Dementia and Alzheimer’s Disease, Essay Example

Introduction

One of the first steps in providing a community assessment of the chosen population is to a comprehensive assessment of the chosen community. This is accomplished using the windshield survey, which is conducted by making observations visually from a driving car through the neighborhood. Windshield surveys can be used in conjunction with walking surveys that can systematically observed on foot, each can be appropriate in understanding the general community and the specific aspect or condition of it. Data collection and valuable information acquired during the windshield survey can be utilized to highlight the health-related needs of the community chosen, and examine the need for additional health services and resources for the communities. In understanding the chosen community of dementia and Alzheimer’ this paper will examine the condition, nature, and age of the community’s available facilities, infrastructures, and the absence of presence of function care faculties. In addition, the use, condition, and location of available resources, and other essential components that will be used in assessing the needs of the community. The windshield theory will be conducted using the quantitative data that will be supported by the direct qualitative observations that will help to reveal the issues within the community.

Dementia is an encompassing term in which consist of a group of the cognitive illnesses that are typically regarded for difficulty in the domains of object recognition, motor activity, language, memory impairment, and the disturbance of execution function, that includes the ability to abstract, organize, and plan. For patients that are diagnosed with dementia, they are generally older individuals, which can also be diagnosed for Alzheimer disease, a common form. For Alzheimer patients it is a progressive disease of the brain, in which people start by losing parts of their memory, then progresses to thinking ability, decision making, lack of capability to perform daily activities, and recognize love ones.  Dementia and Alzheimer’s disease are serious syndromes in which affect over 47.6 million people around the world, and annually have over 7 million new cases. (WHO, 2015) Dementia and Alzheimer is one of the major causes of dependency and disability among older people throughout the world. Dementia has serious impact on society, families, and caregivers, economically, socially, psychologically, and physically. What is critical to the community is there is often a lack of general awareness and understanding of dementia and other disorders that result in barriers and stigmatization to care and diagnosis. The underlying issues is that it is the only cause of death for United States’ top ten that cannot be slowed, cured, or prevented. Almost two-thirds of Americans that are diagnosed with Alzheimer’s disease are women, and just about one in three senior citizens die of Dementia or Alzheimer’s. (ALZ, 2015)

In the United States Alzheimer’s disease ranks as the sixth leading cause of death, but only 45 percent of people, including their caregivers are told of their diagnosis, which leaves over half not aware of their diagnosis. That leads to increase in hospital costs in which doctors have either misdiagnosed or not diagnosed them, in which Alzheimer and other dementias will cost the US over $225 billion, with costs expected to rise to $1.1 trillion by 2050. (ALZ, 2015) It is also estimated that by 2050, the US age group, 65 and over will make up 20%, in which over 11 million will be living with Alzheimer and other dementias. These issues and facts alone, bring significance to understanding the chosen population more critically by looking at the available resources, and developing an appropriate and realistic plan of care that is targeted at resolving the inherent issues in the community. This assessment will include information collected from different care facilities and community profile that will be beneficial to the community.

Windshield Survey

The windshield survey that was conducted on the Alzheimer’s and dementia facility was conducted on a population of 65 years old and older conducted using an internet search that used free online mapping tools to review the facility and the neighborhood. This was done to establish the boundaries of the windshield tour, as the facility was explored mainly through driving around, and using strategies that can collect viable information and data. The constant rise in the older population has led to awareness in the lack of tertiary care hospitals that contributes to the lack of physical activity, and unhealthy dietary habits, to which local clinics must address these growing problems. The facility is well-maintained, with the primary infrastructure made of brick, and modernized with central heat and plumbing. The transportation that the facilities uses are large vans, and the transportation used around the facility are cyclists and walkers.

There is also a public bus system that offers a fixed schedule and fare. The race and ethnicity is mainly made up of African Americans, Latinos, and Caucasians, with no overt indicators of ethnicity observed. There are many open spaces and parks available lined with trees and public trails. There is an accessible hospital, and other health facilities in walking distance. There are natural boundaries around the neighborhood, with several local meat markets and grocery stores. The most obvious health concerns are dementia and Alzheimer’s that is coupled with obvious chronic disease conditions that pose serious health hazards. There are no signs of decay, with major common area is in close proximity to downtown.

Gordon’s Functional Health Patterns

According to Gordon’s Functional Health Patterns, according to Yoost and Crawfod is used in helping nurses focus on patient strengths in relationships (Yoost, Crawford, 2015). The accurate assessment of the patterns is effective in providing patient-centered plan of care. More importantly this information will be used in developing assessment skills that appropriately aid in accurate treatment and diagnosis of their patients. Looking at the Health Perception/Health Management the patterns described the compliance with regimen for medication, the use of health-promotion activities such as annual check-ups, and regular exercise. Looking at the nutritional-metabolic patterns described in the Alzheimer’s and Dementia Facility, shows that patients are accessible to a healthy habit of food and fluid consumption patterns and the condition of teeth and skin shows good nutrition provided.

