Dementia is a disorder that deteriorates memory, vision, behaviour, and the ability to perform daily tasks (Duong et al., 2017). While dementia affects mainly the aged population, this is not a normal aspect of aging. Across the world, 50 million people have dementia and about 10 million new cases that arise every year. The most common type of dementia is Alzheimer's disease, that can affect 60–70 percent of cases (WHO, 2019). It is one of the most important causes of disability and dependency among the elderly in the world. Dementia patients are at high risk of accidents in hospitals and outside hospital settings they are unable to carry out their activities of daily living (ADL) (Timmons et al., 2016). The issues associated with dementia that have an effect on patient safety in clinical settings have been discussed in this essay. Additionally, the consequences for patient health that should be addressed for these facilities when designing a nursing care plan.
Establishing patient safety at the hospital settings is a public health concern. Patient health programs have generally focussed on critical care and surgical patients. Dementia patients perform poorly in hospitals with multiple adverse effects leading to drop, delirium, and functional loss geriatric syndromes with increase duration of stay and higher mortality (George et al., 2013). Besides having a higher risk of falling, people with declining history of dementia are 5 times more prone in getting hospitalized than those with deteriorating dementia. In adults with dementia, there is an increased fall risk leading to significant accidents such as mortality and hip fractures. The risk factors for falling in this population must be identified, so that health care providers can establish successful preventive strategies to minimize the detrimental effect of falling on an individual's quality of life (Fernando et al., 2017). Patients with this condition are twice as likely to develop preventable complications in health care settings, such as pressure ulcers and pneumonia. Uncontrolled dementia pain causes delirium, which is often undiagnosed and untreated in hospitals. As a result, half of these delirium-developing patients die within six months. Dementia patients may be missed at mealtimes by an accident and have eating and drinking problems that get worse in the hospital (Marcantonio, 2017). Older people with cognitive disabilities are more likely to go down without cognitive impairment than their peers.
Dementia patients and the patient with Alzheimer's disease find it difficult to perform ADLs. For example, while some dementia patients appear to have nothing wrong with them, others look dishevelled and may wear dirty clothes that are not matched. In evaluating their cognitive capacity, a person's ability to perform ADLs is also assessed. Since dementia is usually a chronic condition, over time the ability to perform ADLs is diminishing. Sequencing, preparing, and coordinating a multi-step project can be very difficult for such patients (Hamdy et al., 2017). Many people with dementia forget to do the job, or how to do it. They cannot remember to put on clean morning clothes or wash their hair. Poor skills in decision-making can impact ADLs too. The dementia and Alzheimer’s patients find it difficult to perform basic daily activities like shaving, bathing, eating etc Patients with dementia can decide in the middle of winter that they don't need long trousers or a sweatshirt. When the world is noisy or the person feels exhausted or feeling discomfort, the ability to concentrate on doing an activity such as a bath may be difficult. Often dementia can affect personality and actions and a loved one refuses help with ADLs, complicating things more. The visual understanding of where the toothbrush is on the counter in the bathroom or confusion as to which jar is the toilet may make it difficult to complete ADLs (Hamdy et al.,2018).
The provision of clinical care needed to provide care with dignity, is consistent with the holistic model of care underpinning nursing profession, addressing all problems of a patient's related to financial, physical, mental health, and emotional issues. Nurses spend more time with patients delivering compassionate treatment by forming a collaborative strategy, and are specialized in offering an evidence-based approach that provides optimal results to suffering individuals (Crisp et al., 2013). The important nursing strategies which can improve the quality of patient life, including numerous issues related to consumer awareness and health promotion, caregivers help, and dignified patient-centered care delivery and development of patient-centered nursing care plans. The nursing interventions should be to minimize the obstacles for the patient in the clinical environment and room to minimize the risk of falls. The dementia patient has to be assisted with the medications and activities of daily life. These patients show resistance to medications so personalized plans should be made to give them medications (Maxwell et al., 2014).
