NURS 20020 Ageing in Society Case Study Assignment Paper

NURS 20020 Ageing in Society Case Study Assignment Paper

NURS 20020 Ageing in Society Case Study Assignment Paper

Dementia is one of the public health problems with high prevalence in Australia. The affected populations suffer from a decline in neurocognitive functions, which affects their overall health, wellbeing, and quality of life. Patients often experience symptoms that include a decline in thinking, memory, communication, behavior, and the ability to perform optimally in their activities of daily living (Gitlin et al., 2018). Nurses and other healthcare providers play crucial roles in reducing the rate of dementia and providing culturally appropriate dementia care to the affected populations. They explore evidence-based interventions that can be used to achieve optimum care outcomes, including safety, quality, and efficiency. Therefore, the purpose of this paper is to explore Nancy Francis’s case study. Nancy Francis has been diagnosed with vascular dementia. The paper explores the causes and prevalence of vascular dementia in Australia, treatment, assessments and services, and communication needs of family members caring for her.

Health Issue

Vascular dementia is among the leading causes of dementia after Alzheimer’s disease. Vascular dementia is considered a cognitive impairment that results from hemorrhagic brain injury, ischemia, or cerebrovascular disease. Multiple infarctions, ischemia, and cerebrovascular incidences contribute to the development of cognitive impairments in vascular dementia. Vascular dementia exists in types that include hypoperfusion, subcortical vascular, strategic infarct, and multi-infarct dementias (Bonnici-Mallia et al., 2018). Vascular dementia is attributable to several causes/risk factors. They include being elderly, post-stroke patients, diabetes mellitus, and vascular risk factors that include hypertension, hyperlipidemia, and smoking. The other risk factors include sex, genetic factors, and inflammation, atherogenic disorders, occupational exposure to chemicals such as pesticides, dietary fat intake, psychological stress, and low educational attainment (Royal Commission, 2019).

Of the risk factors, vascular conditions are largely implicated in the development of vascular dementia. Conditions such as stroke have been shown to cause brain vascular lesions, vessel damage, and changes in white matter that cause post-stroke dementia. Alternations of the small vessels in the brain also cause selective tissue necrosis and incomplete ischemia, which contribute to vascular cognitive impairment, hence, vascular dementia (Wolters & Ikram, 2019). Age is also the leading risk factor since up to 60% of patients aged above 65 years suffering from Alzheimer’s disease have an overlap of vascular dementia. In addition, vascular dementia contributes to about 20-40% of all dementia cases. Up to 75% of stroke cases affect patients aged 65 years and above. Age is the leading risk factor for the development of vascular dementia in this category of patients (Dyer et al., 2018). Therefore, a focus should be placed on addressing modifiable risk factors for vascular dementia in the populations at risk.

Statistics show that vascular dementia has a prevalence of 20-30% in Australia. It is the second most common dementia after Alzheimer’s disease that has a prevalence of between 50 and 75% (Royal Commission, 2019). The statistics by Dementia Australia show that dementia is ranked the second leading cause of mortalities among Australians with women affected more than men are. The estimated number of people suffering from dementia is 487500 as of 2022. At least 1.6 million people in Australia can individual suffering from dementia. The number of people living with younger onset dementia is estimated to be 28800 and is expected to increase to 41250 people by 2058. The rates of dementia vary across the different regions in Australia. For example, 6600 people currently live with dementia in the Australian Capital Territory, 161600 in New South Wales, 2000 in Northern Territory, 94000 in Queensland, and 40300 in South Australia (Dementia Australia, 2022).

Patients suffering from vascular dementia present to the hospital with several symptoms. The behavioral and psychological symptoms that they report include wandering, depression, apathy, irritability, and difficulty in communicating, which cause verbal and physical aggression. The behavioral and psychological symptoms vary based on the disease progression and patient-related factors such as their circumstances (Bonnici-Mallia et al., 2018). Factors that include fear, pain, stress, and feeling threatened tend to worsen symptoms of vascular dementia. Overall, the symptoms cause functional limitations that include complex attention spans, difficulties in executive functioning, language difficulties, learning, and memory issues, and inhibited social cognition, which affect the social and occupational functioning of the patient alongside their health and wellbeing (Deardorff & Grossberg, 2019).

