Dementia is one of the most common illnesses associated with elderly resulting from neural degeneration resulting in memory loss, confusion, and eventually loss of mobility and difficulty in everyday functioning (James & Bennett, 2018). In the given case scenario, the patient, Marjorie Burns is suffering from dementia and has been shifted to the geriatric ward. The patient was admitted regarding her concern of urinary tract infection (UTI) and was also treated for same. However, incidences of minor confusion were reported that led to the diagnosis of dementia in the patient. The patient is aged 76 years old and is a widow who lives alone and is taken care of by her daughter, Trish. Trish is currently unaware of the recent diagnosis of dementia of her mother. Based on this premise of case study significant literature has been explored to develop an evidence-based analysis. This document will provide a comprehensive annotated bibliography for the explored literature to form a basis of discussion in this study. The literature has been explored from reliable databases like MEDLINE, EMBL, and PubMed. Further, the articles collected have been classified into four themes, informed consent, dementia care for elderly, family support in care for elderly patients, and living alone in dementia. The literature associated with informed consent has been selected as the daughter of Marjorie who is the primary carer is not yet informed about the recent diagnosis, therefore, the continuation of treatment without her consent will be unethical. The literature surrounding dementia care for elderly, family support in care for elderly patients, and living alone in dementia have been explored as they are directly associated with the clinical and psychosocial well being of the patient. Conclusive reflective analysis of the importance and learning derived from this analysis will also be presented in this document.
Theme 1: Informed consent
Article 1: “Regan, E. M. (2018). Clinical Trials Informed Consent: An educational intervention to improve nurses' knowledge and communications skills. Clinical Journal of Oncology Nursing, 22(6), 152-158”
The article presented by Regan (2018) focuses on establishing the importance of informed consent on clinical trials. The study is presented with a clear and concise aim that is to initiate and evaluate the educational program for the nurses to enhance their knowledge and communication skills regarding informed consent. An education-based tool was used to approach this study and the data was collected through Anonymous pre-, post-, and one-month post-program surveys to assess the knowledge improvement in the participant nurses through a teach-back approach. Statistical analysis was done for the results obtained and it was elucidated that the use of the educational tool for nurses enhances their ability to understand and implement informed consent in the care settings.
This article is associated with the case study of Marjorie as the daughter of the patient is still unaware of her diagnosis and is her primary carer. The patient has dementia, therefore, consent from her as well her primary carer is essential to carry out medical treatment of her condition. Therefore, any medical intervention will require her consent. Informed consent is therefore essentially needed in every case scenario. The Nursing and Midwifery Board of Australia (2018) also asserts the importance of informed consent in clinical practice in the code of conduct. This article will help in the nursing practice by understanding the importance and suitable application of informed consent.
Article 2: “Ditai, J., Kanyago, J., Nambozo, M. R., Odeke, N. M., Abeso, J., Dusabe-Richards, J., ... & Storr, J. (2018). Optimising informed consent for participants in a randomised controlled trial in rural Uganda: a comparative prospective cohort mixed-methods study. Trials, 19(1), 699.”
The study by Ditai et al. (2018) focuses on providing the importance of a comprehensible approach in availing consent. The study focuses on providing a clear aim that I s, to improve the informed consent process. The target population in the study are the illiterate female patients in Uganda, Africa. A mixed study approach has been used in the analysis with a prospective comparative cohort design. The information and comprehensibility of informed consent was addressed using the Quality of Informed Consent (QuIC) in the study. The results revealed that slide show messages were preferred more than video messages for the logical progression of information in the patients.
This study is significant for the case study of Marjorie as the patient has been diagnosed with moderate dementia affecting their ability to understand and comprehend information. Therefore, along with her daughter, consent should also be obtained from the patient using easy, comprehensible, and simple information sharing so that the patient can make an informed choice regarding her treatment and management. This article is helpful in the nursing practice as it will help in determination and understanding of alternative strategies that could be applied for gaining consent from patients in a simplified and yet comprehensive manner.
Theme 2: Dementia care for elderly
Article 3: “Jing, W., Willis, R., & Feng, Z. (2016). Factors influencing quality of life of elderly people with dementia and care implications: A systematic review. Archives of Gerontology and Geriatrics, 66, 23-41.”
