Families 11th,2017 I have maintained Academic Integrity in

 

 

 

                                                                     

 

 

Families Dealing
with Dementia

Jennifer Ikpefua

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N01031869

NURS 4111

University of
New Brunswick/Humber College

December 11th,2017

 

 

 

 

 

 

I have maintained Academic Integrity in
my work by adhering to the values of honesty and integrity. I declare that this
work respects APA requirements as well as policies within the School of Health
Sciences.

Student
Signature: Jennifer Ikpefua

Student
Number: N01031869

Introduction

            According to
the World Health Organization (2017), Dementia
is a chronic progressive condition in which there is integration/deterioration
in cognitive function beyond what might
be expected from normal ageing. This
disease affects memory, thinking, comprehension, calculation, orientation to learning
ability, language, and judgment.”Dementia is one of the most
significant causes of disability and dependence
among older adults. It requires early and very attentive care, which is still predominantly provided by the family at
home” (Esand & Canga, 2014). Alzheimer’s
disease is the most common irreversible form of dementia. It is a fatal,
progressive and degenerative disease that destroys the brain cells (Chang, Patel, & Schulz, 2015).

Dementia is one of the most demanding
health challenges facing the world today and is not solvable by any one country,
organization or individual alone.
Prevalence rates are increasing globally, with populations ageing worldwide, and at a significant rate,
including in low to middle-income
countries, where around 60% of all people with dementia live.

The World Health Organization (WHO,2016),
estimates that dementia currently affects more than 47 million people
worldwide, a figure that is expected to rise to 75.6 million by 2030 and 135
million in 2050, as the global population ages. According to World dementia
Council Report (2016), Alzheimer’s Disease International estimates
that the existing worldwide costs of dementia are the US $818 billion and that it will become a trillion-dollar disease
by 2018, and this is unsustainable cost the world economy can bear if the current trend is not contained.

  Chang, Patel,
& Schulz, (2015) suggest that “Dementia is somewhat unique in that its
impact on families is as important to consider as the impact on the person with
the disease. Caregivers of people with dementia often have more serious health
impacts than caregivers of people with other conditions”.

            This paper will provide an overview
and background of this health condition and its implication on family well-being. It will critically review the
extent of the available information and research work, and identify gaps and
new recommendations and ways to diminish the burden of such health impacts on the family.

Overview
and Background

             People living with dementia have poor access
to appropriate healthcare, even in most high-income
country settings, where only around 50% of people living with dementia receive
a diagnosis. In low and middle-income
countries, less than 10% of cases are diagnosed (Alzheimer’s Disease
International,2016). As populations age, due to increasing life expectancy, the
number of people with dementia is increasing. It is unlikely that the usual
specialist-led approach to dementia care can expand fast enough to keep up with
an increase in need, and even more
unlikely that healthcare coverage can be improved without rebalancing to give
primary care a more prominent role(Alzheimer’s Disease International,2016).

In
Canada, the combined health care system cost and
out-of-pocket caregiver estimated to cost 10 billion dollars in 2016,
and by 2031; the cost is expected to rise
by 60 percent, to 16.6 billion dollars. Based on projections using the Canadian
Study of Health and Aging (1994) data, as of 2016, there are an estimated 564 000 Canadians living with
dementia. By 2031, this number is expected to rise to 937 000, an increase of
66%. Of the current num­ber of Canadians with dementia, more than 65% are women
(Alzheimer’s Society of Canada, 2016).

According
to Alzheimer’s Society of Canada (2017), the number of Canadians affected
indirectly or directly by dementia is about 1.1 million, and the annual cost to
Canadians to care for those living with the disease is estimated to be around
10.4million dollars. Dementia affects Canada’s ageing
population and the healthcare systems in
this country and around the world. The government support efforts to prevent,
delay or slow the progress of dementia impacts may be reduced through early
diagnosis, by promoting healthy living and by keeping your brain active.

 Noel,
Kaluzynski, & Templeton, (2015),
argue that an estimated 5 million people in the United States have dementia.
One in nine individuals above the age of 65 and a third of adults above the age
of 85 have cognitive impairment significant enough to affect their day-to-day function As the average age of the
population rises, these figures will grow, making the development of effective
systems of dementia care a critical public health concern.

Generally,
costs for people with dementia are estimated to be five-and-a-half times
greater than for those who do not have the condition. Home care and long-term
care are the largest contributors to direct costs. In 2011, family caregivers
provided 19.2 million unpaid hours of care. This number is projected to double
by 2031, (Alzheimer’s Society of Canada, 2016).

