Wednesday, April 3, 2019
Early Stage Of Dementia
azoic Stage Of DementiaDementia is a public disease in the geriatric nation but can oerly be notice in both phase of pornographichood. In a theatre of operations issued by atomic number 63an questioners, it is estimated that ab let on 35 m nauseatedion spate have h every told(a)ucination worldwide. It is called a syndrome because it involves a serious of signs and symptoms. It is a non-specific clinical syndrome ca employ by a wide variety of diseases or injuries that affect the drumhead. imputable to alarming increase of number of frenzy expressions in aged(a) mountain, destiny for extensive re chase on enamour c atomic number 18 for the antiquated insanity affected economic consumptions arises. nurse d intimatelying house is considered as embodied institution mean to take into account constant allot.In order to field if the breast feeding lieu is the around discriminate electric charge environment for older person diagnosed with dementia, an exten sive books search was performed in accordance to Oxford Brookes style. 10 articles were obtained as a go forth of extensive books search after incorporating inclusion and ex communion mensuration arising collect to the personal need. The results atomic number 18 categorised in to quadruple of import report cards which are as fol humiliatedsThe facilities and cautiousness for sale at a wield for sign. Is multidisciplinary approach of the essence(p)? fear received in treat firm vs. inhabitation office wish.Impact of fourth-year people connective foreboding for habitation at an aboriginal stage.Importance of care for breast feeding crime syndicate in ripened patient roles in the first stage of dementiaAfter applying CASP tool to all the articles, Careful analysis was through with(p) to draw the discussion. Basing on the discussion, treat billet is considered as the some eliminate care environment for aged patient diagnosed with dementia. Recomme ndations are proposed on the confiness of conclusions and implications of my query in the future are mentioned.INTRODUCTIONDementiaDementia is delineate as a medical checkup see to it which is characterised by overtaking of cognitive ability which is cause either referable to normal aging or any kind of sudden price (Berrios, 1987). It is also described as non specific illness ca exploitation fit(p) of symptoms poignant retentiveness, language, attention and problem solving regions of the cognitive region of the brain (Calleo and Stanley, 2008).Dementia could be either static, ca apply due to injury of the brain affecting the cognitive area or progressive (slowly progressive and rapidly progressive) resulting in damage of the brain. Although the disease is seen commonly in elderly patients, it occurs at all(prenominal) stage of adulthood (Berrios, 1987).During sign stages of dementia all the higher intellectual functions are affected leading to confusion, forgetfulne ss leading to gradual progression (Gleason, 2003). In aged people, the experience of dementia is worse due to pain and ill health. These symptoms lead to problems associated with ambulation, manner swings, depression, disturbances in sleep pattern, decreased appetite and unsuitability in activity (Gleason, 2003).Caring People scathe from dementiaDuring the initial symptoms, the patient is taken care by the family members and relatives. They ascertain the patient that the fulfill is normal with aging which makes their lifestyle a bit easy (Algase, 1996). A person suffering from dementia is stir uped to a nurse home due to unavoidable circumstances handle absence of carers, hectic life agenda and excessive progression of disease, expensive treatment (Weinberger et al., 1993).Nursing home is defined as a place of residence for patients needing continuous support. Nursing home is chosen in more circumstances as mentioned by Weinberger and co formulateers. agree to him, the ne ed of skilled breast feeding care, physical handling and penny-pinching taking into custody of the patient play an all definitive(predicate) role. along with continuous care, patients in countries like Ireland, United Kingdom and Wales also receive financial aid from physical, occupational, speech therapists, affectionate reckoners, psychiatrists, psychologists to look after the necessities (Kristine et al., 2002). Emergency management is also provided as an intrinsic part of treatment which forms an added advantage. The more or less grand responsibility of the breast feeding home is elderly care which provides the patients with all the basic services like assistance in living, day care and long depot care (Kristine et al., 2002).The Nursing home acts as a caring unit for many dementia patients at different stages of dementia. The case of breast feeding home varies and is most important variable in determining efficiency (Kristine et al., 2002).The qualification, know ledge and responsibility of the carers or staff in charge and presence of physicians to monitor health check over of the patient play an important role (Kristine et al., 2002).Although efficiency of care is expected, at that place are many disadvantages associated with the nursing homes. The