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Treatment/Management

Pharmacological and non-pharmacological interventions are used in treating vascular dementia. Lack of treatment increases the risk of harm to self and others in dementia patients. In addition, apathy and depression may lead to agitation, excitement, and poor self-care that contribute to injuries and altercations (Jo et al., 2018). Refusal of care and seclusion may result from paranoia. Pharmacological interventions are largely considered if non-pharmacological interventions are not effective or patients experiencing severe symptoms of dementia and vascular dementia. The first category of pharmacological interventions utilized in vascular dementia is the use of antidepressants (Konyushok, 2020). Studies have shown that antidepressants reduce symptom severity compared with placebo. Antidepressants that include citalopram, risperidone, lorazepam, and trazodone are used in the treatment. Antidepressants have a high tolerability level. However, patients should be monitored for vasospasms and bleeding due to the inhibition of serotonin reuptake in platelets (Hsu et al., 2021). Of the antidepressants, Trazodone has the highest level of success in symptom improvement.

Sedatives are the other group of drugs used in vascular dementia. Drugs such as benzodiazepines are recommended in cases where patients are severely agitated. However, patients should be monitored for increased risk of falls due to sedation and confusion. Cholinesterase inhibitors and N-methyl-D-aspartate receptor agonists have also been considered for use in treating vascular dementia. Cholinesterase inhibitors such as rivastigmine, donepezil, and galantamine have been shown to have a modest effect on behavioral symptoms that patients suffering from vascular dementia experience (Dyer et al., 2018). Mood stabilizers are also recommended for use in treating vascular dementia. Mood stabilizers are effective against behavioral symptoms of dementia. Carbamazepine is effective for psychological and behavioral symptoms while Divalproex may be considered for behavioral symptoms. Antipsychotics are also effective in managing behavioral and psychological symptoms of vascular dementia. Second-generation antipsychotics such as Risperidone and olanzapine are effective against psychosis, psychological, and behavioral symptoms (Perng et al., 2018). However, patients should be monitored closely for adverse effects that include tardive dyskinesia, extrapyramidal symptoms, and anticholinergic adverse effects.

Non-pharmacological interventions are also effective in vascular dementia. One of them is exercise and motor rehabilitation. Regular physical activity has the potential of improving cognitive function and reducing the risk of vascular dementia and other types of dementia. They also delay its onset as well as progression in the populations at risk and affected by the disorder (Hansson et al., 2019). Moderate intensity physical exercises decrease the risk of dementia, and depression, and enhance short and long-term cognitive function. In addition, physical activity reduces the factors that contribute to vascular dementia such as diabetes, hypertension, and hyperlipidemia (Morovic et al., 2019). Other studies propose that physical activity reduces arterial stiffness, vascular blood pressure, systemic inflammation, oxidative stress, and improves cerebral perfusion.

Cognitive interventions are also effective for vascular dementia. They can be used to complement the effectiveness of the adopted pharmacological treatments for vascular dementia. Cognitive interventions include cognitive training, cognitive stimulation, and cognitive rehabilitation (Perng et al., 2018). Cognitive stimulation entails the utilization of interventions that include reminiscence therapy and reality orientation therapy to enhance the patient’s social and cognitive functioning. Cognitive training focuses on a specific aspect of cognitive function such as memory, attention, executive, or language functions and improves them. Cognitive rehabilitation entails the adoption of tailor-made interventions that set realistic and achievable goals for patients and their significant others in their daily lives (Jo et al., 2018). Cognitive stimulation receives the highest support for use in any time of dementia due to its effectiveness in improving the overall cognitive functions in patients.

Occupational therapy may also be considered for use in vascular dementia. Occupational therapy focuses on helping patients achieve improved abilities to engage in occupations and their activities of daily living (Raj et al., 2021). Interventions that include skill training, activity simplification, adaptive aids, caregiver education, and problem-solving strategies are used to enhance independence in the affected patients. Occupation therapy improves patients’ physical performance, patient participation, and quality of life (Dyer et al., 2018). Psychological therapies are also effective for patients suffering from vascular dementia. The affected patients often suffer from anxiety and depression. As a result, psychological therapies that include cognitive behavioral therapy, interpersonal therapy, psychodynamic therapy, and supportive counseling are effective to manage these complications (Theleritis et al., 2018). The interventions improve the patient’s quality of life by reducing anxiety and depression symptoms.

