Differences in the Neurological Conditions
Old age is normally placed under a similar category with the vulnerable population groups, besides pregnant women and children, as a stage in a life marred with numerous health challenges. Neurological diseases including short-term or long-term memory loss, Alzheimer’s, and delirium’s are mostly observed among the elderly persons symptomized by a reduction in neurological functions. In average memory loss, the part of the brain that stores short-term and long-term memory temporarily losses this ability restores the stored information (Idland, 2020). According to Mulkey et al.,(2019), dementia is the combination of symptoms that gang up to affect an individual’s mental and cognitive capabilities negatively. These symptoms can affect an individual to the point of one losing the ability to do things for themselves as they would ordinarily do in normal health. According to the World Health Organization (WHO), dementia is a risk-factor for disabilities among older people, imposing great emotional stress and care cost burden for the disease management(Wolters & Ikram, 2018). Currently, it is reported that over forty-seven million people across the globe are living with one or more symptoms of dementia, most of which persists through their lives into older adulthood (Wolters & Ikram, 2018).
Alzheimer’s disease is defined as a progressive illness of the central nervous system, especially the brain, which gradually affects an individual’s ability to remember and impairs their physical activity, and performance (Idland, 2020). Even though the disease majorly affects older people from the ages of sixty years and beyond, the disease is also common among younger people, with current statistics indicating that Alzheimer’s affects over five million people in the United States alone (Dumurgier & Tzourio, 2020). Alzheimer’s is symptomized with loss of memory or recent occurrences, inability to make informed decisions, changes in individuals’ behaviors, and difficulties in exercising psychomotor functions (Idland, 2020).
Delirium is a reversible acute mental impairment that causes cerebral dysfunctions and results in confusion, following cerebral oxidative build-up and abnormalities in neurotransmitter functions (Grover & Avasthi, 2018). Therefore, delirium is mainly an acute state of instability that affects an individual’s attention rather rapidly than normal resulting from acute diseases or an overdose of drugs. Hence Delirium is one of the symptoms of dementia that develops mostly in patients with dementia (Morandi et al., 2017). Despite there being no clear cut for testing the neurological conditions highlighted, a patient’s medical history, physical examinations, and diagnostic tests, neurological examinations, and mental cognitive state assessment tests are always done on the patients as procedural tests for diagnosing the diseases.
Etiologies of Cognitive Changes present in the Older Population
Several cognitive changes are observed among the elderly with the progression of neurological diseases. According to Wolters & Ikram (2018), dementia makes the patients lose their ability to hear well, their sight deteriorates; the sense of smell disappears from the nose while the tongue loses the ability to taste. Other diseases such as diabetes are known to destroy cognitive functions, thus causing an increase in the chances of hypertension and elevated blood cholesterol levels among the elderly (Dumurgier & Tzourio, 2020). Mr. YY had been diagnosed with all these disease conditions, including type 2 diabetes mellitus, hypertension, and dyslipidemia, and was still on medication.
Psychosocial changes are eminent in patients with neurological deficiencies presenting themselves through stress, which leads to depression. The state of depression drives the affected patients into exhibiting various negative life outcomes such as poor nutrition, sleeplessness, poor personal hygiene, and a lack of purposefulness (txt). Pharmacological effects of the disease conditions are expressed in missed medications due to forgetfulness, chances of drug overdoses which may result in delirium for patients with dementia (txt). The patients also lose track of the overall health, and wellbeing which is expressed in the inability to handle hold things and walk around as before. The patients become incapable of driving as a result of the cognitive impairments from illnesses such as dementia.
The implications of these cognitive changes among the older patients for clinicians in care management are huge. For instance, several studies have revealed that among older patients, the confusion of delirium with dementia is a common clinical error that must be observed keenly by clinicians, especially among those patients with long-term memory loss (Mulkey et al., 2019). Given that for most of the stated diseases under dementia there are limited tests, the clinician must be equipped with vast knowledge and experience to be able to promptly differentiate as well diagnose individual neurological conditions for effective care and treatment.
Based on Mr.YYs presentation as evidenced by poor hygiene, social withdrawal, and the abrasion from the reported fall, he must be undergoing some stressful times which have led him to a depressed state. Therefore, it may be a concern over his safety and wellbeing and leads to questions on his ability to continue taking care of his wife. It may also draw a concern as to the adherence with the prescribed medication uptake. With the reported falls, the patient might end up with a severe head injury which could worsen the already deteriorated neurological functions or worse, contemplate suicide.
The patient is depressed and overwhelmed with being his wife’s caregiver while still managing his medical condition, after letting go of their home-health aid. In this case, the healthcare state of the two ailing elderly patients is bent for the worst of outcomes. The next step would be to enroll the patients into elderly care homes or nursing homes, for prompt access to assisted care. However, because the patient seems to be responding well to treatment after the change in medication plan, the patient can continue with outpatient monitoring, at more frequent intervals of hospital visits for continued observation.