patient initially shows signs of disagreement to shift to a nursing home but may agree when explained. The chances of forgetfulness in these issues are also more which could cause agitation after association (Algase, 1996). The initial adjustment of the patient towards the new atmosphere may take a shit more confusion and deteriorate the health condition which is a analyze drawback (Steele et al, 1990). The cost of the nursing home and nursing staff is unaffordable by many of the patients which worsen the situation (Kristine et al., 2002). The extent of care and the support of family members play a vital part in influencing treatment. In particular situations like impaired mobility and di sability or in cases where elder people are state as mentally and physically incompetent, care in the nursing home remains as the outflank factor to increase longetivity of the patients (Steele et al, 1990).The purpose of this opus is to brushup unlike national, International scientific journals and articles which seek to address on Appropriate care of elderly patients diagnosed with too soon stage of dementia. The intention of the impersonate paper is to provide a adequate answer to the investigate headspring Is the nursing home an appropriate environment for an older adult diagnosed with early stage dementia? To answer the question extensive study on belles-lettres search and study was performed. The literature reappraisal covered legion(predicate) journals, policies, and papers which examined the issues on care provided to the elderly patients in early stage of dementia. The reviews include thorough analysis of elderly dementia patients, forms of care available to the m and to examine the best suitable care to improve the health condition of these patients. The limn investigate will evaluate available entropy on nursing home as perfect environment for caring these kinds of patients. The review elaborates on the expectations of the patients and relatives towards care and the attempt of health professionals to live up to the expectations of them. The review also highlights the difference surrounded by care obtained in the home and a typical nursing home. It throws light on advantages and disadvantages of care given in nursing homes and these factors are considered later to draw conclusions on the most appropriate environment to care for elderly dementia patients.OBJECTIVEThe objective of the interrogation paper is to investigate the literature on qualitative, quantitative and mixed info-based approaches on proper care of elderly patients. These inferences would form the basis for accord if the nursing home is the most appropriate place for c aring dementia patients.METHODOLOGYIn order to concentrate on the objectives of the study, extensive literature exploration was performed. Aliterature reviewis a body of schoolbook that aims to review the critical points of current knowledge including substantive findings as well as theoretical and systemological contributions to a particular topic (Aveyard, 2007). literary productions review was considered as a best source of seek methodological analysis because of meter constraint and need of ethical considerations to perform indigenous search. literary productions review focuses on elemental research done in various clinical circumstances. The former(a) advantage is possibility of comparative study among various qualitative, quantitative and mixed primary researches across the world (Aveyard, 2007).During my study on the available literature, various situations experienced by dementia patients in nursing homes were analyze. Ideas about circumstances experienced by the elderly patients in nursing homes were set. Some of the papers focus on style of practice in nursing home and any(prenominal) of them focus on the attitude of patients towards nursing care. There were many controversies identified according to different perspectives of authors. Through these studies, an thought about the best suitable place of care for elderly patients at early stage of dementia could be conveyed.Research passageThe process of research involved organized and vigilant consideration of literature suitable for my research work. The PICO model to formulate a question as suggested by Johnson and Fineout (2005) and by Stone 2002 cited in Gerrish and Lacey, 2010 is shown in the appendix 1 of the present research work. The model gives a simpler representation of the present research work.The four main toll which were use as a part of my literature search include dementia, elderly patients, quality care and nursing home. bit victimisation these toll care was taken to use them in combining rather than using singularly which would widen the research area of expertise. The identify of search terms and the keyword identification table as suggested by Aveyard and sharp (2009) is given in the appendix 2a and 2b one by one of the present investigation report. composition considering the term dementia, early stage was emphasised in particular to lucubrate my search. In addition to early stage, another term, elderly patients were also used to avoid peeping among all the age throngs. The term used for search looked like presented