Multicomponent and multidimensional interventions can also be considered non-pharmacological interventions for the different types of dementia, including vascular dementia. The multidimensional-multicomponent interventions combine different non-pharmacological interventions rather than relying on one treatment option (Yang et al., 2022; Young, 2020). An example is the multidimensional stimulation therapy which combines occupational therapy, recreational activities, cognitive stimulation, and physical exercises to achieve optimum improvement in functional and behavioral outcomes in dementia patients (Shigihara et al., 2020). Complementary and alternative medicine interventions have also been proposed for managing different types of dementia (O’Caoimh et al., 2019). Interventions that include aromatherapy, music therapy, massage and touch, and art therapy are used to enhance sensorial stimulation, hence, arousing the patient’s senses.

Assessments/Services

Debbie’s family requires adequate support in ensuring that they provide the desired care for Miss Nancy. Debbie and John can access several culturally appropriate services that may benefit Miss Nancy. One of the services is help at home services. Debbie and John can utilize help at home services that can be accessed through the myagedcare website to ease the burden of caring for Miss Nancy. They can benefit from a professional who will help them in undertaking daily activities such as cooking, shopping, and offering personal care to Miss Nancy such as dressing, feeding, and bathing. Debbie and John can also benefit from culturally appropriate care services offered by aged care homes. The aged care homes will provide Miss Nancy the care she needs in undertaking her activities of daily living and provide the required healthcare. The care given will help maintain and improve her quality of life despite the effects of the disease on her health (myagedcare.gov.au, n.d.).

Debbie and John can also access the services available for Miss Nancy. An example is seeking information support from the National Dementia Support Program which provides education, services, and resources for dementia to patients and their families. Nancy and her family will be connected with the resources and support systems that they need in managing and living well with vascular dementia (Health, 2019c). Debbie and John should also explore seeking support from Dementia and Aged Care Services (DACS) Fund. The fund helps elderly patients suffering from dementia access the care that they need (Health, 2019b). The fund will help reduce the overall disease burden on Nancy and her family, hence, a better quality of life. Miss Nancy will require assessments such as Regional Assessment Services (RAS) and Aged Care Assessment Program (ACAP) to determine her eligibility for most of the support programs for dementia patients. RAS assessment will facilitate her enrollment into the entry-level support services and programs while ACAP will offer detailed and comprehensive assessment data used for home care packages (Health, 2019a).

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Communication

Debbie and John should be informed that vascular dementia causes a significant decline in neurocognitive functions in the affected populations. The decline manifests through behavioral and psychological symptoms being experienced by Nancy. For example, Nancy is experiencing difficulty in communicating, which makes it hard for her to express her needs. As a result, she may be expressing herself in behaviors and actions that Debbie and John may not understand, which makes Nancy easily agitated, aggressive, and restless. Debbie and John should also be educated that Nancy has lost her functional abilities. She is no longer able to engage in most of her activities of daily living independently. Consequently, she manifests her frustrations through mood swings, being anxious, and being easily navigated. Vascular involvement in Nancy’s dementia also predisposes her to frequent seizure episodes (Gitlin et al., 2018). Therefore, the family should be assisted to develop effective coping strategies for Nancy’s care.

Some of the communication strategies that Debbie and John should be educated to adopt when caring for Nancy include learning to interpret verbal and non-verbal cues, offering comfort, avoiding any distractors, keeping communication simple, and being patient with her. They should also respect her needs, be aware of their non-verbal cues, offer choices, and use visual cues to enhance her understanding (Nguyen et al., 2019). They should also avoid correcting, criticizing, or arguing since they increase agitation, aggression, and anxiety.

Conclusion

In summary, vascular dementia is one of the dementia types with high prevalence in Australia. It is the second leading cause of dementia after Alzheimer’s disease. Vascular dementia is attributed to causes that include vascular disorders, age, diabetes, and socio-demographic factors such as educational level. Patients experience symptoms that characterize a decline in neurocognitive functions. Pharmacological and non-pharmacological interventions are effective in symptom management among patients suffering from vascular dementia. Nurses and other healthcare providers should explore the available culturally appropriate services and support systems for patients affected by vascular dementia and their significant others. Caregivers should also be educated about changes due to vascular dementia to facilitate their adaptation and provision of high-quality care.

References

Bonnici-Mallia, A. M., Barbara, C., & Rao, R. (2018). Vascular cognitive impairment and vascular dementia. InnovAiT, 11(5), 249–255.

