Nursing for Malfunctioning of Brain

Discuss about the Nursing for Malfunctioning of Brain.

Dementia is a mental disorder that is related to the malfunctioning of brain, thereby causing long-term and gradual decrease in thinking ability and memory (Prince et al. 2013 pp.63-75). As a result, the patient’s mental functioning is altered, which affects the daily functioning of the patient. The disease is one of the most common diseases in geriatric population in Australia (Vickland et al. 2012 p.4233). There are a number of symptoms associated with language problem, emotional distress, decreased motivation, loss of autonomy and cognition impairment. Under this broad terminology, several types of dementia have been classified, Alzheimer is the most common one (Herrmann et al. 2013 p.1). Usually people feels helpless in this condition, thus, it acts as a predisposing factor in developing depressive symptoms along with anxiety and agitation. Patients sometimes becomes aggressive, thus therapeutic relationship is very important in the treatment procedures of dementia patients (Prince et al. 2013 pp.63-75). After the development of a trustworthy relationship, patients usually response to the psychotherapies. Thus, person-centered care has been proved to be the most common and successful treatment procedure in psychotherapy of dementia patients (Richardson et al. 2013 pp.1-7). In Australia, dementia is one of the leading causes that are leading to fatal consequences, mostly in the case of geriatric patients. In Australia, 6 % death has been accounted as a result of dementia. In 2011, the Australian Institute of Health and Welfare has reported that 298,000 people are having dementia in Australia (Brooks et al. 2014 pp.491-502).

In this essay, the major focus is to explore the behaviors associated with dementia and the importance of person-centered care in treating dementia patients with aggressive behavioral features. In addition, the current management strategies related to the dementia care, involved in the person-centered care would also be discussed in this essay.  

In Australia, dementia is one of the most common psychiatric issue; three in ten people over 85 years old and one in 10 people over 65 years old are living with dementia (Vickland et al. 2012 p.4233). It has been estimated that in Australia, approximately 1.2 million people are involved in dementia care (Abercromby and Peut 2012 pp. 45-46). It is the second leading cause of death in Australia. The nation faces shortage of approximately 150,000 paid and unpaid carers for dementia and the total expenditure on dementia care, during 2009-10 was approximately $4.9 billion (Stein-Parbury et al. 2012 pp.404-424). Over 50 % of aged facilities in Australian government subsidy include dementia care. In addition, about 44 % of permanent residents having dementia have been diagnosed with other mental illness (Aihw.gov.au 2016). In case of research, the Australian federal government provides $200 million for research in dementia within the next five years (Brooker and Latham 2015 pp 14-16).

Dementia cannot be defined as a single diseased caused by a single pathway. Instead, it is an umbrella term covering more than 100 different diseases caused by malfunctioning of brain, leading to impaired memory, cognition, perception, personality, language and behavioral problems (Herrmann et al. 2013 p.1). In spite of a wide range of difference in severity, symptoms and the developmental patterns of different types of dementia, the diseases are usually progressive and irreversible in nature.  The most common type of dementia in Australia is the Alzheimer disease; this is the most common type of dementia throughout the world. Other common types of dementia are vascular dementia, frontotemporal dementia and dementia with Lewy bodies (Stein-Parbury et al. 2012 pp.404-424). Alzheimer disease accounts for approximately 50% to 75% of dementia cases throughout the world (Edvardsson et al. 2014 pp 1171-1179). The Alzheimer disease is characterized by short-term memory loss, depression and apathy in its early stage of development. The disease has progressive decline and gradual onset. The Alzheimer disease is the most common dementia affecting the older population; however, women are more affected by this disease, compared to male population. Patient loses the reasoning, insight and judgment skills (Wimo et al. 2013 pp.1-11). The most affected part of brain in this disease is hippocampus, but temporal lobe shows shrinkage.

Vascular dementia has been estimated to cause approximately 20 % of dementia cases worldwide. It is the second most common type of dementia (Brownie and Nancarrow 2013 p.1). The main cause of this disease is injury in blood vessels, which damage brain, leading to stroke. Multiple injuries usually leads to progressive dementia, it depends upon the area of brain, where the stroke have occurred.

The fronttotemporal dementia is indicated by a drastic change in personality and language difficulties. It accounts for approximately 10% of the overall dementia cases throughout the world (Munthe et al. 2012 pp. 231-249). Initially, social withdrawal and lack of insight are observed in patients along with the main feature, memory impairment. The FTD has three major types, the behavioral variant of FTD, temporal variant dementia and the progressive non-fluent aphasia (Majounie et al. 2012 pp.323-330).

Dementia with Lewy bodies contributes up to 5 % to 7 % dementia cases throughout the world. The indicative symptoms of the disease include significant fluctuation in cognitive ability and visual hallucinations (Brownie and Nancarrow 2013 p.1). Other symptoms are similar to the Parkinson disease including g tremor and rigidity. This disease is more progressive in nature than Alzheimer disease.