belowDementia OR Alzheimer* OR memory loss and early stageThe Boolean operator and was used in between these terms to ensure that research of literature included these three dustup in combination. In cases of excluding Boolean operator, the research resulted in articles including primary research of dementia at all stages among all age groups.The other important search term was concerned with the age of the patient which was mainly restrain to elderly patients. The parameters used included Boolean operator and. The style was as followsOlder person OR gray OR older adultThe other term used in conjugation in the research term included quality care. As quality care is considered as a wide term, a Boolean operator or and curtness symbol, star *was used to modify thorough research without exclusion of any important article or journal. The term entered was presented as below fictional character care * or appropriate care* or concern or caring* or offbeat or well-beingThe use of Boolean operator and truncation symbol ensured non omission of important articles containing synonyms or other than presented words.The final term used in literature search was nursing home. Since my research focuses to study the most appropriate care environment for elderly dementia patients at early stage, this final term was used separately. The terms used in comparison includedNursing home and care home* or residence*In t his particular context, nursing home and care home are considered in comparison with residence of the patient. To enable the results to be confined to single term, the Boolean operator, or was used. The operator and was used to search results including both, nursing homes and care homes. The truncation symbol star was used to include articles with words displayed in alternative formats.The final research phrase for search looked as displayed belowDementia OR Alzheimer* OR memory loss and early stageANDOlder person OR Elderly OR older adultANDQuality care * or appropriate care* or concern or caring* or wellbeing or well-beingANDNursing home and care home* or residence*The immediate course of action was to use these terms in appropriate databases, I was guided by the university library manuals of the Oxford Brookes to consider CINAHL, British NURSING INDEX and MEDLINE as most relevant databases for search. CINAHL deals mainly in Nursing and health care in North America and Europe (Oxf ord Brookes University, 2009). British Nursing Index includes journals and articles based on care and community health pertaining to nursing and midwifery (Oxford Brookes University, 2009). Medline (Pubmed) is a collection of articles on music and nursing compiled by the interference of National Library of Medicine ground forces (Oxford Brookes University, 2009).When the entire research phrase was posed in CINAHL, it retrieved 332 articles. When the same research phrase was typed in MEDLINE, it retrieved 75 articles. Further refinement was done in the search by using limiters 20000101-20101231 and retrieved 57 and 54 articles respectively. Inclusion and exclusion criteria were used in particular to include time constraint which enabled to postulate most recent articles in the present decade. This included articles beginning from 2000 to present. another(prenominal) inclusion criterion was the place which restricted the search results to the investigation done in the UK. The inc lusion and exclusion criteria yielded 55 and 29 articles in CINAHL and MEDLINE respectively (The database searches and hits are shown in the appendix as suggested by Oxford Brookes University, 2011).To analyse the best suitable material to carry forward my research, four main principles as suggested by Aveyard (2007) were used, which included electronic searching, searching reference lists, hand searching of relevant journals and contacting authors directly. Out of all the suggested principles, the first three types were used as analytical tools in deciding best suitable literature. While choosing the primary research material, utmost care was taken to read through the abstract, findings and research methodology involved. This criterion was used for including or excluding the article for my research purpose. For some of the searches, hand searching was also used to obtain authorized utilizable information on statistics in UK (shown in appendix 4). Due to time constraint in the res earch work, contacting health care professionals and conducting appropriate interviews could not be performed.As a result of the research methodology, 10 articles were undercoat relevant to the context being investigated. The findings of the papers were thoroughly study in order to answer the research question. Nursing home was considered to be an exalted place to take care of an elderly dementia patient in initial stage of the disorder.Critiquing my research methodologyThere were many criticisms sight following my research methodology. The main criticisms observed included the following inability to access all the journals in the databases as it postulate paid registration. nigh of the websites which have excellent articles require a payment. I managed collect as many as articles I wanted to do