Vulnerability and Risks in Alzheimer’s Care

Introduction

According to the NMC Code of practice, the nurses are required to respect privacy and confidentiality of an individual (NMC, 2018). Thus, to maintain confidentiality and privacy of the patient, the pseudonym Margaret is to be used to mention the patient. Margaret is a 76-years old female who is diagnosed four years ago with Alzheimer's disease and currently, her symptoms are seen to have progressed due to which the individual has to be hospitalised. On admission to the hospital, she expressed to show increased confusion and difficulty in executing familiar everyday tasks. She currently lives with her husband and has 2 daughters along 4 grandchildren. Margaret never smoked and was found to be attending social groups indicating to lead a social life which is disrupted for the law 6-7 month before hospitalisation. Margaret is currently been provided care in the hospital to control her health.

Alzheimer’s disease is a progressive neurodegenerative disorder in which abnormal amount of amyloid protein develop plaques near the brain cells and tau protein tangles the brain cells causing loss of neurotransmitters making the brain to shrink and lose ability to deliver signals leading to express symptoms of Alzheimer’s disease (Moore et al. 2017). In the UK, at present, nearly 900,000 people are affected by Alzheimer's disease that is projected to rise to 1.6 million by 2040. According to current condition, in every 14 individual over the age of 65 is affected by Alzheimer’s in the UK (Alzheimer's UK, 2018). This indicates that the disease is widely present among population in the UK and active steps are required to control its prevalence. The role of the nurse to care for Margaret is to educate her regarding the health condition and way she can improve her health. The nurse's role also includes determining the pharmacological intervention, risk assessment and psychological support required by Margaret and her family to improve her health condition.

Vulnerability and Resilience

The vulnerability in care is referred to the state of the patient being exposed to possibility of being physically or emotionally harmed or abused (Fernández-Calvo et al. 2016). In case of Margaret, she is considered to be vulnerable as she is suffering from Alzheimer's disease which had made her develop hindered cognitive functioning. The strangers in society may cause harm or abuse towards her by taking advantage of her cognitive impairment (Lesuis et al. 2018). As argued by Barbosa et al. (2019), dementia patients are considered as burden of care by the carers. This leads the carers avoid taking effective responsibility of the patient, in turn, making the patient vulnerable to abuse and harm during care. In case of Margaret, during care in the hospital, her incapability to execute everyday tasks may lead the nurses to consider her to be burden of care and show neglect towards her making her vulnerable to face lack of effective care.

The people suffering from Alzheimer’s disease are at increased risk of developing dehydration as they are unable to recognise thirst (Jennings, 2018). In case of Margaret, it is seen that she is suffering from Alzheimer’s disease and have developed dehydration which is going to create risk of lower blood flow and perfusion pressure in the body. This is because dehydration impacts the body to have low blood pressure and reduced blood flow to the muscles making the individual feel fatigued (Kalisch Ellett et al. 2016). As argued by Lin et al. (2017), people suffering from Alzheimer's disease by remaining dehydrated can promote development of urinary tract infection. This is because dehydration leads to create less amount of urine that is unable to clear the bacteria from the bladder that may have entered the body. Thus, Margaret showing dehydration state is going to have increased risk of developing urinary tract infection.

The study by Lee et al. (2020), mentions that people in the advanced stage of Alzheimer's diseases develop the risk of experiencing increased falls and lose ability to develop speech. This is because the brain cells are extensively depleted with advancing Alzheimer making the body lose ability to execute most basic of retaining balance and developing speech. In case of Margaret, it is seen that her state of Alzheimer’s disease has seriously created risk of fall as she has already suffered an injury over her head that could not remember and may have been occurred due to fall. Moreover, it would create communication difficulty for Margret to report her needs. As criticised by Buckley et al. (2016), Alzheimer’s disease leads individuals to experience decline in memory, thinking ability and reasoning skills. The health impacts are going to create risk for Margaret to be unable to execute her everyday chores, get lost from home, hindered ability to make care decision, identify people and lose social activity. The social isolation in Alzheimer’s disease makes people develop feeling of being alone and hindered emotional condition (El Haj et al. 2016). It is seen that Margaret has already been confined to home for her current overexpression of symptoms of Alzheimer’s disease which is going to hindered her emotional state to develop depression regarding her condition.

The resilience in care is individual’s ability to cope and overcome challenging situation regarding their health (Rentz et al. 2017). The protective factor present in case of Margaret is presence of a supportive family. This indicates that her husband along with her daughters can be actively involved in taking her effective care by collaborating with the nurses. As asserted by El Haj et al. (2016), active involvement of the family in caring for Alzheimer’s patients promoted better health of the individuals. This is because a supportive care environment is created for the patient where the individual is physically as well as emotionally supported to overcome the disease. Thus, active family support is going to act in favour of Margaret to have enhanced care from the family. This is because Margaret’s husband can take active care to prevent her from getting lost, avoid face abrupt fall by supporting her during walking, take her for social gatherings, participating to help her manage cleaning and other everyday household activities. It would boost her emotional and physical health, in turn, making her able to cope from risky health consequences of Alzheimer's disease that are developed out of hindered care and support.

