Dementia Of Alzheimers Type Health And Social Care Essay

dementedness Of Alzheimers Type Health And happen uponionate bearing EssayAgeing brings with it changes in number of domains, including attitudes, health, self-image, relationships, status, generational changes, sexual procedure and an aw beness of clipping and mortality. These general themes all appears regularly in clinical work with older people as they come to terms with the realisticities of loneliness or unhealthiness. (Wattis and Curran, 2006)The National policy on older persons confers the status of sr. citizen to a person who has attained the age of 60 years (Ministry of favorable Justice website). An estimated 77 million people or 7.7 percent of the commonwealth atomic number 18 senior citizens (Help Age India website) Many of our aged senior citizens sojourn with their families. Hence any physiological and psychiatric changes affect these family members. (Handbook of Psychiatric neighborly Work,2007)Understanding derangementThe word insanity is an umbrell a term which describes a serious radioactive decay in mental functions, such as retentiveness, language, orientation and judgement. Numerous definition of hallucination has been suggested. Roth proposed that it is an acquired global queerment of intellect, memory and personalizedity. A more than(prenominal) comprehensive definition has been suggested by McLean, namely, an acquired decline in a range of cognitive abilities (memory,learning, orientation and anxiety) and intellectual skills (abstraction, judgement, Comprehension, language and calculation), accompany by alterations in personality and doings which impair daily function, social skills and turned on(p) control. in that location is no clouding of consciousness, and otherwise psychiatric distempers be excluded. mania normally has an insidious oncoming, with most people intellecting symptoms gradually oer a period of years. The progression of these complaints is largely unpredictable for each various(p renominal). How and what symptoms develop depend on what per centums of the brain atomic number 18 bear on by which illness, and the unique characteristics of each individual. Dementia has a life changing physical, ruttish and mental impacted on the affected person and their primary reverence regressr and family. Dementia is a neuropsychiatric condition in elderly, disabling illness of new-fashioned life, which is a hidden problem in India, demanding immediate attention from professionals (Shaji Iype, 2006).Different type of crazinessSome types of delirium are permanent and imperfect. This is non true for all types of dementia, in particular if detected beforehand(predicate).Types of dementia involveDementia of the Alzheimers TypeApproximately 50 percent of all cases of dementia are taked by Alzheimers unsoundness.Vascular DementiaVascular dementia is ca single-valued function by small strokes that stop blood flow to parts of the brain.Dementia Due to Other General Medical ConditionsMedical conditions that plunder do dementia include human immunodeficiency virus, head trauma, Parkinsons disorder, Huntingtons disease, Picks disease, Creutzfeldt-Jakob disease, metabolic disorders, and hypoglycemia.Substance-Induced Persisting DementiaThe use of a substance such as alcohol or the sudden withdrawal from a substance backside commence dementia. This is diagnosed only if the symptoms lowest beyond normal withdrawal age for the substance.Dementia Not otherwise SpecifiedThis is the category for dementia that doesnt fit in an above category.Dementia differs from craziness, 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. at that place are medications and therapies that can attention manage the symptoms of the disease, making life easier for the diligent and his/her family.Dementia of Alzheimers Type (DAT)Alzheimers disease is the most common fo rm of dementia. Alzheimers indisposition is named after the German Psychiatrist, Alois Alzheimer, who in 1906 first described the changes cause by the condition. The symptomatic criteria for DAT as mentioned in DSM-IV-TRA. The cultivation of multiple cognitive deficits manifested by both (1) memory impairment (impaired ability to learn new tuition or to recall previously learned information) (2) one (or more) of the following cognitive anxietys (a) aphasia (language disturbance) (b) apraxia (impaired ability to carry out drive 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 significant impairment in social or occupational functioning and represent a significant decline from a previous aim of functioning.C. The scarper is characterized by gradual 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 cognize 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 better accounted for by another Axis I disorder (e.g., Major Depressive Episode, Schizophrenia).Code ground on presence or absence seizure of a clinically significant behavioral disturbance294.10 Without Behavioral overthrow if the cognitive disturbance is not accompanied by any clinically significant behavioral disturbanc e.294.11 With Behavioral Disturbance if the cognitive disturbance is accompanied by a clinically significant behavioral disturbance. (e.g., wandering, agitation)Specify subtypeWith earlyish 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 diagnosis is indorse of a decline in both and thinking which is sufficient to impair personal activities of daily live. The impairment of memory typically affects the registration, storage and convalescence of new information, but previously learned and acquainted(predicate) information may as come up be lost, particularly in later stage. Dementia is more than impaired memory. There is to a fault impairment of thinking and of reasoning capacity, and a decrease in the flow of ideas. The processing of information is impaired, in that the individual finds it increasingly touchy to at dispose to more than one stimulus at a convic tion. (e.g. taking part in a conversation with several(prenominal) people), and to shift the concentrate on of attention from one