answer this research question by login on A becauses. It was beyond my finances to fund for all the articles. escape of time to contact primary health care professionals to curb their views as a part of my research work.Lack of time to go through all the publications of a journal which resulted in referring to recent publications.Lack of much information in the title which would enable me to take appropriate decision regarding the content of article which resulted in reading the abstract in order to include article for research.Thus the major constraints of the present research article were identified to be cost and time. However, the freely available data obtained within the specified time were sufficient to draw conclusions to address the research question.For the entire 10 articles, critical appraisal skills programme, CASP (2006) tools were applied to draw the most relevant themes. The main themes identified areThe facilities and care available at a nursing home. Is multidisciplinary approach essential?Care received in nursing home vs. home care.Impact of elderly people link nursing home at an early stage.Importance of nursing home in elderly patients in th e early stage of dementia.RESULTSThe findings of the literature were categorized into main themes which made it easier to draw conclusions. The section depicts the investigation done in the 10 articles grouped together in accordance with the theme.Theme 1 The facilities and care available at a nursing home. Is multidisciplinary approach essential?Author, Year, LocationTitle rule/ developmentResultsComments1. J. Cohen Mansfield and A.Parpura- Gill (2008). International ledger of Geriatric Psychiatry.Practice Style in the nursing home Dimensions for judgment and quality overtureThe investigation examined the operation style of the nursing home in terms of two main components which are the staff and institutional components.The four domains which served as tool to study the staff conduct included knowledge, proficiency of practice style, flexibility and individual care and communication.The three domains used to test the conduct of institution include support of staff, availability of resources and plaque of policies.As a result of the investigation, key features of institutional factors and staff were studied and monitored. Based upon the need and demand, the features requiring change and improvement were noted to ensure quality of care.The investigation emphasises on the practice styles of the staff in a nursing home with respect to care provided. The research journal gives an insight of vivid styles of care provided within a nursing home which ensures quality of care. It focuses on the knowledge, communication, flexibility and understanding of the staff in taking appropriate care in elderly personsIt also gives a note on ever-changing style of practice to cope up with increasing demand.2. E.Finemma et al., 2005. International daybook of Geriatric Psychiatry.The effect of integrated emotion- point care versus usualcare on elderly persons with dementia in the nursing homeand on nursing assistants a randomized clinical trialThe investigation is based on ra ndomised clinical trial of two groups of elderly dementia patients, metre the effects at baseline after specific period of time. The study involved 146 numbers of elderly dementia patients and 99 numbers of nursing staff. The study was performed in 16 psycho geriatric wards determined in 14 nursing homes situated in the Netherlands.The primary research studied the difference between the usual care and Integrated emotion-oriented care. The nursing assistants were tried and true on the basis of care given.Positive effects were reportedly noticed in patients experiencing mild to manipulate dementia in terms of portrayal emotional balance and positive self image. Results also showed that training nursing staff resulted in less deform reactions increasing quality and patience.The investigation revealed that emotion based care showed increase performance in early stage dementia patients when compared to normal usual care. However, It did not show any eye catching increase in qualit y with regard to people suffering from severe dementia. The study also focuses in reduction of stress in well trained nursing staff.3. D. Challis et al., 2000.Journal article from time and Ageing.Dependency in older people recently admitted to care homes.The investigation was based on the study conducted among 308 elderly people aged over 65 in one of the nursing care home located in North west England. The study was conducted within two weeks of main course for people intending to continue treatment for long term. Barthel s magnetic core and Crichton royal demeanour rating scale were used to analyse the dependency rates.On the basis of Barthel rating scale and Crichton royal behaviour rating scale, 50% of the population were showed to be measured in the low dependency scale (13-20).Out of them, 31% in case of nursing home and 71% in case of residential care homes. On the whole, dementia patients are not assessed originally before admission into the nursing home.Studies revealed that in that location was lack of pre admission assessment and