Case Studies In Aging: Hypertension And Mild Dementia Essay.

Case Study 1: Rob - Hypertension and Mild Dementia

Rob Cameron is 81 years of age, retired and lives with his wife Margaret (65 years) in a small coastal town in rural New Zealand. Margaret was a midwife prior to meeting Rob and during their marriage they purchased a yacht, lived on board and eventually sailed around the world together. Previous to their adventure, Rob worked in various occupations, mostly outside and often independently or in his own businesses. Lila, Rob’s former wife, is 75 years old and lives alone in Auckland. They separated after their three children left home. The GP diagnosed Rob with hypertension and prescribed oral antihypertensives. Rob believes that he does not need to take his antihypertensives unless he feels unwell and that he can control his blood pressure by eating garlic and drinking cider vinegar. Of most concern to him is his belief that taking antihypertensives will make him impotent; their sexual relationship is very important to this couple. Rob is very good at building and making things, and loves to be outside in his shed or maintaining the house. He prides himself on his ingenuity and independence; he would never hire a professional or tradesperson to do a job, believing that he can do everything himself. In addition to his passion for sailing and the ocean, Rob loves cars and has owned some beautiful classic cars in the past. Currently he drives what he describes as a ‘boring’ 10-year-old sedan. They love to eat out or meet friends for a coffee at the local café, go for a drive in the country or a weekend away, but they have to budget as they live on the New Zealand universal superannuation pension of $576.20 per week (Work and Income New Zealand, n.d.). Margaret notices that Rob is becoming increasingly forgetful as he misplaces objects. Recently, he left some tools out in the rain and they were damaged, causing him to become very angry and frustrated with himself. As a result, Margaret researched the Alzheimer’s New Zealand website (Alzheimer’s New Zealand, n.d.) and is concerned that he may have mild dementia. Her suggestion to see the GP leads to an argument, with Rob angrily accusing her of thinking that he is ‘a loony’. Margaret has been trying to encourage Rob to remain well by suggesting that they go on walks together for exercise and meet friends for social stimulation; she has also been trying to get him to take his antihypertensive medication more regularly. Recently, matters came to a head when Rob became distracted when driving Margaret to visit a friend. The car went over the curb and hit a brick fence, causing some damage to the car, the fence and to his forehead when the impact of the airbag deploying forced his spectacles against his forehead and caused a small laceration. After taking a careful history of the accident and the events leading up to it, the GP suggested to Rob and Margaret that it would be worthwhile doing a more thorough assessment of Rob’s cognitive function.

1. Discuss the biophysical processes pertinent to the case.
2. Discuss the psychosocial processes pertinent to the case.
3. Identify an assessment tool appropriate for use in this case and discuss key elements of the tool.
4. Discuss 3 priorities of care for this person.
5. Discuss any equity, rights and access issues relevant to the case.

Betty is a 72-year-old woman who has had multiple falls in the last 12 months. Her last fall resulted in her badly spraining her right shoulder; this has limited her ability to undertake a lot of her general household duties. When presenting to her local doctor about her shoulder injury, she commented that she often feels very unbalanced and dizzy, especially when getting out of bed, and is worried it might have something do with her new blood pressure medication. Betty also indicates she has been having trouble walking because of the arthritis in her feet. Betty’s last fall has really had a significant impact on her confidence and she tells her doctor that she is frightened that the next fall will do some major damage. As a result of this fear and her injury, she has not been getting out much. She also had to cancel her last optometry appointment because she could not drive herself with her shoulder.

1. Discuss the biophysical processes pertinent to the case.
2. Discuss the psychosocial processes pertinent to the case.
3. Identify an assessment tool appropriate for use in this case and discuss key elements of the tool.
4. Discuss 3 priorities of care for this person.
5. Discuss any equity, rights and access issues relevant to the case.