In addition to these four most common types, other less common type of dementia includes Parkinson disease, Huntington disease, creuzfeldt-Jakob disease, HIV/AIDS related dementia, alcohol-related dementia and metabolic trauma related dementia (Wimo et al. 2013 pp.1-11).

People with dementia usually behave aggressively, which can be distressful for the care providers. There are several significant reasons behind aggressiveness of the dementia patient. Aggression can be a challenging behavior, which results from dementia (Richardson et al. 2013 pp.1-7). With aggression, others related challenging behaviors of dementia include restlessness, agitation and being sexually inappropriate (Munthe et al. 2012 pp. 231-249). Dementia makes people unable to identify their needs and unable to communicate with others about their needs. Thus, the person might act in such a way that is seen as challenging. It is the way of the patient to meet his needs or an attempt to communicate with others (van de Ven et al. 2012 p.1). Understanding the causes of person’s aggressive behavior can help the care givers to implement the best practice for the patient. There are biological, social and psychological reasons behind the aggressive nature (Edvardsson et al. 2014 pp 1171-1179). The person centered care mainly involves behavioral therapy, where the patient’s needs are prioritized and the underlying causes of aggressive nature are triggered. Thus, the therapy has high rate of success (Brooker and Latham 2015 pp 14-16).

Agitation is another common behavioral change seen in dementia patients.  A person having dementia may feel anxious or agitated. The patient might feel restless or feel upset in some circumstances. Agitation or anxiety can be caused by different medical conditions, which worsens the patient’s capability of thinking (Corbett et al. 2012 pp. 113-125). Biologically, the patient with dementia experiences a profound loss of the ability of negotiating new information and external stimuli. Treatment includes proper diagnosis and recognition of the underlying causes of agitation and anxiety of the patient (Brownie and Nancarrow 2013 p.1). Person-centered care includes prioritizing the symptoms and causes of agitation and tactfully handling the patient with dignity, respect and trust (Brownie and Nancarrow 2013 p.1). Once the patient starts to feel valued, the symptoms are reduced.

Person centered care is one of the most important tool for treating dementia patients. The care process puts a high value on the patient experiencing dementia, while acknowledging the importance of the care partners at the same time (Edvardsson et al. 2014 pp 1171-1179). The key principle of the person-centered care is related to the principle of holistic nursing. The person-centered care involves the patient in their care plan development and the processes involve the patient’s family members to provide a friendly environment to the patient, where the patient’s improvement is facilitated significantly (Roberts et al. 2015 pp.106-110). Instead of treating the person according the symptoms and behavior to be controlled, the person-centered care focuses on the patient as a whole and attempt to improve the patient’s entire wellbeing including his unique qualities, interests, abilities and physical, emotional, cognitive, psychological and social wellbeing (Roberts et al. 2015 pp.106-110). In this type of care approach, the patient’s health needs are prioritized for establishing the goals of care intervention. Several previous studies have proved the successful interventions based on the person-centered care. However, in the case of dementia patients, the behavioral models are implemented for improving patient’s behavioral impairments including aggressiveness, agitation, anxiety and depressive symptoms (Gitlin, Kales and Lyketsos 2012 pp.2020-2029).

When a person is suffering from dementia, it is easy to see the illness and forget about the characteristic of the person they used to be in before suffering from dementia. The person centered approach was established for ensuring that the patient is the focus of the therapy, not the illness. Another focus is that the patient should always be treated with respect, dignity and as unique individuals (Brooker and Latham 2015 pp 14-16).

The dementia initiative’s person centered dementia care framework consists four parts. The first part includes core values and philosophy. According to the philosophy, every person consist of his own perception about life, authenticity, interest, preferences, needs and history to experience life at all stages of dementia (Prince et al. 2013 pp.63-75). It is essential to focus on the strengths of the person in spite of focusing on the lost abilities and capabilities of the person. In addition, the care activities help to support the patient’s personhood, as it is necessary to “enter the world” of the person living with dementia to understand and communicate with the person’s actual needs and to interpret the meaning of his behavioral expressions from care giver’s perspective (Gitlin, Kales and Lyketsos 2012 pp.2020-2029). The second part is structure of the care approach. To focus on the aggressiveness and agitation related behavioral challenges of the dementia patient, the structure of the care framework is divided into eight domains, used in universal long-term services of dementia. These domains include community, relationships, leadership, governance, care partners, environment, accountability and meaningful life and engagement. The third part is the operational practices, supporting the structure of the person-centered structural domains. Practices for dealing with the aggressive behaviors include the aims related to meaningful, purposeful and interesting actions to do as the part of his daily life for the domain of the meaningful life and engagement of the person (Prince et al. 2013 pp.63-75).. The final part of the framework is individualized practices (Prince et al. 2013 pp.63-75). Through individualized practices, the unique ways of interacting with a patient, supporting the person’s unique interests, preferences and needs are focused. For example, in these kinds of practices, food, perception, way of talking with others are explored according to the choice of the patient (Prince et al. 2013 pp.63-75). As a result, the patient feels valued and the behavioral challenges are reduced. Thus, person-centered care approach has shown significant success regarding dementia care in many Australian hospital and aged-care homes.

