Introduction:
“Dementia” defines a clinical syndrome exemplified by long-term decline in mental functional ability, such as waning intellectual abilities, in a conscious individual. The primary symptoms of dementia include loss of memory, decline in cognitive abilities such as learning and comprehension, judgment, communication, and loss of attention and orientation to oneself and time aspects. In addition, the patient may present hallucinations and delusions in form of paranoia in advanced stages (Raydin & Katzen, 2013).
The syndrome is a progressive condition that worsens with time. The experiences of the condition among patients may vary, just like the several causes that trigger the development of the syndrome. Studies have documented that dementia prevalence is higher in women aged between 65 years and beyond as compared to men (OECD, 2014).
The purpose of this report is to determine appropriate standards for Dementia Care Units and to establish criteria for these units in providing care to patients or residents. The adopted model seeks to provide care with an encouraging inclination and affirmative quality of life, patient protection and optimally personalized. This aspect defines care that espouses rights, dignity, health, comfort, and autonomy with the least restrictive environment.
Causes of Dementia:
The primary cause of dementia is the Alzheimer’s disease, which accounts for about 60 percent of all cases. Alzheimer’s disease affects the brain tissue by forming clumps in the brain protein and thus interfering with the functionality of the brain-cells. With the deterioration of the brain-protein interferes with the cognitive hemispheres of the brain, and hence, an individual depicts the aforementioned symptoms. Moreover, dementia may result from such diseases affecting the supply of blood into the brain. This type of dementia is termed as vascular dementia, and it is the second most common brain. The blood vessels supplying blood to the brain are affected by stroke-inducing condition, by presence of protein deposits, and thus interfering with the brain physiology (Brooker & Lillyman, 2013).
In the advanced stages of dementia, patients may be incapacitated from their daily activities. Their ability to communicate or understand instructions progressively declines. The patient may suffer depression and neither recognize their surroundings, relatives or friends. Consequently, these individuals require assistance in their daily lives, such as, support to personal tasks like cooking, cleaning and washing. In later stages, they may need constant aid moving them around on a wheelchair (OECD, 2014). It is thus critical to redesign the environment in which dementia patient resides for the ease of executing daily operations and enhancing their quality of life.
Dementia Care Unit:
A dementia care unit is an entity that provides care to patients suffering from a related condition. The care services are provided in designated and isolated areas limited to public access. The placement of individuals suffering from the syndrome is done after a rigorous verification process through clinical diagnostic practices. Such units are therapeutically designed to appear home-like and conducive to meet the needs of patients (Brooker & Lillyman, 2013).
Staff assists the patients; that is medical practitioners and nurses. The staff encourages and aids patients in accomplishing their personal and institutional responsibilities and commitments, such as attending the vegetable and flower gardens, reading, writing or as per distinctive work-related interests among the residents. These occupational plans enhance the cognitive abilities of the patients by keeping them active throughout the day (Schoene, Delbaere & Severino, 2013).
Standards for Dementia Care Units:
The development of conducive environments for patients exhibiting dementia syndrome is critical to the management of the condition since there is still no cure. This development involves the removal of physical barriers, enhancing communication and instructional media, special lighting and safety enhancements. It should be noted that these units must appear home-like and favorable to boost the mental and physical functioning of the body systems towards sustaining normal lives among the patients (Raydin & Katzen, 2013).
Size:
The aspect of size may be defined in the number of beds per unit or in terms of area available per patient. The idea of fewer beds in a care unit was investigated by comparing a specialized care unit against traditional care facilities which hosts many beds in a single room. This unit had fewer beds with ten patients living in the six available self-contained bungalows. A fundamental aspect is the provision of comfort and home-like atmosphere that offers more choice of occupational activities, familiarity to the ambience and privacy (Brooker & Lillyman, 2013; OECD, 2014).
In this study, patients from the traditional care facilities were transferred to a more spacious dementia care units. Initially, the patients would dine on spaces accommodating up to 20 residents on one table. However, the new dining spaces accommodated eight to ten residents. It was noted that there were fewer agitation and aggressive behaviors within the new dining arrangements than in the prior settings on mapping the behavior data after a week. In addition, the support staff seemed to have more opportunities to sustained conversations with the patients in the new dining settings as compared to the former dining areas.
It is imperative that the support staff provides personal relationships among the patients. In this study, it was evident that with increased personal contact, the patients manifested progressive development of self-esteem and improved state of well-being. In a qualitative comparison in cases-scenarios where support staff failed to forge compassionate relationships among the patients, psychological conditions were noted to aggravate. Patients showed heightened levels of anxiety, aggression, depression and other psychotic conditions such as paranoia (OECD, 2014).
Safety:
Improving the home environment would entail proper illumination, and removal of obstructive objects, within the rooms and along pathways. In addition, due to low muscle strength among the aged, their bedrooms, bathrooms, and other use facilities must be convenient and easily accessible. High and steep levels, such as staircases, are risk prone areas, which only aggravate falling incidences must be eliminated (OECD, 2014). It is essential to install supportive structures such as handrails and bars, along walkways and other frequently visited areas. It is also advisable to have supporting staff around, in case of an emergency; patients have died after falling, sustaining injuries, and remaining on the floor for long (Erkal, 2010).