Case Study 1: Rob - Hypertension and Mild Dementia

1. As diagnosed by GP, Rob is suffering from hypertension. However, he is unwilling to take up proper medications for it. Moreover, his wife has reported about Rob’s increasing forgetfulness. Rob is also becoming irritated and frustrated. Often he shows his frustration upon himself.  Margaret, Rob’s wife is suspecting that Rob is suffering from mild dementia. Moreover, the GP has suggested Rob to go through a thorough assessment to examine his cognitive function.2. From the case study, it is easily understandable that Rob is suffering from hypertension. Along with that, it can also be understood that he is suffering from anxiety issues (Charras, Eynard and Viatour 2016). He is anxious of the side effects of the medications. Rob is suffering from much insecurity that is related to her old age. He is becoming insecure of the fact the he is aging, and hence might not be able to work efficiently as he used to do earlier. This is leading him to anger and frustration.3. As per the symptoms, the patient is suffering from mild dementia. Hence, the Abbey pain scale Assessment tool can be used in this regard, in order to assess the severity.

• Facial Expression: Examining facial expression is the first step in determining dementia. The patients are seen to have tensed and frightened expression (van der Steen et al. 2014). More often, the patient is seen to be crying or whimpering when put into a tensed situation.
• Physiological Changes: Blood pressure, pulse, pallor of the skin and temperature are to be checked (Weber et al. 2014). This provides information regarding the severity of the patient’s condition.
• Physical Changes: As a result of the hypertension and high blood pressure, the patient can suffer from certain physical changes as well (Charras, Eynard and Viatour 2016). Pressure sores, contracture and even skin are monitored.

4. Patients suffering from dementia and other psychological illness mostly needs attention and mental support. The care plan for Rob will hence include these things.

• Due to the forgetfulness, these patients often forget to take up prescribed medications (Davies et al. 2014). Hence, it is necessary that the nurse has to be more cautious and attentive in monitoring Rob and giving him medications.
• His bed should be in a space that could be easily located and near to the toilet.
• Urging Rob to take regular Exercises will be helpful. In addition, he should be given proper nutritious food and diet (Charras,  Eynard and Viatour 2016).

5. Australia has a well-structured framework to support the patients with Dementia and other mental illness. As Rob goes to the GP, it is his right to be informed if he is suffering from any illness. Before starting medication, Rob has be well informed (Crespo, Hornillos and de Quirós 2013). Moreover, he has the right to select a guardian who will take decisions on his behalf, if his situation worsens. In this case, his wife may play the role if Rob is willing. Rob can also hire an attorney and make a will if he wishes. 1. It is found that women become more prone to weakness and fragile bones. Betty is a 72 years old woman and within past few months, she had multiple falls. This has led her to multiple fractures. As a result of her falls, Betty has sprained her right shoulder. She is suffering from arthritis in her feet. Betty has also complained of having dizziness and she is feeling unbalanced while getting up from her bed. She is taking up medications due to blood pressure. This implies that Betty is suffering from ailment related to blood pressure (Newman-Toker, McDonald  and Meltzer 2013). She had appointment with the optometrist, which means that she has problems be suffering in her eyes.2. Psychosocial implies to the processes that are related to the overall mental wellbeing of a person. In context to this case, it can be said that the patient is suffering from issues such as depression and anxiety (Weber et al. 2014). Betty is facing anxiety issues as a result of her several falls during the past few months. She is frightened that she might be injured severely if something happens again in future. These several falls has resulted into the lower self-confidence in her. As a result if self-confidence, she is restricting herself from social communications. This may lead her to social exclusion. As it can be perceived from her case study, that Betty lives alone. Hence, she is lacking the mental support that a person needs in order to sustain.3. The assessment tool appropriate for this case will be as following:

• Call: The patient should be provided with the call bell and has to be explained clearly (Lei-Rivera et al. 2013). However, it is possible that Betty will forget to use the bell. Hence, the nurse should be within the reach in case she calls out for help.
• Eyesight:  it is to be ensured that the eyesight of the patient has to be checked and the patient is wearing her glasses (Newman-Toker, McDonald and Meltzer 2013). Moreover, it is to be ensured that the patient is able to identify the objects and proper medication is given.
• Bed: as the patient is likely to fall from bed and complaining about dizziness while getting up, hence a low bed should be provided to her.

