Dementia Of Alzheimers Type Health And Social Care Essay

frenzy Of Alzheimers Type Health And Social C ar EssayAgeing brings with it changes in number of domains, including attitudes, health, self-image, relationships, status, generational changes, familiar functioning and an aw atomic number 18ness of season and mortality. These general themes all appears regularly in clinical work with older people as they come to marges with the realities of privacy or illness. (Wattis and Curran, 2006)The National policy on older persons confers the status of senior citizen to a person who has attained the age of 60 years (Ministry of Social judge website). An estimated 77 million people or 7.7 percent of the population are senior citizens (Help Age India website) M any(prenominal) of our aged senior citizens live with their families. Hence any physiological and psychiatric changes affect these family members. (Handbook of Psychiatric Social Work,2007)Understanding frenzyThe word frenzy is an umbrella term which describes a serious deteriorat ion in mental functions, much(prenominal)(prenominal) as recollection, language, orientation and judgement. Numerous definition of dementia has been suggested. Roth proposed that it is an acquired global injury of intellect, memory and personality. A much comprehensive definition has been suggested by McLean, namely, an acquired decline in a range of cognitive abilities (memory,learning, orientation and forethought) and intellectual skills (abstraction, judgement, Comprehension, language and calculation), accompanied by alterations in personality and behaviour which impair day-to-day functioning, social skills and emotional control. There is no clouding of consciousness, and some other psychiatric dis holy orders are excluded.Dementia usually has an insidious on frozen, with most people developing symptoms step by step oer a period of years. The progression of these diseases is largely unpredictable for each individual. How and what symptoms develop depend on what parts of th e brain are change by which illness, and the unique characteristics of each individual. Dementia has a life changing physical, emotional and mental impacted on the affected person and their ancient caregiver and family. Dementia is a neuropsychiatric condition in elderly, disabling illness of late life, which is a hidden worry in India, demanding immediate attention from professionals (Shaji Iype, 2006).Different compositors case of dementiaSome types of dementia are irreversible and progressive. This is not true for all types of dementia, oddly if detected archean.Types of dementia includeDementia of the Alzheimers Type rough 50 percent of all cases of dementia are fountd by Alzheimers disease.Vascular DementiaVascular dementia is cause by small strokes that stop ocellus flow to parts of the brain.Dementia Due to dispa roll General Medical ConditionsMedical conditions that can cause dementia include HIV, head trauma, Parkinsons disease, Huntingtons disease, Picks disease , Creutzfeldt-Jakob disease, metabolic disorders, and hypoglycemia.Substance-Induced run DementiaThe use of a substance such as alcohol or the sudden withdrawal from a substance can cause dementia. This is diagnosed just now if the symptoms last beyond normal withdrawal time for the substance.Dementia Not Otherwise SpecifiedThis is the category for dementia that doesnt fit in an preceding(prenominal) category.Dementia differs from delirium, which is characterized by a state of sudden confusion. Dementia is not part of the normal aging process nor is it mental retardation or psychosis. There are medications and therapies that can help manage the symptoms of the disease, making life easier for the patient and his/her family.Dementia of Alzheimers Type (DAT)Alzheimers disease is the most common form of dementia. Alzheimers Disease is named after the German Psychiatrist, Alois Alzheimer, who in 1906 first described the changes caused by the condition. The diagnostic criteria for DAT as menti onenessd in DSM-IV-TRA. The development of multiple cognitive deficits manifested by both (1) memory impairment (afflicted ability to learn new information or to recall frontly learned information) (2) one (or more) of the interest cognitive disturbances (a) aphasia (language disturbance) (b) apraxia (impaired ability to carry out aim activities despite intact motor function) (c) agnosia (failure to recognize or identify objects despite intact sensory function) (d) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)B. The cognitive deficits in Criteria A1 and A2 each cause epochal impairment in social or occupational functioning and represent a significant decline from a previous direct of functioning.C. The guide is characterized by delaying onset and continuing cognitive decline.D. The cognitive deficits in Criteria A1 and A2 are not due to any of the following(1) other central nervous system conditions that cause progressive deficits in memory and cognition (e.g., cerebrovascular disease, Parkinsons disease, Huntingtons disease, subdural