Case Study Of A 75-Year-Old Patient Living With Dementia

You are required to write a nursing care plan for a resident you are caring for on your placement.

1.You are to gather information on resident during clinical placement.

2.You will need to ask permission from the clinical placement facility before you begin gather information about your chosen resident.

3.No identifying information should be included in the case study.

4.The resident should have dual diagnosis including but not limited to dementia and continence issues .

Patient Description

This is the case study of a Patient A who is 75 years old, who is living with dementia, and has been under the live in support of a residential care. Dementia has affected the life of patient A, as he was suffering from memory loss of recent events. The patient was already suffering some mild cognitive impairment, which has worsened over time and the person is having difficulties in performing even the simplest tasks. The patient was having several episodes of depression and schizophrenia, which have led to his hospital admission.  Patient A was having low to moderated tremors. He had also been suffering from some incontinence issue which has further deteriorated his self confidence. Patient has also got a past history of substance abuse and alcohol. Incontinence is common is patients with dementia as cognitive deficits in patient causes loss of visuospatial abilities and frontal lobe dysfunction that interferes with the patient's ability to recognizes the needs  to go to the toilet, to recognize the toilet, to disrobe or use the toilet properly.  The brain fails to control the sphincter muscles of the bladder (Orme et al., 2015). He is unable to move on his own which signifies an end stage dementia. The patient has also reported that he is having difficulties in swallowing. Brain imaging and blood tests have confirmed the occurrence of dementia (Selmen et al., 2012). Mood testing IQ examination has also indicated towards the occurrence of dementia. Subjective data reveals that the patient had been suffering from tremors. Tremors, confusion and shuffling can be associated with Lewy body dementia (Reijnders et al., 2013). It is the most misdiagnosed and the second most common cause of progressive dementia. Occurrence of lewy bodies is linked with ageing.  The patient was also suffering from age related incontinence issues. The patient had been reported to be suffering from Vitamin B 12 and folate deficiencies have also taken a toll on the life of the patient, which can be one of the perpetuating factors behind dementia (Moor et al., 2012). Vitamin D is known for its ability to utilise phosphorus and calcium of the body. The results of the ‘mini-mental state examination’ result were compared to the Vitamin D status of the patient and were found to be quite low than the normal value (Moor et al., 2012). vitamin D have numerous functions in the nervous system of animals, such as regulation of the neuro-trophic factors, calcium homeostasis, release of the neurotransmitters, oxidative stress mechanisms, and modulation of the inflammatory process and immune system (Moor et al., 2012)..

Physiological Processes of Aging

Cognitive impairment is one of the common symptoms of the dementia. Dementia is a disease related to brain and such a disorder might disrupt the problem solving capacity and judgement function of the brain, which has led to behavioural and metal problems in the patient A (Reijnders et al., 2013).

Although the world has advanced in the fields of molecular biology, the mysteries controlling the lifespan of the human is still to be unravelled. Many theories that fall in the two broad categories ‘programmed and error theories’ have found to be unsuccessful explaining the process of ageing. Yet one of the modern theories that go well with this case study is the 'free radicals theory (Liochev, 2013)'. This theory was introduced by Dr. Denham Harman, who has proposed that free oxidative radicals and super oxides damages the macromolecular cell components, such as lipids, sugars, nucleic acids and proteins, causing the cell to stop functioning (Kirkwood & Kowald, 2012). The body poses some natural antioxidants that curb the ill effects of the oxidative radicals.

Reactive oxygen species (ROS) are the by-product of the mitochondrial electron transport chain during aerobic respiration. If the ROS are produced in excess then it overwhelms the natural antioxidants of the body and due to which cells such as the neuronal microglia gets damaged. ROS are produced in abundance in the central nervous system (Kirkwood & Kowald, 2012). The brain is vulnerable to oxidative damage as it is rich in peroxidizable fatty acids, responsible for the 20% of the total oxygen consumption of the body. The oxidative species causes nitration of the lipids, leakage of the DNA strands and the nitration of the proteins of the neuronal cells (Liochev, 2013). Free radicals are also found to be responsible for the extrinsic skin ageing by the damaging the skin DNA (Zuluaga et al., 2012). 

The case study reveals that the patient had a past history of alcohol addiction. It should be noted that the environmental sources of oxidative radicals includes smoke, alcohol and saturated fat. Thus alcohol can be considered as one of the precipitating factor behind the formation of the oxidative stress in the brain (Kruman eta l., 2013).

