Alzheimer's/Dementia patient

Adam Tobey, Paige Hanna, Lindsey Switzer, Lindsey Cobb, Elena Kolinski, Kaitlin Harper, Andrew
Becker

1. Identify any group of people for whom you have particular concern or empathy. A group
considered a vulnerable population. Answer the following questions:
a. What are your assumptions about this group?
 They forget things easily
 They may be irritable from confusion
 Have difficulty taking care of themselves
 They can't afford medications
 They don't understand their disease processes
 They don't have anyone to take care of them

b. How is this group's health status in jeopardy?

 They cannot afford treatment or they never understand what their doctor is telling
them so they avoid going to the doctor's office altogether.
 They do not have the means to get to their appointment (drives, etc.) (Hegde &
Ellajosyula, 2016).
 Even if the doctor sets up an appointment with them, they could easily forget
about it (Alzheimer's disease, 2017).
 This population could be forgetful when it comes to hygiene which could lead to
problems including infections (Dementia, 2017).
 They may be confused and overwhelmed when it comes to treatment options and
medications
 The care of this population has decreased even though the numbers of this illness
is increasing (Reuben., et al., 2010).

2. CDC- https://www.cdc.gov/chronicdisease/resources/publications/aag/alzheimers.htm

This article is relevant for this culture of people because it shows the age group that it
typically targets and how it impacts a person and their health. The age group is usually over the
age of 60 and it slowly destroys the brain function of the person. Eventually, there will be a
decline in functional status and they won't be able to take care of themselves. The article also
explains the increased need for caregivers and the "burnout" they may have when caring for a
patient with Alzheimer's/dementia.
WHO- http://www.who.int/mediacentre/factsheets/fs362/en/
This article is relevant for those caring for elderly patients because it explains signs and
symptoms, stages, forms, treatment and care, and risk factors and prevention for dementia. It also
provides the reader with the social and environmental impacts of dementia, the impact it can have
on families and caregivers, and human rights information for dementia patients.
NCBI- https://www.ncbi.nlm.nih.gov/books/NBK442425/?term=dementia%20risks
 The "Interventions to Prevent Age Related Cognition" describes the loss of function an
individual has when they have this illness. They have a significant loss of cognition and function
and that puts a lot of burden on the family. This article states as well that the rates for this illness
are rising and the healthcare related costs that are associated with this.
AHRQ - https://www.ncbi.nlm.nih.gov/pubmed?term=20374405
This article is important to consider because it explains that the population is increasing
but the care of these individuals have not gone up as well. This study shows that the
recommended care for this population was not preformed when it should have been. This leads to
an increase in problems that this population faces because of the inability to live on their own and
take care of themselves.
WHO - http://www.who.int/bulletin/volumes/95/11/17-021117/en/
This article correlates to this population because it explains the affects that
dementia/Alzheimer's can have on a particular person and their families. This article also explains
that the number of the population has increased and is continuing to get higher. The loss to do
daily activity affects this population because they must rely on others to help the
NCBI- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5109759/
This article is relevant for this population because respecting the patient's ability to make
decisions is important in their lives but with this disease, there must be a time where their ability
to make decisions are limited. This article assesses one's ability to living independently including
being able to drive, manage finances and keeping up on their health.

3. What key information about this group makes them vulnerable to health disparities and/or
health status risks (and possibly other psycho-social stigmas)?
 A main concern with someone who has Alzheimer's or dementia is that they are forgetful, and
they may forget to go to appointments, eat, or take their medications (Alzheimer's Disease, 2017).
 Depending on the extent of their dementia, they may not have a license to drive and would need
help getting around to appointments or to get groceries (Hegde & Ellajosyula, 2016).
 If the dementia has progressed to a bad enough state, they may need a caretaker or someone to
check on them because of their inability to live alone (Alzheimer's Disease, 2017).
Questions to Assess:
1. How would you prefer to be addressed?
2. Do you live alone or with someone?
3. If you live alone, do you have someone who lives near by and checks on you?
4. Are there others that you would like to be involved in your care?
5. If so, who are these people and what relationship do you have with them?
6. When did you start noticing the loss of memory?
7. Do you feel comfortable living independently?
8. Do you live in a supportive community?
9. Do you have a form of transportation?
Cultural awareness tool: Understanding cultural diversity in mental health. (2002). Retrieved March 30,
2018, from
https://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/2016-
Culture-of-Safety/AppendixA-CulturalAssessmentTool-IndividualsFamilies.pdf (Links to an
external site.)

