Evidence-Based Interventions For Dementia Patients In Nursing Homes

In this assignment, you are required to provide an overview of the literature you found in the previous assignment. You need to use the previous 5 articles of relevance to your understanding of a CaseWorld case.

This assignment mainly focuses on health of an older patient who has been recently diagnosed with dementia. The nursing professional who would be providing care to the patient has to ensure that she provides proper pharmacological as well as non-pharmacological interventions aimed at bringing improvement in the quality of life of the patient.  A patient suffering from dementia can be seen to show symptoms like issues in memory, communication and language issues, and ability to focus and pay attention, reasoning and judgment as well as visual perception (Melnyk et al. 2014, pp 10). The patient of the case study was seen to be highly confused in her approaches andexhibited many symptoms of dementia. Therefore, it becomes extremely important for the nursing professionals to gather knowledge about the medications as well as the non-pharmacological interventions that may assure proper quality and safe care (Wilson et al. 2015, pp 20). Therefore, for this reason, it become extremely important for nursing professionals to undertake evidence based studies by which she can collect valuable information about the approaches she can take which will result in better outcome for the patient. Therefore, five important papers were selected and annotated bibliography was conducted to find out information, understand its credibility and applicability, its utilization in the nursing profession and others (Upton et al. 2015, pp 81). This assignment will not only help the nurse gain new knowledge but will also help to provide best quality modern evidences that will bring out best outcomes for the patient of the case study.

Masoumi, J., Abbasloui, M., Parvan, R., Mohammadnejad, D., Pavon-Djavid, G., Barzegari, A. and Abdolalizadeh, J., 2018. Apelin, a promising target for Alzheimer disease prevention and treatment. Neuropeptides.

Masoumi et al. (2018) aimed at studying Apelin, a neuropeptide that has been explored as a promising target for prevention and treatment of Alzheimer’s disease (AD) in the recent past. According to the researchers, Alzheimer’s disease is known to be a progressive neurodegenerative disorder that has significant outbreak rates. The disease condition indicates a cognitive impairment of the individual due to pathological production of amyloid beta neurofibrillary tangles in the brain along with inflammatory mediators and toxic free radicals. The researchers further pointed out that there have been no treatment options available for altering the course of the disease. Nevertheless, research has been going on continuously to come up with new therapies at different stages. Neuropeptides are signaling molecules essential for communication of neurons in the body. Apelin is a significant neuropeptide which is extracted from bovine stomach. Research indicates that Apelin and its receptor APJ disseminate in the neurons and oligodendrocytes of the central nervous system. Further, Apelin-13 acts as the predominant neuropeptide in neuroprotection whose primary role is in the processes of memory and learning. It further prevents neuronal damage. Previous studies were responsible for pinpointing that Apelin has the potential to prevent production of amyloid beta and bring a reduction in its amount. The aim of the review was to put forward the different functions of apelin in relation to AD.

In the paper the researchers have given a thorough description of apelin. The pathogenesis of Alzheimer’s disease and the target for apelin has been illustrated. The research paper has been successful in highlighting that apelin can be effective in reducing the production of amyloid beta through decrease in the activity of beta-secretase and amount of APP. Neurodegenration can be prevented by reduction in the level of inflammatory mediators that are integral part of pathogenesis of AD. Further, apelin holds the potential to bring an increase in the synaptic plasticity in the neurons that is responsible for improving memory as well as cognitive function of patients through enhanced activity of factors like eNO, ACE2, and GLP-1

From the study it could be concluded that apelin can act as a suitable agent for treatment of AD. Nevertheless, further investigations are required for understanding the impact of apelin on the brain with reference to AD pathogenesis. The research paper though gave a clear idea of the potential of apelin, did not consider discussing how apelin can be applied as a therapeutic approach. A nursing professional would need to carry out further research to understand the applicability of apelin in practice. There is a need of highlighting how the knowledge about apelin can be translated into nursing practice (Hempell et al. 2016, p. 528). 