topic to another. If dementia is the furbish up diagnosis, evidence of clear consciousness is required. However, a double diagnosis of delirium superimposed on dementia is common. The above symptoms and impairments should father been observable 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 divided 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, recollection 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 uncomplaining the early stages, previous personality may strongly influence the presentation. Patients with a tendency to be suspicious of others or to deny their consume limitations may upset cautionrs by accusing them of stealing mis propertyd items. Others may play off to these early changes by becoming extremely dependent on relatives, especially if family patterns of doings 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 douranimous, but may be inferred from behavioural changes and response to treatment with antidepressants. The longanimous usually lacks insight, and as the disease progress their behaviour may run more erratic. Disorientation with regard to time, place and person will also increase, usually in that order. The combination of disorientation in time and place and topographical diso rientation may cause the affected type to wander, resulting in ample di test for the family, risk to the longanimous and the involvement of neighbours, other individuals and the police, who may wealthy person to bring the patient home. Patients may get up in the early hours believing that it is time to go to work or get the children organise for school. Hallucinations (usually visual) are fairly common, but are not usually evident except finished the description of safekeepingers (e.g he spends a lot of time picking up imaginary food from thr floor). As the disease progress, the patient will become unable t recognise their relatives, who often finds this di extending. The patient may then become distressed, as they may believe that their fellow or son or daughter 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 moder ate to barren impairment include apraxia, which presents with difficulties in dressing and washing and other tasks involving visuo-spatial skills. Dysphasia (inability to register oneself in words or to understand words) can lead to horrific frustration when combined with all of the other impairments and confusion. Incontinence (both urinary and faecal) usually develops late in the disease and for many superintendrs is the last-place straw. Eventually the demonstrate is reached when the patient is unable to or anything from him- or herself including the following dressing, personal hygiene, home(prenominal) tasks, toileting and feeding.There are characteristic changes in the brain a mark 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 show a definite progression in their development (although plaques without amyloid are known to exist) and granulovacular bodies. Neurochemical changes build 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 degenerative cerebral disease of unknown etiology, with characteristics neuropathological and neurochemical features. The precise etiology of AD is poorly understood. However, it is grand because such an understanding may have implications for both prevention and treatment. The relationship amidst 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 BrainAl zheimers disease leads to brass section cell death and tissue mischief end-to-end the brain. As the disease progresses, brain tissue shrinks and the ventricles (chambers within the brain that contain cerebrospinal fluid) become larger. The damage disrupts chat 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 in that respect are a change of medications that appear to help maintain mental function and slow the disease progression. If these treatments are given 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 degree Celsius million. Much of the increase will be in create countries. already more than 60% of people with dementia live in developing countries, but by 2040 this will rise to 71%. The fastest gain in the elderly population is taking place in China, India, and their southmost Asian and western Pacific neighbours. (Ferri et al, 2005)Stages of Dementia/ADKnowing a persons disease stage helps health professionals to determine the treatment approach and help communication between health providers and health professionals. 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. gerontological 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 intervention representative for dementia one has to keep in mind stages in dementia, linguistic context and circ umstance, as care submits 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 curb 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 hinderanceForgets familiar names futile to name familiar objectsUnable to go on what is readUnable to perform simple calculationsreduced knowledge of on-going and recent eventsBecomes careless in grooming habitsBecomes anxious and frustrated in demanding situationsDenies memory problems and inability to perform tasksWithdraws from challenging situationsGets lo st in familiar surroundingsDenial apply as defense mechanism in grapple with pain of relatives diagnosisFalse hope of improvement apprehension of futureFear that they will also get dementia meet astir(predicate) the effect on their lifeConflict over care planning decisionsFamily assessment to include genogram, influence of pre-existing family patterns, cultural items, smell of relationships, family conflict, can system, and socioeconomic aim.Educate closely disease processestablishment of feelings (e.g anger)Refer to health professional patronise groupEvaluate environment of dementia victimRefer for information on legal and financial issues look for 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, occupy decisionsFlattening of affect (facial expres sion)Sleeping pattern affectedBehaviour changes- may become delusional, obsessive, easily agitated, depressedRole changesSocial