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Case Background and Medical Condition

Discuss about the Alzheimer’s disease with malnutrition in elderly.

Alzheimer’s is one the common neuro degenerative disease among the older adults. It is causes loss of quality of life along with cognitive and memory impairment (Jahn, 2013). The following assignment aims to conduct an aged care related case study via conducting an interview with an elderly person and one of his family members who is suffering from Alzheimer’s and is malnourished. Based on the medical condition (Alzheimer’s and malnutrition) gathered from the interview, the assignment will aim to provided a detailed insight about the pathophysiology of the medical condition, including the contributing factor behind the disease development. The assignment will also aim to throw light on the impact of Alzheimer and its associated malnutrition on overall health of the person along with model for care and associated legal or ethical dilemmas.

Mr. X is a 70 years old a retired government employee and was diagnosed with dementia about two years ago. He lives alone in his two stored building after his wife passed away three years ago. He has two sons and both of them are married and reside outside the town due to job. During the interview, Mr. X was found saying that he could not remember the exact incidence that turn around to his hospitalization. His son, he came to visit him in the hospital informed that her felt lawn which resulted in traumatic head injury. Mr. X is also malnourished and this is relevant from his severe muscle wasting and under weight. He said that after his wife passed away, he developed depression. He also stated that during his 2 weeks admission in the hospital he stated forgetting things like taking medication. In his discharge summary, the doctors highlighted that he has degenerative neuronal disease (Alzheimer’s) that has progressed during his retried life, after his wife passed away. `the discharge summary also highlighted that he is now on cholinesterase inhibitor. He is also facing difficulty in feeding, moving around despite being on post-discharge medication. During the interview, it was visible that he is facing difficulty in communicating because of his slurred speech along with occasional restlessness and agitation due to anxiety. His sense of reasoning and judgement seemed to be distorted along with absence of coherence in answering questions during the interview. Sometimes Mr. X repeats the same answers for different questions. Based on the first hand information gather from one of his son, a mini-mental state examination was undertaken one year age and it revealed 18 indicating signs of cognitive impairment. Loss of memory, impaired judgement, and disruption of visual perception, focus and reasoning are mostly observed among the patients suffering from the neurodegenerative disease like Alzheimer’s (Jahn, 2013). Mr. X reported was also found reporting that the food service that he has availed after the death of his wife, scarcely supplies quality food on time. Moreover, he hates to go out to house and remains mostly seated and suffers from loss of appetite. His son reported that he is also a patient of type 2 diabetes and has sudden restriction of food and takes metformin regularly. He has also been detected with mild symptoms of Alzheimer’s disease and hence has been on cholinesterase inhibitor for the past 2 years.

Pathophysiology of Alzheimer's Disease

Alzheimer’s disease is one of the most common neurodegenerative diseases that accounts for more than 80% of dementia cases worldwide (Kumar & Singh, 2015). It leads towards the generation of progressive loss of memory, cognitive behavioural function and the reduction in the ability to learn. Kumar and Singh (2015) have further opined that, amyloid beta fibrils form oligomers in the brain which form amyloid plaques and thereby causing synaptic impairment. Alzheimer disease falls under the umbrella disease of dementia. Alzheimer’s disease mainly attacks the brain cells resulting in the significant loss of memory, thinking and other cognitive impairment (Jack Jr, et al., 2013). Jack Jr. Et al. (2013) have also stated that Alzheimer;s disease causes degeneration of the cortical and subcortical pyramidal cells of the brains along with the degradation of the cholinergic neurons which are responsible for the maintenance of cognitive functions of the brain. The neuropathological hallmarks of Alzheimer’s are detected by the presence of senile plaques (commonly known as amyloid deposits) along with the deposition of the neurofibrillary tangles in the autopsied brains. These neurofibrillary tangles are made up of hyperphosphorylated tau protein, which are situated within the neurons, whereas senile plaques are mainly composed of amyloid-P species, which aggregate within the extracellular space of the neurons (Jahn, 2013). These signatures neuropathological changes begin in the entorhinal cortex and in the hippocampus of the brain, which later spreads into the temporal, parietal, and frontal cortex of the brain. All these neurological complications lead to the generation of memory loss along with decrease in the cognitive function (Jahn, 2013). Alzheimer’s also leads to dementia due to signification loss of the equilibrium of the association cortex. This disruption in the equilibrium of the brain impairment in judgement, language, speech and gross motor movements all these disrupts the normal daily activities. Alzheimer’s disease is known to be associated with the decrease in the intake of food as people tend to forget about what they have ate or whether they have consumed food or not and thereby leading to the development of malnutrition of under nutrition (Droogsma, Van Asselt, Scholzel-Dorenbos, Van Steijn, Van Walderveen, & Van der Hooft, 2013).