Abbatecola, A.M., Bo, M., Barbagallo, M., Incalzi, R.A., Pilotto, A., Bellelli, G., Maggi, S. and Paolisso, G., 2015. Severe hypoglycemia is associated with antidiabetic oral treatment compared with insulin analogs in nursing home patients with type 2 diabetes and dementia: results from the DIMORA study. Journal of the American Medical Directors Association, 16(4), pp. e7-12.

Abbatecola et al. (2015, p. 7-8) highlighted that severe hypoglycemia has a significant relation with cognitive decline in dementia patients having type 2 diabetes. The background of the present study was the fact that role of antidiabetic treatments for addressing severe hypoglycemia had not been explored in dementia patients. The present research’s focus was found to be on exploration of the prevalence of severe hypoglycemic events, and understanding ofassociations between anti-diabetic treatment and severe hypoglycemia in dementia patients at nursing homes. This study had a cross-sectional observational research design encompassing 150 nursing homes in Italy. 2258 patients were recruited for the study suffering from type 2 diabetes of which 1138 were suffering from dementia. Data collection was done in terms of functional status, antidiabetic treatments, glycemic control, comorbidities, and biochemical and clinical measurements.Severe hypoglycemia was found to be more prevalent in those suffering from dementia as compared to those without the condition. Dementia patients had more age and demonstrated more impairment in daily activities of living, more number of comorbidities, higher post prandial blood glucose level and lower fasting blood glucose level when compared to those not having dementia. The study further indicated that sulphonylureas for addressing hypoglycemia in patients. Nevertheless, long acting and rapid insulin analogs gave safer effects in individuals. Upon carrying out adjusted logistic regression models in patients suffering from dementia showed that rapid- and long-acting insulin analogs were associated with reduced odds ratio (OR) (OR 0.333; 95% confidence interval [CI] 0.184e0.602; OR 0.248, 95% CI 0.070 e0.882, respectively). However, sulphonylureas and combined metformin þ sulphonylurea indicated an increased ORs (OR 8.805, 95% CI 4.260e18.201; OR 6.639; 95% CI 3.273e14.710, respectively) of experiencing severe hypoglycemia.

It can be concluded that insulin analogs are an effective alternative for the prevention of severe hypoglycemia in those having dementia in a clinical setting which is controlled. Further, sulphonylureas are to be administered with caution to patients with dementia. At this juncture it is to be mentioned that the study had distinct drawbacks. The cross-sectional research design acted as the main limitation of the study. The results of the study are not applicable for testing the cause-effect relationship. There were wide implications of the research findings for nursing practice since the use of insulin for treating hypoglycemia in dementia patients in care units might assuage risks caused due to nursing home staff turnover. A nurse should be engaging in further research to understand the implications of use of long-acting and rapid insulin analogs for addressing changes in cognitive abilities in frail and older patients of dementia. Through an adequate knowledge of the appropriate drugs, nurses can consider patient-centered approaches for dementia patients so that quality of life is improved (Twigg and Schwartzkopf 2017, p. 387).

Smith, M.A., Bowen, R.L., Nguyen, R.Q., Perry, G., Atwood, C.S. and Rimm, A.A., 2018. Putative Gonadotropin Releasing Hormone Agonist Therapy and Dementia: An Application of Medicare Hospitalization Claims Data. Journal of Alzheimer's Disease, (Preprint), pp.1-9.

