was sufficient enough to implement a change. C Full APA citation for at least 5 sources | Evidence Strength (1-7) and Evidence Hierarchy | 1. H., Bell, J., Karttunen, N. M., Nykänen, I. A., M., & Hartikainen, S. A. (2013). Analgesic Use and Frailty among Community-Dwelling Older People. Drugs & Aging, 30(2), 129-136. doi:10.1007/s40266-012-0046-8 | 2 and Experimental | 2. Haasum, Y., Fastbom, J., Fratiglioni, L., Kåreholt, I., & Johnell, K. (2011). Pain Treatment in Elderly Persons With and Without Dementia. Drugs & Aging, 28(4),...
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...older patients is due to the vast array of problems created by advanced dementia. A variety of these problems may also be of concern as they arise from the primary disease and may include end of life care for a shorter period, communication problems due to dementia or plain misunderstanding and even chances of lack of family motivation (Blackburn, 1989). The elementary design of palliative care is to provide bodily, mental and spiritual support to the family and patient to facilitate the life quality until expiration (Australian Government Department of Health and Ageing, 2004). In the initial phases of the diseases, palliative care can be imbued with prolonging treatments (WHO, 2003) and it is not intended in any way to either accelerate or reduce the dying timeline but is meant to alleviate distress by lessening pain and other factors that result in it (WHO, 2003). It is vital that preliminary diagnosis, evaluation and therapy of pain and various other requirements such as bodily, traditional, social, spiritual and mental requirements be tended to for the accomplishment of palliative methodology (WHO, 2003). It is proper to start the palliative care in the scenario when the illness has been proven to be incurable and the care of the patient according to the symptoms is specific (Australian Government Department of Health and Ageing, 2004). Symptoms of advanced dementia, termed also last stage dementia include confused or memory failure, unresponsiveness to verbal communication...
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...Person with Dementia With Lewy Bodies. The purpose of this article is to use a single study participant to show the effectiveness of the STOMP intervention with a person with dementia with Lewy bodies (DLB). The STOMP intervention is skill building through task oriented motor practice which could be used in future occupational therapy treatments. This is a client centered mixture of task oriented training and motor learning concepts. The intervention was performed because of a lack of evidence based interventions in Lewy body dementia. Even though the impact of the functional limitations within the sufferers is large, treatment in altering or diminishing the losses is not fully studied as...
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...The aim of this assignment is to explore challenging behaviour in the person with dementia. As it is outside the scope of this assignment to explore all the potential reasons for challenging behaviour, the focus of this assignment will be on challenging behaviour in the context of the communication of pain, using a case study to illustrate this. This assignment will describe challenging behaviours, the behaviours associated with pain, and the management strategies employed by nursing staff, using a person-centred approach to care. Finally, ways of improving the care provided will be explored and recommendations made. The rationale for choosing to discuss this issue is that I currently work as a staff nurse on an organic assessment ward, and am frequently involved in caring for people with dementia who present with challenging behaviours that are difficult to manage in the community setting. There are currently 750,000 people with dementia in the UK. As the UK’s population grows, there will be substantial increases, and it is estimated that there will be 940,000 people with dementia by 2021, rising to over 1.7 million by 2051. Alzheimer’s disease is the most common form of dementia (Alzheimer’s Society, 2010). Gogia and Rastogi (2009) describe Alzheimer’s disease as a progressive illness, where there is a decline in almost all functions, including memory, movement, language and communication skills, behaviour, judgement and abstract reasoning, and the ability to carry out...
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...Following the morning rounds, I was reviewing some daily routines with my preceptor in her busy dementia Unit. Suddenly, the RPN is working on the floor, knocked at the door with a worried expression on her face. Consequently, we stopped what we were doing and paid attention to her problem. Stressed about a resident, she reported sudden onset of agitation and anxiety when this resident was getting assistance for toileting in her bathroom. As reported by the front line staff, the resident shook his fist at the mirror and was about to break it with her hair brush. However, we find out later that, the resident was thinking that her daughter is “trapped inside” the mirror and she was attempting to get her daughter out. To address the emergency...