diagnosis before joining patients. This study throws light on lack of communication about the pre assessment and diagnostic information about the patients to the health care and nursing staff. Effective targeting of institutionalised resources is focussed with high greatness.4. Leontjevas et al., 2009.American Journal of Alzheimers Disease Other DementiasApathy and Depressive Mood Symptoms in Early onset dementia.As a part of epidemiological study, patients were studied for symptoms of lethargy and depressive mood in early onset of dementia. Studies were performed in 63 nursing homes. MADRS, NPI and MMSE scales were used to detect rate of depression and MDS-RAI and GDS were used to detect tartness of dementia.Studies revealed that depressive mood disorders and apathy are not observed severely in cases of patients suffering from early onset dementia .The results noted were accounted as 14% in ADL, 13% in GDS and 9% in MMSE.The investigation reveals that the symptoms of mood depression and apathy are seen extensively in patients suffering with early onset of dementia when compared to elderly patients revealing the severity of aggression.Theme 2 Quality of care received in nursing home vs. home care.Author, Year, LocationTitleMethod/StudyResultsCOMMENTS1. Ehrlich et al., 2006. property health care management and practiceCaring for the Frail Elderly in the Home A Multidisciplinary ApproachThe study depends upon short portable mental post questionnaire proposed by Pfeiffer in 1975 to identify dementia in geriatric population.The test confines to recall and memory of short term and long term orientation.Additionally, evidence based practice is applied to harbor patients with the disease.The application methodology enabled identification of patients suffering with dementia. Interdisciplinary approach is applied to propose a model for caring elderly people in home atmosphere.The primary research a rticle focussed on the major disorders affecting the elderly person which forms the basis of joining a nursing home for care. The interdisciplinary approach gives an idea about caring older patient from the most necessary syndromes to enable ease of treatment in the house without hindrance of nursing home.2. Milke et al., 2006.Journal of Applied GerontologyMeeting the Needs in ContinuingCare of Facility-Based ResidentsDiagnosed With DementiaComparison of Ratings by Families,Direct Care Staff, and Other StaffThe data was collected by sampling method in five different places including Edmonton, Alberta, Canada, Pennsylvania and New York. A conglomeration of 184 elderly residents diagnosed with dementia and 197 nursing staff participated in the study. Suitably betrothed questionnaires were distributed across the five sites among non direct care staff, family group, direct care group, licenced practical nurses.The results of the investigation provided the comparison of care between families, direct caregivers, and other staff and volunteers. It also gave an idea about extent of care compulsory by the residents by apiece class. The results provide comparison of care in nursing home and the care in the patients own house.The research work emphasizes on individual care provided by various groups like families, friends, commissioned medical nurses, volunteers and other professional care givers. It gives a relation of arrogance and cooperation between the patient and care givers. It focuses on various negative aspects of care in the patients house created due to stress, pressure and miscommunication.The article gives insight on the advantages of care provided by professional care givers over the family members in terms of knowledge, patience and quality.Theme 3 Impact of elderly people joining nursing home at an early stage.Author, Year, LocationTitleMethod/StudyResultsCOMMENTSConnor et al., 1991.Papers from British Medical JournalDoes early intervention reduce the number of elderly people withDementia admitted to institutions for long term care?The investigation utilised seven general practice areas located in Cambridge in the form of controlled clinical trials. 2885 subjects aged over 75 diagnosed with dementia were involved. 159 subjects in the group were diagnosed with initial stage dementia, 86 of them required extra support and 73 of the subjects had access to usual services and acted as control.The research revealed that there was no direct contribution of early intervention to long term admission of patients in the nursing home. 9 out of 14 subjects who were living at home without support joined nursing home due to the extended facilities available.The investigation focussed on screening procedures of dementia to identify level of severity of the disorder in the patients. In certain patients, the severity is high requiring instant admission into nursing home and in some cases, support by family members would be sufficient. Evidenc es also repose that early intervention of dementia would decrease the risk of severity in the disease.Theme 4 Importance of nursing home in elderly patients in the early stage of dementia.Author, Year, LocationTitleMethod/StudyResultsCOMMENTS1. Voyer et al., 2005clinical effectiveness in nursing2. Dettmore