In case of Mr. X there are several contributing factors that have been responsible for the development of Alzheimer and subsequent malnutrition. The first contributing factor behind the development of Alzheimer’s in case of Mr. X is depression. Depression generated during the later stages of life increases the susceptibility of mild cognitive impairment and thereby increasing the chance of developing Alzheimer’s disease (Steenland, Karnes, Seals, Carnevale, Hermida, & Levey, 2012). Comorbid depression leads to neuropsychiatric complications that increase the susceptibility of developing Alzheimer’s disease (Sepehry, Lee, Hsiung, Beattie, & Jacova, 2012). Sepehry et al. (2012) have further opined that serotonin reuptake inhibitors fails to give adequate protection against the cormorbid depression and thus the development of Alzheimer’s during the later stages of life inevitable. Alzheimer’s disease and its relation to malnutrition in case of Mr. X can be linked with the research findings of Droogsma et al. (2013) which states that Alzheimer’s disease leads to loss of memory and the affected individual forgets to take food and thereby causing manutrition. Alzheimer’s disease leads to frontotemporal lobar degeneration which leads to decrease in apetite along with reduction in total protein content of the body and thereby leading to malnutrition along with muscle wasting among the Alzheimers patients ( (Koyama, et al., 2016). Cholinesterase inhibitor is also responsible for the development of significant weight loss along with malnutrition (Droogsma, Van Asselt, Scholzel-Dorenbos, Van Steijn, Van Walderveen, & Van der Hooft, 2013). The other factors that have contributed towards the development of Alzheimer disease include lack of socialization and looniness in case of Mr X.

Contributing Factors for Alzheimer's and Malnutrition in Case of Mr. X

Disengagement Theory of Aging is a psychological theory of ageing which states that aging is inevitable. Ageing causes mutual withdrawal or disengagement resulting in decrease in the level of social interaction. The theory also claims that this kind of withdrawal symptoms from socialization is acceptable in case of older adults. Disengagement postulates that man's central role in life is work and woman's central role in life is marriage and family. When the individuals abandon themselves from their central roles, they at once lose their social life space and also suffer from crisis along with extreme demoralisation unless they assume something different roles in their life in their disengaged state (DeLiema, 2017). In case of Mr. X, he is a retired person, thus he has withdraw himself from his central role in life and further loss of this wife has created a sense of void leading towards his disengagement or repulsion towards socialization.


Stress theory of ageing states that aging is defined as imbalance in the body resulting out of biological dysfunction. The main stress factor which propagates ageing is neurodegenration. Stress theory emphasizes that stressful environments leads to damage of the cellular mechanism leading to the disruption in the cellular functions and senescence (Cesari, Vellas, & Gambassi, 2013). Mr. X is 70 years old and at in age group the normal ageing process initiates this lead to the neurological damage leading towards the development of breast cancer. Moreover, ageing leads to oxidate stress via generating reactive oxygen species and thereby leading to the development of Alzheimer’s (Padurariu, 2013).

Alzheimer’s is a progressive disease and hence its impact of life of the survivors is not limited to only specific physiological effects. Alzheimer’s has significant impact on the psychological, emotion and physical health of the person. The main psychological complications that affects the mental health of a person in Alzheimer’s disease include sadness, depression, sudden loss of temper, a sense of paranoid, worry and stress (Conde-Sala, et al., 2013). Alzheimer’s disease also hampers the quality of life via creating disequilibrium in cognitive thinking (Leroi, McDonald, Pantula, & Harbishettar, 2012). Leroi et al. (2012) is of the opinion that even mild to moderate levels of cognitive impairment increases the rate of disability along with impairment of the overall function which acts in tandem with the further cognitive decline. Furthermore, decrease in the cognitive status in the elderly person leads to the decrease in appetite and thereby promoting weight loss and muscle wasting and same is in the case of Mr. X. The Australasian Nutrition Care Day Survey (ANCDS) revealed that both poor intake of food and malnutrition are responsible for increase in hospital mortality rate in the Australian (Agarwal, Banks, Batterham, Bauer, Capra, & Isenring, 737-745). Main impact of malnutrition on the health of Mr. X include increase amount of accidental falls, increase in the vulnerability of infection, loss of energy and morbidity. Moreover increase in the level of confusion associated with stress may lead to the generation of dementia in Mr. X. Malnutrition may also cast an impact on the oral health status of the Mr. X (Van Lancker, Verhaeghe, Van Hecke, Vanderwee, Goossens, & Beeckman, 2012).