hematoma, normal-pressure hydrocephalus, brain tumor)(2) systemic conditions that are known to cause dementia (e.g., hypothyroidism, vitamin B or folic acid deficiency, niacin deficiency, hypercalcemia, neurosyphilis, HIV infection)(3) substance-induced conditionsE. The deficits do not occur exclusively during the course of a delirium.F. The disturbance is not best(p) accounted for by another Axis I disorder (e.g., Major Depressive Episode, Schizophrenia).Code based on presence or absence of a clinically significant behavioral disturbance294.10 Without Behavioral choker if the cognitive disturbance is not accompanied by any clinically significant behavioral disturbance.294.11 With Behavioral Disturbance if the cognitive disturbance is accompanied by a clinically significant behavioral disturbance. (e.g., wandering, agitation)Specify subtypeWith Early Onset if onset is at age 65 years or belowWith Late Onset if onset is after age 65 yearsICD-10 diagnostic criteria for dementiaThe primary requirement for the diagnosing is evidence of a decline in both and thinking which is sufficient to impair personal activities of daily living. The impairment of memory typically affects the registration, storage and convalescence of new information, but previously learned and familiar information may also be lost, particularly in later stage. Dementia is more than impaired memory. There is also impairment of thinking and of reasoning capacity, and a reducing in the flow of ideas. The processing of information is impaired, in that the individual finds it increasingly hard to attend to more than one stimulus at a time. (e.g. taking part in a conversation with several people), and to shift the charge of attention from one topic to another. If dementia is the sole diagnosis, evidence of clear consciousness is required. However, a double diagnosis of delirium sup erimposed on dementia is common. The above symptoms and impairments should fall in been evident for at least six months for a confident clinical diagnosis of dementia to be made.Alzheimers disease (F00)In ICD-10, Alzeheimers disease (AD) is divide into Dementia in AD with early onset (F00.0) and Dementia in AD with late onset (F00.1). These categories include the definition of dementia discussed above. For Dementia in AD with late onset, onset is after the age 65years. AD has an insidious onset with a gradual decline in the mental stage, Memory difficulties, especially with regard to new memories, are usually the first symptoms to be noticed. Memory problems may be attributed to old age or absent-mindedness. The onset is so gradual that even a close relative living with the patient the early stages, previous personality may strongly influence the presentation. Patients with a tendency to be suspicious of others or to deny their own limitations may upset carers by accusing them of stealing misplaced items. Others may react to these early changes by change state extremely dependent on relatives, especially if family patterns of behaviour encourage this. Mood disturbance is not a diagnostic feature of AD. It may also be common in more advanced AD. Here it may not be reported by the patient, but may be inferred from behavioural changes and rejoinder to treatment with antidepressants. The patient usually lacks insight, and as the disease progress their behaviour may become more erratic. freak out with regard to time, place and person testament also increase, usually in that order. The combination of disorientation in time and place and topographical disorientation may cause the patient to wander, resulting in grand di strain for the family, risk to the patient and the involvement of neighbours, other individuals and the police, who may have to bring the patient billet. Patients may get up in the early hours accept that it is time to go to work or get the ch ildren ready for school. Hallucinations (usually visual) are fairly common, but are not usually evident except done the description of careers (e.g he spends a lot of time picking up imaginary food from thr floor). As the disease progress, the patient will become unavailing t recognise their relatives, who a great deal finds this distressing. The patient may then become distressed, as they may believe that their spouse or son or girlfriend in a intruder. In addition, the patient may fail to recognise him or herself , and this can also cause considerable distress. Carers often find that removing mirrors solves the problem. Other difficulties with moderate to severe impairment include apraxia, which presents with difficulties in dressing and washing and other tasks involving visuo-spatial skills. Dysphasia (inability to express oneself in words or to understand words) can regard to severe frustration when combined with all of the other impairments and confusion. Incontinence (bo th urinary and faecal) usually develops late in the disease and for umteen carers is the final straw. Eventually the evidence is reached when the patient is unable to or anything from him- or herself including the following dressing, personal hygiene, domestic