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3Ds - Dementia, Delirium, and Depression

Introduction to Dementia, Delirium, and Depression

As per the World Health Organization (2019), around 50 million people in the world suffer from dementia every year. This disorder affects mostly aged people who are above 60 or 65 years of age. It is one of the major causes of dependency among older adults, and the most common form of dementia is Alzheimer's. Another abnormal condition that primarily affects older people is delirium, an acute disorder related to attention. According to Oh et al. (2017), delirium is one of the serious and fatal medical condition that is observed in older people. Depression is also one of the most common neurological disorders that affect 7 percent of the older population (World Health Organization, 2017). Older people require more care than the other age group because of all these neurological and psychological disorders. As per the given case study, Mr. David Geoffries is 88-year-old suffering from dementia, delirium, and depression. The aim of this paper is to assess and evaluate the given case study and to provide a suitable plan for managing Mr. Geoffries' medical conditions. This paper provides information about dementia, depression, and delirium, and their association with old age. It also discusses person-centered dementia care and its importance in improving the medical conditions of the patient.

Assessment of Patient's Medical Conditions

Dementia is a medical condition that affects the mental health, cognitive health, and physical health of the person. The patients of dementia lose their cognitive functions such as thinking and remembering. The patient in the given case study has also been diagnosed with dementia. Some of the common assessment techniques for dementia include neurological tests, physical tests, brain scans, and neurophysiological tests (National Institute on Ageing, 2017). The health professionals use the patient's family medical history to diagnose whether the patient is at high risk of dementia or not. The physical examination of the patient's blood pressure and other vital signs can be used to assess the level of dementia in the patient. Neurological tests also help in assessing the medical conditions of patients; for example, assessment of balance and other cognitive functions can be used as assessment tools. Brain scans such as computed tomography (CT) can be used to detect the presence of tumors in the brain and other brain damages that can cause dementia. The patients of dementia are aggressive and do not remember most of the things. The assessment of their daily activities is also helpful in the diagnosis of dementia. The patient is also having atrial fibrillation, Type 2 diabetes, and had an attack of Cerebrovascular accident (CVA) or stroke twenty years ago. All these are severe medical conditions that need support and patient-centered care. These can have a negative impact on patient's mental conditions and can lead to depression.

Depression is one of the most common neurological disorders in people above the age of 60 years. As per the American Speech-Language-Hearing Association (2018), depression is very common in most dementia patients. Late-life depression that occurs after the age of 60 years is generally related to cognitive impairment that causes dementia syndrome (Leyhe et al. 2017). Depression increases the risk of dementia as well as other neurological disorders in the patients. As per Blackburn (2017), late-life depression in older adults can be diagnosed with DSM-5 criteria, Geriatric Depression Scale (GDS), and Cornell Scale for Depression in Dementia (CSDD). According to PSYCOM (2019), under DSM-5 criteria, patients' depressed mood and loss of interest are measured. GDS includes an 11 pointer scale to diagnose depression in older people while CSDD is based upon the interviews conducted with patients, patient's family members, and healthcare professionals to analyze the mental state of the patient.

The patient in the given case study is having cognitive impairments such as deafness, inability to speak properly, poor communication skills, poor memory. The patient requires continuous care and support to complete daily activities such as bathing, sitting, and walking. All these are symptoms of delirium, a serious mental illness that causes confused thinking and reduces a person's ability of problem-solving and decision making. (Mayo Clinic, 2018). Assessment of delirium is important for its management, and some of the common assessment tools of this disorder are the Confusion Assessment Method (CAM), which is used to evaluate the onset of delirium, inattention in patients, disorganized thinking, and conciseness level in the patients. Delirium Triage Screen (DTS) is also used nowadays for assessing delirium in older people (Rosen et al., 2016).

Patient's Caring Plan

Patient-centered care plans are important during the treatment of adults as well as older people. The aim of these plans is to improve patient care and to increase patient outcomes in the future. The patient's caring plan should have the objective of improving the patient's medical conditions. Most dementia patients are unable to plan their day as they poor memory and attention power. The patient care plan must be based upon the patient's interests, likes, and dislikes. Some of the daily activities that must be included in the care plan of older people suffering from dementia are mealtimes, household chores, physical activities, spiritual activities, and personal care. It is the role of the family members and registered nurses to provide patient-centered care to dementia patients. The patient must be provided with all the medications such as insulin, digoxin, aspirin, and metformin. All these medications must be provided to the patient on a regular basis and in desire doses. The patients of dementia who are admitted to home care require more support and care because they live away from their homes. This is the reason that the registered nurses and other healthcare professionals working in aged care homes should be more concerned about dementia patients. The patient is also suffering from Type 2 diabetes and glaucoma; had a stroke attack around 20 years back. This reflects that the patient care plan must also include care related to these disorders to improve the patient's overall mental and physical conditions.

