Dementia Case study Discussion

Hello, I agree that dementia is a common diagnosis among elderly adults aged 65 years and above. According to Arvanitakis et al. (2019), the onset of dementia is 65 years. Approximately 15% of Americans aged 68 years and above have dementia (Arvanitakis et al., 2019). Alzheimer’s disease (AD) is the most significant factor in dementia. Currently, dementia has affected more than five million people, which is anticipated to rise to 13.8 million by 2050 (Arvanitakis et al., 2019).

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Consequently, AD has become the sixth major cause of death in the general population and the fifth cause of death in individuals aged 65 years and above (Arvanitakis et al., 2019). Dementia is mainly characterized by loss of cognitive abilities and impaired functioning capacity (Cipriani et al., 2020). Additionally, I concur that psychiatrists should develop a treatment plan for individuals diagnosed with dementia. According to Hoffman et al. (2014) evidence-based practiced should be applied in shared decision-making. However, family members should be engaged during the client’s treatment to give their informed consent. In your case, the client’s son provided the informed consent needed to make significant treatment decisions. Her son preferred to seek guardianship for the client. According to Ottawa Hospital Research Institute (2020) seeking support is an effective treatment intervention for older adults with dementia. However, the client should still have been involved in treatment planning to avoid the feelings you stated she felt of being blind-sided.

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Seeking guardian for the client was probated by the court, claiming that the client should stay in the hospital until the doctor felt she was safe for discharge. I also support your idea of prescribing medication to the client. Pharmacological therapy is used in treating individuals diagnosed with dementia. However, medication alone is ineffective treatment therapy for people with dementia due to dementia-related symptoms, including forgetfulness. Thus, a multidisciplinary approach consisting of medication and non-pharmacological techniques such as speech therapies should be used in treating individuals diagnosed with dementia (Zucchella et al., 2019). According to Melnyk and Fineout-Overholt (2018), evidence-based interventions leads to quality patient care and superior health outcomes.

References

Arvanitakis, Z., Shah, R. C., & Bennett, D. A. (2019). Diagnosis and management of dementia. Jama, 322(16), 1589-1599. Doi: 10.1001/jama.2019.4782

Cipriani, G., Danti, S., Picchi, L., Nuti, A., & Fiorino, M. D. (2020). Daily functioning and dementia. Dementia & neuropsychologia, 14, 93-102. https://doi.org/10.1590/1980-57642020dn14-020001

Ottawa Hospital Research Institute. (2020). Choosing a support option for caregivers of older adults living with dementia: Les options pour soutenir le proche aidant d’un aîné présentant des troubles neurocognitifs. https://decisionaid.ohri.ca/AZsumm.php?ID=1947

Hoffman, T.C., Montori, V.M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. Journal of the American Medical Association, 312(13), 1295-1296. Doing:10.1001/jama.2014.10186

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Zucchella, C., Sinforiani, E., Tamburin, S., Federico, A., Mantovani, E., Bernini, S., … & Bartolo, M. (2018). The multidisciplinary approach to Alzheimer’s disease and dementia. A narrative review of non-pharmacological treatment. Frontiers in neurology, 9, 1058. https://doi.org/10.3389/fneur.2018.01058

Recently, we had an elderly woman admitted to our inpatient psychiatric unit on a mandatory 72 hold. Upon further assessment, it was clear this woman had dementia. The psychiatrist determined this. From this point, the woman was not included in her treatment plan or was only shared certain information. During her stay, her son made the decision to seek guardianship and she was probated by the court to stay until the doctor felt she was safe for discharge. She refused medications and insisted on returning to her home, which was not in livable conditions due to her hoarding behaviors and recent forgetfulness. The women understood that she was probated by the courts but did not know that her son had filed for guardianship. When the guardianship fillings were complete the patient was made aware. She was not happy and felt blindsided by staff and her son. Because of his guardianship, all decisions of her treatment plan were made through him. He also had control over her personal funds. He made the decision to place her in a nursing home. The patient was devastated.

Every clinical decision has ethical aspects to it and the clinician must act in the patient’s best interests which will demonstrate a relationship grounded in clinical stewardship and patient trust (Melnyk & Fineout-Overholt, 2018). In this scenario, I agree that it was best for her to have a guardian and to be in a nursing home. I do however believe she should have been more included in her treatment plan to enforce trust. She did not have a good relationship with her son and she could have asked for a lawyer to have guardianship. She could have also chosen the nursing home herself, or at least had a say. In a systematic study done by Bhatt et al. (2018), it was found that it is not uncommon for patients with dementia to not be included in significant decisions, such as placement, but they were included in minor decisions to respect their autonomy.

The patient decision aid I would utilize in the future is “Choosing a support option for caregivers of older adults living with dementia”. Dementia affects all family members/caregivers. The family may not be familiar with caring for a loved one with this diagnosis. As healthcare providers, we can help them. In this decision-making aid, University Laval (2017) helps caregivers in all stages of dementia, including early stages. Which was neglected by my patient’s caregiver. They never allowed her to cope with the shock of the diagnosis, they immediately began to take away her independence without her knowledge.

References

Bhatt, J., Walton, H., Stoner, C. R., Scior, K., & Charlesworth, G. (2018). The nature of decision-making in people living with dementia: a systematic review. Aging & Mental Health, 24(3), 363–373. https://doi.org/10.1080/13607863.2018.1544212

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

University Laval. (2017). Boîte à décision | boîte pdf. Boîte à décision. https://www.boitedecision.ulaval.ca/boite-pdf/?tx_tmboites_tmboitesshow%5Bboite%5D=44

TO ASSIST IN PREPARING A RESPONSE :

COURSE RESOURCES TO USE

>>>>> REVIEW the Ottawa Hospital Research Institute’s Decision Aids Inventory at https://decisionaid.ohri.ca/.
Choose “For Specific Conditions,” then Browse an alphabetical listing of decision aids by health topic.

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Hoffman, T.C., Montori, V.M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. Journal of the American Medical Association, 312(13), 1295-1296. Doing:10.1001/jama.2014.10186