This article had mainly focused on a very new aspect for effectively treating patients with dementia as well as Alzheimer’s diseases. Previously, it was hypothesized by the researchers that degradation of the sex steroid hormones after menopause in women and andropause in men were mainly associated with the development of the Alzheimer’s disease in the older patients. However, such a claim was questioned when the conjugated equine estrogen therapy failed to reverse the occurrence of the Alzheimer’s disorders which made the researchers think more gravely in the situation. Smith et al. (2018, pp 7) had therefore taken patients within the age group of 67 to 75 and consisted participants divided into control groups comprised of patients with cholescystectomy, herniorrhaphy and transurethral prostatectomy  and experimental group comprising of patients with prostate cancer. An interesting result was obtained which showed that reduction of sex steroid hormones were not the main factors that were resulting in development of Alzheimer’s diseases. Sex-steroid hormone depletion results in complete dysregulation of HPG axis which in turn lead to the increase of the gonadotropin, GnRH and activin. The later is therefore the main cause of the occurrence of the Alzheimer’s diseases. This was proved from the fact that when the patients with prostate cancer who were treated with GnRH agonist did not develop alzheimers but those of the control groups whose sex steroid depletion had taken place and whose GnRH and Gn had also increased. Therefore, this scientific discovery is entirely unique as hormone replacement therapy for treating Alzheimer’s is novel in the scientific field and is provides a very interesting scope for treatment of Alzheimer’s in the near future. Therefore, as a registered nurse, one can select the paper as an effective procedure for treating Alzheimer’s. Until date, researchers were of the opinion that it is a disorder, which can never be completely cured, but the progression can be controlled with effective treatment procedures (Nead et al., 2017, pp 50).

This research had opened a new field in this treatment as it states that the GnRh agonists can help in the prevention and cure of the Alzheimer’s disorder via the procedure of down regulation of serum gonadotropins. Hence, as a nurse, one can really look forward to the application of this GnRH agonist therapy as a preventative as well as diseases modifying approach to the management of the disorders. However, this paper is published in this year only and need further research work to support the argument that had been made in the paper regarding not the depletion of sex steroid but the increase of the Gn and GnRH that cause the disorder (Hagan et al. 2016, pp: 1655). Only after sufficient evidences are there to support the paper then only a registered nurse can ensure use of such therapy.

O'connor, M.N., O'sullivan, D., Gallagher, P.F., Eustace, J., Byrne, S. and O'mahony, D., 2016. Prevention of Hospital?Acquired Adverse Drug Reactions in Older People Using Screening Tool of Older Persons' Prescriptions and Screening Tool to Alert to Right Treatment Criteria: A Cluster Randomized Controlled Trial. Journal of the American Geriatrics Society, 64(8), pp.1558-1566.

Medication error is one of the most important safety and quality aspect that affect the quality life of the patients associated with increased suffering. One of them is the adverse drug reactions that have severe impacts on the patients. It results in unavoidable deaths to the patients and increases their sufferings. They have to stay in hospitals for longer days and some are also seen to take readmissions after the reactions occur after few days. In many cases, it is also seen that it increases the medication costs of the patients, as more medications are required to make them cured from the conditions. Therefore, this paper would be extremely helpful to the nursing and other healthcare professionals in understanding the interventions that they can take in order to reduce one specific type of medication error like adverse drug reactions. The authors had proposed that two specific type of screening tools called the Screening Tool of Older Persons’ Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) would be able to reduce the rates of adverse drug reaction. Randomized controlled trail was conducted where old patients above 65 years hospitalized over a period of 13 months. It was a Single-blind cluster randomized controlled trial (RCT). The secondary outcomes which were to be tested is the effect of the such intervention screening tools on length of stay at the hospital as well as the 28 day medication cost. An interesting result was found which would help the registered nurses to ensure that they can also reduce chances of medication errors in their own practices with the help of these two tools.

The researchers have shown that the use of the tools resulted in reduced number of incidences of adverse drug interactions in the group of participants in the intervention groups where the tools were used in comparison to the number of adverse drug events in the patients who were of the control group who were not exposed to the tools. Moreover, the 28 day medication cost was also seen to be less in the patients of the intervention group than that of the control group. However, the median length of stay in the hospital remained unchanged in both the control and intervention groups that showed the fact that these tools may not help in reducing stays of people at hospital. One of the most interesting features of this article is that it had clearly mentioned three important limitations that the readers can follow to understand the credibility of the information or to avoid when further researches on this would be conducted. However, the paper can prove as one of the best evidence based studies that they can follow to find out interventions when they are making medication errors like adverse drug reactions. The paper shows the success of the tools and therefore these tools can be used by them as well as to provide better quality and safe care to patients (Parry, Barriball and While 2015, pp 405). 