The patient is also having depression and delirium, which are neurological disorders affecting mental well-being. The patient care plan must include supportive care for these neurological disorders; for example, the care plan should focus on providing a nutritious plan to the patient, must address incontinence, and should aim at reducing the symptoms of both these disorders. Regular visits of family members must be included in the patient care plan as it provides emotional support to the patients and improves their treatment outcomes. In this case study, the patient's wife and grandson must try to give some quality time to the patient that will help the patient in remembering family members and will also improve their communication skills. Another aim of this care plan must be to manage dementia, depression, and delirium in the patient through different intervention techniques. The registered nurses should build a nursing plan in such a way that they can improve patient's interaction and behavior. The dementia patients are unable to build a strong interaction with the people due to which there recover rate is low. This can be overcome if the patients take active participation in the interactive sessions. Healthcare professionals should encourage dementia patients and motivate them to improve their interaction with other people. Thus, a well-organized patient care plan is very important while treating the patients of dementia and other neurological disorders such as delirium and depression. 

Management of Patient's Health Conditions

Managing dementia is important to improve the mental as well as physical conditions of the patients. The patient is suffering from various fatal disorders such as delirium, depression, diabetes, and many more. Management of all these disorders is crucial to improve the overall well-being of the patients and to enhance patient care. Dementia is considered as one of the major causes of delirium in older people (Grover & Avasthi, 2018). The management of both these diseases are generally similar and aim at managing the cognitive impairments in the patients. Dementia, depression, as well as delirium, are incurable diseases that affect the lives of people for a longer period o time. This is the reason that aim of managing these medical conditions is to control them and cure them. The management plans for controlling these mental disorders aim at improving the quality of life (Cheng et al. 2019).

Dementia can be managed by taking various steps such as the use of interventions of cognitive impairment, provide caregiving support to the patients, promoting independence and mobility in dementia patients, and any more (Grover & Avasthi, 2018). The behavior of patients suffering from mental disorders, especially dementia, is unpredictable, and most of these patients become aggressive with the course of time. This is the reason that strict intervention methods are adopted to control their behavior and to protect the patient's from severe injuries such as falls. Psychological interventions such as psychoeducation and counseling can help in the management of dementia. Moreover, the patients of dementia can be provided with multicomponent interventions such as skills training, problem-solving, and other can enhance treatment outcomes.

As per Shaji, Sivakumar, Rao, & Paul (2018), the management of delirium is also important as it is regarded as a psychiatric emergency. It's management needs identification of the cause and proper treatment of all the symptoms. The symptoms of delirium can be managed by adopting both pharmacological and non-pharmacological methods such as reorientation, supportive measures, and many more. The prevention of secondary health complications of dementia, such as falls and bedsores, is also important for managing delirium. Depression can also be managed by using the techniques of psychoeducation and psychotherapy. The process of psychotherapy is recommended for all the patients of depression; antidepressant medications are also vital for managing this mental illness. The patient in the given case study is suffering from urinary tract infection also, which has made him aggressive and depressed. The management of depression is possible by using antidepressants and proper care. The positive and safe environment built around patients can help in reducing aggressiveness and depression; this is the reason that the healthcare professionals working at the aged care have started admonishing Mr. Geoffries. The patient's care should be planned in such a way that it is helpful in treating the symptoms of depression, delirium, and dementia. The aim of the patient's care plan cannot be treating depression, delirium, and dementia because these all are incurable diseases. However, their symptoms can be reduced through the use of appropriate medications and other treatment methods.

Evaluating Patient's Care

As per Jones (2016), all the nurses have the key responsibility of evaluating their nursing practices, patient outcomes, and the quality of the healthcare service provided to all the patients. It is very important to evaluate the management plans that are provided to all the patients. This is because evaluation helps healthcare professionals to understand the improvement steps that are required to make the plan more effective. The process of evaluation helps healthcare professionals in using evidence-based approaches while executing their practice. A number of interventions are used for treating the patients of dementia, but there is a lack of tools that can rigorously evaluate the success rate of these interventions (Handley, Bunn & Goodman, 2019). Most of the interventions are not evaluated properly due to which healthcare professionals are unable to evaluate the actual recovery rate of dementia patients. The older people who have dementia are not expressive and keep them socially isolated; due to cognitive impairment. This is the reason that healthcare experts are not able to judge their speed of recovery. This indicates that there is an urgent requirement for better evaluation methods to access the recovery rate of dementia patients. These evaluation tools will also help in evaluating other mental disorders such as depression and delirium.

Dementia can lead to poor nutrition, falls, infections, and other disabilities, and this can lead to the admission of older adults in age care homes. The family members are not able to provide proper care to dementia patients, especially the ones above the age of 65 years. They are not aware of the assessment and evaluation techniques of dementia and other mental impairments due to which they take the support of aged care homes. The healthcare professionals and the registered nurses of the aged care homes must be aware of the proper evaluation techniques in order to provide high-quality care to older patients. The patient care provided to older adults suffering from dementia, delirium, and depression must be evaluated properly. The interventions such as psychoeducation and psychotherapy should be evaluated timely; the cognitive functioning such as speech, balance, posture should be checked to evaluate patient's improvement.