et al., 2009Geriatric nursingCharacteristics of institutionalize olderpatients with delirium newly admitted to anacute care hospital incursion in Persons with DementiaUse of Nursing Theory to Guideclinical PracticeThe investigation involves cross sectional secondary analysis study of old patients in nursing homes and other health care units. confusion assessment method was used to test patients with delirium upon their admission.The research work utilizes Need-driven Dementia- compromised Behavior (NDB) model to explain aggression in the individuals undergoing constant core in a nursing home.In the total of 104 patients suffering from cognitive impairment, 68% people were recor ded to possess delirium. The MMSE scale was used to screen patients to test the presence of delirium. The major symptoms which were observed in all the patients were catgut incontinence, illness. The most uncommon symptom observed was hearing impairment which occurred rarely.Clinical management algorithm was framed in accordance with the NDB model to study the behavior of aggressive patients and frame a theory to take care of the patients in aggressive moods and to avoid repetition of the syndrome.The research emphasizes on the importance of nursing homes in providing care and offer screening of the disorder. The severity of cognitive impairment doesnt influence the preventive nursing interventions. Independent of the level of impairment, nursing care portrays important feature in improving the quality of patients requiring close care.The patients suffering with dementia undergo frequent episodes of aggressive beahvior making care by professional care givers difficult. The paper foc usses on the proposal of clinical management algorithm which is based on ndb model to manage certain aggressive episodes of the patient.3. Holliday-Welsch et al., 2009Geriatric nursingMassage in the Management of upthrow inNursing Home Residents with CognitiveImpairmentThe study was performed using subjects who are susceptible to agitation and aggrieve mood by nursing staff. The susceptible patients were selected by the use of minimum data set (MDS) report. The data collection was done during 3 days considered as base line, then the intervention followed up to another 6 days continued by follow up for the next few days.it was observed that Subjects agitation was degrade during the intervention of massageThan at baseline and remains still low at follow-up. Wandering, verbally agitated, physically agitated and care resistance were proven to be decreased upon intervention of massage.In this study, the five aspects of agitation which are wandering, verbal agitation, physical agitation , abusiveness, socially inappropriate agitation, disruptive aggressiveness. At each of the observation, agitation was scored for five times. Massage is one of the non pharmacological interventions in these patients suffering from agitation. This could be used as an effective tool by nursing staff in eliciting quality careDISCUSSIONAll the themes identified in the research play a suitable role in delivering the conclusion to provide a suitable answer for my research question. The themes are arranged sequentially to ultimately conclude upon appropriate care for elderly dementia patients at early stage of the disorder. Each of the 10 articles selected, carries an important examination which forms the basis for future implications in the nursing staff.The first theme based in my results is facilities and care available in nursing homes using a multidisciplinary approach. This particular theme identifies the importance of nursing home as an institutionalised care centre to exhibit suppor t and care to all kinds of dementia patients. The study proposed by J. Cohen Mansfield and A.Parpura- Gill (2008) suggests the nomenclature involved in nursing homes including the care provided by the nursing staff. The paper focuses on the improvement of these facilities to improvise style of nursing home which ultimately determines the quality. He regards flexibility, knowledge, communication as an essential factor for influencing care by nursing professionals. Along with characteristics of the staff, he also focuses on certain institutional factors which serve as tool of improvement (Beck et al., 1999). The most important institutional factors include clock of care, alternatives of care, resident and family involvement (Porras, 1987 Kanter, 1993). The frame work which is important for a nursing home is changed regularly on the basis of organizational and staffs needs to ensure implementing better system for staff especially in case of dementia, where there is a need of care speci alist to monitor a group of care providers (Noelker and Harel, 2001). The investigation based by on the study of e. Finnema et al., 2005 portrays the role of emotion oriented care in the patients suffering from mild to moderate dementia in nursing homes. He describes the role of emotional oriented care in influencing body adaptation and balance of the dementia patient seen in early stages (Finnema et al., 2000). General health condition was also proven to improve especially in c
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