Ballard, C., Orrell, M., Sun, Y., Moniz?Cook, E., Stafford, J., Whitaker, R., Woods, B., Corbett, A., Banerjee, S., Testad, I. and Garrod, L., 2017. Impact of antipsychotic review and non?pharmacological intervention on health?related quality of life in people with dementia living in care homes: WHELD—a factorial cluster randomised controlled trial. International journal of geriatric psychiatry, 32(10), pp.1094-1103.

Very few researches had been conducted earlier to the publication of this paper that focused on the effects of different treatments on the patients suffering from dementia. The use of antipsychotic medication to control the aggression and psychoticbehaviorsof the dementia patients are extremely popular in the care home settings to keep the patients under control and care for them effectively. This paper helps in understanding that although such medications are extremely helpful for controlling the neuropsychiatric symptoms and its management, but it cannot help in developing the quality of health of the patients suffering from dementia. The paper had conducted antipsychotic review, which had shown that it had poor effect on the health related quality of life. The paper had also shown that withdrawal of the antipsychotic medication also had very poor quality on the health-related quality of life (HRQL) which is worse than the effect of using the antipsychotic medication on the health-related quality of life (HRQL) alone. Therefore, the use of antipsychotic medication should not be completely withdrawn by registered nurses working with the patients to develop health-related quality of life (HRQL) as it may also stop helping in the control of the neuropsychiatric symptoms. However, one interesting feature is also stated here is that person centered care and social interaction are the non-pharmacological interventions that have resulted in positive outcomes on the health-related quality of life (HRQL). However, exercises regimen did not yield out any different outcome on the health-related quality of life (HRQL). Therefore, this information is extremely useful for the registered nurses as well as the healthcare professionals, who aim to develop the health-related quality of life (HRQL) of their patients in addition to controlling the symptoms of dementia. Therefore, the professionals can learn from this paper is that a proper antipsychotic reviews may lead to reduction in the number of medications to be used for the patient which might reduce the side effects but cannot result in development of the health-related quality of life (HRQL). They should not completely withdraw the medication as that many not only deteriorate the health-related quality of life (HRQL) but can also result in increase of the neuropsychiatric symptoms.

Although the paper had suggested the combined use of person centered care and social interaction along with the pharmacological interaction of the antipsychotic medication, they have not provided evidence for the combined use. They have only proved the action of the medication and non-pharmacological interventions separately on the health-related quality of life (HRQL) but their combined effect is not jotted down. Here lies one of the negative impacts of the information of the paper. However, this information can be helpful for the registered nurses in understanding the applicability of the information. They can also gain knowledge on whether they could use them in their care for their patients to develop their quality life (Carbera et al. 2015, pp 135)

It has been learnt that the procedure of collecting and critiquing articles from the library must be relevant and credible and at the same time help me in enhancing my knowledge and skills about the effective procedure of treatment. Evidence based practices will help me to ensure better patient outcomes, increase the safety of the patient and ensured better outcomes for patient. The more relevant and better the level of evidence, the higher the credibility of the papers which tend to bring out the best outcomes. The more recent the paper, the higher is their importance; preferences and values in clinical decision making that ensure safe care. This assignment has helped me to collect huge amount of information about the different pharmacological as well as non-pharmacological interventions that I can adapt in my practices and therefore would develop my expertise in treatment of patients who are suffering from dementia. Analyzing and critiquing articles helped me to find out their feasibility in their utilization as evidences in handling the patient of the case study and thereby such approach would also ensure me successful outcomes when treating patients with various disorders in the future.

Abbatecola, A.M., Bo, M., Barbagallo, M., Incalzi, R.A., Pilotto, A., Bellelli, G., Maggi, S. and Paolisso, G., 2015. Severe hypoglycemia is associated with antidiabetic oral treatment compared with insulin analogs in nursing home patients with type 2 diabetes and dementia: results from the DIMORA study. Journal of the American Medical Directors Association, 16(4), pp.349-e7.

Ballard, C., Orrell, M., Sun, Y., Moniz?Cook, E., Stafford, J., Whitaker, R., Woods, B., Corbett, A., Banerjee, S., Testad, I. and Garrod, L., 2017. Impact of antipsychotic review and non?pharmacological intervention on health?related quality of life in people with dementia living in care homes: WHELD—a factorial cluster randomised controlled trial. International journal of geriatric psychiatry, 32(10), pp.1094-1103.

