Dementia. Health, Medicine and Nursing Assignment.

Dementia
Student Name
Institution Affiliation
Introduction
The health care sector continues to witness success and challenges in equal measure. Particularly, long-term conditions that are characterized by illnesses that lack conclusive cures and as such, can only be controlled and managed through medicines and other forms of treatment are a major concern in society (Stenberg & Furness, 2016). Long-term conditions have lasting effects not only on the patients but also their families, jobs and finances (Phillips & Harris, 2019). One notable long-term condition is dementia that the World Health Organization (WHO) has labelled a global epidemic (Deacon & Rickards, 2012). Dementia is a chronic syndrome that involves deterioration of a person’s cognitive functioning. As such, it affects various cognitive aspects including memory, thinking, comprehension and judgment among others. Dementia predominantly affects older people but it is essential to note that it is not a normal part of aging. It is estimated that over 50 million people globally suffer from dementia and that more than 10 million new cases are reported annually (Alzheimer Association, 2020). Similarly, statistics indicate that a significant number of people suffering from dementia live in low and middle income nations where support and social protection services are very limited (Who.int, 2020).
Figure 1: /government/publications/dementia-applying-all-our-health/dementia-applying-all-our-health
According to the figure above, the number of individuals suffering from dementia in the UK is rising drastically and if effective measures are not instituted, the figure could double by the year 2040 (GOV.UK, 2020). Medical experts have not succeeded to develop a cure for dementia and as such, it is one of the leading causes of death in the UK. It is essential to note that dementia affects people differently and the signs and symptoms occur gradually in three distinct stages: early, middle and last stages (Mayo Clinic, 2020). Additionally, there are several forms of dementia with Alzheimer disease being the most common. Other types of dementia include vascular dementia, Lewy body dementia and mixed dementia. Doctors and medical experts have proposed the following as being the cause of dementia.
* Degenerative neurological diseases such as Alzheimer’s disease and Parkinson’s disease (National Institute on Aging, 2020).
* Vascular disorders and those that majorly affect blood circulation in the brain (WebMD, 2020).
* Traumatic brain injuries.
* Infections of the CNS (National Institute on Aging, 2020).
* Long-term abuse of alcohol and other drugs.
Several search terms were used when searching for academic evidence to support the learning on dementia. These include the signs and symptoms of dementia. Research material was also obtained by searching for common forms of dementia and statistics of individuals suffering from dementia globally and particularly in the UK.
Research database searched