The family members have to be educated about the conditions and can be instructed to behave calmly with the patients. Maintenance of hygiene is another important issue for these patients. The patient needs personal assistance to perform daily activities so nurses should also educate the care giver in helping the patient in ADLs. Some patients are also geared towards nature and the natural world so assisted outdoor activity can be planned. The patient must be acquainted with issues around. The prospective caregivers should be taught how to direct patients by time, person, location, and circumstances. After release from the hospital, these carers would be responsible for the patient's health. The patient should always be provided with constructive feedback when it's necessary to think and behave or when the patient verbalizes that other articulated ideas are not currently focused. The warm feedback enhances self-esteem and the desire to mimic good behaviour. The dementia patient should be communicated using descriptive language, face-to-face descriptions while engaging with customers helps them in better understanding (Banovic et al., 2018).
Maintaining patient protection in health care settings is a concern for public health. In acute hospitals settings, special care needs to be taken to improving the protection and care quality for patients with dementia. Patients face issues like falls and delirium because of the lack of safety standards in the clinical settings. Patients are unable to perform the daily activities for which they need assistance. The condition effects on a person's ability because it gradually impairs their potential to effectively perform everyday work in daily lives, affecting both physical and mental abilities. The care givers like nurses make a major contribution in providing a quality life to dementia patients, as they address many of the daily personal health needs and encourage a holistic person-centered care plan.
Banovic, S., Zunic, L. J., & Sinanovic, O. (2018). Communication difficulties as a result of dementia. Materia Socio-medica, 30(3), 221–224. https://doi.org/10.5455/msm.2018.30.221-224
Crisp, J., Taylor, C., Douglas, C., & Rebeiro, G. (2013). Fundamentals of nursing. Chatswood, Australia: Elsevier.
Duong, S., Patel, T., & Chang, F. (2017). Dementia: What pharmacists need to know. Canadian Pharmacists Journal : CPJ = Revue des pharmaciens du Canada : RPC, 150(2), 118–129. https://doi.org/10.1177/1715163517690745
Fernando, E., Fraser, M., Hendriksen, J., Kim, C. H., & Muir-Hunter, S. W. (2017). Risk factors associated with falls in older adults with dementia: A systematic review. Physiotherapy Canada. Physiotherapie Canada, 69(2), 161–170. https://doi.org/10.3138/ptc.2016-14
George, J., Long, S., & Vincent, C. (2013). How can we keep patients with dementia safe in our acute hospitals? A review of challenges and solutions. Journal of the Royal Society of Medicine, 106(9), 355–361. https://doi.org/10.1177/0141076813476497
Hamdy, R. C., Kinser, A., Kendall-Wilson, T., Depelteau, A., & Whalen, K. (2018). Impulsive, disinhibited behavior-dining in a restaurant. Gerontology & Geriatric Medicine, 4, 2333721418756994. https://doi.org/10.1177/2333721418756994
Hamdy, R. C., Lewis, J. V., Kinser, A., Depelteau, A., Copeland, R., Kendall-Wilson, T., & Whalen, K. (2017). Too many choices confuse patients with dementia. Gerontology & Geriatric Medicine, 3, 2333721417720585. https://doi.org/10.1177/2333721417720585
Marcantonio E. R. (2017). Delirium in hospitalized older adults. The New England Journal of Medicine, 377(15), 1456–1466. https://doi.org/10.1056/NEJMcp1605501
Maxwell, C. J., Stock, K., Seitz, D., & Herrmann, N. (2014). Persistence and adherence with dementia pharmacotherapy: Relevance of patient, provider, and system factors. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 59(12), 624–631. https://doi.org/10.1177/070674371405901203
Timmons, S., O'Shea, E., O'Neill, D., Gallagher, P., de Siún, A., McArdle, D., Gibbons, P., & Kennelly, S. (2016). Acute hospital dementia care: Results from a national audit. BMC Geriatrics, 16, 113. https://doi.org/10.1186/s12877-016-0293-3
WHO. (2019). Dementia. https://www.who.int/news-room/fact-sheets/detail/dementia
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