Physical exercises program:
In managing dementia, physical exercises have been documented to offer benefits in enhancing both the physical capacity of the body and mental abilities. The syndrome extends to the psychological facets as well, and hence, it is critical to protecting the patient’s mental health from progressive damage. This aspect implies that it is advisable to extend care, stimulate enthusiasm and confidence in the patient through physical activities. Progressively, the patient shall learn to appreciate his or her state, as a step towards recovery (Lim & Sung, 2012).
The need to customize the patient needs must be in line with the intervention program. Patients, often, exhibit different clinical symptoms, which implies that their physical exercise plan must be customized to suit the unique needs. The needs could be physiological or environmental related. For example, in alleviating falls among mobility and cognitive impaired adults, a pilot study in Norway administered a home based training program that sought to improve on the reactive responses and cognitive parameters.
The treatment program involved the use of exercises based on a computer game software, Dance Dance revolution (DDR). The game involved consistent and multi-directional foot stepping, with a series of computer-generated directions. The game required synchronized foot movement-instructions in the right timing.
The essence of the game was to challenge co-ordination and balance, reaction time and reactive responses, as well as attention to instructions and activity. Such a practice was consistent with the treatment of neuropsychological related conditions, which entails exercise to the physical and mental states of the patient, to enhance recovery.
After the eighth week, an evaluation test revealed that most of the patients who adhered to the intervention program had improved on their cognitive parameters. For example, many of the participants showed attentiveness to instructions, improved central processing speeds, movement balance, and reactive responses despite a poor start (Schoene et. al., 2013).
For optimal success in any intervention program, it is necessary to adopt a practice that stands compatible to what is best for the patient, and in line with the priorities of particular clinical organization.
Recommendations:
Provision of a conducive home-like environment is of prime significance to the care of patients and in the management of dementia. The term ‘conducive’ implies a safe and private; that is offering adequate residential spaces. In addition, providing therapeutic conversations to patients promotes the state of mental awareness and subsequently developing self-awareness abilities (OECD, 2014).
In dispensing care to dementia patients, it is important to not only focus on the physical needs only, such as nourishment, but it is essential to include activities that enhance the recovery of their cognitive abilities through mental involving activities. Moreover, it is essential to diagnose and identify the particular needs of each patient, for a successful intervention program (Schoene et al., 2013).
Repeatedly, the support staff stereotypes the symptoms presented by one patient across all patients. Ultimately, this becomes a major bottleneck to an appropriate intervention plan to the individual needs of every dementia patient.
Conclusion:
The traditional setting entails patient isolation and restriction of patients to beds. By limiting the movement of patients and spending more time on the bed sleeping, patients show a declined state of mind, agitation and depression. In addition, this inactivity results to weakening of the body and loss of mobility functional; that is, overtime patients present an inability to walking. In the model of a home-like environment, it is important to provide a range of activities to sustain the patients in an active mode and committed to their social roles (Erkal, 2010).
The support staff ought to establish personal, sympathetic relationships with the residents, and help them in occupational activities. Such activities include attending to small gardens within the facility, reading, and music and dancing, cleaning and laundry, and cooking. These activities must be implemented in a safe and secure environment, which gradually enhances the mental and physical functionality of the patient (OECD, 2014).
References:
Brooker, D., & Lillyman, S. (2013). Dementia Care. Hoboken, Taylor and Francis. http://public.eblib.com/EBLPublic/PublicView.do?ptiID=1583372.
Erkal, S. (2010). Home Safety, Safe Behaviors of Elderly People, and Fall Accidents at Home. Educational Gerontology, 36(12), 1051-1064. doi:10.1080/03601277.2010.482482
Lim, Y., & Sung, M. (2012). Home environmental and health-related factors among home fallers and recurrent fallers in community dwelling older Korean women. International Journal of Nursing Practice, 18(5), 481-488. doi:10.1111/j.1440-172X.2012.02060.x
Organization for Economic Co-operation and Development (OECD). (2014). Unleashing the Power of Big Data for Alzheimer's Disease and Dementia Research Main Points of the OECD Expert Consultation on Unlocking Global Collaboration to Accelerate Innovation for Alzheimer's Disease and Dementia. Paris: OECD Publishing.
Ravdin, L. D., & Katzen, H. L. (2013). Handbook on the neuropsychology of aging and dementia. New York, NY, Springer. http://dx.doi.org/10.1007/978-1-4614-3106-0.
Schoene, D., Lord, S. R., Delbaere, K., Severino, C., Davies, T. A., & Smith, S. T. (2013). A Randomized Controlled Pilot Study of Home-Based Step Training in Older People Using Videogame Technology. Plos Clinical Trials, 8(3), 1-8. doi:10.1371/journal.pone.0057734
Appendices:
Appendix A: Scheduled Activities
Appendix B: Therapeutic activities.
Appendix C: Health & Safety.
