The biophysical changes caused by people suffering from dementia are increased deterioration of mental and physical health. Gradually the body shuts down and they lose their capability to identify speech and nonverbal communication with the help of sense of smelling, touching, seeing and listening.
The biophysical changes occurring in the body are a loss of mobility and their incapability to sit along with the loss of memory and the ability to communicate through words. There is also a difficulty to swallow liquids and foods thereby leading to weight loss. There is a poor circulation of blood and as a result with the impairment of functions of bladder and bowel.
As per Cerejeira, Lagarto and Ladinska (2012) the psychological processes relating to the case are repetitions in the behavior, depression, agitation, social inappropriateness, wandering, disturbance in the sleep, physical aggression and delusions and hallucinations.
The assessment tool that is applicable to this case is Alzheimer’s Disease Assessment Scale-Cognitive Subscale test that is used to evaluate the cognition in the clinical trials for new drugs and research studies and other related interventions.
It measures the language and memory of the patient and comprises of 11 parts. It takes almost 30 minutes to assess the patient. It contains 11 elements namely word recalling task in which the person has been given 3 chances to recall the words as shown in the list of 10 words. It is used to test short-term memory.
The other items include naming figures and objects and following of commands in which the patient is asked to follow certain commands such as to place a pencil ta the top of the card etc (Kueper, Speechley and Odasso, 2018).
The priorities of care for the person suffering from dementia can be person centered care . Firstly, it is the responsibility of the person who care for the patient to set a positive mood of interaction. The person should be addressed in a respectful and pleasant manner.
Secondly, the facial expressions physical touch and tone of voice of the care giver should be in such a way that helps to convey the message and the feelings of affection. The personalized care should be given to the patient. Simple words and sentences to convey the message should be used.
Thirdly , Simple and answerable questions should be asked . One question at a time should be asked with an answer of yes or no. The visual prompts and cues will help to clarify the query and shall guide the patient to the response.
Discuss any equity, rights and access issues relevant to the case.
The aspects of equity, rights and access issues can pertain to the patient centred and personally tailored approaches relevant to the patient. It comprises of providing support that takes into account of the necessities arising from culture and faith like acre pertaining to diet and beauty of hair and skin.
Despite of the barriers in language, it is mandatory for the staff to communicate with the family members of the patient specially the spouse, Margaret in this case, throughout the process of care. She and the other family members should be informed about the decisions related to the discharge of the patient from residential treatment centre, medication etc.
Lastly, the patients and their carers should be offered better access to the services (Scoot, Shannon and Davies,2017) .
As per Samuelson, Crawford and Alexander (2016) some of the biophyocal changes seen in Dulcie were difficulty in managing the tasks of routine life and repetitive behaviour .She has started forgetting the events of the family and sometimes forgets at what place she is .
She has even forgotten the names of the members of the family. She has forgotten how to chew and swallow which has caused loss of appetite and memory. It has led to failure in taking the right decisions regarding the intake of right kind of food, getting the right nutrition and eating habits.
The psychosocial processes associated with the case are short term loss of memory , difficulty in finding of words ,handling of complicated things of everyday things , apathy and irritation , loss of speech and inability to walk( Mushtaq et al.,2014). It is also associated with malnutrition with weight loss along with disruption of behaviours related to eating and feeding.
The assessment tool that is appropriate in the given case is Malnutrition Universal Screening Tool (MUST). A five step-screening tool is recognized nationally in order to identify malnutrition in old aged people suffering with dementia. It can be executed online by utilizing the on line MUST calculator.
As per Chaoa et al.,(2015) the purpose of MUST is to evaluate the patients who are at the risk of malnutrition on the basis of the association with the impaired nutritional status , the composition of the body and the physical function.
The three elements of the system comprise of evaluating the present status of weight using BMI, unplanned loss of weight and acute effect of disease that has induced a phase of nil per OS for less than a period of 5 days.
Discuss 3 priorities of care for this person.
Firstly, the dietitians must comprehend the nutritional status and the need of the patients. They must help them to achieve their dietary goals. In the given case, Dulcie would require the advice related to weight gain as she has started eating less and is reluctant to share her feelings of grief, loneliness and pain with her friends and family.
Secondly, she would require the support of the dietician and family members regarding her access to food, its preparation and storage along with eating the food. As she is fond of perapring lavish meals for her family, she must be allowed to cook food for her family that will also help in importing her own eating habits.
Thirdly, she would require expert advice regarding her poor intake of food and symptoms that affect her nutritional status like loss of appetite change of taste and difficulty in chewing or swallowing food.
The equity, rights and access issues relating to the nutritional requirements pertain to the requirements of increasing the fluid intake. The person should be given access to drinking water. The nursing home residents should prompt the patient to drink their preferred beverage repetitively.
It would help them to rehydrate themselves which is an important part of the care .The patients have the right to eat nutritious food rich in B12, vitamin A, D and C and magnesium . Their diet should target on serving food with high fibre, whole grains, low fat food and leafy green vegetables (Kolset et al., 2018) .
As per Robson(2016)the biophysical changes leading to fall and immobility in old age people like Betty can be visual or hearing impairment , chronic disease, confusion or cognitive impairment and inconsistency of urine.
The other factors include reduced strength of the lower limb, imbalanced impairment. Most of the old age people fall due to the decrease in the sensitivity of the postural control systems.
