Discuss about the Behavioral and Psychological Symptoms of Dementia.
The state of dementia is manifested by the pattern of irreversible loss of the memory as well as the cognitive potential of an individual (Scott & Barrett, 2007). This loss of cognitive potential leads to the reduction in the social functionality of the demented people across the community environment. The manifestations of dementia consistently deteriorate the emotional and physical capacity of the affected individuals over the course of time. The findings by (WHO, 2016) indicate the deterioration in the pattern of thinking and behaviour of the demented individuals. The statistical findings indicate the high prevalence of dementia among the elderly people; however, this disease does not develop in response to the normal physiological ageing (WHO, 2016). Dementia is an outcome of various pathological conditions; however, the conditions like Alzheimer’s disease and stroke are the major conditions that lead to the establishment of dementia among the elderly patients (WHO, 2016). The demented people experience the pattern of behavioural changes leading to the states of agitation and aggression in late stage under the stressful circumstances (WHO, 2016). Therefore, the administration of person-centered and holistic healthcare interventions to the demented patients is highly warranted in the context of controlling their behavioural inadequacies and aggression during the late stage of dementia. The effective control of the behaviour of the demented patients assists the healthcare professionals in terms of elevating the quality of self-care methods required for improving their overall quality of life and associated wellness-outcomes.
Healthcare professionals require giving due consideration to the family caregivers of demented individuals while considering the fact that their pattern of depression and other psychosocial complications adversely influences the behavioural outcomes of the demented patients (Brodaty & Donkin, 2009). Their family caregivers considerably facilitate the administration of the person-centered interventions for the demented patients and therefore the stabilization of the state of mental and physical health of these caregivers is highly warranted in the context of improving behavioural complications of the demented patients. The healthcare professionals require attaining thorough insight regarding the onset and establishment of violent behaviour and aggressive attitude among the demented patients in the context of configuring alternative strategies for the effective management of their dementia related behavioural disorientation and aggression (Enmarker, et al., 2011). Healthcare approaches by the NDB (Need-driven Dementia-compromised Behavior) and PLST (Progressively Lowered Stress Threshold) models advocate the requirement of undertaking environmental modification for effectively mitigating the pattern of agitation and aggression among demented individuals (Dettmore, et al., 2009). The pattern of aggression of the demented people emanates because of the unaccomplished psychosocial and physical requirements and absence of appropriate environmental support. This happens because demented individuals fail in effectively communicating their individualized requirements to their caretakers. Therefore, healthcare professionals require configuring effective communication strategies in the context of teaching demented individuals regarding practicing various coping mechanisms for generating the pattern of self-dependence and autonomy for accomplishing their personalized needs (Dettmore, et al., 2009). Furthermore, healthcare professionals need to evaluate the potential environmental triggers that induce the pattern of behavioural changes and aggressive behaviours in the demented people. Accordingly, they can configure person-centered strategies for reducing the intensity of behavioural disorientation among the demented individuals (Dettmore, et al., 2009).
The thorough evaluation of the personal history of depression and anxiety in the demented people is highly required in the context of controlling the pattern of their physical aggression and agitation. The identification of the root cause of depression of the demented patients facilitates the configuration of remedial interventions for reducing the causative factor in the context of reducing the intensity of the violent behaviour of the demented people. The administration of the skilled nursing care interventions is highly warranted for improving the quality of life and mitigating the dangerous behavioural outcomes of the patients affected with dementia and associated clinical manifestations (Wharton & Ford, 2014). The institutionalization of healthcare services and educational enhancement of the demented people is required for improving their mental healthcare outcomes across the community environment (Wharton & Ford, 2014). Healthcare professionals require the systematic administration of emotional and physical care strategies for the physiologically and physiologically unstable demented patients in the context of controlling the intensity of their physical and emotional pain (Liu, et al., 2013). Nurse professionals need to utilize the diagnostic instruments and psychiatric assessment tools with the objective of identifying the likelihood of the demented patients towards development of aggressive symptoms and associated emotional dysregulation (Liu, et al., 2013). The reconfiguration of a safe and non-precipitating environment considerably assists the healthcare professionals in the context of controlling the pattern of aggressive behaviour of the demented patients (Jutkowitz, et al., 2016). The training of the healthcare staff in relation to the enhancement of their skills to facilitate the thorough evaluation of the behavioural complications of the demented patients, required for effectively customizing the healthcare interventions for stabilizing their behavioural disruption and associated agitation (Jutkowitz, et al., 2016).
