Chronic diseases are considered as a form of ailment which sustains for over a period. Most of the chronic diseases cannot be cured but could be managed with effective nursing interventions (Mostafalou & Abdollahi, 2013). It has been found that more than half of the global population suffer from one or more chronic illnesses (Murray & Lopez, 2013). The purpose of the assignment is to discuss about the self management of a chronic illness. The chosen chronic disease selected for the assignment is dementia. Dementia is defined as a form of brain disease that leads to the reduction in the ability of thinking and remember things for long period of time. Due to the effect of dementia a person could suffer from memory issue, complication with language, emotional issues and distress as well. Such condition affects the ability of a person to perform daily activities (Baumgart et al., 2015). Such impact on the mental health of the patient has significant effect on the family and care givers as well (Ornstein et al., 2013). Reports revealed by World Health Organization state that more than 47.47 million people is suffering from dementia across the world and the number is expected to reach over 75.63 million by the year 2030 (who.int, 2018). Thus, it has become one of the major concerns of the world health system. Thus, it is important to conduct in-depth research on dementia in order to understand the factors influence the chronic disease to introduce adequate nursing interventions to address the factors in an effective manner. Due to such reasons, dementia has been chosen as a subject of discussion for the following assignment. The following paper will provide brief discussion on dementia including Pathophysiology, causes, impact, treatment, health promotion, self-management, cultural safety and empowerment.
According to Baumgart et al., (2015) dementia is not defined as the specific disease but is explained as the combinations of group of symptoms that affect the thinking, memory, social abilities to perform daily activities and emotional distress. However, several people suffer from memory loss, however such a health issue tends to cause due to various reasons. Thus memory loss alone cannot be considered as dementia (Ornstein et al., 2013). There can be identified different causes of dementia and according to the causes the symptoms of dementia also varies and can be reversed. Symptoms of dementia comprise both psychological and cognitive changes whereby the most common psychological symptoms include depression, changes in personality, anxiety, inappropriate behaviour and agitation as well. In some cases people suffering from dementia has been found to suffer from visual and auditory hallucinations (Baumgart et al., 2015). Paranoia is another symptom associated with dementia that leads to the persistent and irrational feelings within a person (Freud, 2014). Beside such psychological sufferings there are some significant cognitive changes as well. In case of dementia, memory loss is one of the most common cognitive changes within the patient (Baumgart et al., 2015). In addition, communicating problem, difficulty in reasoning, confusion, disorientation, lack of concentration, problem in coordinating motor functions, difficulties in recognizing language and understanding words have been found as the common signs of dementia (Ornstein et al., 2013). There are some treatable medical conditions that could help to live life meaningfully while managing dementia, thus it is important to identify the underlying causes and consult with health professionals in case the symptoms are identified (Chen et al., 2014).
The main cause of dementia includes the damage of nerve cells present in the brain and the effect of dementia varies according to the area of brain that has been affected. Alzheimer’s disease has been considered as the most common cause of dementia (Rajan et al., 2015). Vascular dementia is occurred due to the damage of the blood vessels connected to brain. Such damage in the blood vessels can be caused due to severe blood vessel conditions or stroke as well (Barker et al., 2014). In certain cases it has been identified that some abnormal clamps of protein leads to the consequence of lewy body dementia, one of the most common progressive dementia (Donaghy & McKeith, 2014). Breakdown or damage of nerve cells in the temporal or frontal lobes in the brain could lead to the consequence of dementia (Chen et al., 2014). There are some severe disorders that could cause dementia such as, traumatic brain injury, Parkinson’s disease, disorder due to genetic mutation and some brain disorders (Homma et al., 2015). In addition, it has been found that symptoms of dementia can be caused due to infections or side effects of immune disorder, medication issues, nutritional problems, anoxia and brain tumour as well (Rullier et al., 2013). Furthermore, age such as 65 years or more, family history such as parents or other family members having dementia, down syndrome, cognitive impairment, excessive use of alcohol, depression, smoking, diabetes, cardiovascular risk and sleeping disorder have been found as the risk factors of dementia (Baumgart et al., 2015).