4. Based on your research so far, what information should nurses know about this particular
group?
 Nurses should understand that these patient's need more attention when it comes to performing
even simple tasks like grooming and eating (Dementia, 2017).
 If the patient does not have a family caretaker, they may need more assistance in a facility
 This population should not be able to go home alone because of memory loss and the lack of self-
care (Hegde & Ellajosyula, 2016).
 Checking the patient frequently because they are a higher wander risk (Dementia, 2017).

5. Provide some case study exemplars

 Symptoms of illness- expected symptoms, three different stages (early, middle, late)
(Alzheimer's stages, 2015).
 Memory loss, language difficulty- barriers in understanding information, compliance to
treatment, impaired patient provider communication (Hegde & Ellajosyula, 2016).
 Functional status- ability to engage in activities of daily living and self-care (Alzheimer's
Disease, 2017).
 Social interactions- may act inappropriate and agitated in certain situations (Dementia,
2017).
 Decision making- impaired cognition affects one's ability to make proper decisions and
may need a guardian (Hegde & Ellajosyula, 2016)

1. Ursula T. Indigo is a 77-year-old female with mild dementia who often has confusion and
memory loss. Her memory loss does not impair her enough to be dependent on others, but she is
forgetting certain things including the day of the week or where she puts her keys. Ursula lives by
herself, she is widowed and has two daughters. One daughter passed away, the other lives five
hours away and occasionally will call and check on her. She loves to hang out with her friends on
Saturday's for bingo and is involved in her church community. Since she is involved in her
community, she found herself holding in the urine when she felt the urge to go because there was
not always a bathroom present. Recently someone from church noticed that she was not showing
up for church because she was forgetting the day of the week for a couple of weeks in a row. This
 church member went to check on Ursula at her home and noticed an unclean home with used
briefs in every trash can. The person was concerned and decided to called Ursula's daughter. Her
daughter called her shortly after this and Ursula told her daughter that she was getting ready for
the prom. Her daughter is becoming worried and makes a trip to see Ursula. When the daughter
saw the house and her mother she noticed a foul odor coming from the briefs and the urine was
dark and cola-colored. When she asked her mother about it, Ursula complained of burning every
time she urinated ("Urinary Tract Infection", 2017). Her daughter decided to take Ursula to see
her primary care physician. After this visit, Ursula was diagnosed with a UTI and was put on
Cipro and Pyridium. Ursula sent on her way and was giving a follow up appointment in a few
weeks. With her insurance she can afford treatment and can pay for the medication that she was
put on. Taking this medication could be a problem because she is having an increase in memory
loss and increased incontinence. She is going to forget to take the medication that was prescribed,
and her daughter had to go back home so she will not be there to help her.

2. Ursula was to cognitively impaired to understand what was going on with incontinence and the
burning sensation. She thought it would just go away on its own and thought it was just
something that had to do with the frequent urination. The church member and daughter realized
something had to be done so something had to be done for her to get better. The daughter took
Ursula to the doctor's appointment to seek the help of her primary care provider. Ursula was
hesitant to go to the doctor because she thinks incontinence and the symptoms she was
experiencing was from old age. She does not want to accept the fact that she is getting older. She
was embarrassed to go out while wearing a brief because she feared that her friends and church
members would see the brief through her pants. She was afraid her friends would judge her
because she knows that only babies wear briefs.

