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Topic 1: 
An annual influenza vaccination is highly recommended for all individuals older than 65, and for those who are regularly exposed to older individuals, such as community nurses. Discuss. Your discussion should include (but NOT be limited to) the following: Description of the flu vaccine recommended for older adults; rationale behind the requirement for annual boosters; rationale for the recommended immunization of the over 65 population group; contraindications for the flu vaccine; analysis of the requirement for nurses to be immunized against influenzaherd immunity; how you would respond with evidence to an older adult in the community who argued that the flu vaccine results in getting the flu; cultural safety; empowerment. 
Topic 2:
Choose a chronic disease from the list below and critically discuss how you would support self-management of your client/patient living with this chronic illness in the community. Your discussion should include (but NOT be limited to) the following: Main causes and brief pathophysiology (in simple terms - as you would explain it to your patient); impact of the disease on the individual and family/carers; health promotion; cultural safety; empowerment. Choose one of the following chronic diseases:
• Parkinson’s disease 
• Dementia
• Multiple sclerosis 
• Motor neurone disease 
• Osteoarthritis 
• Rheumatoid arthritis

Causes and Impacts of Dementia

Dementia described as the set of symptoms such as memory loss, difficulty in thinking, issues in problem-solving or language. These symptoms are not very harmful in the beginning but in severe cases, it might affect a person's daily life events. A person with this health condition may also face symptoms like mood and behaviors changes.  Dementia can be caused when the brain functions are impaired by a disease or disorder like Alzheimer's or the series of strokes. However, it is not the only disorder responsible for dementia. This health issue is progressive; it means that the symptoms associated with this, gets worse over time (Gorelick, Scuteri, Black, DeCarli, Greenberg, Iadecola, & Petersen, 2011). It has been found that around 425,416 Australian are living with dementia and these numbers are expected to increase close to 536,164 by 2025 (Prince, Bryce, Albanese, Wimo, Ribeiro, & Ferri, 2013). According to the World health organization (2017) it was estimated that nearly 2 million people were diagnosed with this psychological illness in 2014. Among all the identified case nearly 1 million had Alzheimer’s (Carling, Bigby, & Iacono, 2014). This essay will focus on the discussion of self- management approach for the patient with dementia. Main causes, pathophysiology, impacts on family carers, health promotion, cultural safety, and empowerment will also be discussed.

Dementia is affecting people from all over the world. It was estimated that nearly 47.47 million population were living with this health issues in 2015, and this number will be reaching to 75.63 by 2030 and nearly 135.46 million in the year 2050. It was estimated that worldwide 7.7 million new people of dementia were reported each year and 3.6 new cases per year in Asia, 2.3 million in European region, in America 1.2 and 0.5 million in Africa (Rizzi, Rosset & Roriz-Cruz, 2014).

According to estimation, 298,000 Australian had dementia in 2011, and it was expected to reach 400000 by 2020. In the year 2010, this health condition was the third leading cause of deaths, accounting for nearly 6 percent of total death. According to that estimation, nearly 25 people died every day that particular year (Australian Institute of Health and Welfare, 2012). These numbers were increased by 2.4 times between 2001 and 2010 Dementia is found to be the second leading reason for deaths in Australia. It accounts for 5.4 % of total death in men and nearly 10.6 % of all deaths in women per year. It has become the leading cause of deaths among all the Australian females after heart diseases. In the year of 2018 nearly 425, 416 Australian recorded to live with this health issue. Without any medical breakthrough, the incidence of dementia is expected to reach 536,164 by 2025 and nearly 1,100,890 by 2056 (Dementia Australia, 2018).

Prevalence of Dementia Worldwide

The symptoms of this health condition are the problem in communicating, disorientation, misplacing, recent memory loss, difficulty in performing the daily tasks, mood swings, personality changes, and loss of initiative. Early signs of this mental illness are changes in short-term memory, apathy, confusion, being repetitive, trouble in finding a rights word, poor sense of direction, difficulty in adapting the changes (MacGill, 2017). There are several sorts of dementia but Alzheimer’s disease and vascular dementia are the most common type of this disorder (Li, Guthridge, Aratchige, Lowe, Wang, Zhao, & Krause, 2014). Diseased person may also have the problem like becoming aspathetic or withdrawn, easily upset, unusually sad and anxious. The person with late stages of dementia may face physical issues such as weakness of muscles or weight loss, changes in sleeping habits, and abnormal appetite (Cerejeir, Lagarto, & Mukaetova-Ladinska, 2012).