tasks, toileting and feeding.There are characteristic changes in the brain a marked reduction in the population of neurons, particularly in the hippocampus, substantia innominata, locus ceruleus and temporopareital frontal lobe cortex appearance of neurofibrillary tangles made of paired helical filaments neuritic (argentophil) plaques, which consist largely of amyloid and charge a definite progression in their development (although plaques without amyloid are known to pull through) and granulovacular bodies. Neurochemical changes have also been found, including marked reduction in the enzyme choline acetyltransfearse, in acetylcholinse itself, and in other neurotransmitters and neuromodulators.Causes of ADAD is a primary d egenerative cerebral disease of unknown etiology, with characteristics neuropathological and neurochemical features. The precise aetiology of AD is poorly understood. However, it is important because such an understanding may have implications for both prevention and treatment. The relationship between cause and effect may be difficult to establish, particularly with regard to neurotransmitter deficits and the characteristics of neuropathological changes that are seen in AD. On the basis of epidemiological research, the most important risk factors for AD are old age and a family history of dementia and Downs syndrome.Alzheimers and the superstarAlzheimers disease leads to nerve cell death and tissue button throughout the brain. As the disease progresses, brain tissue shrinks and the ventricles (chambers within the brain that contain cerebrospinal fluid) become larger. The victimize disrupts communication between brain cells, crippling memory, speech, and comprehension.Alzheimers MedicationsThere is no cure for Alzheimers disease, and no known way to slow the nerve damage within the brain. But there are a variety of medications that appear to help have got mental function and slow the disease progression. If these treatments are minded(p) during the early stages of Alzheimers, your loved one may be able to remain independent and carry out daily tasks for a longer period of time. prevalence of DementiaGlobal ImpactWorldwide, there is a new case of dementia every seven seconds. As of 2008, there are an estimated 30 million people with dementia worldwide. By 2050, it is projected that this figure will have increased to over 100 million. Much of the increase will be in developing countries. Already more than 60% of people with dementia live in developing countries, but by 2040 this will rise to 71%. The alacritous growth in the elderly population is taking place in China, India, and their south Asian and western Pacific neighbours. (Ferri et al, 2005)Stages o f Dementia/ADKnowing a persons disease stage helps health professionals to determine the treatment address and aids communication between health providers and caregivers. Sometimes the stage is simply referred to as early stage, middle stage or late-stage dementia, but often a more exact stage is assigned, based on a persons symptoms. Geriatric population is more affected by dementia of Alzheimers Type (DAT) or Alzheimers Disease (AD) 60-65 % and other related disease. Therefore, when choosing a suitable hitch model for dementia one has to persist in in mind stages in dementia, context and circumstance, as care needs vary with stage to best help both the elderly people and their families.The below table demonstrates the changes in persons with Alzheimers disease and related disorders that usually occur during the progression of the illnesses. As patients move through stages, family issues are also changing. The type of clinical intervention that is most appropriate and effective for a particular family should be determined by the types of problems and issues the family needs to address.Early/Mild Stage mild memory loss and deterioration of skills 1-5 yearsChanges occurring in patientEffect on family membersClinical InterventionForgets familiar namesUnable to name familiar objectsUnable to wait what is readUnable to perform simple calculationsDecreased knowledge of current and recent eventsBecomes careless in grooming habitsBecomes anxious and frustrated in demanding situationsDenies memory problems and inability to perform tasksWithdraws from challenging situationsGets lost in familiar surroundingsDenial used as defense mechanism in coping with disquiet of relatives diagnosisFalse hope of improvementFear of futureFear that they will also get dementiaConcern round the effect on their lifeConflict over care planning decisionsFamily assessment to include genogram, influence of pre-existing family patterns, cultural items, quality of relationships, family co nflict, support system, and socioeconomic level.Educate about disease processValidation of feelings (e.g anger)Refer to caregiver support groupEvaluate environment of dementia victimRefer for information on well-grounded and financial issuesExplore care optionsMiddle/Moderate Stage Pronounced and severe decline of skills 5-15 yearsUnable to recall addresses, phone numbers, names