3. Adam is a registered nurse at the primary care facility where Ursula sees her physician. Adam
notices that Ursula had missed her previous follow up appointment. When she finally came in he
noticed that she seems to be more confused and agitated than she was during the last visit. As a
patient advocate, Adam has an obligation to assist his patients in their follow up care, access to
medications, and overall wellbeing after their appointments. Adam knows that Ursula has mild
dementia that has recently been exacerbated by her current UTI. During the appointment Adam
tries to answer all the questions that Ursula has in terms that Ursula can understand easily. Adam
tries to make sure Ursula has a supply of easy to understand literature or pamphlets explaining the
details of what to expect with a UTI. Adam called the pharmacy that Ursula uses to check if her
Medicare insurance will cover her antibiotic and pyridium, and what her copay may be. Adam
also makes sure that Ursula will receive automated phone calls to remind her of upcoming
appointments and discusses transportation options to the office if she does not have a ride there.
Adam has also found time to make a call to Ursula's daughter, with Ursula's permission to discuss
her treatment and make sure the daughter understands as well. Adam and Ursula's daughter
discuss the potential need for Ursula to have a guardian or care giver that checks in on her and
takes her to her appointments. This will benefit her because is she losing some of her
independence but not all of it. Having a guardian will allow for someone to check up on her a
couple times a week to make sure she was compliant with medications and follow up
appointments. This guardian could transport Ursula to her appointments and places where she
would need to go.
 4. An intervention for Ursula that could be used is education on how to prevent UTI from
reoccurring. For example, Nurse Adam could educate Ursula about the importance of infection
control and minimizing the transmission of bacteria. This could include telling her to wipe front
to back and going to the bathroom at the first urge. Scheduling times to go to the bathroom could
decrease the amount of incontinence experienced (Wilkinson &Barcus, 2017). She might still
have to wear an incontinence pad instead of a brief if she empties her bladder regularly. Another
important topic that Adam could tell Ursula is to increase the fluid intake to limit the bacteria and
to also work the pelvic floor muscle (Wilkinson & Barcus, 2017). This will benefit her, so she
does not get frequent UTIs and this could also could the flow of urine.

References

Alzheimer’s Disease. (2017, September 12). Retrieved March 27, 2018, from
https://www.cdc.gov/chronicdisease/resources/publications/aag/alzheimers.htm

Alzheimer's stages: How the disease progresses. (2015, November 24). Retrieved from
https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers-
stages/art-20048448?pg=2

Dementia. (2017). Retrieved March 27, 2018, from

http://www.who.int/mediacentre/factsheets/fs362/en/

Hegde, S., & Ellajosyula, R. (2016). Capacity issues and decision-making in dementia. Annals of
Indian Academy of Neurology, 19(Suppl 1), S34–S39. http://doi.org/10.4103/0972-
2327.192890

Kane, R.L., Butler, M., Fink, H., Brasure, M., Davila, H., Desai, P., Jutkowitz, E., et al. (2017).
Interventions to prevent age-related cognitive decline, mild cognitive impairment, and
clinical Alzheimer's-type dementia. Agency for Healthcare Research and Quality, (188).
https://www.ncbi.nlm.nih.gov/books/NBK442425/
Reuben, D. B., Roth, C. P., Frank, J. C., Hirsch, S. H., Katz, D., McCreath, H., . . . Wenger, N. S.

(2010, January 26). Assessing Care of Vulnerable Elders-Alzheimer's Disease: A Pilot

Study of a Practice Redesign Intervention to Improve the Quality of Dementia Care.
Retrieved March 27, 2018, from https://onlinelibrary.wiley.com/doi/full/10.1111/j.1532-
5415.2009.02678.x

Supporting families to care for people with dementia. (2017). Retrieved March 27, 2018, from

http://www.who.int/bulletin/volumes/95/11/17-021117/en/

Urinary tract infection (UTI). (2017). Retrieved March 27, 2018, from
https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-
causes/syc-20353447

Wilkinson, J.M., Barcus, L. (2017) Pearson nursing diagnosis handbook: NANDA-I diagnoses,
NIC interventions, NOC outcomes (11th ed.). Boston: Pearson.