This
tremendous increase in a number of people
with dementia that are being cared for in  Canadian hospitals has put the healthcare
system’s facilities and resources under strenuous pressure, increasing
personnel stress level. The increase in the stress
level of nursing staff can be attributed
to insufficient resources cum lack of skilled and educated personnel to meet
patients’ complex behavioural,
psychological and physical needs. Jacklin, Pace & Warry,(2015) stated that “Caregiving practices are heavily influenced by culture including traditional beliefs and
historical experiences. Cultural interpretations of a particular illness can
impact the amount and type of care that are provided, who becomes responsible
for the care, coping and self-care strategies, and the use of social
supports”.

Despite almost two decades of accumulating evidence
of more than a dozen successful models of
comprehensive care for older adults with chronic conditions, implementation of
care delivery system redesign continues to lag as the demographic demands of
our aging population challenge the
capacity of our existing delivery systems to adequately meet the needs of
families with dementia  (Noel et al, 2017).
In utilizing chronic disease models for quality dementia care, providers must
address another layer of complexity. Due to cognitive disability, the client with dementia is unable to reliably
exchange healthcare information and
eventually becomes unable to manage his or her own care (Noel et al., 2017 ).
The majority of persons with dementia are
home-dwelling and eventually rely entirely on a caregiver to accomplish the
most basic activities of daily living. Caregivers must oversee all medical
needs and interact with healthcare
providers in addition to attending to financial issues, transportation, home
maintenance, and other necessary instrumental activities of daily living (Noel
et al., 2017).Daily nursing practice is still oriented toward the
problems and needs of families living with dementia, rather than strengthening
the families’ own resources and abilities(Esand & Canga,2014). With respect
to current strategies,(Esandi & Canga, 2014), noted that support
initiatives for carers have been informed mainly by a stress-burden model,
pharmacological intervention like antipsychotic and hypnotic medications, failing
to capture the dynamic nature of family care. According to (Esandi & Canga,
2014), most family care support programmes and services have been developed
under two main standards: while most of the initiatives direct their attention
to supporting the older people with dementia, other strategies provide support
to the carers. Also, there is no review of
health care delivery methods because the Canadian health care system was
created with a focus on cure rather than health promotion or primary health
care.

Noel
et al,(2017) identified financial
limitation as one of the primary barriers
for growth of support programs as time
dedicated to addressing the needs of caregivers and to assist them in managing the person with dementia’s health needs is
limited. Intervention is required on all
fronts in order to enhance caregiver ability to cope and psychologically
prepared for the burdensome role. Health professionals have applied general
systems theory, introduced in 1936 by von Bertalanffy, to the understanding of
families for a number of years, and there is general
belief that “systems theory and its extrapolation to the family has been
the most influential of all the family frameworks” ( Wright & Leahey,2009).The
Systems concepts provide a theoretical foundation for understanding the family
as a system. A system can be defined as a complex of elements in mutual
interaction( Wright & Leahey,2009). When this definition is applied to
families dealing with dementia it allows the nurse
to view the family as a unit and thus focus on observing the interaction among
family members, and between the family and the illness or problem rather than
studying family members individually. It should be noted that each individual
family member is both a subsystem and a system in his or her own right. An
individual system is both a part and a whole, as is a family( Wright &
Leahey,2009). Chang et al.(2015), argues
that “Caring for someone who is less and less able to direct his or her
care and whose behaviour may be increasingly difficult to understand can create
significant stress for caregivers of a person with dementia hence is necessary
to observe the interactions as a unit rather than individually. It should be
noted that of all age-related chronic progressive diseases, dementia has great
potential to exhaust human and health care resources, given its high
prevalence, a prolonged course of
increasing functional dependency, and lack of effective treatments on the near
horizon(Noel et al.,2017). This is the reason why the nursing approach to dementia care should be reviewed and
implemented.

According
to world Alzheimer (2016), one of the
gaps in health care delivery for this group noted is interventions targeting
the avoidance of hospitalization. One of the biggest risk that sends clients
with Alzheimer to the hospital is falling due to problems with gait, balance
and cognitive deficit. This is a potential health promotion strategy that is in
the domain of nursing. As a nurse, I
would recommend some strategies to address this gap. I would recommend a
community of care specifically for the clients with Alzheimer. A big place in
every city where they could move freely around without restrictions and
monitored by nurses. What is obtainable now is just a little place that can
only accommodate few individuals and waitlist is very long. In Holland, there is a village called the town of
Hogeway where every resident is an Alzheimer client. Though the Canadian
government might claim inability to provide this kind of facility, what I am recommending
is like a big place with an open hall and rooms that could accommodate clients
for few hours so that caregivers could
have a life of their own. It will be a day place and short time stay like a
maximum of one week.