Impact on life of individual and family:
Beside physical and psychological problems, dementia poses severe impacts on the lives of the patient, family and the care givers as well. Both the personal and professional life gets affected by the symptoms of dementia. Due to suffering from dementia it becomes difficult for the patient to recognize the language and words thus they face problems in communicating with others (Ornstein et al., 2013). Due to depression and anxiety they become stubborn and sometimes become detached from the family and the society as well. Due to the lack of ability to remember things and reasoning they face difficulties in performing daily activities thus they have to depend on other family members or the care givers for their daily activities (Kasper et al., 2015). Such realization of disability leads to lack of ability to maintain relationships. Due to such condition the person suffering from dementia lacks the ability to provide service work place thus they might leave their job or they forced to leave. Such condition leads to financial challenges and social isolation (Ornstein et al., 2013). In addition such sufferings of the patient affect the family members as well. It is difficult to see a loved one to suffering from dementia and challenging as well. Sometimes living with a person having dementia affects the mental health of family members and brings significant changes in relationships (Kasper et al., 2015). Furthermore, the caregivers also face challenges while managing a person with dementia. It has been reported that lack of mental well-beings and risk of physical illness are associated with dementia care. This is due to poor sleep pattern and increased emotional attachment with the patient. Sometimes the care givers also become depressed and irritated while managing such patients (Ornstein et al., 2013).
Diagnosis and Treatment:
In order to provide adequate treatment care it is important to diagnose the illness at early stage. de Vug & Verhey, (2013) has indicated that diagnosis of dementia require impairment of minimum two central mental function that could affect the daily activities. The diagnosis mainly focuses on the language skills, memory, and capability to concentrate on a matter, reasoning ability and visual perception as well. However a single test cannot diagnose the presence of dementia (Chen et al., 2014). Thus, in order to diagnose dementia various tests need to be performed. For example, doctors evaluate the neurological condition; conduct CT scan, MRI and PET scan. In addition, blood test is conducted in order to identify any physical problem that has contributed to the development of dementia. Furthermore, psychiatric evaluation is also done to identify depression, anxiety, stress and other contributing factors (Hall et al., 2017).
Research conducted by Blom et al., (2017) has indicated that in most cases dementia cannot be cured however, with proper nursing interventions the illness can be managed in an effective manner. There are various therapies that could help a person with dementia such as occupational therapy, music therapy, doll therapy, massage therapy and art therapy (Singh et al., 2014). Other effective methods include improvement in communication, using exercise, encourage to keep calendar to remember dates and important incidents and proper diet (Chen et al., 2014). Effective medications are also available for example, cholinesterase inhibitors, memantine, omega 3 fatty acids and vitamin E (Blom et al., 2017). Beside such nursing care, adequate support from the family, friends, care giver and society is most important to manage dementia (Singh et al., 2014). Together such interventions could help a person with dementia to cope up with the situation and living a meaningful life.
Health promotion is another important factor that helps individual to increase the control over their illness, improve health condition and maintain well-beings. Health promotion in dementia focuses not only on the individual health behaviour but also on the social interventions (Woo, 2017). Various programs are available that helps to access important information about dementia and about preventive measures. ‘Your brain matter’ is one of such programs that help to promote healthy behaviour associated with dementia in Australia (yourbrainmatters.org.au, 2018). Such health promotion programs mainly focus on the prevention. Effective prevention methods such as involving in mentally stimulating activities, quit smoking and alcohol, proper diet, adequate physical activities, manage other chronic disease and proper consultation with doctor if symptoms are identified to manage the illness from early stage (Haber, 2013). Such information helps to promote health and create awareness within people regarding dementia.
Quinn et al., (2016) observe that educating the patient suffering from dementia regarding self-management is one of the most effective methods to help the patients to manage their illness. In this regards it is important to provide information regarding the quality of life and important components of living well and maintain day to day activities. Study has indicated that knowledge and support are two most important factors of self-management. The patients need to be trained about coping skills, acceptance of the disease and self-awareness in order to reduce the risk of self-harm (Livingston et al., 2017). The patients could be educated about the importance of healthy habits and skipping smoking and alcohol. Motivation is another important factor in self-management of dementia. The patients need to be motivated to set their personal goals and achieve them while managing their illness (Martin et al., 2013). Such contribution in the management of dementia helps to cope up with the illness with less difficulties.
Cultural safety in treatment is defined as the care approach which is emotionally, culturally and physically safe for the patients and does not contain any assault or denial of identity (Harding, 2013). Beside adequate treatment, prevention measure and effective self-management it is also important to provide care to the patient with dementia that is culturally safe. The patients with dementia suffer from significant emotional distress, thus it is important for the nurse and care giver to have the skill of cultural competency (Teodorczuk et al., 2015). It could help the nurse or care giver to understand the culture, views, beliefs and perception of the patient and introduce holistic care approaches that are easily acceptable for the patients (Harding, 2013). It would help to induce shared respect and dignity and trust. Such culturally safe care could help to manage the disease in an effective manner.
