Dementia Agents
Instructions: Case Discussion on Dementia Treatment:
Discussion
3 references
Eleanor is a 77-year-old white female resident of a skilled nursing facility. Recently her daughter requested an evaluation from the staff psychologist because she noticed that her mother’s Alzheimer’s symptoms appeared to be getting worse. Eleanor was admitted to the facility six months ago with moderately severe cognitive and physical decline and had to be placed in a skilled facility since she could no longer manage herself at home. Her daughter is a single mother of four teens and works too many hours to care for her mother in her home. She had attempted to care for her until Eleanor left the stove on, resulting in a minor kitchen fire. Eleanor has no history of mental illness, but she began to show signs of cognitive decline in her late fifties. The symptoms became much more pronounced after her husband’s death five years ago.
Recently her daughter and other members of the nursing staff noticed that Eleanor has become rather restless and combative. When she gets confused over her surroundings, she wanders through the halls attempting to open fire doors. When nurses attempt to redirect her back to her room, she swears at them and even struck one of them in the face. Her PCP authorized the use of restraints one day after she managed to wander out the front door and was found standing in the middle of the street trying to take a dog away from a woman who was walking it. She yelled at the woman, telling her that she needed the dog to protect her from people who were stealing her clothing in the nursing home.
In addressing Eleanor’s case, it’s important to consider various factors contributing to her behavior and cognitive decline. Dementia, particularly Alzheimer’s disease, is a complex condition that requires a comprehensive approach involving medical, psychological, and social interventions. Here are some potential strategies for managing Eleanor’s symptoms:
- Medication Management: Pharmacological interventions may be necessary to manage Eleanor’s symptoms. Cholinesterase inhibitors such as donepezil, rivastigmine, or galantamine are commonly prescribed for Alzheimer’s disease to improve cognitive function and manage behavioral symptoms. Additionally, memantine, an NMDA receptor antagonist, may be used to help regulate glutamate activity and improve cognitive function.
- Behavioral Interventions: Non-pharmacological approaches are also essential in managing behavioral symptoms associated with dementia. These may include environmental modifications to reduce confusion and agitation, such as ensuring adequate lighting, minimizing noise, and maintaining a consistent daily routine. Staff training in dementia care techniques, such as validation therapy and person-centered care, can also be beneficial in effectively communicating with and managing individuals with dementia.
- Psychosocial Support: Eleanor’s recent increase in restlessness and combative behavior may be influenced by various psychosocial factors, including grief following her husband’s death and the stress of adjusting to life in a skilled nursing facility. Providing emotional support through individual counseling or support groups can help Eleanor cope with these stressors and improve her overall well-being.
- Caregiver Support: It’s important to acknowledge the challenges faced by Eleanor’s daughter, who is also balancing caregiving responsibilities with her own family and work obligations. Providing caregiver education and support can help her better understand Eleanor’s condition and learn effective coping strategies. Respite care services can also offer temporary relief for caregivers, allowing them to recharge and attend to their own needs.
- Monitoring and Safety Measures: Given Eleanor’s recent wandering behavior and aggression towards staff, it’s crucial to implement appropriate safety measures to prevent harm to herself and others. This may involve the use of door alarms, wander guards, or supervised recreational activities to redirect her attention and reduce the risk of elopement.
- Regular Follow-Up and Evaluation: Close monitoring of Eleanor’s symptoms and response to interventions is essential for ongoing management of her condition. Regular follow-up appointments with her primary care provider, psychiatrist, and other specialists involved in her care can help adjust treatment plans as needed and address any emerging concerns.
In conclusion, managing dementia-related behaviors like those exhibited by Eleanor requires a multifaceted approach involving pharmacological, behavioral, psychosocial, and environmental interventions. By addressing her symptoms holistically and providing support for both Eleanor and her caregivers, it’s possible to enhance her quality of life and promote a safe and supportive living environment.