The caring for Margaret is to be considered by analysing his lifespan and taking psychosocial approach in managing her condition. According to Erikson’s psychosocial theory, the personality of an individual is mentioned to develop in predetermined order by following eight stages. The eighth stage that is integrity vs despair is developed among individual who are above 65 years (Çelik and Ergün, 2016). This stage is relevant to explain psychosocial activity of Margaret as she is above 65 years of age and falls in this stage. The integrity is referred to one’s understanding of self and development of satisfaction with life. However, inability to develop integrity leads individual to develop despair which is wasted feeling of opportunities in life (Dunkel and Harbke, 2017). In case of Margaret, her Alzheimer state which has rendered her to face loss of memory and ability to perform everyday task would make her feel despair and avoid feeling of integrity. This is because the social isolation along with physical and emotional health complication created out of Alzheimer’s would make her feel dissatisfied with life. Moreover, loss of memory would lead her unable to perform actions on her own to take care making her lose integrity and develop despair. However, through holistic care, the despair can be resolved and satisfaction with life can be enhanced in Margaret.

Holistic Care

Holistic care is referred to complete patient care which considers physical, emotional, economic, social and spiritual need of the individual in response to their health and impact of disease on the ability to meet personal needs (Jasemi et al. 2017). In the case of Margaret, while focussing on to improve her physical health, effective contribution is to be made to enhance her emotional health to deliver holistic care. This is because emotional health and physical health are inter-related to ensure effective response towards clinical intervention on the patient for their well-being and ability to cope with health issues (Murphy and Shwartz, 2018). Thus, without controlling the emotional health of Margret to develop acceptance towards her health condition she may show hindered compliance in accepting care for her physical health issues such as medication, psychotherapy, physical assistance and others in turn creating barrier to enhance her well-being. As commented by Schulz et al. (2017), compassion in care for Alzheimer patient is required to be presented by nurses. This is because it would make the patient feel the nurses understand and recognise their situation as well as lead the nurse delivery empathetic care where they communicate and support the patients by understanding their struggle. Thus, compassionate care is to be delivered for Margaret by the nurses as it would make them show empathy towards them to make them trust and comply with the nurses in availing care.

The NICE guidelines mention that people suffering Alzheimer's are to orally administered donepezil, rivastigmine, memantine and galantamine for their treatment (NICE, 2018). This is because these medications act as acetyl-cholinesterase which works to enhance the acetylcholine levels allowing the nerves cells in the brain to communicate in delivering signals all over the body (Kokras et al. 2018). Thus, use of the medication as pharmacological intervention for Margret is required to control her overexpressed symptoms and confused behaviour as a result of Alzheimer's disease. As argued by Sutcliffe et al. (2016), without inter-professional consultation the primary physicians are unable to understand the psychological support required by the patients to enhance their emotional health that is disrupted by the current health condition of Alzheimer disease. As mentioned by NICE, the primary physicians are required to involve psychologist to determine the therapies to be provided to be patient suffering from Alzheimer’s disease in enhancing their emotional health. The psychological therapies suggested for Alzheimer’s disease include cognitive stimulation, interpersonal therapy and others (NICE, 2018). In case of Margaret, the occupational therapy along with group cognitive stimulation therapy is required to be delivered to Margaret through inter-professional care in which psychiatrist is to be involved along with nurses caring for the patient. This is to enhance her cognitive and social functioning to overcome her fears of health issues related to Alzheimer’s disease along with feeling of isolation.

The progression of Alzheimer's disease leads individuals to depend on non-verbal communication like facial expression, vocal sounds, body language and others (Burgio et al. 2018). This is because with progress of the disease the patients lose ability to develop speech and communicate verbally. Thus, to deliver care to Margaret the nurses require to use non-verbal communication to understand her needs and demands of care and accordingly deliver her care to ensure satisfactory support and well-being. According to Ballard et al. (2018), person-centred care is offered coordinated care by the nurses with the patients by understanding the individual’s specific health need and demands. In case of Margaret, it is seen that she is suffering from dehydration and UTI as additional condition due to Alzheimer disease. Thus, person-centred care for Margaret requires making her drink more water and develop a fluid chart to monitor her fluid intake to control dehydration.

The study by Fasugba et al. (2020) mentions that increased intake of water during UTI leads the individual to develop increased urine to clear the bacteria out of the bladder. Thus, increased drinking of water is to be promoted for Margaret to avoid risk of UTI. As commented by Ballard et al. (2018), person-centred care is to be delivered by showing dignity and respect to the individual. In case of Margaret, to ensure her dignified care the nurses require to make her take informed decision regarding her care and accordingly deliver support. Margaret is seen to face hindrance in balancing her body and perform everyday chores. Thus, in person-centred care for Margaret a social carer is to be allocated to her after release from the hospital along with her husband is to be included in support her health. The assistive devices such as GPS locator, communication aids, home monitoring devices, medication management application and others are to be provided to Margaret. This is because it would help to create independence for Margaret to be able to take her own care by remembering when to take medication, avoid getting lost through GPS tracking and others (National health Services, 2018).

Conclusion

The above discussion informs that Margaret is suffering from Alzheimer's disease that results in memory loss and hindered cognitive function. This makes her vulnerable as she may be considered as burden of care making others to abuse and neglect in providing her care. The risk factors current faced by Margaret due to Alzheimer's disease includes speech development incapability, dehydration and UTI, memory loss, confused behaviour and others. However, the active support from her family is going to help her develop resilience in managing the disease. The NICE guidelines for Alzheimer treatment along with compassionate and person-centred care with effective communication are to be implemented for Margaret to offer her holistic care to overcome physical and emotional complication regarding Alzheimer’s disease.

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