Impact of Ageing on Psychological Health

Impact of Ageing on Psychological HealthIt should be noted that all names of individuals and places in this report watch been changed in regulate to foster the patients confidentiality (Nursing midwifery council 2009). Therefore the patient exit be known as Mrs. dark-brown.Mrs Brown is an 86 year old lady who lives with her elderly husband. match to Mrs Brown husband they have two sons together and 3 grandchildren, they both visit occasionally. She used to work as a secretary until she retired in her betimes 60s. She clearly had a good memory. She enjoyed travelling abroad, with her husband. For many years she had attended services at the local church where she was well known .as a kind, warm-hearted normal lady in her town for the good things she did. Mrs Brown clinical notes written by her community intellectual health nurse states that she was diagnosed with lunacy the Alzheimer disease 12 years ago. Alzheimers is a brain disease that precedents problems with memory, t hinking and behaviour. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks (online www.alz.org/alzheimers_disease 21/02/11). Her husband has been her main c ber ever since. She attends a day centre once a week and has carers coming in twice a week to assist with individualal care. The staff at the day centre has also reported that Mrs Brown now showed no interest and was reluctant to acquiesce with activities which showed that she had lost sense of pleasure.Mr Brown stated that before the diagnosis, they were several episodes when she got lost and was picked up by police to be returned at home.Mrs Brown become disorientated roughly where she was because of her hallucination. She became confused about time. She pass on also miss her doctors appointments .Mrs Brown couldnt even remember her sons names later on recognise her husband and would lose stinger of conversations.Mr Brown stated that he made an appointment then to see the general practitioner (GP) who then referred them to the memory clinic where she was diagnosed with Alzheimer.In the last year Mrs Browns mental and physical health has deteriorated rapidly. She can no longer do her activities of daily living and she needs support with personal care. Her behaviour has gradually become much and more eccentric that her husband is no longer copying.Mrs Brown was recently admitted to hospital with chest and urinary tract infection, which would also increase her take of cloudiness and lack of orientation (Adams 2008).Although now discharged from hospital Mrs Browns sleep pattern was disturbed, she now wanders around at night.She has become more physical and verbally strong-growing towards her husband, Mr Brown has raised concerns that he can no longer cope with her behaviours to her CPN.The community mental health team have been monitoring Mrs Brown break for some time now and liaising with the family, GP, social worker and psychiatrist r egarding her care and support as required by the Department of health (DOH 2001), in social intercourse to older people (over 65yrs) with mental disorder.Mr Brown was considering looking for permanent placement in a nursing home for his wife.Mrs Brown was prescribed the following for her crazinessDonepezil hydrochloride/Aricept 10 mg once daily at bedtime is a reversible inhibitor of acetylcholinesterase.They are for the adjunctive treatment of moderate Alzheimers disease. Like all other medical specialty donepezil has its side effects which are nausea,vomiting,anorexia,diarrhoea,insomnia,dizziness and agitation just to mention a few.(Source British National Formulary 2007)There is currently no cure for Alzheimers disease. However, they are some drug treatments are available that can ameliorate the symptoms or slow down the disease progression in some people such(prenominal) as donepezil, Exelon ,reminyl and galantamine these drugs maintain the supplies of the acetylcholineThe (N ational Institute for Health and Clinical Excellence NICE 2011) available online, states that these drugs are recommended as an option for people in the mild-to-moderate stages of Alzheimers disease.Older person presentationDementia is the general term used for diseases affecting the brain, including Alzheimers disease it is characterised by progressive cognitive impairment and the emotional and behavioural problems that result from the cognitive downfall (Sungaila Crockett,1993 citied in Tappen,R 1997).There are many different types of madness although some are far more common than others. They are often named harmonize to the condition that has caused the dementia. They are Alzheimer disease which is the most common cause, followed by the vascular dementia, dementia with lewy bodies and fronto temporal dementia these are the common ones.To rule out that individual has dementia test has to be carried out .Winter (et al 2001) states that there are different illnesses that appear to affect the brain in ways that can cause symptoms similar to dementia. Winter (et al 2001) describes these as people with underactive thyroid gland, deficiencies of certain vitamins and general physical illness can give rise to symptoms of dementia, vile concentration and poor memoryln the case study Mrs Brown was diagnosed with Alzheimers below the author describes what Alzheimer is and its features which lead to the diagnosis.Miriam (1994) describes Alzheimers disease as a brain disease accompanied by characteristics microscopic structural changes in the brain tissue leading to the death of brain cells.lt is the most common cause of dementia in the UK.The stolon signs of Alzheimers disease include lapses in memory and problems with finding the right words (Alzheimer society available on line).In normal ageing memory lapse are common as we get older. Also the person mood changes Particularly as the parts of the brain that control emotion becomes affected by disease. store lo ss is the most common potential impact on the psychological ageing. Remembering everyday tasks becomes a chore.People with dementia may also step sad, frightened or angry about what is happening to them.The person with Alzheimers may start to have communication problems like inability to recall names quickly, decline in co-ordination and control of speech and action.Feeling and becoming lost in familiar surroundings. slightly of these symptoms where noticed in Mrs. Brown.Depression is other symptom for dementia (Tappen R, 1997) states that many individuals in the early stages of Alzheimers disease are also clinically depressed. Some of the behavior exhibited by Mrs. Brown may have been caused