Deardorff, W. J., & Grossberg, G. T. (2019). Behavioral and psychological symptoms in Alzheimer’s dementia and vascular dementia. Handbook of Clinical Neurology, 165, 5–32.

Dementia Australia. (2022). Dementia statistics. https://www.dementia.org.au/node/711

Dyer, S. M., Harrison, S. L., Laver, K., Whitehead, C., & Crotty, M. (2018). An overview of systematic reviews of pharmacological and non-pharmacological interventions for the treatment of behavioral and psychological symptoms of dementia. International Psychogeriatrics, 30(3), 295–309. https://doi.org/10.1017/S1041610217002344

Gitlin, L. N., Arthur, P., Piersol, C., Hessels, V., Wu, S. S., Dai, Y., & Mann, W. C. (2018). Targeting Behavioral Symptoms and Functional Decline in Dementia: A Randomized Clinical Trial. Journal of the American Geriatrics Society, 66(2), 339–345. https://doi.org/10.1111/jgs.15194

Hansson, O., Svensson, M., Gustavsson, A.-M., Andersson, E., Yang, Y., Nägga, K., Hållmarker, U., James, S., & Deierborg, T. (2019). Midlife physical activity is associated with lower incidence of vascular dementia but not Alzheimer’s disease. Alzheimer’s Research & Therapy, 11(1), 1–15.

Health, A. G. D. of. (2019a, December 12). About the aged care assessment programs [Text]. Australian Government Department of Health; Australian Government Department of Health. https://www.health.gov.au/initiatives-and-programs/aged-care-assessment-programs/about-the-aged-care-assessment-programs

Health, A. G. D. of. (2019b, December 19). About the Dementia and Aged Care Services (DACS) Fund [Text]. Australian Government Department of Health; Australian Government Department of Health. https://www.health.gov.au/initiatives-and-programs/dementia-and-aged-care-services-dacs-fund/about-the-dementia-and-aged-care-services-dacs-fund

Health, A. G. D. of. (2019c, December 19). National Dementia Support Program (NDSP) [Text]. Australian Government Department of Health; Australian Government Department of Health. https://www.health.gov.au/initiatives-and-programs/national-dementia-support-program-ndsp

Hsu, T.-W., Stubbs, B., Liang, C.-S., Chen, T.-Y., Yeh, T.-C., Pan, C.-C., & Chu, C.-S. (2021). Efficacy of serotonergic antidepressant treatment for the neuropsychiatric symptoms and agitation in dementia: A systematic review and meta-analysis. Ageing Research Reviews, 69, 101362.

Jo, K., Jhoo, J. H., Mun, Y.-J., Kim, Y. M., Kim, S. K., Kim, S., Lee, S.-H., & Jang, J.-W. (2018). The Effect of Cognitive Intervention on Cognitive Improvement in Patients with Dementia. Dementia and Neurocognitive Disorders, 17(1), 23–31. https://doi.org/10.12779/dnd.2018.17.1.23

Konyushok, M. (2020). Why Neurologists Should Remember About Antidepressants. European Journal of Medical and Health Sciences, 2(4).

Morovic, S., Budincevic, H., Govori, V., & Demarin, V. (2019). Possibilities of dementia prevention-it is never too early to start. Journal of Medicine and Life, 12(4), 332.

myagedcare.gov.au. (n.d.). | My Aged Care. Retrieved April 8, 2022, from https://www.myagedcare.gov.au/help-at-home

Nguyen, H., Terry, D., Phan, H., Vickers, J., & McInerney, F. (2019). Communication training and its effects on carer and care-receiver outcomes in dementia settings: A systematic review. Journal of Clinical Nursing, 28(7–8), 1050–1069. https://doi.org/10.1111/jocn.14697

O’Caoimh, R., Mannion, H., Sezgin, D., O’Donovan, M. R., Liew, A., & Molloy, D. W. (2019). Non-pharmacological treatments for sleep disturbance in mild cognitive impairment and dementia: A systematic review and meta-analysis. Maturitas, 127, 82–94. https://doi.org/10.1016/j.maturitas.2019.06.007

Perng, C.-H., Chang, Y.-C., & Tzang, R.-F. (2018). The treatment of cognitive dysfunction in dementia: A multiple treatments meta-analysis. Psychopharmacology, 235(5), 1571–1580. https://doi.org/10.1007/s00213-018-4867-y

Raj, S. E., Mackintosh, S., Fryer, C., & Stanley, M. (2021). Home-based occupational therapy for adults with dementia and their informal caregivers: A systematic review. The American Journal of Occupational Therapy, 75(1), 7501205060p1-7501205060p27.