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...For the pass this assignment will describe the investigations that are carried out to enable the diagnosis of these physiological disorders. For the merit this assignment will assess possible difficulties involved in the diagnosis from their signs and symptoms. P3 There are a range of tests and diagnostic procedures is needed to diagnose dementia, but there are several that are fairly commonly used to diagnose dementia. A GP might refer a person to a specialist to help with the diagnosis. For example, they may be referred to a clinical psychologist which is a healthcare professional who specialises in the assessment and treatment of mental health conditions. Another specialist who the GP might refer someone to is a psychiatrist and they are qualified medical doctor who has further training in treating mental health conditions. The specialist may be based in a memory clinic alongside other professionals who are experts in diagnosing, caring for and advising people with dementia and their families. A specialist will usually assess the mental abilities using a special questionnaire and one that is widely used is the mini mental state examination (MMSE). This involves being asked to carry out activities such as memorising a short list of objects correctly and identifying the current day of the week, month and year. However the MMSE is not used to diagnose Alzheimer's disease, but it is useful for assessing the level of mental impairment that a person with the condition may have...
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...alzheimers.org.uk Unusual behaviour As dementia develops, it can cause behaviour changes that can be confusing, irritating or difficult for others to deal with, leaving carers, partners and family members feeling stressed, irritable or helpless. By learning to understand the meaning behind the actions, it can be easier to stay calm and deal effectively with the challenges that arise. This factsheet outlines some typical sorts of unusual behaviour in people with dementia and explains some common causes. Each person is an individual, with their own preferences and character traits. However, certain forms of behaviour are particularly common in people with dementia. If the person you are caring for has difficulty expressing him or herself in words, the unusual behaviour may become more extreme. By working out what each behaviour means, and finding ways to overcome the problem, the situation can become more manageable. Common types of unusual behaviour Repetitive behaviour People with dementia often carry out the same activity, make the same gesture, or ask the same question repeatedly. Medical professionals sometimes call this ‘perseveration’. This repetition may be because the person doesn’t remember having done it previously, but it can also be for other reasons, such as boredom. It is not unusual for a person with dementia to go through the motions of the activity they may previously have carried out at work. 1 This can indicate a need to be occupied...
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...forearm or shoulder when sitting with the patient, or speaking in a soft and kind tone while addressing the patient are only a couple of measures that can be taken in an attempt to encourage adherence (Gueguen, Meineri, & Charles-sire, 2010). There is, however, a much different approach to patient medication when in hospice care. In the hospice environment, medications to treat a disease or condition are halted. Only medication that give the patient relief from pain and discomfort are administered under the direct care of a physician; however, nurses are given quite a bit of autonomy when it comes to administering medication if he/she sees the patient is still in considerable pain and discomfort (Jerayaman, Kathiresan, & Gopalsamy, 2010). The purpose of hospice care is to provide a pain free, comfortable, and dignified death, by providing relief of symptoms, not to treat conditions or prolong life (Jerayaman, Kathiresan, & Gopalsamy, 2010). There are, however, those who do not seek pharmacological relief from pain, whether for religious or personal reasons. For those, there are alternative...
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...individuals perceive pain to a lesser degree or that sensitivity is diminished. Although pain is a common experience among individuals 65 years of age and older, it is not a normal process of aging. Pain indicates pathology or injury. Pain should never be considered something to tolerate or accept in one's later years. Unfortunately, many clinicians and older adults wrongfully assume that pain should be expected in aging, which leads to less aggressive treatment. Older adults have additional fears about becoming dependent, undergoing invasive procedures, taking pain medications, and having a financial burden. The most common pain-producing conditions for aging adults include pathologies such as arthritis, osteoarthritis, osteoporosis, peripheral vascular disease, cancer, peripheral neuropathies, angina, and chronic constipation. People with dementia do feel pain. The somatosensory cortex is generally unaffected by dementia of the Alzheimer type. Sensory discrimination is preserved in cognitively intact and impaired adults.1 Because the limbic system is affected by Alzheimer disease, current research focuses on how the person interprets and reports these pain messages.24 See further discussion on pain assessment with dementia on p. 170. Gender Differences Gender differences are influenced by societal expectations, hormones, and genetic makeup. Traditionally, men have been raised to be more stoic about pain and more affective or emotional displays of pain are accepted for women...
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...PAIN MANAGEMENT Level 6 The purpose of this assignment is to identify a client group and discuss the current pain management strategies used to assess pain in the selected client group. This assignment will explore and discuss the pain management strategies adopted in the clinical area to meet the needs of this client group. At the same time one pain, management strategy will be chosen critically evaluated and explored in light of the available evidence. The final part of the assignment will identify the improvements that need to introducing in the clinical area, in order to improve the management of pain. The student of this assignment works on a busy medical ward admitting both young and elderly patients with acute and chronic pain. However, most of the patient’s admitted to unit have dementia. The British Pain Society (2010) states that, “pain is under recognised and undertreated in older people,it is a subjective personal experience only known to the person who suffers”. Dementia is said to be caused by a variety of conditions with a complex of symptoms characterized by progressive global deterioration of cognitive functioning. Patterson et al (1999). The chronic pain coalition ( 2007) states that poor pain management impacts on quality of care and recovery and patients’ morbidity and mortality resulting in prolonged hospital stay coupled with economic implications for the health service. Pain has many defintionss have defined pain differently, the International...