Damage to brain cells may result in dementia and it is estimated that it affects a person’s memory and also block blood circulation in the body system which can increase the cardiovascular problems. Brian cells are the most important part of the human body system and the damaged brain cells directly affect the communicating ability of a person. There are various types of dementia which can damage brain cells such as Alzheimer’s disease, vascular, mixed, and dementia with Lewy bodies. According to National Health Service, there are main two key issues that lead to dementia such as lack of exercise or physical activities and consuming unhealthy diets. If any individual consumes the essential nutrient and follows workout plans than he or she can reduce many health disorders and cardiovascular disorders. Other main causes of this disorder include brain cell death, a neurodegenerative disease, head injury, stroke, and brain tumors. Another cause of this health issue includes prion diseases like Creutzfeldt- Jacob disease, HIV infection and reversible factors such as drug interactions, vitamin deficiency, thyroid abnormalities, depression, loss of memory, and excess use of alcohol (Muangpaisan, Petcharat, & Srinonprasert, 2012). The chemical connection between brain cells may be damaged and the problem of memory loss can occur. This leads to health issue where a person cannot find the right words and he or she cannot communicate properly with another person (Page, Potter, Clifford, McLachlan, & Etherton, 2015).  

Vascular dementia is the cognitive abnormality caused by blood vessels damage in the brain. It can also be caused by a single or several strokes occurring over time. This type of dementia is diagnosed when there is evidence of the blood vessel disease in the brain and abnormal cognitive function that causes issues with daily living (T O'Brien & Thomas, 2015). The symptoms of this dementia can begin immediately after a stroke or may begin gradually after worsening of blood vessel disease. The symptoms are different and depend on the location and size of damage to the brain. It may affect just one or more specific cognitive functions. Vascular dementia may appear the same as Alzheimer’s disease, and the combination of Alzheimer’s disorder and vascular type of dementia is common (Murden, 2011)

Symptoms of Dementia

There are different types of dementia and each has a different pathophysiology but most of them are similar with respect to thrombi and emboli. Vascular infection may show intensely when thrombi, emboli, or intense injury bargains perfusion. Thrombosis is regularly of an athermanous nature and happens in the lower limits more much of the time than in the furthest points. Different elements incline patients for thrombosis. These elements incorporate sepsis, hypotension, low heart yield, aneurysms, and aortic analysis; sidestep joins, and hidden atherosclerotic narrowing of the blood vessel lumen (Iemolo, Duro, Rizzo, Castiglia, Hachinski, & Caruso, 2009). The risk of developing Alzheimer’s disease is increased when a person is exposed to the vascular risk factors such as hypertension, peripheral arterial disease, and smoking. Some of the studies show that vascular processes in both diseases may induce each other. In Alzheimer’s disorder and vascular disease, Apo-lipoprotein E plays a major role. The patient who survivors the strokes have the higher risk of dementia due to Apo-lipoprotein E4. It is the strong factor for developing the cerebral amyloid angiopathy in person with Alzheimer disorder. Alzheimer's illness causes a cortical-subcortical deterioration of uphill cholinergic neurons and the huge pyramidal cells in cerebral cortex. Clinically, the sickness reflects decay of capacity in the affiliation cortex part of the brain (Venkat, Chopp & Chen, 2015).

When a person developed dementia symptoms, their family members and friends may begin a completely new and hard journey of their own. The carers have to try to cope with the emotional breakdown and implications of the diagnosis. They have to provide emotional and practical help to the patient on a daily basis and making difficult decisions related to treatment options. Treatment of dementia takes a long time to treat and it causes financial and psychological impacts on the family members. Caring for the person with dementia may results in increased depression, anxiety and stress compared to the non-carers. According to the survey conducted among the dementia family carers, it was found that 31 present of the participants face an adverse impact on their physical health, nearly 34 % respondents reported to feel weary or tired. The stress caused during the care, may lead to impaired immunity, hypertension, and high levels of stress hormone and increased risk of developing cardiovascular diseases. Social isolation might be there among the carers, which occurs due to the demands of the patient. A national care survey report shows that most of the carers cancel or giving up their holidays or hobbies while caring dementia patient (Alzheimer’s Australia, 2015)

Pathophysiology of Dementia and Vascular Dementia

Self-management is the learning and practicing some skills that are necessary to promote the mental and physical health in a chronic condition. The characteristics of management programs include problem-solving, decision making, finding and utilizing sources, and taking actions (Hickey & Bourgeois, 2012).  The self-management strategies in dementia case include managing the physical aspects of the disorder, emotional management, role management, and system support, having the necessary information about the diagnosis. The physical aspects can be managed using strategies to solve the issues like memory loss and improving physical activity. Emotional management includes social support from family and friends. System support involves the societies, groups or organizations such as Alzheimer society (Toms, Quinn, Anderson, & Clare, 2015).