The study provides a systematic analysis with a succinct aim to identify the possible factors that are associated with dementia and impact the quality of life of the elderly. The paper aims to identify the difference in the impact of these factors at different stages of dementia. For the study, PubMed, PsycInfo, and several databases were used to identify literature in 15 years from 2000-2015. The keywords that were used in the study included “quality of life” and “dementia in the elderly”. The results indicated that a variety of factors like demography, phycological influences, social, and religious aspects influence the important role of environmental factors.
This study is important and associated with the case analysis of Marjorie as the study is focused on the factors that are associated with dementia in the elderly. The patient lives alone and aged. These psychosocial and biological factors are associated with the health condition of the patient. Further, it will also help in understanding the care needs of the patient and help in the provision of more effective care. This study is also important in nursing practice as it helps in the understanding of several factors associated with dementia in patients at different stages
Article 4: “Wang, S. C., Yu, C. L., & Chang, S. H. (2017). Effect of music care on depression and behavioral problems in elderly people with dementia in Taiwan: a quasi-experimental, longitudinal study. Aging & Mental Health, 21(2), 156-162.”
A longitudinal analysis by Wang, Yu and Chang (2017) is focused on the examination of the effectiveness of music care on cognitive function, depression, and behavioural problems among elderly people with dementia. The study follows a longitudinal and quasi-experimental research design and applies the Bandura's social cognition theory. The results are evaluated using the Clifton Assessment scores. The findings indicate that long term non-invasive therapies like music therapies can be helpful in the improvement of the condition of patients with dementia. The focus of the study is on elderly patients with moderate and severe dementia. Further, the target audience of nurses and clinicians have been focused on this analysis.
This study will be effective with the case of Marjorie as it provides a non-invasive and a therapeutic means of care for the patient. Non-invasive methods in dementia management and care are highly effective and accepted readily by the patients and the carers (James & Bennett, 2018). Non-invasive treatments like music therapies are being explored for cognitive and behavioural management for the patient with neural dysfunctions in diseases like dementia and also for patients with mental illnesses. Therefore, this study will also be helpful in nursing practice by providing an alternative to classical dementia management studies (Baez et al., 2019).
Theme 3: Family support in care for elderly patients
Article 5: “Kim, G. M., Lim, J. Y., Kim, E. J., & Kim, S. S. (2018). A model of adaptation for families of elderly patients with dementia: focusing on family resilience. Aging & Mental Health, 22(10), 1295-1303.”
The study by Kim et al. (2018) aims to provide a comprehensive model to explain a method for positive adaption of families of elderly patients that are suffering from dementia. The study addresses that dementia is a progressive disorder that results in the development of several behavioural and cognitive problems in the elderly. The study has been done using surveys for data collection and analysis. The results indicate that the effectiveness of communication, stress, and overall health condition of the patient affects how the illness is perceived during care. Therefore, suitable interventions with a timely approach in synchronicity with disease progression are required with the use of an integrative and educative model.
This study is helpful in the case of the patient, Marjorie as it can help in the development of a comprehensive care plan with a participatory approach and inclusion of her daughter in the care regimen. As the patient lives alone, the development of family support and care plan becomes essential (Schoeni et al., 2018). This study is also of high importance with the perspective of nursing considerations as it will help enhance knowledge about the role of family caregivers and management and care of elderly with dementia through a family involved participatory approach.
Article 6: “Digby, R., Lee, S., & Williams, A. (2017). The experience of people with dementia and nurses in hospital: an integrative review. Journal of Clinical Nursing, 26(9-10), 1152-1171.”
Digby, Lee and Williams (2017) provide an integrative review on the experience of people with dementia and nurses in the hospital setting. The study outlines a clear aim which is to identify and analyse the perspectives of individuals on dementia care in acute hospital settings. The literature from years 2000-2015 were analysed to identify the experience of people and healthcare professionals suffering from dementia. The focus audience of this study is the nurses as it highlights the importance of understanding the complex needs of patients with dementia. The study is integrative and inclusive. The results indicate that there is a need for improved education and support to care for a patient suffering from dementia. There is also a need for increased practical support, empathy, and strong clinical leadership for the management of the condition for patients suffering from illness.