Person-centered approaches require a systematic evaluation of reversible causes of behavioural disorientation of the demented patients (Salzman, et al., 2008). The identification of the environmental and social stressors of the demented patients required for effectively controlling these stressors in the context of reducing the probability of their behavioural disorientation and aggression across the community environment. The healthcare professionals, psychologists and nurses need to organize training sessions for the demented patients and their caretakers with the objective of reducing their psychosocial burden and associated behavioural complications (Salzman, et al., 2008). Healthcare professionals require proactively evaluating the prospective healthcare requirements of the demented patients upon their admission to the healthcare facility. They also need to understand the preferences and habits of the treated patients in the context of configuring the remedial strategies for effectively treating their behavioural disruption and aggressive attitude (Salzman, et al., 2008). Healthcare professionals also need to identify, evaluate and understand the familial context of the aggressive symptoms experienced by the demented patients across the community environment (Merrilees, et al., 2010). They also need to track and identify the co-morbid conditions like ALS (Amyotrophic lateral sclerosis) and their potential impact on the behaviour of the demented patients while configuring the remedial interventions for effectively minimizing their behavioural disruption (Merrilees, et al., 2010). The systematic evaluation of the symptoms attributing to the executive deficits, apathy, irritability, impulsivity, poor judgement, emotional changes, social inhibition and hyperorality of the demented patients required in the context of configuring behavioural strategies for reducing the pattern of aggression, compulsivity and rigidity among the demented patients (Merrilees, et al., 2010). The effective enhancement of the executive mental functionality of the demented patients by healthcare professionals required for effectively improving their problem solving skills, behavioural inhibition, attention deficits and psychosocial deficits across the community environment. Eventually, demented patients will exhibit an improvement in the pattern of their cognition, agitation, aggression and other behavioural manifestations.
The healthcare professionals require understanding the pattern of the neuropathological changes experienced by the patients affected with dementia and Alzheimer’s disease (Achterberg, et al., 2013). The type and intensity of pain in various types of dementia states require evaluation in the context of correlating the pattern of pain with the intensity and type of behavioural manifestations experienced by the demented patients. Healthcare professionals require training the demented patients in the context of enhancing their self-management skills in relation to effectively controlling their behavioural manifestations (Achterberg, et al., 2013). Behavioural approaches administered by the healthcare professionals facilitate the self-reporting of behavioural symptoms by the dementia patients. The pattern of self-reporting of aggressive behaviour by the demented patients assists healthcare teams in effectively identifying the onset of behavioural disruption during its initial stage (Achterberg, et al., 2013). This reportedly facilitates the improvement in the cognitive decline of dementia patients that reciprocally reduces the intensity of their behavioural symptoms, including the pattern of aggression and agitation. Healthcare professionals require carefully observing the behavioural expression, vocalization and body movements of the demented patients for evaluating the level of emotional and physical discomfort faced by them across the community environment (Achterberg, et al., 2013). Accordingly, they need to configure the behavioural strategies for decreasing the psychosocial discomfort of the treated patients in the context of minimizing the level of their aggression and agitation. The healthcare professionals require evaluating the thought content, motor function and perception of the demented patients in the context of tracking their emotional disturbances and associated outcomes. The evaluation of the lack of patient’s ability to effectively express the feelings of hopelessness, unhappiness and sadness is highly required by the healthcare professionals in the context of relating these symptoms with the pattern of the patient’s disrupted behaviour. The investigation of the state of patient’s panic episodes, anhedonia, somatic concerns and motor outcomes of tension required by the healthcare professionals for effectively configuring the goal-oriented strategies with the objective of enhancing the emotional stability and cognitive functionality of the demented patient (Cerejeira, et al., 2012). This resultantly decreases the intensity of behavioural disruption, aggression and agitation episodes of the demented patients.
The healthcare facilitators require administering regular interview sessions to the demented patients with the objective to facilitate the face-to-face interactions with them in relation to evaluating the pattern of their disinhibition, euphoria, irritability, abnormal eating behaviour and eating abnormalities (Cerejeira, et al., 2012). These manifestations considerably facilitate the agitation episodes in the demented patients and accordingly the healthcare professionals need to undertake the behavioural interventions for controlling the pattern of behavioural inconsistencies and associated aggressive episodes of the treated patients. Healthcare professionals also require administering training sessions to the demented patients with the objective of promoting the execution of physical exercise on a regular basis for effectively enhancing the pattern of their neurogenesis, neuroprotection and brain neurplasticity (Christofoletti, et al., 2011). This resultantly, improves the behavioural manifestations and symptoms related to aggression and agitation experienced by the demented patients. The healthcare professionals also require evaluating the sleep quality of the demented patients and accordingly organize counselling sessions for increasing the level of awareness of demented patients in relation to improving the pattern of their sleep for the betterment of their behavioural outcomes (Christofoletti, et al., 2011). Evidence-based research literature advocates the requirement of administering CBT intervention for effectively controlling the pattern of aggression, day/night disturbance, agitation, motor restlessness and anxiety of the demented patients (Spector, et al., 2015). Indeed, CBT intervention reduces the intensity of catastrophic thinking and negative automatic thoughts of the demented patients that considerably reduce their behavioural disruptions and associated manifestations attributing to aggression and agitation (Spector, et al., 2015). The findings of various observational studies reveal the requirement of configuring a therapeutic relationship with the demented patients, with the objective of extending personal care interventions for improving the behavioural outcomes (Dolley, et al., 2015). Furthermore, the pattern of therapeutic communication of healthcare professionals with the demented patients improves their compliance, trust and confidence on the recommended treatment interventions warranted for reducing the episodes of their aggression and violence (Dolley, et al., 2015). These findings advocate the requirement of optimizing the healthcare approaches in accordance with the personalized requirements of the demented patients in the context of stabilizing their mood and behaviour.