Health promotion plays a significant role in the reduction of dementia and Alzheimer's disease. Health promotion provides a platform to identify the cause and the impact of this mental illness on human health. A Person suffering from this health concern can be benefited by health promotion that promotes healthy diets and exercise. Health promotion maintains human brain cells and reduces the associated problems in which they promote healthy diets and exercise. Health promotion focus on the human body system and Australian government produced many strategies in which a national dementia strategy is one of an effective strategy (Salva, Andrieu, Fernandez, Schiffrin, Moulin, Decarli, & Vellas, 2011).  

Various cultural safety steps can be used to reduce the problem of dementia. One of them is involving the family member and friends. A family member or individuals can provide a platform where patients can reduce the burden of dementia. In the next step is the nurses can communicate with patients and motivate them to develop confidence. Participate in activities with dementia patients and improve cultural programmes & plans can encourage the patient to improve their health (Ashby, Burns, Shaw, & Anstey, 2017).

Empowering a person with dementia to make them stronger and more confident, specifically in controlling their lives and claiming their rights. Engaging in enabling and empowering the patient is the health-promoting projects that produce resources for the people living with this disorder. These type of resources provide information and tips regarding how to make the most of lives with dementia and encourage the people to look after themselves, staying energetic and engaged in four different areas of life: keeping mind active, keeping body active, seeking for appropriate support and taking care of their general health (Lindsay, Brittain, Jackson, Ladha, Ladha, & Olivier, 2012)

Impacts of Dementia on Family Carers

Empowering and encouraging people with dementia are the key aspect for providing a better life for them. People with this health issues should be provided with small responsibilities. Carer should observe strength & skill in every patient and empower them to use those skills. This may boost their confidence and develop the feeling of independence. Encouraging the patient to do as much as activities or tasks for themselves. The patient should be allowed to use their skills or hobbies such as cooking, games, gardening, and sewing, but should do the tasks in a safe environment (Nomura, Makimoto, Kato, Shiba, Matsuura, Shigenobu, & Ikeda, 2009).

Dementia is the term that describes various types of symptoms that are responsible to affects the memory, social wellbeing and ability to do perform the dial activities. It was estimated that almost 60% of people in Australia are suffering from Alzheimer’s disease. Between 2014 and 2015, the incidence of dementia increased by 5 %. It can be caused by lack of exercise, unhealthy diet, brain cell death, head injury, stroke, and brain tumors. The symptoms associated with this health issue include memory loss, combination issues, disorientation, apathy, confusion, poor sense of direction, and difficulty in adapting the changes. Various studies have been concluded that consuming healthy foods such as fruits, vegetables, eggs, and fish and drinks soft water rather than beverages can help to reduce many health disorders. The pathophysiology of this disorder includes different types of specific basic mind disease and few outline deterioration. The impacts of dementia on family members include beginning a difficult journey, financial issues, depression, anxiety, stress, and canceling holidays to provide care for the dementia patient. The self-management strategies include managing physical and emotional aspects of the disorder, role management, system support and having proper information of dementia and its associated risk factors. To reduce the incidence of many health organizations, communities and health promotion groups developed many strategies and policies by which people can be recovered from Alzheimer’s dementia. The Australian government should develop health and wellbeing programmes and improve health promotion through which they can decrease this type of health problem.

References

Alzheimer's Australia (2015). Caring for someone with dementia: the economic, social, and health impacts of caring and evidence-based supports for carers. Retrieved from: https://www.dementia.org.au/files/NATIONAL/documents/Alzheimers-Australia-Numbered-Publication-42.pdf

Ashby, K., Burns, R., Shaw, J., & Anstey, K. J. (2017). The proportion of dementia in Australia explained by common modifiable risk factors. Alzheimer's research & therapy, 9(1), 11.