Number of results

Signs and symptoms of dementia

76,100,000

Common forms of dementia

44,100,000

Statistics of individuals suffering from dementia globally

61,700,000

Statistics of individuals suffering from dementia in the UK

89,400,000

Pathophysiology of dementia

8,680,000

Portfolio Entry 1
Alois Alzheimer is accredited for being the first neuropathologist and psychiatrist to describe the abnormalities that existed in the brain of patient with dementia (Yaffe, 2010). It is essential to note that doctors and medical experts have not fully expounded on the exact cause of dementia. Nonetheless, there is a proposal that amyloid plaques and neurofibrillary tangles are the major contributing factors. The production and accumulation of plaques and tangles usually occurs because of not only synaptic dysfunction but also neuronal degeneration (Waterall, 2020). As such, the patient tends to exhibit a slow progressive and irreversible deterioration of cognitive functions such as memory and language. Amyloid plaques are made up of beta-amyloid proteins that are obtained from amyloid precursor protein (APP) that is identified as the parent protein (Phillips & Harris, 2019). The APP is cleaved into soluble fragments using three distinct enzymes in alpha, beta and gamma secretase. Medical experts have strongly suggested that amyloid plaques are formed when the APP is inappropriately cleaved by the beta and gamma secretase enzymes. The inappropriate cleave of the APP results in insoluble beta amyloid proteins that accumulate over time to develop plaques in the brain as shown in the figure 2 below. These plaques then result in neurotoxicity and cell death.
Figure 2:
Similarly, medical experts have shared that neurofibrillary tangles occur because of over phosphorylated tau proteins. According to Larson (2011), “Tau proteins naturally contain phosphate molecules; in AD, these proteins are hyperphosphorylated, causing the tau proteins to twist around one another and form insoluble tangles that disrupt neuronal transport”. Additionally, dementia in some families occurs because of some genetic mechanism. The e4 allele that is part of the apolipoprotein E (ApoE) is believed to carry the strongest genetic risk. Medical reports indicate that at least one in every five people carries the e4 allele (Howard, 2019). These carriers are also at a higher risk of contracting dementia. ApoE is very essential in the human body because it not only assists in the processing but also clearing of APP. As it was shared previously, dementia mostly occurs because of ineffective clearance of APP and which then causes excessive production and deposition of beta-amyloid (Almkvist, 2016). In this regard, it is believed that carriers of the e4 allele suffer from such a predicament and are incapable of effectively clearing APP.
Furthermore, it has also been proposed that neuron inflammation is another possible cause and effect of dementia. Inflammation of some parts of the brain is quite common with old age and which then results in the production of plaques and tangles. Deacon & Rickards (2012) note that “Once formed, plaques and tangles cause more inflammation, accelerating the formation of additional plaques and tangles and leading to further cognitive decline”. Other risk factors of dementia include depression, heavy smoking and alcohol abuse, diabetes mellitus, and physical inactivity. Reports from the World Health Organizations reveal that at least one-third of dementia cases worldwide occur because of the aforementioned risk factors (Anderson & McConnell, 2017). As such, through controlling these risk factors, it is possible to prevent or delay the occurrence of dementia.
Portfolio Entry 2: Role of the Nurse in Managing Patients with Dementia
Health care practitioners including nurses are mandated and obligated to provide quality care and treatment to all their patients without discrimination or victimization. Nurses are supposed to ensure that the safety of patients in the medical facilities is guaranteed and that their outcomes are improved as soon as possible (Zangerle & Kingston, 2016). With rising costs of medical treatment, nurses are also supposed to minimize on errors that would result in the patient requiring additional stay in the hospital or in need of more medications. It is the role of nurses worldwide to ensure the provision of holistic care in the sense that the treatment does not only center on physical and psychological care but also social and spiritual care (Sanchez, 2013). As it was shared in the previous section, long-term conditions such as dementia do not currently have cures but doctors and nurses can usually manage to control the symptoms and complications with some forms of treatment.
Similarly, it was also noted that individuals suffering from dementia have significant damage to their cognitive functions and as such, are dangerous not only to themselves but also to the people around them. Medical reports indicate that patients with dementia are more likely to commit suicide or harm themselves because of some of the harsh effects of the disease such as depression, mood disorders and anxiety (Russell, 2018). In this regard, it is highly recommended that patients with dementia are placed in facilities where qualified, experienced and skilled nurses will be in a position to help them manage the symptoms and complications of the disease. Morley (2014) reiterates that position and shares that “nurses are an essential element of the multidisciplinary team and should take the lead in delivering complex care at home to people with long-term conditions, while maintaining a focus on developing self-care, empowerment, community engagement and acting as an advocate for clients and their families”. The above statement is a reflection of the fact that nurses handling patients with dementia are supposed to provide holistic care
Physical Care of Patients with Dementia