of family membersDisorientation to time or placeHas difficulty choosing the proper clothing to wearDecreased ability to travel, handle finances, make decisionsFlattening of affect (facial expression)Sleeping pattern affectedBehaviour changes- may become delusional, obsessive, easily agitated, depressedRole changesSocial IsolationAnger, resentment over caregiving responsibilitiesEmbarrassed by patients behaviour guilt trip over relinquishing caregiving responsibilitiesConflict over care planning decisionsOverwhelmed by caregiving responsibilitiesMarital problemsDepressionHelp to prioritize caregiving tasksAs sist family with feelings associated with caregiving and/or institutional placement get along family members to continue contact with the person in an institutional setting, participating in their care planProblem-solve to alleviate conflict by resolving issuesEncourage affair in a caregiver support groupBe supportive to family members who are providing careIncrease family support networkUse crisis intervention strategies when indispensableEducate about behaviour managementIndividual, marital or family therapyLate/Severe stage Complete loss of functioning and basic skills 3-5 years unsuspecting of recent events and escortsUnaware of surroundings, the year, the seasonVerbal abilities are lostIncontinence of bowel and bladderLoses basic psychomotor skillsRequires assistance in feeding, difficulty in swallowingUnable to acknowledge recognition of family members, friendsWeight lossGrief over the loss of the person they once knewConflict over care planning decisionsGuilt over this des ire for the disease to progress to deathSupport the familys decisions on terminal care.Problem-solve to alleviate conflict by resolving issuesAddress the long term grief of caregivers and help them to prepare for their future without the patientProvide case management services as needed, continually assessing the patients needs and the familys coping ability project the family permission to let goEncourage funeral arrangementsEffects of ADAs people with dementia need sustained care, it becomes important to provide services for patients with dementia also provide support and guidance to their caregivers. The burden of looking after patients with AD is wide, and carers and families become physically and emotionally exhausted and socially more taxing. At this time families need support from the multidisciplinary team. For the better quality of life of both AD patients and caregivers, there is need for research and intervention models specific to individuals (familys) culture. Most of the time the caregivers are family members, they are encouraged to learn about the principles of long term care in general and dementia care in particular.In India, caregivers have their own strategies for care giving suitable to the family member of dementia. What is lacking is the knowledge of AD, therefore educating them is important, which will change their cognizance and attitude toward the family member (support with research). In boorish areas, lifestyle, physical activity (farming) and environment difference could have contributed to the lower percentage of dementia. This is in particular reference to research done in Ballabgarh (New Delhi, India), there exist no case of dementia in this area, as studied in comparison with/to Pennsylvania partnership of elderly people, USA. Developing countries are also comer the statistics of developed countries of increased life expectancy and stress related lifestyle, therefore, increasing risk of Dementia/AD.Some of the Intervention programs for caregivers are mentioned in the next session. This includes different models of intervention based on theory and research. Details of family intervention programs for caregivers of AD includes Educating about dementia, providing support-family counseling, group home support ,skill training. number of sessions, time period, and documentary, content, success rate/effectiveness of the session/model.Family Intervention/treatmentCaregivers of ADRole of caregiversChallenges faced by caregiversIntervention programsCaregiverIn our society more and more debt instrument is placed on the family to provide care. The family caregiver is that significant person in the family, who looks after the basic needs of the patient throughout the day. The care for the caregiver is of immense importance as this population suffers more psychological effect than the patient.With the onset of a disability, the family is forced to take on new roles and greater responsibility. This causes high le vels of stress in an already stressful situation. Caregivers are sometimes forced to give up their own needs in order to care for a family member. The sympathize with for someone and constantly giving up ones own personal interests can affect the caregiver both physically and emotionally which, in turn affects the patient. The caregivers need to be aware of their own feelings, judgements, and different ways of reacting to the patients behaviour. They must also take care of their own physical and