Registered nurses can evaluate the patient's recovery by accessing the impact of the patient's care. All the assessment tools of dementia, depression, and delirium must be evaluated properly. This will help in opting for the best assessment tool for diagnosing the neurological and mental condition of the patient. The evaluation of the patient care plan is also important because it helps the medical experts in detecting the impact of these plans on the patient's recovery. Thus, Mr. David Geoffries medical conditions can be accessed by evaluating his medical treatment plan, the impact of this plan on his health, and by evaluating the interventions that are used for treating him. Evaluation is an important step for providing the best quality healthcare services to all the patients of mental disorders.

Conclusion on Dementia, Delirium, and Depression

Thus, this paper concludes that dementia is one of the most common disorders in older adults, and it can lead to various other mental disorders such as delirium and depression. The patients of dementia are unable to perform their daily activities, need dependency, and support. They require a patient-centered dementia care plan that aims at reducing the symptoms and improving patient's quality of life. The family members of most dementia patients prefer aged care homes as these aged care homes can give better care to dementia patients. Assessment of dementia and other neurological disorders is important to screen out older people who have these diseases, and this will help in providing more care to such people. Some of the common assessment techniques for dementia include neurological tests, physical tests, brain scans, and neurophysiological tests, physical examination of the patient's blood pressure and other vital signs.

The assessment of balance and other cognitive functions can be used as assessment tools of dementia. The patient care plan for such patients should aim at providing support and quality care to the patients. For example, the care plan should focus on providing a nutritious diet to the patient, must address incontinence, and should focus on reducing the symptoms of both these disorders. Interventions such as psychoeducation, psychotherapy, and counseling can help in managing the care of dementia patients. The multicomponent interventions such as skills training, problem-solving, and other can enhance treatment outcomes. The use of antidepressants is also vital to manage depression in depressed dementia patients. All these interventions focus on improving the interaction of patients and in building a safe environment around them. Timely and regular evaluation of the patient care plan is vital to analyze the recovery of patients and to assess the impact of care plans on the recovery of the patient.

References for Dementia, Delirium, and Depression

Blackburn, P. (2017). Depression in older adults: Diagnosis and Management. BC Medical Journal, 59(3), 171-177.

Cheng et al. (2019). Psychological Interventions for Dementia Caregivers: What We Have Achieved, What We Have Learned. Current Psychiatry Reports, 21(7), n.d. doi: 10.1007/s11920-019-1045-9

Grover, S. & Avasthi, A. (2018). Clinical Practice Guidelines for Management of Delirium in Elderly. Indian Journal of Psychiatry, 60(3), 329-340. doi: 10.4103/0019-5545.224473

Handley, M., Bunn, F. & Goodman, C. (2019). Supporting general hospital staff to provide dementia sensitive care: A realist evaluation. International Journal of Nursing Studies, 96(n.d.), 61-71. https://doi.org/10.1016/j.ijnurstu.2018.10.004

Jones, T. (2016). Outcome measurement in nursing: imperatives, ideals, history, and challenges. The Online Journal of Issues in Nursing, 21(2), n.d. doi: 10.3912/OJIN.Vol21No02Man01

Leyhe, T., Renyolds III, F. C., Melcher, T., Linnemann, C., Kloppel, S., Blennow, K., Zetterberg, H., Dubois, B., Lista, S. & Hampel, H. (2017).A common challenge in older adults: Classification, overlap, and therapy of depression and dementia. Alzheimer's & Dementia, 13(1), n.d. https://doi.org/10.1016/j.jalz.2016.08.007

Mayo Clinic. (2018). Delirium. Retrieved from https://www.mayoclinic.org/diseases-conditions/delirium/symptoms-causes/syc-20371386

National Institute on Ageing. (2017). What is dementia? Symptoms, Types and Diagnosis. Retrieved from https://www.nia.nih.gov/health/what-dementia-symptoms-types-and-diagnosis

Oh., S. E., Fong, G. T., Hshieh, T. T. & Inoyue, K. S. (2017). Delirium in older persons. Journal of American Medical Association, 318(12), 1161-1174. doi: 10.1001/jama.2017.12067

PSYCOM. (2019). Depression Definition and DSM-5 Diagnostic Criteria. Retrieved from https://www.psycom.net/depression-definition-dsm-5-diagnostic-criteria/

Rosen, T., Connors, S., Clark, S., Halpren, A., Stern, E. M., DeWald, J., Lachs, S. M. & Flomenbaum, N. (2016). Assessment and Management of Delirium in Older Adults in the Emergency Department: Literature Review to Inform Development of a Novel Clinical Protocol. Advanced Emergency Nursing Journal, 37(3), n.d. doi: 10.1097/TME.0000000000000066

Shaji, S. K., Sivakumar, T. P., Rao, P. G. & Paul, N. (2018). Clinical Practice Guidelines for Management of Dementia. 60(3), 312-328. doi: 10.4103/0019-5545.224472

World Health Organization. (2017). Mental health of older adults. Retrieved from https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults

World Health Organization. (2019). Dementia. Retrieved from https://www.who.int/news-room/fact-sheets/detail/dementia

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