Nurses who are tasked to manage patients with dementia in residential care facilities have to provide physical care. Dementia is a serious long-term condition that not only affects cognitive functioning but also has physical health complications (Mendez, 2014). Considering that dementia predominantly affects old people and who are already plagued by mobility issues, it is imperative that nurses in the facilities are effectively trained in the provision of physical care. Medical experts have shared that the progression of dementia in patients is directly associated to the decline and deterioration of their physical health. As is mostly the case, patients with dementia usually have no realization of the impacts that the disease has on their human bodies (Mackintosh, 2019). There are several ways that dementia affects physical health and which warrant for the need of a nurse to be present at all times around the patients.
To begin with, patients in the later stages of dementia tend to exhibit jerky movements. Majority of these patients usually suffer from Alzheimer’s disease. The jerky movements are in such a manner that the patients cannot control and serve no purpose and can greatly affect their posture. Kasai & Meguro (2018) note that “These movements can be anything from quick, jerking tics to longer tremors and seizures”. As a result of the lack of control in their movements, patients with dementia are prone to injuries. In this regard, nurses have a role to play in helping the patients to move around with relative ease. The nurses can administer walking aids. They can also take the patients through physical exercises to improve the movement of their limbs. Overall, nurses will be present to prevent excessive damage from seizures and tremors. Secondly, patients with dementia also showcase loss of appetite and become very choosy on the types of food to consume. With severe impairment to the cognitive function of memory during the later stages of the disease, patients are likely to forget how to cook, use utensils or even chew and swallow their food (Jensen et al., 2017). As such, through interactions with the patients in the facilities, nurses are able to examine and identify the types of foods that patients desire and consequently, create balanced diet programs. The nurses in residential care facilities will also manage to feed the patients who are unable to feed themselves because of severe shaking of the limbs. Moreover, nurses at the facilities can recommend the use of feeding tubes and other aids to assist patients who have forgotten how to chew and swallow their food (Holmes, 2017). The presence of nurses in the residential care facilities ensures that patients with dementia are not weakened from lack of food consumption and on the contrary get strength from consuming meals with high nutritional values.
Thirdly, patients with severe dementia tend to lose control of their bowels and without proper care will become very unhygienic and contract other diseases that will complicate their condition (Gupta & Pant, 2010). However, nurses in residential care facilities are instrumental in changing the patients every so often. The nurses also encourage patients particularly those in the early stages of dementia and have some control of their cognitive functions to go for bathroom breaks after every one or two hours. Last but not least, patients in later stages of dementia usually suffer from lack of sleep. These patients when left unattended and at the mercy of effects such as depression and mood disorder are likely to harm themselves or injure those around them (Elliot & Adams, 2011). With nurses at residential care facilities, the patients can be given medications that relax them and influence them to sleep. Similarly, the nurses can take the patients through vigorous physical activities that tire their bodies and put them to sleep soundly.
Psychological Care of Patients with Dementia
Patients with dementia usually suffer from various psychological issues including depression, anxiety and mood disorders. These issues combined with their impaired cognitive functioning can result in detrimental consequences if not addressed. According to Davis et al., (2010), “Depression is common among people with dementia and is associated with significant adverse effects, including decrease in quality of life, increased need for institutionalization, greater health care utilization, higher mortality rates and increased caregiver burden”. Medical reports further suggest that patients with dementia and who also suffer from depression are more likely to harm themselves of commit suicide just to put an end to their suffering (Criseno, 2019). Dementia patients who are also plagued by psychological problems put additional burden on their care givers and put additional pressure on the already limited finances directed towards their treatment.
Based on the above psychological concerns in dementia patients, nurses in residential care facilities have integral roles to play. To begin with, nurses assist in minimizing the changes in mood and behavior that are associated with dementia by encouraging the patients to engage in activities they like or are interested in (Boucher, 2012). For instance, some nurses have recommended painting as a pass time activity to their patients. Secondly, nurses also provide strategies that not only the patients with dementia but also their family members can cope with their experiences of anxiety, sadness and depression. With severe progression of dementia, nurses can encourage family members to shower their loved ones with affection and moral support. Nurses skilled in counseling can also advise the members that dementia is not a curse and that the condition is manageable with effective treatment. Thirdly, upon thorough examination of the level of dementia in patients, nurses can recommend various memory tools. For example, they can suggest the use of alarm to remind the medication when it is time to take their medication. They can also propose the creation of a to-do list as a memory substitute. Furthermore, they can simplify tasks and routines by breaking larger activities into small steps. Fourthly, the nurses can also help the dementia patients to manage their stress by being empathetic. They can assist the patients to exercise of encourage them to talk to their friends and family members. Nurses can also relieve some of the stress from the patients by involving them in the diagnosis and treatment process. Additionally, Bellanger (2011) suggests that “People with dementia and mild to moderate symptoms of depression may be offered psychological interventions (such as cognitive behavioral therapy [CBT], interpers...