emotional health in order to provide care to their loved one.Ethnicity and culture issues also play a greater role in care giving. In society today, we have many different types of families. Some cultures tend to have extended and blended families, which can offer more support to the caregiver. Some cultures also view care-giving as an judge family function that can put added pressure and stress on the family. It is important for treatment team to understand the patients needs, but it is a lso important that they understand the families (caregivers) needs. stress and caregiver burdenThe negative phenomena associated with caring for victims of illness and injury is defined as caregiver burden. Caregiver burden may be further categorised into objective burden and subjective burden. Objective burden included changes in the patients personality and behaviour which are seen by the caregiver as well as financial strain, changes in the daily routine, changes in living conditions, and changes in social activities. Subjective burden is defined as the caregivers negative reaction in reply to the presence of objective burden.A study conducted by Mitrani et al (2006) on the role of Family Functioning in the Stress Process of Dementia Caregivers A morphologic Family Framework. It was conducted on One hundred eighty-one family caregivers from the Miami site of the Resources for Enhancing Alzheimers Caregiver Health (REACH) project participated in this study. They assessed socio demographics, burden, depression, anxiety, and perceived health for each caregiver. The results of the study indicated that family functioning importantly contributed to distress in the overall sample and partially mediated the relationship between objective burden and distress. The implication of the study is that Family structural functioning is one contributor to the caregiver stress process. This suggests that interventions targeting structural family problems may reduce caregiver distress.The disease follows a predictable irreversible progression that lasts from between three to 20 years.NonPharmacologic Management of DementiaThe first line of treatment for an older person with dementia, especially one who has recently been diagnosed, is pharmacological, that is medication with cholinesterase inhibitors.Family systems ModelThe family systems model is based on the premise that members of family groups influence and are influenced by all other members. Each family is a unique sy stem, with its own set of rules that specify power structure, roles, communication techniques, and problem solving (Bowen, 1971 Haley, 1971 Minuchin, 1974 Kerr, 1981). Family treatment from a systems framework begins with an assessment of family organization and functions. An understanding of the familys structure and dynamics is necessary for making decisions regarding change strategies.From a family systems perspectives, the changes in health and functional status that are associated with dementia affect all members of the family unit. Although a primary caregiver usually assumes the daily care of the dementia patient, all family members experience some changes in roles, relationships, and goals. In some cases, the burden on the family can become excessive, jeopardizing the familys physical, emotional, and social stability (Niederehe Fruge, 1984)Interventions based on the family systems model can be focused on cognitive, emotional, and/or behavioural levels of functioning in fami lies (Wright Bell, 1981). These interventions are directed toward change within the structure of the family, altering the postions of family members and resulting in individual changes as well. The following types of interventions have been found to be effective with families of dementia patients and can be used alone or simultaneously.Cognitive interventionsDirected at the cognitive level of family functioning, these interventions provide new information or a new perspective on a problem. They can include educating the family about the dementing illness and discussing the capableness effects of the disease on family members. The next step is to suggest ways in which the family can respond to these effects and to provide information about community resources. It may be extremely painful for the family of a dementing patient to make the decision to place her in a nursing home. The clinician can provide an objective viewpoint, alleviating some of the familys guilt in making the fina l decision.Emotional interventionsThese interventions validate a familys emotional responses and often affect feelings that may be blocking their efforts at problem solving. Validation of family members emotions, such as sadness, anger, and guilt, can help them understand the connection between the dementing illness and their stress. In the validation process, it is important to emphasize that the whole family is affected by the illness.Behavioural interventionsAimed at the behavioural level of functioning, these interventions can assist family members in modifying behaviours that cause problems in their