Rob Cameron’s health has deteriorated as result of biophysical and psychosocial processes. Rob is 81 years old and is married to Margaret who is 65years and both live in a coastal town in New Zealand. Rob has become forgetful and even got distracted when driving that caused damage to their car and some laceration on the forehead. Rob has a medical history of hypertension and was prescribed to take oral hypertensive by a GP. However, Rob does not take his medication regularly and believes that he should do so only when he feels unwell and uses garlic and cider vinegar to control his blood pressure. Rob loves to do tasks by himself and spends most time building and making everything on his own. Margaret is supportive and advises Rob to take his medication regularly and also engage is social stimulation activities. Rob and Margaret live under Universal superannuation pension of $576.20 per week. Rob has believes that antihypertensive drugs can cause impotent that undermine his acceptance of adherence to GP prescription.
The current health condition of Rob is as a result of biophysical and psychosocial processes. His failure to regularly talk antihypertensive medication has led to his forgetfulness. According to Lin et al. (2013), hypertension causes progressive damage to organs and is the leading cause of dementia and Alzheimer’s disease. Rob’s beliefs also affected his consistency to taking prescribed medication by GP. Tsai and Pai (2016) stated that a person’s beliefs, values and culture influence their treatment acceptable and health professional should consider then when providing health care.
Rob needs cognitive function assessment to establish if his memory has been affected. The most approapriate tool to use to assess Rob’s cognitive function is Montreal Cognitive Assessment (MoCA). The MoCA design allows rapid screening for mild cognitive dysfunction. The MoCA takes a wide scope of cognitive domains that include executive functions, language, memory, attention and concentration, conceptual thinking, orientation, calculations and visuo-constructional skill (Gorelick et al., 2011). This methodology is more appropriate to diagnosing Rob cognitive impairment. Therefore the GP can adopt the MoCA tool and assess Rob’s cognitive function and establish his cognitive state.
According to Rob’s scenario, there are 3 main priorities of care to manage his health condition. Rob is experiencing forgetfulness, distractions, and hypertension. Rob has cognitive impairment that makes him forget easily that lead to frustrations. Secondly, Rob gets distraction when undertaking activities that puts him and the surrounding to risk. The other care priority is hypertension treatment. Rob suffers hypertension and does not regularly take his medication that impairs his cognitive function. These care priorities will enable Rob to remember things, concentrate or improve attention and maintain his blood pressure hence managing the cognitive impairment.
People suffering from Cognitive Impairment fall under Alzheimer’s disease or Dementia and there are policy to promote access and equity. One is entitled to appropriate and highest attainable health services standards of care. People with cognitive impairment have difficult in communication and making decisions and therefore there are set out rights to facilitate their health care or other activities. One of the relevant right issue in Rob’s scenario is appointing someone to make health care and personal decision on his behalf. Rob can appoint an enduring guardian who will then make decisions on his behalf about medical treatments, consenting, home care, changing doctors, going to residential aged care, and other health decisions. This right is important for facilitating a person health care even when they lose their mental capacity.
Dulcie’s changes in biophysical and psychosocial processes led her health condition to dementia. John died quickly that grieved her and felt her alone in the house. She then stopped cooking as she was used to and even started eating what she thought before was unhealthy. Dulcie refused to share meal with her neighbours and spent much of her time inside the house. Lack of companion in her house contributed to her appetite loss. McGuinness et al. (2016) associated poor nutrition status to development of dementia and adequate nutrition can reduce major risks that lead to it development. According to Kim et al (2011), prolonged grief triggers development of dementia. Dulcie was much grieved by John’s death that made her spend more time inside the house. Physical inactive lifestyle increases a person’s risk of developing dementia. Therefore, Dulcie change in diet, physical activities, grief, and isolation led to development of dementia.
Dulcie has early stage dementia and needs assessment to establish if cognitive impaired. The most appropriate tool to use to assess Dulcie cognitive impairment is Mini-Mental State Examination (MMSE) (Kamaruzaman, and Riaz, 2013). The MMSE takes 10-15 minutes and has 30 Scores. A score below 24 will indicate that Rob has cognitive impairment. According to Artioli et al, (2017), MMSE provides a practical methodology that can grade cognitive state of a person. Therefore the MMSE tool will be effective for assessing Dulcie cognitive function and establish his cognitive state.
Dulcie’s health condition can be prioritized to meet her health need. These care priorities are good nutrition, physical activities, and dementia treatment. Dulcie need to get a balance diet that will reduce her risk of Dementia development. She will need to get back her appetite and have nutritious meal to will help her body stabilize. Secondly, Dulcie will need to engage in physical activities to reduce time spent inside and make the body active. Thirdly, Dulcie need to start dementia treatment that can either be administering therapies or medication. Treatment will improve her cognitive functions.
The Dulcie scenario has rights and access issue. Dulcie condition makes her lose capacity to make decisions about her health or personal issues. She needs to appoint someone who will be making decisions on her behalf. Dulcie has a right to appoint anyone that she wants to make decisions and in case she can be able to do so, her daughter are the ones responsible and should be the ones to make her decisions.