This study will be essential in the case study of Marjorie as it will help in understanding the complex care needs of the patient and develop a comprehensive care plan for the management of her health condition. The study will also be helpful in nursing practice as it provides crucial insights about patient experiences with dementia and helps in understanding their care needs. This, in turn, will help in the improvement of the overall quality of care provided to the patients and enhance person-centred care practice.
Theme 4: Living alone in dementia
Article 7: “Lara, E., Martín-María, N., De la Torre-Luque, A., Koyanagi, A., Vancampfort, D., Izquierdo, A., & Miret, M. (2019). Does loneliness contribute to mild cognitive impairment and dementia? A systematic review and meta-analysis of longitudinal studies. Ageing research reviews, 52, 7-16.”
A systematic review and a meta-analysis of longitudinal studies conducted by Lara et al. (2019) explain how loneliness impacts the mental health and can result in mild cognitive impairment and can trigger illnesses like dementia in elderly. The study is focused on elderly patients that live alone through data retrieval from fifteen databases. The age of patients ranged from 64.9 to 83.1 years and a total of 37339 individuals were assessed. The study revealed that loneliness was positively correlated with mild cognitive impairment and triggering of conditions like dementia.
This study is helpful in the case of the patient, Marjorie in the case study as she a widower and lives alone. Therefore, the insights gathered from this study can help in understanding the triggers of her dementia and help to develop a comprehensive care strategy for the patient. Further, this study will also be helpful in nursing practice by helping in the understanding of triggers of cognitive impairment and dementia in the elderly patients and encourage care practices and advocation to avoid them to minimize the impact. Loneliness in a patient with dementia can be extremely fatal as patients require constant care and support as the disease progresses (James & Bennett, 2018).
Article 8: “Penninkilampi, R., Casey, A. N., Singh, M. F., & Brodaty, H. (2018). The association between social engagement, loneliness, and risk of dementia: a systematic review and meta-analysis. Journal of Alzheimer's Disease, 66(4), 1619-1633.”
The study by Penninkilampi et al. (2018) identifies that loneliness can result in triggering of dementia and the onset of Alzheimer’s. The study followed a systematic review structure and has collected primary studies that associate onset of dementia due to lack of social engagement and loneliness. The study articulated research from twelve databases like MEDLINE, CINAHL, Cochrane, etc. and provides a detailed account and analysis. The results of the study indicated that elderly patients with limited social engagement have an increased risk of dementia development. The focus of this study is on elderly patients and address their needs for social engagement to minimize the risk of cognitive impairment and onset of dementia.
This study relates to the case study as the patient lives alone and is contacted by her children to follow-ups. The patient has been single after the death of her husband. This can be associated with a prolonged feeling of loneliness in the patient and can, therefore, be considered a cofactor for the onset of dementia along with her age. The study will also be helpful in nursing practice by asserting the importance of increased engagement in care, gather family support for disease management, and enhance the quality of care provided.
The experience of writing this assessment has been enriching. Dementia is a complex progressive disorder that is associated with the elderly and affects their overall well-being by hindering the cognitive function. In the course of writing this assignment, I was able to learn and gather a range of new information associated with the health condition. Through this process, I came across a range of articles and learned how to curate, analyze, and identify the relevant literature associated with the case study. As a registered nurse in future, this knowledge will be of high importance as it will assist in the development of evidence-based practice. This assessment has helped enhance my ability to critique and express the research in a summary. This will be helpful in future where I will be able to summarize the required information briefly and succinctly for easy comprehension and overall perception. I have gained a significant amount of knowledge in this assessment regarding dementia that has helped me expand my knowledge base and understanding of the disease. Further, I have been able to learn how to associate the findings with a case scenario in this assessment to develop evidence for interventions and clinical understanding of the disease. Moreover, this will also help me comply with the code of conduct in nursing that ensures the well-being of patients by encouraging research. Therefore, as a registered nurse, these skills will help me advance into competent care and ensure well being of the patient by ensuring quality research and evidence-based application of the interventions.