Self-Management Strategies for Dementia

Australian Institute of Health and Welfare (2012). Dementia in Australia. Retrieved from: https://www.aihw.gov.au/getmedia/199796bc-34bf-4c49-a046-7e83c24968f1/13995.pdf.aspx?inline=true

Murden, R. A. (2011). Neuroimaging In Dementia. Journal of the American Geriatrics Society, 59(2), 375-376.

Carling, R., Bigby, C., & Iacono, T. (2014). Family experiences of supporting a person with Down syndrome and dementia in Australia. Intellectual disability and dementia: Research into practice, 14, 145-160.

Dementia Australia (2018). Dementia statistics and epidemiology. Retrieved from: https://www.dementia.org.au/information/for-health-professionals/dementia-the-essentials/dementia-statistics-and-epidemiology

Dementia Australia (2018). Dementia: key facts and statistics 2018. Retrieved from: https://www.dementia.org.au/files/documents/Key-facts-and-statistics.pdf

Gorelick, P. B., Scuteri, A., Black, S. E., DeCarli, C., Greenberg, S. M., Iadecola, C., & Petersen, R. C. (2011). Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 42(9), 2672-2713.

Hickey, E., & Bourgeois, M. S. (2012). Dementia: from diagnosis to management- A Functional Approach. (2nd ed.). New York: Taylor & Francis.

Iemolo, F., Duro, G., Rizzo, C., Castiglia, L., Hachinski, V., & Caruso, C. (2009). Pathophysiology of vascular dementia. Immunity & Ageing, 6(1), 13.

Li, S. Q., Guthridge, S. L., Aratchige, P. E., Lowe, M. P., Wang, Z., Zhao, Y., & Krause, V. (2014). Dementia prevalence and incidence among the Indigenous and non-Indigenous populations of the Northern Territory. Med J Aust, 200(8), 465-9.

Lindsay, S., Brittain, K., Jackson, D., Ladha, C., Ladha, K., & Olivier, P. (2012). Empathy, participatory design and people with dementia. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems (pp. 521-530).

MacGill, M. (2017). Dementia: symptoms, stages, and types. Retrieved from: https://www.medicalnewstoday.com/articles/142214.php

Muangpaisan, W., Petcharat, C., & Srinonprasert, V. (2012). Prevalence of potentially reversible conditions in dementia and mild cognitive impairment in a geriatric clinic. Geriatrics & gerontology international, 12(1), 59-64.

Nomura, M., Makimoto, K., Kato, M., Shiba, T., Matsuura, C., Shigenobu, K., & Ikeda, M. (2009). Empowering older people with early dementia and family caregivers: A participatory action research study. International journal of nursing studies, 46(4), 431-441.

Page, A., Potter, K., Clifford, R., McLachlan, A., & Etherton-Beer, C. (2015). Prescribing for Australians living with dementia: study protocol using the Delphi technique. BMJ Open, 5(8), e008048.

Prince, M., Bryce, R., Albanese, E., Wimo, A., Ribeiro, W., & Ferri, C. P. (2013). The global prevalence of dementia: a systematic review and meta-analysis. Alzheimer's & Dementia, 9(1), 63-75.

Rizzi, L., Rosset, I., & Roriz-Cruz, M. (2014). Global epidemiology of dementia: Alzheimer’s and vascular types. BioMed research international, 2014.

Salva, A., Andrieu, S., Fernandez, E., Schiffrin, E. J., Moulin, J., Decarli, B., & Vellas, B. (2011). Health and nutrition promotion program for patients with dementia (NutriAlz): cluster randomized trial. The journal of nutrition, health & aging, 15(10), 822-830.

T O'Brien, J., & Thomas, A. (2015). Vascular dementia. The Lancet, 386(10004), 1698-1706.

Toms, G. R., Quinn, C., Anderson, D. E., & Clare, L. (2015). Help yourself: perspectives on self-management from people with dementia and their caregivers. Qualitative health research, 25(1), 87-98.

Venkat, P., Chopp, M., & Chen, J. (2015). Models and mechanisms of vascular dementia. Experimental neurology, 272, 97-108.

World Health Organisation (2015). The epidemiology and impact of dementia: current state and future trends. Retrieved from: https://www.who.int/mental_health/neurology/dementia/dementia_thematicbrief_epidemiology.pdf

World Health Organization (2017). Dementia. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/dementia.

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