IsolationAnger, resentment over caregiving responsibilitiesEmbarrassed by patients behaviour fault over relinquishing caregiving responsibilitiesConflict over care planning decisionsOverwhelmed by caregiving responsibilitiesMarital problemsDepressionHelp to prioritize caregiving tasksAssist family with feelings associated with caregiving and/or institutional placementEncourage family members to maintain contact with the person in an institutional setting, participating in their care planProblem-solve to alleviate conflict by resolving issuesEncourage participation in a caregiver contribute groupBe bindive to family members who are providing careIncrease family swan networkUse crisis intervention strategies when necessaryEducate about behaviour managementIndividual, marital or family therapyLate/Severe stage finish loss of functioning and basal skills 3-5 years unwitting of recent events and experiencesUnaware 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 decisions transgression over this desire 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 patient bequeath case management services as needed, continually assessing the patients needs and the familys heading abilityGive the family permission to let goEncourage funeral arrangements effectuate of ADAs people with dementia need sustained care, it becomes important to provide services for patients with dementia also provide nourish and steering to their caregivers. The encumbrance of looking after patients with AD is immense, and carers and families become physically and arousedly exhausted and socially more taxing. At this time families need support from the multidisciplinary squad. For the better quality of life of both AD patients and caregivers, there is need for research and intervention models proper(postnominal) to individuals (familys) finish. 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, thence educating them is important, which will change their perception and attitude toward the family member (support with research). In folksy areas, lifestyle, physical activity (farming) and environment difference could have contributed to the lower section 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 analyse in comparison with/to Pennsylvania confederation of elderly people, USA. Developing countries are also reaching the statistics of developed countries of increased life expectancy and stress related lifestyle, therefore, increasing risk of Dementia/AD.Some of the interjection programs for caregivers are mentioned in the next session. This includes different models of intervention based on system 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 objective, content, success rate/effectiveness of the session/model.Family Intervention/treatment caregivers of ADRole of caregiversChallenges faced by caregiversIntervention programsCaregiverIn our so ciety more and more responsibility 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 greatness as this population suffers more psychological effect than the patient.With the onset of a disability, the family is forced to take on new regions and greater responsibility. This causes high levels of stress in an already stressful situation. Caregivers are virtuallytimes forced to give up their own needs in order to care for a family member. The caring 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 shipway 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 expected 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 also important that they understand the families (caregivers) needs.Stress and caregiver burdenThe proscribe phenomena associated with caring for victims of illness and injury is defined as caregiver burden. Caregiver burden may be further categorize 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 bur den is defined as the caregivers negative chemical reaction in response to the presence of objective burden.A study conducted by Mitrani et al (2006) on the role of Family Functioning in the Stress growth of Dementia Caregivers A Structural 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 significantly 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 predictab le irreversible progression that lasts from between three to twenty years.NonPharmacologic worry 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(prenominal) family is a unique system, 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 constitution 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 families (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 edu cating the family about the dementing illness and discussing the electromotive force 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 final 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. behavioral interventionsAimed at the behavioural level of function ing, 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 corresponding 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 continuous 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 glide by 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 father, who was caring for Tracys grandfather, an Alzheimers patient. Tracy and her mother had always had a well relationship, but Tracy had now become focused on how her mother 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 angry because she intellection her mother was neglecting herself and other family members while caring for grandfather. Tracy reacted to her grandfathers illness by concentrate intensely on her mot hers 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 consider 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. commit 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.Family intermediationFamily Mediation is a family- oriented, problem-solving, task completion model that was originally 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. ternary 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 involved to define ways to agree or disagree. 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, childr en, 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