Empowerment is identified as another important aspect of dementia care and self-management. Empowerment helps the patient to realize their importance and understand that that they are the central focus of the treatment. It helps them to involve in the treatment (Hutchinson et al., 2016). There are various ways to induce empowerment in the dementia care, for example, identify the strengths and weaknesses of the patient and use them to develop purposeful activities, try to agree with the sense and views of the patient, listen to their story and pay attention, increase self-reliance and ability to take decision and increase the contribution in wider community (Klug et al., 2014). It could help to empower individual along with community. Such methods would help to encourage the patient so that they could manage their illness effectively.
From the above discussion it can be concluded that, dementia is a brain disease that leads to the lack of ability of thinking and remember things for prolong period. Due to the effect of dementia a person could suffer from memory issue, complication with language, emotional issues and distress as well. Such condition affects the ability of a person to perform daily activity. There are various causes that could leads to the consequence of dementia. Dementia cannot be cured completely however, the symptoms can be managed with effective nursing interventions. Beside effective treatments, therapies and medication, support from the family, friends and society is also important. There are different programs that help to promote health and prevention measures about dementia. In addition adequate self-management is also important. Culturally safe care approaches are also important to involve the patient in treatment. Furthermore, empowerment could help to encourage the patient to participate in the treatment in an effective manner. Such dementia management process could help the patient to live life meaningfully while managing their illness.
Barker, R., Ashby, E. L., Wellington, D., Barrow, V. M., Palmer, J. C., Kehoe, P. G., ... & Love, S. (2014). Pathophysiology of white matter perfusion in Alzheimer’s disease and vascular dementia. Brain, 137(5), 1524-1532. Retrieved from https://doi.org/10.1093/brain/awu040
Baumgart, M., Snyder, H. M., Carrillo, M. C., Fazio, S., Kim, H., & Johns, H. (2015). Summary of the evidence on modifiable risk factors for cognitive decline and dementia: a population-based perspective. Alzheimer's & Dementia, 11(6), 718-726. Retrieved from https://doi.org/10.1016/j.jalz.2015.05.016
Blom, K., Koek, H. L., Sanders, J. B., Kruithof, H. C., & Claassen, J. A. H. R. (2017). Treatment of dementia. Nederlands tijdschrift voor geneeskunde, 161, D1851-D1851. Retrieved from https://europepmc.org/abstract/med/28936936
Chen, R. C., Liu, C. L., Lin, M. H., Peng, L. N., Chen, L. Y., Liu, L. K., & Chen, L. K. (2014). Non?pharmacological treatment reducing not only behavioral symptoms, but also psychotic symptoms of older adults with dementia: A prospective cohort study in T aiwan. Geriatrics & gerontology international, 14(2), 440-446. Retrieved from https://doi.org/10.1111/ggi.12126
de Vugt, M. E., & Verhey, F. R. (2013). The impact of early dementia diagnosis and intervention on informal caregivers. Progress in neurobiology, 110, 54-62. Retrieved from https://doi.org/10.1016/j.pneurobio.2013.04.005
Donaghy, P. C., & McKeith, I. G. (2014). The clinical characteristics of dementia with Lewy bodies and a consideration of prodromal diagnosis. Alzheimer's research & therapy, 6(4), 46. Retrieved from https://doi.org/10.1186/alzrt274
Freud, S. (2014). Psycho-analytic notes on an autobiographical account of a case of paranoia (dementia paranoides). Read Books Ltd. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=Hn1-CgAAQBAJ&oi=fnd&pg=PT5&dq=paronia+in+dementia&ots=ROqfI5azF4&sig=qzA15aTHgwcWS3jqyXHcX7Sqx50#v=onepage&q=paronia%20in%20dementia&f=false
Haber, D. (2013). Health promotion and aging: Practical applications for health professionals. Springer Publishing Company. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=_EsSVOyEarMC&oi=fnd&pg=PP2&dq=health+promotion+in+dementia&ots=1fk5foLEy4&sig=zfNEhRKsF49LkACyXL1RZc4qbpQ#v=onepage&q=health%20promotion%20in%20dementia&f=false
Hall, B., Mak, E., Cervenka, S., Aigbirhio, F. I., Rowe, J. B., & O’Brien, J. T. (2017). In vivo tau PET imaging in dementia: pathophysiology, radiotracer quantification, and a systematic review of clinical findings. Ageing research reviews, 36, 50-63. Retrieved from https://doi.org/10.1016/j.arr.2017.03.002