Cabrera, E., Sutcliffe, C., Verbeek, H., Saks, K., Soto-Martin, M., Meyer, G., Leino-Kilpi, H., Karlsson, S. and Zabalegui, A., 2015. Non-pharmacological interventions as a best practice strategy in people with dementia living in nursing homes. A systematic review. European Geriatric Medicine, 6(2), pp.134-150.

Hagan, K.A., Munger, K.L., Ascherio, A. and Grodstein, F., 2016. Epidemiology of major neurodegenerative diseases in women: Contribution of the nurses’ health study. American journal of public health, 106(9), pp.1650-1655.

Hempel, P., Heinig, B., Jerosch, C., Decius, I., Karczewski, P., Kassner, U., Kunze, R., Steinhagen?Thiessen, E. and Bimmler, M., 2016. Immunoadsorption of Agonistic Autoantibodies Against α1?Adrenergic Receptors in Patients With Mild to Moderate Dementia. Therapeutic Apheresis and Dialysis, 20(5), pp.523-529.

Masoumi, J., Abbasloui, M., Parvan, R., Mohammadnejad, D., Pavon-Djavid, G., Barzegari, A. and Abdolalizadeh, J., 2018. Apelin, a promising target for Alzheimer disease prevention and treatment. Neuropeptides.

Melnyk, B.M., Gallagher?Ford, L., Long, L.E. and Fineout?Overholt, E., 2014. The establishment of evidence?based practice competencies for practicing registered nurses and advanced practice nurses in real?world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence?Based Nursing, 11(1), pp.5-15.

Nead, K. T., Gaskin, G., Chester, C., Swisher-McClure, S., Leeper, N. J., & Shah, N. H. 2017. Association between androgen deprivation therapy and risk of dementia. JAMA oncology, 3(1), 49-55.

Nightingale, G., Hajjar, E., Swartz, K., Andrel-Sendecki, J. and Chapman, A., 2015. Evaluation of a pharmacist-led medication assessment used to identify prevalence of and associations with polypharmacy and potentially inappropriate medication use among ambulatory senior adults with cancer. American Society of Clinical Oncology.

O'connor, M.N., O'sullivan, D., Gallagher, P.F., Eustace, J., Byrne, S. and O'mahony, D., 2016. Prevention of Hospital?Acquired Adverse Drug Reactions in Older People Using Screening Tool of Older Persons' Prescriptions and Screening Tool to Alert to Right Treatment Criteria: A Cluster Randomized Controlled Trial. Journal of the American Geriatrics Society, 64(8), pp.1558-1566.

Parry, A.M., Barriball, K.L. and While, A.E., 2015. Factors contributing to Registered Nurse medication administration error: A narrative review. International journal of nursing studies, 52(1), pp.403-420.

Smith, M.A., Bowen, R.L., Nguyen, R.Q., Perry, G., Atwood, C.S. and Rimm, A.A., 2018. Putative Gonadotropin Releasing Hormone Agonist Therapy and Dementia: An Application of Medicare Hospitalization Claims Data. Journal of Alzheimer's Disease, (Preprint), pp.1-9.

Twigg, P. and Schwartzkopf, C.E., 2017. Nursing Management of Dementia. Gerontological Nursing Competencies for Care, p.387.

Upton, P., Scurlock-Evans, L., Williamson, K., Rouse, J., and Upton, D. 2015. The evidence-based practice profiles of academic and clinical staff involved in pre-registration nursing students' education: A cross sectional survey of US and UK staff. Nurse education today, 35(1), 80-85.

Wilson, M., Sleutel, M., Newcomb, P., Behan, D., Walsh, J., Wells, J. N., and Baldwin, K. M. 2015. Empowering Nurses With Evidence?Based Practice Environments: Surveying Magnet®, Pathway to Excellence®, and Non?Magnet Facilities in One Healthcare System. Worldviews on Evidence?Based Nursing, 12(1), 12-21.