Royal Commission. (2019). Dementia in Australia: Nature, prevalence and care. 29.

Shigihara, Y., Hoshi, H., Shinada, K., Okada, T., & Kamada, H. (2020). Non-pharmacological treatment changes brain activity in patients with dementia. Scientific Reports, 10(1), 6744. https://doi.org/10.1038/s41598-020-63881-0

Theleritis, C., Siarkos, K., Politis, A. A., Katirtzoglou, E., & Politis, A. (2018). A systematic review of non-pharmacological treatments for apathy in dementia. International Journal of Geriatric Psychiatry, 33(2), e177–e192. https://doi.org/10.1002/gps.4783

Wolters, F. J., & Ikram, M. A. (2019). Epidemiology of vascular dementia: Nosology in a time of epiomics. Arteriosclerosis, Thrombosis, and Vascular Biology, 39(8), 1542–1549.

Yang, Q., Lyu, X., Lin, Q., Wang, Z., Tang, L., Zhao, Y., & Lyu, Q. (2022). Effects of a multicomponent intervention to slow mild cognitive impairment progression: A randomized controlled trial. International Journal of Nursing Studies, 125, 104110.

Young, D. K.-W. (2020). Multicomponent intervention combining a cognitive stimulation group and tai chi to reduce cognitive decline among community-dwelling older adults with probable dementia: A multi-center, randomized controlled trial. Dementia, 19(6), 2073–2089.

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OPTION 1:
Task Details: Case Study – OPTION 1 (Option 2 is on next page)
This assessment is designed to inform your understanding of dementia and to grow your
awareness of the support needs of families and carers who help someone with dementia to live
well at home. The information that you provide in this paper will be supported by a variety of
quality academic literature and should be referenced using APA style. Please use the assignment
writing template provided in Moodle (this is set up using APA format).
Using the following case study, present an academic paper based on your research into vascular
dementia (multi-infarct type).
Miss Nancy Francis (aged 68) lives in Gosford on the NSW Central Coast with her niece Debbie
and Debbie’s husband, John. Miss Nancy has had a number of small strokes over the last 18
months and has recently been diagnosed with vascular dementia. Whilst she is still trying to be
active in her role as an Aboriginal Elder, Miss Nancy can no longer catch public transport to events
due to some weakness in her left side caused by the strokes. Debbie and John don’t drive and
feel overwhelmed by their aunty’s emotional swings since she was last in hospital nine weeks ago.
During an outing to visit friends in Wyong, Miss Nancy had a seizure and was taken to hospital for
assessment, receiving several stitches to her elbow, and a provisional diagnosis of epileptic
seizure related to vascular dementia. She was discharged home.
Your assignment should address the following:
• Introduction: An introduction that provides an overview of the paper, identifying the
importance of the topic and providing a ‘map’ for the reader to follow that shows what will be
covered.
• Health Issue: Aetiology and prevalence of vascular dementia in Australia including common
symptoms, using data from the Australian Bureau of Statistics to highlight the trend over time.
• Treatment/Management: Best practice treatment for vascular dementia, including
pharmacological and non-pharmacological approaches.
Debbie speaks with a friend who recommends that they contact the Bungree Aboriginal
Association to talk about ageing and disability support programs that could benefit Miss Nancy.
• Assessments/Services: Outline culturally appropriate services that may benefit Miss Nancy,
Debbie and John. You should pay attention to the myagedcare.gov.au website and use it as
a reference. Information about the NDIS and other relevant schemes should be included
here, but limit government websites to no more than five. Include any relevant assessments
that may need to be undertaken (eg. ACAT), and the role or scope of support agencies you
include. Select one peer support program or group that could benefit John and Debbie and outline the
nature and purpose of that program/group.
John is increasingly concerned about Miss Nancy’s ‘mood swings’ and infrequent episodes of
confusion, and tells Debbie that if Miss Nancy has any more seizures he doesn’t want her to live
with them anymore. This upsets Debbie, and she feels torn between her aunt and her husband.
• Communication: What information do you think Debbie and John need about the impact of
dementia on their aunt? Include evidence for communication strategies that work when
interacting with people who have dementia.
• Conclusion: Include a conclusion that highlights those important aspects that have been
covered in your paper.