by that she was depressed.Some of these features led to the diagnosis that Mrs Brown was suffering from Alzheimer as she was exhibiting these problems. Once a diagnosis of dementia has been made, the next stage volition be to assess its cause.Mrs Brown had a series of tests and examination t o exclude disease in the rest of the body and to rule out some other brain conditions. The persons memory will be assessed, initially with questions about recent events and past memories. Given these problems Mrs Brown was exhibiting, and the in-put from the community nurse it was agreed that she required further assessment to determine her level of cognitive impairment. This was done by using the mini mental state examination (MMSE) developed by Folstein et al (1975), with consent Mrs Brown scored 12, which indicated severe cognitive impairment. According to Miller (1999) to examine specific cognitive impairment a Mini Mental state examination is used .The National institute of health and clinical excellence (2011) recommends that this tool be used for determining a persons suitability for the anti-dementia drugs such as Aricept which was prescribed to Mrs Brown.Aronson M,k (1994) suggests that it is appropriate to include a compendious list of complete blood count, vitamin B12 le vel, thyroid function test and brain inspect as MMSE may not offer clues to their presences.A brain scan may be carried out to give some clues about the changes taking place in the persons brain. There are a number of different types of scan, including computerized imagination (CT) and magnetic resonance imaging (MRI).Vascular dementiaAlzheimer society (2010) describes vascular dementia as a type of dementia caused by problems in the add of blood to the brain. There are two main types of vascular dementia one caused by stroke and one caused by small vessel disease. It is the guerilla most common form of dementia The risk factors associated with Vascular dementia, as indicated ,are those associated with cardiovascular disease and include lofty blood pressureDiabetesDeficiencies of certain vitaminsHigh cholesterol levelsDieses in arteries elsewhere in the body and rhythm abnormalities(Soucers Martin 1998, Gould 2002, Taylor 2006).People with Vascular dementia may experience these symptomsproblems concentrating and communicatingdepression accompanying the dementiasymptoms of stroke, such as physical weakness or paralysisepileptic seizuresPeriods of acute confusionhallucinations (seeing things that do not exist)delusions (believing things that are not true)physical or verbal aggressionrestlessnessIncontinence.Dementia with Lewy bodiesDementia with Lewy bodies (DLB) is a form of dementia that shares characteristics with both Alzheimers and Parkinsons diseasesPerson with lewy bodies may have these symptomsA person with DLB will usually have some of the symptoms of Alzheimers and Parkinsons diseases.fall asleep very easily by day, and have restless, disturbed nights with confusion, nightmares and hallucinationsFaint, fall, or have funny turns.(Source Alzheimer society 2010) good and ethical issues surrounding people with dementiaDementia raises difficult ethical issues for people with dementia, for their formal and informal carer and for society in general. Forma l carers are pay and trained to perform their caring role those bear on in Mrs Brown care were GP, community mental health nurse, and social worker. Informal carers usually is provided by family and in Mrs Brown case it was her husband and children.Tappen R (1997) states that ethical issues include the often painful decisions that must be made about restrictions on liberty, or end of life decisions and the legal issues include patients rights, abuse, neglect and incapacity.Myron F and Wiener M (2004) suggested that legal issues are best addressed while patients still have the capacity to understand and communicate while ethical issues begin at the time of diagnosis and may include whether to tell patients about their diagnosis.The key pieces of commandment surrounding people with dementiaThe Mental health Act 1983 amended 2007-it protects the rights of people who have been assessed as having mental disorder including dementia.lf a person with dementia is behaving in a way that i s risking other and his/her health can be detained in hospital using this act.The Mental capacity act 2005 (implemented 2007) designed to protect people who cant make decisions for themselves or lack the mental capacity to do so.Recognised that in some circumstances ,being placed in a hospital or care home may deprive individual of their liberty.Deprivation of liberty safeguards code of practice (2008)-DOLS in practice provide guidance for professionals involved in administering and delivering the safeguards. The Code is also intended to provide information for people who are, or could become, subject to the deprivation of liberty safeguards, and for their families, friends and carers, as well as for anyone who believes that someone is being deprived of their liberty unlawfully (department of health online).Before Mrs Brown dementia became severe, when she still had capacity, they had sat down with his husband .They discussed about future blueprint on what to do with everything i ncluding her care.Mrs Brown choose her husband to be her durable power of attorney for all her health care needs and property. Myron F Weiner, M (2005) states that with appropriate durable power of attorney, Mrs Browns husband can consent to her medical care, but the patients wishes if known, must be respected.Mrs Brown capacity was limited to live singly or make her own choices, inorder to respect her autonomy her husband and family were involved in taking active steps to act as advocates and to try and labour her autonomy.As Mrs Brown diagnosis was early she and her family had time to plan about her preferences on treatment and facilitate support from community organisation.Mrs Brown was treated or care for justly by everyone involved in her care. Everyone worked together to create an environment that is safe, sustaining her dignity and optimizing opportunities for independent decision making and functioning.Ethical problems carersBalancing risks and freedomAvoiding telling the truth to prevent distressHow to manage conflict between caring for the person with dementia and other commitments.Those caring for people with dementia typesetters case ethical problems in caring out day to day care, these problems are important and stressful, those providing care receive little support and providing such support will improve good dementia care.Conclusion