Harding, T. (2013). Cultural safety: a vital element for nursing ethics. Nursing Praxis in New Zealand, 29(1). Retrieved from https://web.a.ebscohost.com/abstract?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=01127438&asa=Y&AN=86982966&h=XNErbOCfD4jN2snwT7vkA6UhYHfyjRXwC1V6esAYTP8ziWdX4wbXA1isPGMikae4aMFTLnw9xF7DyIoDilGCCg%3d%3d&crl=c&resultNs=AdminWebAuth&resultLocal=ErrCrlNotAuth&crlhashurl=login.aspx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype%3dcrawler%26jrnl%3d01127438%26asa%3dY%26AN%3d86982966
Homma, T., Mochizuki, Y., Takahashi, K., & Komori, T. (2015). Medial temporal regional argyrophilic grain as a possible important factor affecting dementia in P arkinson's disease. Neuropathology, 35(5), 441-451. Retrieved from https://doi.org/10.1111/neup.12208
Hutchinson, K., Roberts, C., Daly, M., Bulsara, C., & Kurrle, S. (2016). Empowerment of young people who have a parent living with dementia: a social model perspective. International psychogeriatrics, 28(4), 657-668. Retrieved from https://doi.org/10.1017/S1041610215001714
Kasper, J. D., Freedman, V. A., Spillman, B. C., & Wolff, J. L. (2015). The disproportionate impact of dementia on family and unpaid caregiving to older adults. Health Affairs, 34(10), 1642-1649. Retrieved from https://doi.org/10.1377/hlthaff.2015.0536
Klug, M. G., Halaas, G. W., & Peterson, M. L. (2014). North Dakota assistance program for dementia caregivers lowered utilization, produced savings, and increased empowerment. Health Affairs, 33(4), 605-612. Retrieved from https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2013.1061
Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D., ... & Cooper, C. (2017). Dementia prevention, intervention, and care. The Lancet, 390(10113), 2673-2734. Retrieved from https://doi.org/10.1016/S0140-6736(17)31363-6
Martin, F., Turner, A., Wallace, L. M., & Bradbury, N. (2013). Conceptualisation of self-management intervention for people with early stage dementia. European journal of ageing, 10(2), 75-87. Retrieved from https://link.springer.com/article/10.1007/s10433-012-0253-5
Mostafalou, S., & Abdollahi, M. (2013). Pesticides and human chronic diseases: evidences, mechanisms, and perspectives. Toxicology and applied pharmacology, 268(2), 157-177. Retrieved from https://dx.doi.org/10.1016/j.taap.2013.01.025
Murray, C. J., & Lopez, A. D. (2013). Measuring the global burden of disease. New England Journal of Medicine, 369(5), 448-457. DOI: 10.1056/NEJMra1201534
Ornstein, K., Gaugler, J. E., Devanand, D. P., Scarmeas, N., Zhu, C., & Stern, Y. (2013). The differential impact of unique behavioral and psychological symptoms for the dementia caregiver: how and why do patients' individual symptom clusters impact caregiver depressive symptoms?. The American Journal of Geriatric Psychiatry, 21(12), 1277-1286. Retrieved from https://doi.org/10.1016/j.jagp.2013.01.062
Quinn, C., Toms, G., Anderson, D., & Clare, L. (2016). A review of self-management interventions for people with dementia and mild cognitive impairment. Journal of Applied Gerontology, 35(11), 1154-1188. Retrieved from https://doi.org/10.1177%2F0733464814566852
Rajan, K. B., Wilson, R. S., Weuve, J., Barnes, L. L., & Evans, D. A. (2015). Cognitive impairment 18 years before clinical diagnosis of Alzheimer disease dementia. Neurology, 10-1212. Retrieved from https://dx.doi.org/10.1212%2FWNL.0000000000001774
Rullier, L., Lagarde, A., Bouisson, J., Bergua, V., & Barberger?Gateau, P. (2013). Nutritional status of community?dwelling older people with dementia: associations with individual and family caregivers' characteristics. International journal of geriatric psychiatry, 28(6), 580-588. Retrieved from https://doi.org/10.1002/gps.3862
Singh, J., Sabbagh, M. N., Nair, A. K., Grundman, M., Kinney, G. G., Yuen, E., & Black, R. (2014). Treatment of Dementia. Geriatric Neurology, 556-585. Retrieved from https://doi.org/10.1002/9781118730676.ch23
Teodorczuk, A., Mukaetova-Ladinska, E., Corbett, S., & Welfare, M. (2015). Deconstructing dementia and delirium hospital practice: using cultural historical activity theory to inform education approaches. Advances in Health Sciences Education, 20(3), 745-764. Retrieved from https://link.springer.com/article/10.1007/s10459-014-9562-0
who.int (2018). Dementia. Retrieved from https://www.who.int/news-room/fact-sheets/detail/dementia
Woo, B. K. (2017). Dementia health promotion for Chinese Americans. Cureus, 9(6). Retrieved from https://dx.doi.org/10.7759%2Fcureus.1411
yourbrainmatters.org.au (2018). Your Brain Matters - About dementia. Retrieved from https://yourbrainmatters.org.au/about-dementia