The current management strategies include both the psychotherapy and pharmacotherapy. However, no single therapy has shown significant benefits, which has been revealed, when the combined therapy of psychotherapy and pharmacotherapy has been provided. In addition, the provision of a calm and comfortable environment is very essential for gaining successful patient outcomes in dementia care (Herrmann et al. 2013 p.1).

In conclusion, it can be said that, dementia is one of the most common mental health issue in Australia, which has became a burden of the health system in Australia. As it is the second leading cause of death in Australia, the government has several steps to look after the dementia cases and reducing the underlying causes. In this essay, the main focus was to explore the status of dementia in Australia. The essay revealed the nature of the disorder, the Australian statistic related to this disease and the most common types of the disease. In addition, the essay included the most common and successful therapy of dementia in Australia, the person-centered care. In previous literatures, it has been seen that mostly dementia patients experiences behavioral challenges including change in their attitude, aggressiveness, agitation, anxiety and depression. The person-centered care has been reviewed in dealing with these symptoms. A dementia care framework has also been discussed here. The psychotherapy includes behavioral therapy, focusing on the aggressive nature causing contexts, for a particular patient. Involving the patient’s family and providing respect to the patient, the person-centered care covers the emotional, physical, mental and social wellbeing as a whole.

References

Abercromby, J. and Peut, A., 2012, December. Dementia in Australia. InAUSTRALASIAN JOURNAL ON AGEING (Vol. 31, pp. 45-46). 111 RIVER ST, HOBOKEN 07030-5774, NJ USA: WILEY-BLACKWELL.

Aihw.gov.au, 2016. Dementia in Australia (AIHW). [online] Aihw.gov.au. Available at: [Accessed 14 Aug. 2016].

Brooker, D., and Latham, I. 2015. Person-Centred Dementia Care: Making Services Better with the VIPS Framework (pp 14-16). Jessica Kingsley Publishers.

Brooks, A., Farquharson, L., Burnell, K. and Charlesworth, G., 2014. A narrative enquiry of experienced family carers of people with dementia volunteering in a carer supporter programme. Journal of Community & Applied Social Psychology, 24(6), pp.491-502.

Brownie, S., and Nancarrow, S. 2013. Effects of person-centered care on residents and staff in aged-care facilities: a systematic review. Clinical interventions in Aging, 8, 1.

Corbett, A., Smith, J., Creese, B., and Ballard, C. 2012. Treatment of behavioral and psychological symptoms of Alzheimer’s disease. Current treatment options in neurology, 14(2), 113-125.

Edvardsson, D., Sandman, P. O., and Borell, L. 2014. Implementing national guidelines for person-centered care of people with dementia in residential aged care: effects on perceived person-centeredness, staff strain, and stress of conscience. International Psychogeriatrics, 26(07), 1171-1179.

Gitlin, L.N., Kales, H.C. and Lyketsos, C.G., 2012. Nonpharmacologic management of behavioral symptoms in dementia. JAMA, 308(19), pp.2020-2029.

Herrmann, N., Lanctôt, K. L., and Hogan, D. B. 2013. Pharmacological recommendations for the symptomatic treatment of dementia: the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012.Alzheimer's research & therapy, 5(1), 1.

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Prince, M., Bryce, R., Albanese, E., Wimo, A., Ribeiro, W. and Ferri, C.P., 2013. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimer's & Dementia, 9(1), pp.63-75.

Richardson, T.J., Lee, S.J., Berg-Weger, M. and Grossberg, G.T., 2013. Caregiver health: health of caregivers of Alzheimer’s and other dementia patients. Current psychiatry reports, 15(7), pp.1-7.

Roberts, G., Morley, C., Walters, W., Malta, S. and Doyle, C., 2015. Caring for people with dementia in residential aged care: Successes with a composite person-centered care model featuring Montessori-based activities.Geriatric Nursing, 36(2), pp.106-110.

Stein-Parbury, J., Chenoweth, L., Jeon, Y. H., Brodaty, H., Haas, M., and Norman, R. 2012. Implementing person-centered care in residential dementia care. Clinical gerontologist, 35(5), 404-424.

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Vickland, V., Morris, T., Draper, B., Low, L.F. and Brodaty, H., 2012. Modelling the impact of interventions to delay the onset of dementia in Australia. A report for Alzheimer’s Australia. For further information, please contact Alzheimer’s Australia: www. fightdementia. org. au, 2(6254), p.4233.

Wimo, A., Jönsson, L., Bond, J., Prince, M., Winblad, B. and International, A.D., 2013. The worldwide economic impact of dementia 2010. Alzheimer's & Dementia, 9(1), pp.1-11.

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