The psychological processes pertain to intrinsic and extrinsic factors. The intrinsic factors comprise of old age , hypertension , living alone , fear of falling, lack of confidence , polypharmacy i.e .the patient is given more than five mediations and the intake of antidepressants and the previous fall history.
The extrinsic factors pertain to type of floor surfaces, height of the bed and unacquainted atmosphere and poor lighting (Kourkouta, Iliadis and Monios ,2015).
Identify an assessment tool appropriate for use in this case and discuss key elements of the tool.
The Fall Risk Assessment Tool (FRAT) would be appropriate to assess the screening of falls of Betty. It is divided into three sections viz. fall risk status, risk factor checklist and action plan. It is a risk-based tool used for evaluation of the risk of fall of old aged people of 65 years or above.
It also includes elements of other validated sensorimotor analysis of predicting falls amongst the older people like the Short Physical Performance Battery (SPPB), the Choice Arm, Steeping Reaction Time and Iconographical Falls Efficacy Scale.
It also uses a questionnaire to trace the history, medication of the patient, vision, fear of falling and peripheral sensation (WHO, 2015).
Firstly, Betty should be properly screened and analyzed for the risk of fall during the admission phase. Her reassessment should also be executed if the conditions of her health changes during six months.
A multifunctional approach to manage the fall of risk is also crucial at this stage. If the issues relating to mobility are evaluated, then the walking aids should be used for her.
Secondly, Betty may be benefitted by use of hip protectors so that the risk of hip fractures can be reduced. Furthermore, the use of electrical alarm systems can be effective for the management of the risk of falls in people suffering from cognitive impairment (Sherrington and Tiedemann, 2015).
Thirdly, the inconsistent issues should be evaluated and strategies must be implemented for their management that shall include protocols relating to toilet. It should also be ensured that the physical environment is safer for Betty and her personal belongings are easy to reach.
Discuss any equity, rights and access issues relevant to the case.
The issues pertaining to access, equity and rights are related to determinants of culture and gender. In some of the cultures, social participation of old age people is considered not virtual. They are meant to be at rest.
They should have the right to participate in the social and cultural activities that can enhance their confidence thereby decreasing the risk of fall. In addition, there are biological differences such as reduction in the muscle mass in women is more than men.
Therefore, the old aged women should have the right and access to nutritious diet along with men. It can reduce their risk of falling. Lastly, the health seeking habits also play an important role in reducing the risk of fall (Pin and Spini , 2016) .
It has been observed that men do not seek medical care unless their condition becomes severe. They should have the appropriate access to the health care policies and fall prevention strategies’ to reduce their risk of fall.
Reference List
Cerejeira, J., Lagarto , L. and Ladinska, E.B.M.(2012) Behavioral and psychological symptoms of dementia. Frontiers in Neurology .3(73), pp. 1-21.
Chaoa , P.C., Chuang, H.J., Tsao , L.Y., Chen , P.Y., Hsub , C.F., Lin , H.C., Chang , C.Y. and Lin , C.F. (2015)The Malnutrition Universal Screening Tool (MUST) and a nutrition education program for high risk cancer patients: strategies to improve dietary intake in cancer patients. BioMedicine. 5(3),pp. 30-3.
Kolset, S.O., Nordstrøm, M., Hope, S., Retterstøl, K. and Iversen, P.O.(2018) Securing rights and nutritional health for persons with intellectual disabilities – a pressing challenge. Food & Nutrition Research. 62(1268),pp.1-4.
Kourkouta, L., Iliadis, Ch. and Monios, A.(2015) Psychosocial issues in elderly. Progress in Health Sciences.5(1), pp. 232-237.
Kueper, J.K., Speechley, M. and Odasso, M.M.(2018) The Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog): Modifications and Responsiveness in Pre-Dementia Populations. A Narrative Review. Journal of Alzheimer’s Disease. 63 (2018), pp. 423–444.
Mushtaq , R., Shoib , S., Shah, T. and Mushtaq, S.(2014) Relationship Between Loneliness, Psychiatric Disorders and Physical Health ? A Review on the Psychological Aspects of Loneliness. Journal of Clinical and Diagnostic Research. 8(9), pp. 1-4.
Pin , S. and Spini , D.(2016) Impact of falling on social participation and social support trajectories in a middle-aged and elderly European sample. SSM -Population Health,2(2016),pp. 382–389.
Robson, K.(2016) Mobility and Falls Prevention. Australia: Oxford University Press ANZ. pp. 389.
Samuelson, M., Crawford , R. and Alexander, A.(2016) Optimal Nutrition and Hydration. Australia: Oxford University Press ANZ .pp. 370.
Scoot, B., Shannon, K. and Davies, C.(2017) Dementia. Australia: Oxford University Press ANZ .pp. 325-326 .
Sherrington, C. and Tiedemann, A.(2015) Physiotherapy in the prevention of falls in older people. Journal of Physiotherapy . 61 (2015),pp. 54–60
WHO(2015) World report on Ageing and Health [online] Available from: https://apps.who.int/iris/bitstream/handle/10665/186463/9789240694811_eng.pdf;jsessionid=B2012951F8939F40A5DAEE3821155F35?sequence=1 [Accessed 7th October 2018].
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