interactions. This type of intervention attempts to change such behaviour by teaching new adaptive skills. Families area also encouraged not to make sudden and major adjustments in their daily routines following a diagnosis of dementia. Family members do not all react in the analogous way to this illness whereas some tend to exist in a state of denial throughout the initial stages and fail to recognize the real needs of the patient, others overcompensate and encourage dependence by the patient. To avoid a dogging state of family disruption, it may be necessary to assign specific behavioural tasks to family members. At the same time, it is important to emphasize that family members should try to continue their regular activities and maintain their accustomed role responsibilities for as long as possible.Before intervening in a family system that is dealing with a dementing illness, clinicians need to understand the familys perception of the illness. The clinicanss objectives is to help the family to adjust t it, not necessary to accept it.Tracy was a 30 year old teacher who sought help for her recent anxiety attacks. During the initial interview with the social worker, she focused on her mother, who was caring for Tracys grandfather, an Alzheimers patient. Tracy and her mother had always had a good relationship, but Tracy had now become focused on how her mo ther was coping with her grandfathers illness and was making recommendations on how she could get some respite from her caregiving responsibilities. Her mother refused to consider Tracys recommendations.ProblemOriginally sympathematic to her mothers caregiving situation, Tracy was now frustrated and provoked because she thought her mother was neglecting herself and other family members while caring for grandfather. Tracy reacted to her grandfathers illness by focusing intensely on her mothers cargiving responsibilities and taking on her mothers problem as her own. This focus on her mother allowed her to avoid dealing directly with her feelings about her grandfathers progressive illness and eventual death.Tracys mother reacted to her fathers illness by overcompensating and enmeshing herself in the role of caregiver. Although she often complained that caring for her father was exhausting and left her with little time and energy for herself or other famly members, she refused to consi der assistance from her family or community services.Treatment approachAdvise Tracy to stop giving recommendations to her mother, but to continue to be supportive.Encourage Tracy to discuss her feelings about her grandfathers illness and any perceived expectation that she would assume the same caregiving responsibility for her mother in the future. circularise communication between Tracy and her mother (and other family members, if possible) to share contents about the patients illness.Suggest meeting with Tracys mother. Encourage her to set time aside for herself and her family, providing support and information on resources and care options. Giver her permission to acknowledge the negative as well as positive feelings of caregiving.GoalsOpen lines of communication between Tracy, her mother, and other family members.Acknowledge Tracys and her mothers feelings associated with the patients illness.Remove Tracys self-imposed responsibility for solving her mothers caregiving problems.F amily MediationFamily Mediation is a family- oriented, problem-solving, task completion model that was primitively used as an intervention in child custody and divorce situations, child-parent conflicts, and family disputes (Parsons Cox, 1989). A model that empowers mediation is an effective strategy for many of the caregiving problems that occur during the course of a dementing illness.The mediator role is based on conflict theory. Three dimensions of conflict have been identified with these caregiving familiesa. Family members perceptions of illness and strategies for care.b. Their attitudes and behaviour toward the patient andc. Their attitudes and behaviour toward the primary caregivers (Miles Huberman, 1984, Semple, 1992).Conflict often results from interaction between systems such as individuals, families, organizations, and communities, and may grow out of differences in values and power that make it difficult for the parties problematic to define ways to agree or disagre e. The role of the mediator is to move the conflict from the emotional and values level to a more objective level that provides the opportunity for negotiation.Families involved in the care of a person with dementia are faced with many options for difficult decisions, such as relocation, assignment of caregiving responsibilities, home health care, assisted living arrangements, and nursing home placements. Participants in the decision-making process may include dementia patients spouse, children, friends, neighbours and professional care-givers. Decisions involving several participants are usually not unanimous, with conflict resulting throughout the process from feelings of guilt, grief connected with the progression of the deme