Although neuronal damage due to oxidative stress was supported by Vitamin C level lower in aged patients, yet low Vitamin B level is associated with depression, agitation, irritability, agitation as seen in case of patient A (Tarter & Van Thiel, 2013).

Free Radicals Theory

Ageing can be considered as a progressive physiological degeneration causing cessation of the function of the organ system and reduction of the physical reserve (Selmen et al., 2012). Among most of the body systems the two systems that are significantly affected are the skin and the brain. In general there is a neuronal loss both in the brain and the spinal cord. Loss of the neuronal dendrites hampers the synaptic transmission (Tarter & Van Thiel, 2013). Sense of smell, taste, touch, and hearing diminishes with time (Balash et al., 2013). Mild to moderate cognitive impairment takes place. In case of brain diseases the cognition is greatly affected causing drastic, unmanageable behavioral change. Impaired synaptic activity leads to depression and anxiety (Balash et al., 2013). All these can be linked to the current health condition of patient A. Furthermore elderly patients with dementia can have urinary incontinence as impaired neural control mechanisms fails to control the pelvic floor muscles causing involuntary bladder contraction leading to incontinence (Grant et al., 2013). Furthermore, alcohol consumption can deteriorate the condition of the heart and the blood vessels and can exacerbate the process of ageing. It can also worsen the mood disorders and memory loss in the patient (Tarter & Van Thiel, 2013). Smoking and drugs can damage the neuronal cells and ceases the development of the new nerve cells, which may give rise to several cognitive ailments (Kruman eta l., 2013). Elderly people often develop complications with the stomach enzymes and the acids that are required for the synthesis of Vitamin B. This is mainly due to the thinning of the stomach lining that reduces the acids of the stomach. This is one of the physiologies of ageing that can be linked with the condition of patient A (Kirkwood & Kowald, 2012). Hence the physiological processes of ageing such as neuronal loss, vitamin B deficiency, incontinence and mental health problems like depressions, schizophrenia can be well related to the concerned patient of the case study. 

References

Balash, Y., Mordechovich, M., Shabtai, H., Giladi, N., Gurevich, T., & Korczyn, A. D. (2013). Subjective memory complaints in elders: depression, anxiety, or cognitive decline?. Acta Neurologica Scandinavica, 127(5), 344-350. 

Bedi, R. (2015). Dementia and oral health. Journal of public health policy, 36(1), 128-130.

Kirkwood, T. B., & Kowald, A. (2012). The free?radical theory of ageing–older, wiser and still alive. Bioessays, 34(8), 692-700.

Kruman, I. I., Henderson, G. I., & Bergeson, S. E. (2012). DNA damage and neurotoxicity of chronic alcohol abuse. Experimental Biology and Medicine, 237(7), 740-747.

Kyle, G. (2012). An insight into continence management in patients with dementia. British journal of community nursing, 17(3).

Liochev, S. I. (2013). Reactive oxygen species and the free radical theory of aging. Free Radical Biology and Medicine, 60, 1-4.

Moore, E., Mander, A., Ames, D., Carne, R., Sanders, K., & Watters, D. (2012). Cognitive impairment and vitamin B12: a review. International psychogeriatrics, 24(4), 541-556

Noble, J. M., Scarmeas, N., & Papapanou, P. N. (2013). Poor oral health as a chronic, potentially modifiable dementia risk factor: review of the literature. Current neurology and neuroscience reports, 13(10), 384.

Orme, S., Morris, V., Gibson, W., & Wagg, A. (2015). Managing urinary incontinence in patients with dementia: Pharmacological treatment options and considerations. Drugs & aging, 32(7), 559-567.

Reijnders, J., van Heugten, C., & van Boxtel, M. (2013). Cognitive interventions in healthy older adults and people with mild cognitive impairment: a systematic review. Ageing research reviews, 12(1), 263-275.

Selman, C., Blount, J. D., Nussey, D. H., & Speakman, J. R. (2012). Oxidative damage, ageing, and life-history evolution: where now?. Trends in ecology & evolution, 27(10), 570-577.

Tarter, R. E., & Van Thiel, D. H. (Eds.). (2013). Alcohol and the brain: Chronic effects. Springer Science & Business Media.

Zuluaga, D. J. M., Ferreira, J., Montoya, J. A. G., & Willumsen, T. (2012). Oral health in institutionalised elderly people in Oslo, Norway and its relationship with dependence and cognitive impairment. Gerodontology, 29(2).