Impact of Alzheimer's Disease and Malnutrition on Health

Model of care for Mr. X will be Eden’s Alternative Principles of Care. According to this model, loneliness, boredom and helplessness are plagues of human spirit (Thomas, 2013). Mr. X is departed from his wife and his sons also do not visit often and this is the main cause of his depression which has taken the form of malnutrition. Eden model suggests close and contact with children and loving companion ship is helpful to fight loneliness and depression (Thomas, 2013). This is because receiving and giving care are regarded as antidotes towards helplessness. Another model of care for Mr. X will be person centred care which deals with treating each person as individual while respecting person’s dignity and thereby developing therapeutic relationships. Moreover, person centred or patient centred care will be suitable for Mr. X because it covers eight major dimensions including patient’s preferences, emotional support, physical comfort, proper information and education, continuity followed by transition, proper co-ordination of care, optimal access of care and inclusion of family and friends (Brownie & Nancarrow, 2013)

Strategies and resources to maintain and improve quality of life

Apart from pharmacological interventions, the main non pharmacological interventions that will be utilised in case of Mr. X include encouragement of social participation via promotion of the community activities. This will help to keep Mr. X pre-occupied and thereby increasing his involvement with the community members. This increase in involvement will help him to fight against his depression while giving a break from his sedentary life (Lai, Hiles, Bisquera, Hure, McEvoy, & Attia, 2013). Another strategy that can be proved to be effective is rotation of food items in the diet plan while keeping the nutritional quotient intake. This rotation of the food items will help to break the monotony of the same repetitive yet tasteless food as served by the food delivery service (Correia, et al., 2014). Moreover, Mr. X also needs round the clock assistance coming from either care givers or his family members to carry out daily living activities. Coping strategy-based on family carer therapy either in the absence or presence of patient’s activity intervention helps to improve the quality of life of people living with Alzheimer’s at home (Cooper, et al., 2012)

The main ethical issues that must be taken into consideration informed consent and shared decision making and this will fall under the ethical domain of autonomy. In order to practice autonomy, advanced care planning must be used and thus allowing Mr. X to make decision if he becomes unable to speak at any point of time during the care (Houben, Spruit, Groenen, Wouters, & Janssen, 2014). Another ethical consideration that must be taken into account as per the Nursing and Midwifery Board of Australia include maintenance of privacy or confidentiality and this signifies that the personal information that will be shared by Mr. X during counselling and while at interview would never be disclosed to any other person without the informed consent of Mr. X (Hofmann, 2013). In the legal ground, power of attorney must be signed. The power of attorney lays down a framework for legal consent for neurodegenerative patients like Mr. X to enjoy the assistance of proxy decision makes on his behalf. (Wang, Yu, & Hailey, 2013). Moreover, while practising care, the care providers if coming from any defined organisation is required to submit General Purpose Financial Report (GPFR). Along with this, unaudited Aged Care Financial Report (ACFR) is also required as per Australian norms in order to avoid legal complications (Potter, Ravlic, & Wright, 2013). Moreover, legal complication may bridge in if Mr. X is admitted to hospital for a routine checkups of curial parameters. This legal complexicity may come in the form of neglect and abuse and thus required detailed attention include the person-centred-care plan (Australian Human Rights Commissions 2017).

Model of Care for Alzheimer's and Malnutrition


Thus from the above discussion, it can be concluded that Mr. X is suffering from Alzheimer and malnutrition arising from that neurodegenerative disorder. This neuro degenerative disorder can be effectively be linked with the theories and aging and thereby providing relevance towards aging and depression. The main models of care that will help Mr. X for speedy recovery include Eden's Alternative Principles of Care, Person Centred Care. However, while procuring care to Mr. X numerous legal and ethical issues must be taken into consideration like advanced care planning and power of attorney.

References

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Legal and Ethical Dilemmas Associated with Alzheimer's and Malnutrition

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Droogsma, E., Van Asselt, D. Z., Scholzel-Dorenbos, C. J., Van Steijn, J. H., Van Walderveen, P. E., & Van der Hooft, C. S. (2013). Nutritional status of community-dwelling elderly with newly diagnosed Alzheimer’s disease: prevalence of malnutrition and the relation of various factors to nutritional status. The journal of nutrition, health & aging , 606-610.

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