Ethical concerns while handling the patients’ needs must be considered. In this regard, the patient’s autonomy must be respected, through discussions over the medications and whether there is a need for changes in their medication. In the care plan, the current medication management options should be continued as they are already showing some slight positive changes with the patient. The care plan should also involve some awareness of health education and the reduction of risk of falls besides fostering adherence to medications.
Step 3
Mrs.YYs exhibits a frail nature, and her untidy state points out a deteriorating ability of the patient to continue with self-care, especially after letting go of the home aid. Mrs. YY’s bruising further points to the fact that she has grown way older, and her skin has continued to thin as a result of the age factor. The patient is on low-dose aspirin as a preventive measure against a heart attack from hypertension. This is a factor of concern given the high risks of bleeding with aspirin use, especially with the bruising observed on the patient.
The next action would be the outright admission of the two elderly patients into an elderly care home or the introduction of a home safety plan. Nursing homes for elderly patients have been legislatively approved as the best way to ensure the safety, and wellbeing of many patients, especially the elderly patients. While in the nursing care homes, patients’ medical and hygiene needs are adequately addressed by qualified primary care professionals, such as the advanced practice registered nurses (APRNs). The patient’s decision and request for discharge in the nursing care homes must be respected, as means of allowing for voluntary care access, to reflect on the ethical principles of autonomy and beneficence. The admission into the nursing care homes must be made voluntary to the will of the patients, without coercion but with an informed decision approach. However, in the case that the patient asks for the home-safety approach as opposed to the nursing home care option, their ethical needs must still be met.
Communication Strategy with the Elderly
Communication with elderly people must put into consideration, the state of their mental abilities. In this sense, it would be beneficial to use precise, simple words and sentences that are easy to grasp and understand by the patient. According to Lanzi, Burshnic & Bourgeois, (2017) elderly patients are slow in responding to questions and in effectively communicating their concerns, therefore the healthcare provider must observe patience, allowing extra time for the patients to respond. Other studies also recommend that patience includes keen listening to the patient while avoiding possible interruptions, and maintaining eye contact with the patient, as a way of an assurance that one understands what the patient is saying.
While communicating with the two elderly patients over their home safety plan as an option, it is important to bring them an understanding of what the cost-benefit analysis of the decision will be. According to Costa et al., (2018), in-home care options have been reported to be very costly for elderly patients, especially those suffering from dementia, if they have to be observed several times in a day. Mr. and Mrs.YY is in a critical stage in their life which calls for assisted living, either through the in-home services or, to join the elderly nursing homes for improved health outcomes. The communication would also consider discussing the elderly peoples living environment, highlighting the need for the elimination of obstacles and stairways which may be a hindrance for the elderly. The sleeping environment must also be a concern at this stage, given the rates of sleeplessness reported especially for Mr. YY in general, the elderly persons living area should be promptly renovated for movement convenience and to reduce the risks of falls.
In conclusion, the spectrum of illnesses allied to dementia affects many people in the world as it is, but the elderly persons remain the most affected individuals ever. Assisted living for most of the patients living with neurological challenges is a good option for enhanced health outcomes of the patients. Mr. and Mrs. YYs’ health outcomes could be greatly enhanced if the considerations for home-aid care or nursing home care are introduced as an intervention. With assisted living, the patient’s safety, medication adherence, nutrition, and hygiene needs will be enhanced.
References
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Dumurgier, J., & Tzourio, C. (2020). Epidemiology of neurological diseases in older adults. Revue Neurologique. Web.
Grover, S., & Avasthi, A. (2018). Clinical practice guidelines for management of delirium in elderly. Indian Journal of Psychiatry, 60(Suppl 3), S329. Web.
Idland, A. V. (2020). Alzheimer’s disease-associated biomarkers in delirium and cognitively normal older adults.
Lanzi, A., Burshnic, V., & Bourgeois, M. S. (2017). Person-centered memory and communication strategies for adults with dementia. Topics in Language Disorders, 37(4), 361-374.
Morandi, A., Davis, D., Bellelli, G., Arora, R. C., Caplan, G. A., Kamholz, B.,… & Rudolph, J. L. (2017). The diagnosis of delirium superimposed on dementia: an emerging challenge. Journal of the American Medical Directors Association, 18(1), 12-18.
Mulkey, M., Everhart, D. E., Hardin, S., Olson, D., & Munro, C. (2019). Distinguishing delirium from dementia. Journal of Health and Caring Sciences, 1(1), 56-67. Web.
Wolters, F. J., & Ikram, M. A. (2018). Epidemiology of dementia: the burden on society, the challenges for research. In Biomarkers for Alzheimer’s Disease Drug Development (pp. 3-14). Humana Press, New York, NY. Web.