Baez, S., Pinasco, C., Roca, M., Ferrari, J., Couto, B., García-Cordero, I., ... & Manes, F. (2019). Brain structural correlates of executive and social cognition profiles in behavioral variant frontotemporal dementia and elderly bipolar disorder. Neuropsychologia, 126, 159-169. https://www.sciencedirect.com/science/article/abs/pii/S0028393217300581
Digby, R., Lee, S., & Williams, A. (2017). The experience of people with dementia and nurses in hospital: an integrative review. Journal of Clinical Nursing, 26(9-10), 1152-1171. https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.13429
Ditai, J., Kanyago, J., Nambozo, M. R., Odeke, N. M., Abeso, J., Dusabe-Richards, J., ... & Storr, J. (2018). Optimising informed consent for participants in a randomised controlled trial in rural Uganda: a comparative prospective cohort mixed-methods study. Trials, 19(1), 699. https://link.springer.com/article/10.1186/s13063-018-3030-8
James, B. D., & Bennett, D. A. (2019). Causes and patterns of dementia: An update in the era of redefining Alzheimer's disease. Annual Review of Public Health, 40, 65-84. https://www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-040218-043758
Jing, W., Willis, R., & Feng, Z. (2016). Factors influencing quality of life of elderly people with dementia and care implications: A systematic review. Archives of Gerontology and Geriatrics, 66, 23-41 https://www.sciencedirect.com/science/article/abs/pii/S0167494316300735
Kim, G. M., Lim, J. Y., Kim, E. J., & Kim, S. S. (2018). A model of adaptation for families of elderly patients with dementia: focusing on family resilience. Aging & Mental Health, 22(10), 1295-1303. https://www.tandfonline.com/doi/abs/10.1080/13607863.2017.1354972
Lara, E., Martín-María, N., De la Torre-Luque, A., Koyanagi, A., Vancampfort, D., Izquierdo, A., & Miret, M. (2019). Does loneliness contribute to mild cognitive impairment and dementia? A systematic review and meta-analysis of longitudinal studies. Ageing Research Reviews, 52, 7-16. https://www.sciencedirect.com/science/article/pii/S1568163718302472
Penninkilampi, R., Casey, A. N., Singh, M. F., & Brodaty, H. (2018). The association between social engagement, loneliness, and risk of dementia: a systematic review and meta-analysis. Journal of Alzheimer's Disease, 66(4), 1619-1633. https://content.iospress.com/articles/journal-of-alzheimers-disease/jad180439
Regan, E. M. (2018). Clinical trials informed consent: An educational intervention to improve nurses' knowledge and communications skills. Clinical Journal of Oncology Nursing, 22(6), 152-158 https://web.b.ebscohost.com/abstract?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=10921095&AN=133097147&h=ArG6LPRR4KTA%2f68uz%2fViPRnc3mcHDK9oIbQu5rL7ObIHkuuZBRrt0teWnckS9hfgASdDAeQh6xZ0hC5S0d4nrw%3d%3d&crl=c&resultNs=AdminWebAuth&resultLocal=ErrCrlNotAuth&crlhashurl=login.aspx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype%3dcrawler%26jrnl%3d10921095%26AN%3d133097147
Schoeni, R. F., Freedman, V. A., & Langa, K. M. (2018). Introduction to a supplement on population level trends in dementia: Causes, disparities, and projections. The Journals of Gerontology: Series B, 73(1), 1-9. https://academic.oup.com/psychsocgerontology/article/73/suppl_1/S1/4971573
The Nursing and Midwifery Board of Australia (2018). Code of conduct. Retrieved from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwj-q_eYqM_qAhUj73MBHZULDSIQFjABegQIDRAD&url=http%3A%2F%2Fwww.nursingmidwiferyboard.gov.au%2Fdocuments%2Fdefault.aspx%3Frecord%3DWD17%252F23850%26dbid%3DAP%26chksum%3DL8j874hp3DTlC1Sj4klHag%253D%253D&usg=AOvVaw2_EwvXELm1PrjH5t5kPGZh
Wang, S. C., Yu, C. L., & Chang, S. H. (2017). Effect of music care on depression and behavioral problems in elderly people with dementia in Taiwan: a quasi-experimental, longitudinal study. Aging & Mental Health, 21(2), 156-162. https://www.tandfonline.com/doi/abs/10.1080/13607863.2015.1093602
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