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...Music Therapy: Different Ways Music Can Help Heal People. When dealing with emotions, we all have ways to escape from the stresses of life. One of the most common ways of escaping from our stress is through music. Music can sometimes have a very calming and soothing quality to it. Other times music can inspire us and pump us up for certain situations in our lives. Music is also used as therapy for illnesses. Whether their illness is a psychological disorder or cancer, music has been proven to ease some of the symptoms that these people may have. People who are suffering from any kind of illness are under tremendous stress, confusion, and sometimes they can feel lost. Music therapy can help with all of these problems. Music has been used in medicine for thousands of years. Ancient Greek philosophers believed that music could heal both the body and the soul. Native Americans have used singing and chanting as part of their healing rituals for millennia. The more formal approach to music therapy began in World War II, when U.S. Veterans Administration hospitals began to use music to help treat soldiers suffering from shell shock and to help cope with the tragic events they witnessed during that time. In the remainder of this paper I will be discussing music therapy and the effects it can have on people that are suffering from an illness. Music therapy is becoming a very common practice around the world. In 1944, Michigan State University established the first music therapy...
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...hypertension, and urinary incontinence (UI). She is receiving carbidopa/levodopa, pramipexole, selegiline, tolterodine, diazepam, metoprolol, and hydrochlorothiazide. When she comes to your pharmacy to get her prescriptions, she walks slowly with a cane, and she is stooped over. 1. Identify age-related pharmacokinetic and pharmacodynamic changes in older people. 2. Evaluate the pharmacotherapy regimens of older people to support the maintenance of optimal physical and mental function. 3. Identify inappropriate medication prescribing in older people. 4. Recommend appropriate pharmacotherapy for patients with dementia. 5. Evaluate the risks and benefits of the use of antipsychotics (APs) (including atypical APs) in older patients with dementia. 6. Recommend appropriate interventions for patients suffering from behavioral symptoms related to dementia. 7. Identify the types of urinary incontinence and recommend appropriate treatments. 8. Given a patient’s American Urology Association Symptom Index for benign prostatic hyperplasia, recommend appropriate therapy. 9. Recommend appropriate analgesic therapy for older patients with osteoarthritis. 10. Discuss risks and benefits of medication classes used to treat rheumatoid arthritis. 2. Which of the following is the single most important intervention you can make to reduce her risk of falls? A. Suggest to J.T. that her neurologist reassess her Parkinson disease...
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...When assessing pain in dementia patients in an acute setting, nurse-patient relationship is most important. Nurses must be able to understand and respond to a patient with dementia, and remember they are a person and not a disease. Nurses can find it difficult to engage with dementia patients as it is challenging and emotionally upsetting for both them and the patient themselves (Leach, M. J. 2005). The nurse patient relationship must encompass three important aspects of care: physical, psychological and emotional care (Pelzang, 2010). Communication with dementia patients is important and again comes with challenges, nurses need to be sensitive, patient and be aware of the needs and abilities of each individual to provide the best possible...
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...The Devastation of Dementia: Pathophysiology and Case Study Introduction Relatively little is known about dementia, a disease which affects over 35 million people worldwide (Norton, et al., 2012). Early signs and symptoms may be confused with the “normal” aging process. Those with the disease often try to cover up their mental decline in the early stages, making early diagnosis even more difficult. Educating the medical community and the general population about the signs, symptoms and causes of dementia is an important step in seeking out a cure for this fatal disease. Dementia is a general term for a syndrome that is progressive in nature and is marked by deterioration in cognitive function that is greater than what would normally be expected. There are many types of dementia, the most common of which is Alzheimer’s Disease. Alzheimer’s Disease accounts for over 60% of the cases of dementia. Vascular Dementia is the second most common form. Others include Lewy Body Dementia, Parkinsonian Dementia, and Frontotemporal Dementia. There is no cure for any type of dementia, although there are treatments that help lessen the symptoms. Dementia is a progressive disorder and always results in death, either from complications such as falls" or pneumonia or the dementia itself. The number of people with dementia worldwide is expected to reach over 115 million by the year 2050. The current cost of treating dementia is over 1.5 times that of all cancers combined (Hurd...
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