Elimination patterns of the excretory functions shows the perception of a normal function, as one can assess a frequency of bowel movements from the amount of diapers and other waste material in trash. The activity-exercise pattern shows the amount of physical activity involved in a patient’s daily life. From the facility is seems that patients are involved in minimal exercise routine that is influential in their drug therapy, that is also tied with leisure activities such as arts and crafts. Looking at the Cognitive- Perceptual pattern of the facility shows that patients have a poor diagnosis, as there level of cognitive function continues to deteriorate from the debilitating disease. This is also an indicator of the symptoms and diagnostic criteria of dementia patients provided by Kensigner (Kensigner, 2006). The Sleep-Rest pattern also shows a poor condition as the use of sleep aids, and steady routine is needed in providing consistent quantity and quality of sleep and energy of the patient population. Examining the Self-Perception/Self Concept pattern shows that the patients have a poor pattern of attitudes of body image, feeling state, or body posture and eye contact, but the facility has a good condition of body comfort. The Role-Relationship pattern sees that the major roles and responsibility falls on the nurses and other attendants of the facility, as they satisfy the social, work, and family relationships of the patients.  The Sexuality-Reproductive Patterns shows poor diagnosis of the satisfaction of reproductive and sexuality patterns. The population is aging and this is not a priority of sexual functioning or sexual relationships. The Coping/Stress Tolerance Patterns show a poor system of handling stress, with limited support systems, and the lack of the ability to control or manage situations. The Value-Belief Patterns of the facility shows that a majority of the clients have a strong religious affiliation, which at times conflict with the special religious and health practices of the facility.

Community Diagnosis

Examining the assessment of the community population of the Alzheimer’s and Dementia facility, shows that the strengths in the level of comfort provided, as indicated in the Gordon Functional Health Patterns, shows that the conditions are fair. Additionally, it is a phenomenological community in which patients share an intra/inter personal connections as they try to cope with their chronic conditions (Harkness, DeMarco, 2012). The strength of the facility is also the patient-centered approach taken by nursing staff in order to provide quality care for patients in which they understand the different levels of dementia patients. According to Gallagher, Steffen, and Thompson (2007), “preliminary data suggesting that people with Alzheimer’s dementia present with decreased affective components of pain and have a higher pain tolerance than vascular dementia patients who tend to have increased affective components of pain and less pain tolerance.” A third strength of the facility is also the cultural concerns that give prevalence to the religious beliefs that can sometimes interfere with the members being able to be treated accurately. They have included coalitions with religious and community leaders that help to improve health status maintenance of the patients.

The weaknesses of the facility however are the lack of physical activity that is beneficial to patients suffering from Dementia/Alzheimer’s. “Exercise also favors brain health via the well-known attenuating influences on atherosclerotic cerebrovascular disease” (Ahlskog, Geda, Graff-Radford, Peterson 2011). An additional weakness of the facility is the poor attention that is paid to the emotional and social relationships that are needed in helping to increase the cognitive functions of patients. Emotional support is needed for Alzheimer’s dementia patients in providing ways in which they can cope with the disease. Lastly, a weakness that the facility needs to improve on is the Self-Perception/Self-Concept of the patients in which does not provide an adequate care paid to increasing the perceptions of their self-image as they are impacted by both the signs of aging, and the conditions of the chronic disease.

A nursing diagnosis that is accurate for the community, which is supported, includes improving cognitive impairment of patients, improve the levels of activity for patients which as addressed will be beneficial to improving their social activity, and control over the disease.  The domain of health promotion with an increase in sedentary lifestyles, ineffective self-health management, domain of self-perception, and domain of self-perception/cognition. An additional diagnosis that needs to be focused on is the improvement for self-concept and self-perception for patients that do not have normal or positive assessments of self-image.