Conclusion
Healthcare practitioners require undertaking systematic behavioural interventions in the context of improving behavioural complications and the resultant pattern of aggression and agitation experienced by the demented patients. The enhancement of the quality of life of the demented patients is highly required for reducing the intensity of their psychosocial manifestations across the community environment. The holistic and person-centered interventions must focus on the configuration of the therapeutic relationship with the demented patients in the context of improving the pattern of their self-dependence and personhood. The effective enhancement of the sense of self among the demented patients reduces the probability of the appearance of their aggressive episodes and irritability. Healthcare professionals must focus on the effective enhancement of the social connectedness of the demented people for reducing the intensity of their psychosocial manifestations that prove to be the potential transducers of their aggression and agitation episodes.
References
Achterberg, W. P. et al., 2013. Pain management in patients with dementia. Clinical Interventions in Aging, pp. 1471-1482.
Brodaty, H. & Donkin, M., 2009. Family caregivers of people with dementia. Dialogues in Clinical Neuroscience, 11(2), pp. 217-228.
Cerejeira, J., Lagarto, L. & Mukaetova-Ladinska, E. B., 2012. Behavioral and Psychological Symptoms of Dementia. Frontiers in Neurology, 3(73).
Cerejeira, J., Lagarto, L. & Mukaetova-Ladinska, E. B., 2012. Behavioral and Psychological Symptoms of Dementia. Frontiers in Neurology.
Christofoletti, G. et al., 2011. Physical activity attenuates neuropsychiatric disturbances and caregiver burden in patients with dementia. Clinics, 66(4), pp. 613-618.
Dettmore, D., Kolanowski, A. & Boustani, M., 2009. Aggression in Persons with Dementia: Use of Nursing Theory to Guide Clinical Practice. Geriatric Nursing, 30(1), pp. 8-17.
Dolley, J., Bailey, C. & McCabe, R., 2015. Communication in healthcare interactions in dementia: a systematic review of observational studies. International Psychogeriatrics, 27(8), pp. 1277-1300.
Enmarker, I., Olsen, R. & Hellzen, O., 2011. Management of person with dementia with aggressive and violent behaviour: a systematic literature review. International Journal of Older People Nursing, 6(2), pp. 153-162.
Jutkowitz, E. et al., 2016. Care-Delivery Interventions to Manage Agitation and Aggression in Dementia Nursing Home and Assisted Living Residents: A Systematic Review and Meta-analysis. Journal of the American Geriatric Society, 64(3), pp. 477-488.
Liu, J., Lewis, G. & Evans, L., 2013. Understanding Aggressive Behavior Across the Life Span. Understanding Aggressive Behavior Across the Life Span, 20(2), pp. 156-168.
Merrilees, J. et al., 2010. Cognitive and Behavioral Challenges in Caring for Patients with Frontotemporal dementia and Amyotrophic Lateral Sclerosis. Amyotrophic Lateral Sclerosis, 11(3), pp. 298-302.
Salzman, C. et al., 2008. Elderly Patients with Dementia-Related Symptoms of Severe Agitation and Aggression: Consensus Statement on Treatment Options, Clinical Trials Methodology, and Policy. The Journal of Clinical Psychiatry Impact & Description, 69(6), pp. 889-898.
Scott, K. & Barrett, A. M., 2007. Dementia syndromes: evaluation and treatment. Expert Rev Neurother, 7(4), pp. 407-422.
Spector, A. et al., 2015. Cognitive-behavioural therapy for anxiety in dementia: pilot randomised controlled trial. The British Journal of Psychiatry, 206(6), pp. 509-516.
Wharton, T. & Ford, B. K., 2014. What is Known About Dementia Care Recipient Violence & Aggression Against Caregivers?. Journal of Gerontological Social Work, 57(5), pp. 460-477.
WHO, 2016. Dementia. [Online] Available at: https://www.who.int/mediacentre/factsheets/fs362/en/ [Accessed 27 11 2016].
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