4. Betty is suffering from arthritis and she is suffering from anxiety and lower confidence issue as a result of her fall. Hence, in this regard, it is very important that Betty should be under constant monitoring. The priorities care for Betty can be as follows:

• Betty is complaining about dizziness, hence, she should be kept under constant monitoring so that further injuries can be prevented (Crocker et al. 2013). A call bell should be given to her so that she can call for help in emergency. Moreover, a low be will be helpful in this case.
• Regarding her muscle strain, she should undergo mild stretching. In addition to this, Betty should be given anti-inflammatory medications in order to reduce her pain and improve mobility (Crocker et al. 2013). Betty should be allowed to participate in mobility protocol under the supervision of the nurse.
• As it is evident that she is suffering from bone weakness, hence a proper diet is also very much necessary for her.

5. The Australian governmental framework aims at providing equal rights and access towards all citizens. However, it has been seen that people suffering from chronic diseases and complex problems may find it difficult to access all these rights. In regard to this case, Betty can opt for the governmental elderly care policies (Little, Paterson, Humphreys and Stathokostas 2013). As Betty is living alone, before going through treatment she can select a guardian for her. This will ensure the continuation of her treatment even in critical condition. In this regard the reference of the governmental frame work, namely “My Aged Care” can be taken (Little et al. 2013). This works towards providing the elderly people an easy access to the care services.

Reference:

Charras, K., Eynard, C. and Viatour, G., 2016. Use of space and human rights: planning dementia friendly settings. Journal of gerontological social work, 59(3), pp.181-204.

Crespo, M., Hornillos, C. and de Quirós, M.B., 2013. Factors associated with quality of life in dementia patients in long-term care. International Psychogeriatrics, 25(4), pp.577-585.

Crocker, T., Forster, A., Young, J., Brown, L., Ozer, S., Smith, J., Green, J., Hardy, J., Burns, E., Glidewell, E. and Greenwood, D.C., 2013. Physical rehabilitation for older people in long-term care. Cochrane Database Syst Rev, 2, p.CD004294.

Davies, N., Maio, L., Rait, G. and Iliffe, S., 2014. Quality end-of-life care for dementia: What have family carers told us so far? A narrative synthesis. Palliative Medicine, 28(7), pp.919-930.

Lei-Rivera, L., Sutera, J., Galatioto, J.A., Hujsak, B.D. and Gurley, J.M., 2013. Special tools for the assessment of balance and dizziness in individuals with mild traumatic brain injury. NeuroRehabilitation, 32(3), pp.463-472.

Little, R. M., Paterson, D. H., Humphreys, D. A. and Stathokostas, L. (2013). A 12-month incidence of exercise-related injuries in previously sedentary community-dwelling older adults following an exercise intervention. BMJ open, 3(6), e002831.

Newman-Toker, D.E., McDonald, K.M. and Meltzer, D.O., 2013. How much diagnostic safety can we afford, and how should we decide? A health economics perspective. BMJ Qual Saf, 22(Suppl 2), pp.ii11-ii20.

van der Steen, J.T., Radbruch, L., Hertogh, C.M., de Boer, M.E., Hughes, J.C., Larkin, P., Francke, A.L., Jünger, S., Gove, D., Firth, P. and Koopmans, R.T., 2014. White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the European Association for Palliative Care. Palliative medicine, 28(3), pp.197-209.

Weber, M.A., Schiffrin, E.L., White, W.B., Mann, S., Lindholm, L.H., Kenerson, J.G., Flack, J.M., Carter, B.L., Materson, B.J., Ram, C.V.S. and Cohen, D.L., 2014. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. The journal of clinical hypertension, 16(1), pp.14-26.