 This community will be overseen by nurses that
will provide education to families on fall preventions and other symptoms to
look out for that necessitates hospitalization. Example during winter the nurse
will provide education on flu vaccine, proper dressing and signs of dehydration in these populations. From my
experience as a PSW in the community, I have always noted that some of my
clients sometimes end up in hospitals during winter because of dehydration.
Having this community of care will also prevent this as the trained nurse’s goal will be to limit hospital
admission as much as possible.

Most
Alzheimer clients and family have limited times spent outside during winter
period. Having this community with a big open space will give some of the
clients who have the wandering tendency a lot of space to move around and the
family time to go out. I have a client family member in the community who told
me that the last time she went out was Thanksgiving
because she can’t leave her mom alone in the house.

To
prevent infections amongst the clients there could be a different hall for
those with cold and a different hall for those without the cold. It is not like isolation in the hospital
or Long-term care homes. The nurses
working at this section will not be scheduled to work the order section of
clients without the cold. This is to
prevent the spread of infection and still
give the clients the needed freedom and space to move around. Clients will be
free to go outside well dressed for the season without being restricted for
fear of missing.

This nursing approach to care can be achieved by making sure patients
and caregivers receive continuous training and resource information specific to
their needs through regular training and
workshops that are made fun to attend. “Through working partnership with
the family, the meaningful conversation
can be maintained and invite individuals/
people to talk about what they know, feel
and think about dementia and the caregiving
role, nurses can explore the meaning, values and beliefs that families attribute
to the experience”(Esand & Canga,2014).

The
nurses working in this community will be
paid just like their counterpart in the hospitals. This makes the job
opportunity more attractive to the best
candidates and continuous training is highly encouraged and rewarded. This
community emphasis on health promotion will greatly improve the health of the
family both emotionally, psychologically and physically and reduce the cost of
hospital expenses.

According
to World Health Organization report (2015), on “Call for global action” against
dementia provides actions for advancing dementia care efforts. Such actions
will facilitate a coordinated health care
delivery and social care for people living with dementia, including capacity
building for the workforce, support for mutual care-taking across generations
at an individual, family and society level, and strengthening of support and
services for caregivers and families. There is a greater need for
caregivers education and training, as this will enhance the caregiver ability
to support the individuals with dementia. (Noel et al.,2017), argues that “there is an explicit focus
on encouraging caregivers to adopt healthy lifestyles that may lessen their own
risk of dementia or health complications and increase their stamina for caregiving over the course of the illness.
Patients and caregivers receive information and facilitated referral(s) from
the nurse care teams for community resources”.  Esand & Canga,(2014) indicates that caring
for families is a role intrinsic to nursing’. This means that nursing has the
responsibility for providing holistic care that relates to family health, and
ensures inclusive and balanced responses to family needs and strengths. Consulting
the family at each stage of the process
and respecting what the family considers to be sustainable ways of living with
dementia will also become priorities in nursing practice. Having this big
community environment will enable nurses to build
therapeutic relationships with families without the interference from
doctors and other healthcare providers. According to (Noel et al.,2017),  including caregivers in the chronic disease
management of an individual with dementia is likely to have multiple benefits
that may reduce hospitalization rates. Potential cost savings include improving
the management of other co-morbid conditions, medication compliance,
nutritional oversight, prompt recognition of changes in health status, advance
care planning, and attention to multiple other safety issues that can prevent
injuries. We
believe that it is the nurse’s responsibility to facilitate change in
collaboration with each family. Facilitating change does not imply that a nurse
can predict the outcome, and a nurse should not be invested in a particular
outcome ( Wright & Leahey,2009). 
Primary care nurses should also focus working towards care as a process
of opportunities for the family, bearing in mind the skills, values and hopes of family members. Minor actions, such as
praising what they are doing well, will be stimulating and meaningful to the
family since strengths are usually overshadowed by difficulties(Esand
&Canga,2014).

 

Conclusion

            Dementia is
a progressive condition, so symptoms become more severe over time. This means
that people with dementia and their care partners have to cope with a reduced
capacity to make decisions about major life events and day-to-day situations,
as well as a range of other issues and changes. Dementia is one
of the major causes of impairment and injuries on the older people globally. The statistics about dementia in Canada and around the
world are quite worrisome and frightening(worrisome). The consequences of
dementia transcend the limits of the
individual and affect everyone who cares for a person(s) with the condition. Most people with dementia received assistance
from family, friends or neighbours for a variety
of tasks. Primary care Nurses, as professionals who work closely with
families, may act as mediators to guide them in the care and decision-making
along the journey of dementia.

Researchers
need to work more closely with
policymakers and healthcare providers to ensure that interventions tested are
realistic and relevant.

 

 

 

 

 

 

 

REFERENCES

 

 

 

 

 

 

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