Betty health biophysical and psychosocial processes have caused her falls. Betty is 72 years of age and has experienced multiple falls in the past 12 months. The fall has resulted to bad right shoulder injury and she isn’t able to do her household duties. Betty has new blood pressure medications that make her feel dizzy and unbalance. Blood pressure medicines have side effects of causing falls (Gillespie et al., 2012). Betty also has arthritis that is associated with old age and can cause falls. Arthritis decreases a patient bone density increasing risk of falling. Arthritis cause stiffness and pain around and in one or many joints that lead to a person’s inability to walk or stand upright hence falling. Therefore arthritis causes joints to just give way to falling. Betty’s old age is also a contributor to her falls. According to Johnson, Ling, and McBee, (2015), natural ageing process increases risk for one falling. Ageing impairs the body making the muscles weak and vision poor. Therefore, Betty’s fall is as a result of arthritis, blood pressure medication, and ageing.
The most appropriate tool to assess Betty’s falling condition is Falls Risk Assessment Tool (FRAT). The FRAT that three parts namely; falls risk status, risk factor checklist and action plan. The first part screens a patient fall risk, the second part assesses the environment while the third part recommends on appropriate actions to reduce risk for falling (Entringer, Buss, and Wadhwa, 2012). The first part details recent falls, medications, psychological and cognitive status. The second part details all factors that can possibility affect the patient and include vision, behaviors, nutrition, continence, mobility etc. The last part matches the patient problems (need) to a solution or service to handle the need. FRAT is therefore appropriate because it detailed and outlines actions to solve a patient problem.
There are three main priorities care for Betty’s condition. They include reducing fall risk, arthritis management, and use of blood pressure medication. Betty needs to start arthritis treatment to reduce it affects on Betty’s joint. The blood pressure medications have side effects that cause falls. Betty can be advised how to take them and what to do or not do to avoid the blood pressure medicines side effects. Lastly, the risk of falling can be reduced by providing Betty with walking aids such as walkers, walking cane, rollators etc. These care priorities will reduce falling risk hence improving her quality of life.
Betty’s falling condition raises issues of access to health care. Patients who have falling conditions have limited mobility and are not able to access a health care centre. A person with falling condition therefore needs to be supported to see a health practitioner. According to Karlsson et al. (2013), patient with falling condition develop low self esteem and avoid public places. All Australian have equal right to access to quality health care and people with falling condition deserve to be facilitated to accessed health care. Falls therefore undermines a person’s rights to access to health care that can lead to poor health outcomes.
Reference List
Artioli, G., Foà, C., Cosentino, C. and Taffurelli, C., 2017. Integrated narrative nursing: a new perspective for an advanced assessment. Acta Bio Medica Atenei Parmensis, 88(1-S), pp.7-17. DOI https://doi.org/10.23750/abm.v88i1%20-S.6279
Entringer, S., Buss, C. and Wadhwa, P.D., 2012. Prenatal stress, telomere biology, and fetal programming of health and disease risk. Sci. Signal., 5(248), pp.pt12-pt12. DOI: 10.1126/scisignal.2003580.
Gillespie, L.D., Robertson, M.C., Gillespie, W.J., Sherrington, C., Gates, S., Clemson, L.M. and Lamb, S.E., 2012. Interventions for preventing falls in older people living in the community. Cochrane database of systematic reviews, (9). DOI: 10.1002/14651858.CD007146
Gorelick, P.B., Scuteri, A., Black, S.E., DeCarli, C., Greenberg, S.M., Iadecola, C., Launer, L.J., Laurent, S., Lopez, O.L., Nyenhuis, D. and 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), pp.2672-2713. DOI: 10.1161/STR.0b013e3182299496
Johnson, H.L., Ling, C.G. and McBee, E.C., 2015. Multi-disciplinary care for the elderly in disasters: an integrative review. Prehospital and disaster medicine, 30(1), pp.72-79. https://doi.org/10.1017/S1049023X14001241
Kamaruzaman, M.F. and Riaz, R.P.M., 2013, April. Conceptual framework study on dynamic visual reminiscent therapy in Alzheimer psychosocial treatment. In Business Engineering and Industrial Applications Colloquium (BEIAC), 2013 IEEE(pp. 189-191). IEEE. DOI: 10.1109/BEIAC.2013.6560111
Karlsson, M.K., Magnusson, H., von Schewelov, T. and Rosengren, B.E., 2013. Prevention of falls in the elderly—a review. Osteoporosis International, 24(3), pp.747-762. DOI: 10.1007/s00198-012-2256-7
Kim, N.H., El Hoyek, G. and Chau, D., 2011. Long-term care of the aging population with intellectual and developmental disabilities. Clinics in geriatric medicine, 27(2), pp.291-300. DOI: https://doi.org/10.1016/j.cger.2011.02.003
Lin, J.S., O’Connor, E., Rossom, R.C., Perdue, L.A. and Eckstrom, E., 2013. Screening for cognitive impairment in older adults: a systematic review for the US Preventive Services Task Force. Annals of internal medicine, 159(9), pp.601-612. DOI: 10.7326/0003-4819-159-9-201311050-00730
McGuinness, B., Craig, D., Bullock, R. and Passmore, P., 2016. Statins for the prevention of dementia. The Cochrane Library. DOI: 10.1002/14651858.CD003160
Tsai, Y.C. and Pai, H.C., 2016. Burden and Cognitive Appraisal of Stroke Survivors’ Informal Caregivers: An Assessment of Depression Model With Mediating and Moderating Effects. Archives of psychiatric nursing, 30(2), pp.237-243. DOI: 10.1161/STROKEAHA.116.015234
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