Population-Based Intervention

For the community population, there are several population-based interventions that can be provided to patients in the facility. The first intervention is promoting independence and self-perception. This intervention will also help with patients in which functions begin to deteriorate and they begin to withdraw from social environments and complex activities. It is important for the care providers and nurses to consider the appropriate activities, the level of engagement, and the complexity of the activity that helps them maintain their social roles and active life. This includes ADL skill training that involves assessing patient’s task performance, impairments, and abilities to understand the underlying neurological, psychosocial, and physical factors. This intervention involves developing programs of activity planning, environmental modifications, adaptive aids, assistive technology, and rehabilitation programs for patients. Each of these programs is useful in providing interventions that can be combined to address the issues of social, emotional, physical concerns. According to the NICE Clinical Guidelines (2007), “Continual engagement in life’s roles and activities is a means in itself for maintaining independence; however, as dementia progresses, some aspects will inevitably become more difficult.” Other intervention possibility is centered towards the psychological development, includes cognitive rehabilitation, cognitive training, and cognitive stimulation that involves engagement and exposure with materials and activities involving a degree of cognitive processing; specific training; and individually tailored work towards personal goals for patients. (Claire, Woods, 2004) These population based intervention approaches encourage enthusiasm and creativity for not only the patients’ benefit, but for the development of the practitioners and nurses attending to patients.

Expected Outcomes

These interventions are feasible for the facility in which they will be able use case studies, and experimental designs in which help in creating individually tailored programs for rehabilitation, that target the selected goals of the patients. Based on research from numerous sources these approaches shows promises to improving the prompting of remote memories, memory triggers, and physical stimulation that includes hand massages or other programs for dementia patients. The expected outcomes for the intervention includes focus on incorporating a group-based approach, validation therapy, atmospheric music and sounds, and visual light displays that encourages communication in a facilitative and safe environment.

Healthy People 2020 objective(s)

According to the Healthy People 2020 Objectives, in relation to the population, the objectives include, health-related quality of life and well-being, dementias including Alzheimer’s disease, physical activity, and educational and community-based programs. For Dementia, the goal is to reduce the costs and morbidity in relation to enhance or maintain their quality of life. (Healthy People 2020, 2015) Educational and Community-Based Programs are used in increasing the quality of effectiveness and availability of programs that are designed to enhance and health and quality of life. The Physical Activity goals are improve the quality, fitness, and health of life through daily physical activity for all individuals. (Healthy People 2020, 2015) These objectives are used in combination to address the problems of the facility which will help in improving the overall quality of life of patients.

Conclusion

Overall, the community of the Alzheimer’s and Dementia facility patient provides an overall well-maintained facility based on the Windshield Survey, and the Gordon Patterns that have been explored in this assessment. Based on the collected data, and in-depth analysis the facility needs in improvement in several areas that include the cognitive functioning, physical activity, and the promotion of self-perception of patients that are negatively impacted by the debilitating disease. It is important to apply these interventions that address the numerous diagnosis, and problems that outlined by the highlighted weaknesses of the facility. In addition to the Healthy People 2020 objectives addressed in the assessment, in applying the goals of each objective it will increase the patient’s quality of life, as well as their overall well-being. By applying these interventions and addressing these problems will greatly improve the quality of life for patients, and improve patient satisfaction.

References

2015 Alzheimer’s Disease Facts and Figures. (2015). ALZ. Retrieved from http://www.alz.org/facts/overview.asp

Ahlskog, J. E., Geda, Y. E., Graff-Radford, N. R., & Petersen, R. C. (2011). Physical Exercise as a Preventive or Disease-Modifying Treatment of Dementia and Brain Aging. Mayo Clinic Proceedings, 86(9), 876–884. doi:10.4065/mcp.2011.0252

Dementia. (2015). WHO. Retrieved from http://www.who.int/mediacentre/factsheets/fs362/en/

Dementia/Alzheimer’s Disease. (2015). CDC. Retrieved from http://www.cdc.gov/mentalhealth/basics/mental-illness/dementia.htm

Thompson, Dolores Gallagher, Steffen, Ann, Thompson, Larry. (2007). Handbook of Behavioral and Cognitive Therapies with Older Adults. Springer Science & Business Media.

Harkness, G. A., DeMarco, R. F. (2012). Community and public health nursing evidence for practice. Philadelphia, PA: Wolters Kluwer Health/Lippincott, Williams, and Wilkins.

Kensinger, Elizabeth. (2007). Cognition in Aging and Age-Related Disease. Department of Psychology. Boston College.

Logsdon, R. G., McCurry, S. M., & Teri, L. (2007). Evidence-Based Interventions to Improve Quality of Life for Individuals with Dementia. Alzheimer’s Care Today, 8(4), 309–318.

National Collaborating Centre for Mental Health (UK). (2007). Dementia: A NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care. Leicester (UK): British Psychological Society; 2007. (NICE Clinical Guidelines, No. 42 Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK55462/

U.S. Department of Health and Human Services. (2015). Healthy people 2020. Retrieved from http://healthypeople.gov/2020/TopicsObjectives2020/pdfs/HP2020_brochure_with_LHI_508.pdf

Yoost, Barbara, Crawford, Lynne R. (2015). Fundamentals of Nursing: Active Learning for Collaborative Practice. Elsevier Health Sciences.