Ruth Livingstone was a 65-year-old African-American woman brought to the agency by her son. I first met Ruth during her admission day where we collected details of her medical past. Her son had noted that Ruth was recently having memory problems, she would forget to eat or she would cook a number of different meals. The recent scare was when she had left a pot on the gas and caused a fire in her house. Her son, Roy, saw the need to seek medical care for her.
We diagnosed Ruth with early stages of Alzheimer’s disease. She presented with signs of memory loss. Although she could still recognize her son, she had no recollection of the activities of the previous week, including the fire. When asked about how the fire started or how she got the burns on her hands, Ruth was not able to give an explanation. In an effort to ensure the memory loss was not due to the traumatic experience, other memory tests were conducted where we found that she would tell accurate stories about her children and how she was brought up but she had trouble giving information about her husband and her marriage to him. Roy explained that she had recently started having conversations with his father, who died six years ago. Also, she presented signs of changes in moods and difficulty identifying the passing of time. There was a need to admit her to the facility since our treatments would be most effective at this early stage of the disease.
Goal
The client came in with a number of treatment goals that the agency should meet. The goals include improvement or retaining the cognitive abilities, and retaining the emotional memories and processing abilities. We provided the son with a number of intervention options that we would provide to Ruth. The intervention programs included cognitive therapy practices, mental and social stimulation, and emotion related interventions. The emotion-based treatments will focus on the patients’ feelings with an intention to improve their quality of life. One of the programs used in this field is validation therapy, which is based on the idea that it is best to enter the reality of a person with dementia than to bring them back to reality. This is a way for caregivers to build trust and create a sense of security for the patient. It is most beneficial in reducing the number of conflicts with such a patient. This form of therapy is based on the idea that people who have short-term memory loss may not be in a position to intellectually think about the situation or make sense of their current situation (Alzheimer’s Australia, n.d.). Such patients are likely to go in and out of the present in an attempt to resolve their past unfinished conflicts and relive their past experiences. For instance, in Ruth’s case, the application of this program would allow her to have a conversation with her deceased husband as if he is still alive.
Ruth would also benefit from Reminiscence therapy, which is an emotion-based therapy program applied with the aim of reaching the viable memories in a patient’s brain. Studies show that this form of therapy is effective in enhancing an Alzheimer’s and dementia patient’s cognitive capacity and helps them participate in normal activities. The therapy is conducted through group or one-on-one discussions where patients share their memories (Schmid, 2011). The process involves the evaluation of the memories to identify the emotions and feelings surrounding their memories. Other therapies can be integrated during this program such as music therapy. Music is one of the ways to stimulate people’s memories. For instance, a song can help a patient relive their wedding day or the birth of their child. Such therapeutic practices exercise the patient’s brain memory capacity, resulting in a positive feedback that is likely to improve the patient’s quality of life.
Other intervention programs can include cognitive therapy approaches that focus on a patient’s mental abilities like reasoning and perception. Such interventions provided in the agency include cognitive stimulation, cognitive rehabilitation, and cognitive training. All these programs would be useful to Ruth being that she is still in the early stages of the disease. Cognitive stimulation is intended to engage the patient in normal everyday tasks that can stimulate their mental activity (Choi & Twamley, 2013). One of the techniques in the agency is reality orientation. Here, a reality orientation board with items like famous faces and present day information is shown to the patients. The therapy practices include continuously reminding patients of information using items like food to create a continuity in the information. Cognitive stimulation practices are designed for patients with sufficient cognitive resources for computer programs or a professional therapist to guide them in a drill designed to exercise different cognitive abilities. This form of therapy is based on the idea that practicing a certain cognitive skill repeatedly creates the potential to improve that skill (Choi & Twamley, 2013). The program would be beneficial to Ruth who still has some well-functioning cognitive skills. The agency uses certain software applications that focus on a patient’s cognitive domains like spatial memory, divided attention, and object discrimination. For instance, Cognitive-Motor Intervention is a combination of cognitive exercises like reality orientation and normal day-to-day activities.
Cognitive rehabilitation is a more comprehensive program that includes the use of different approaches in a rehabilitation setting (Choi & Twamley, 2013). The model uses programs of cognitive training, cognitive stimulation, and other similar approaches. The approach is designed to meet an individual’s dementia progress. In the agency, Ruth would receive cognitive rehabilitation practices like cognitive stimulation aimed at proper orientation of times and places, computer drills to practice and train for attention and processing speeds. Other practices will include training and rehearsing normal day-to-day activities like shopping and paying bills.
Needs
During the evaluation of Ruth, before her admission, other medical problems were discovered and there was a need to make referrals. We found out that she had incurred a more extensive burn injury and fracture of the elbow during her previous fire accident. We referred her to the burn unit of a neighboring hospital to get further treatment of the burns. Also, in the same hospital, we referred her to an orthopedic specialist to check on her fracture. It is common for Alzheimer’s patients to incur accidents that may seem as being clumsy at first but with time one can note the frequency and seriousness of the injuries increases. Also, they may have difficulty expressing themselves in regards to the place of their bodies where it is painful. Without a thorough examination of the patient, such injuries can be missed. It is necessary for the physicians to have skills on how to deal with Alzheimer’s patients. In addition, we found that Ruth, who was once a teacher, would no longer read her favorite books as before. We attributed this to an eyesight problem probably related to aging. As such, we referred her to an optician where she was to get prescribed reading glasses.
Crisis
The current crisis in Ruth’s life was her failure to eat or drink anything and her tendency to get violent if people did not agree with her or if forced to eat something. During her admission, her son explained that she had not eaten for almost three days. There was an immediate need to find a way to solve the current crisis. We started out by asking Ruth what her favorite foods and drinks were and the places she liked eating. With time, she was warm to the idea of eating an apple, which was her favorite fruit.
Recommendations
Based on a thorough medical evaluation on Ruth, we found that she was still in the early stages of the Alzheimer’s disease. As such, most of her cognitive abilities are still intact and her memory loss is not progressive yet. Based on these symptoms, she can benefit a lot from the services provided in this agency, especially those geared towards her cognitive capabilities and emotion-based programs. With regards to emotion-based treatment programs, we recommend that Ruth goes through reminiscence therapy. As explained, she still has most of her life memories and this form of therapy can further help improve her mental abilities. The reminiscing process would integrate different items like photos and familiar music. Family photos showing her past memories and her life history would be beneficial to help her recall and retain these memories. Other recommended treatments include activities of cognitive stimulation, training, and rehabilitation. That involves engaging the patients in activities like puzzle games or memory games and arithmetic problems. The activities will be geared towards meeting the goal of retaining her current well-functioning cognitive skills and an attempt to improve these abilities further and decrease the rate of their deterioration. With time, if her memory loss progresses and her cognitive training and rehabilitation are no longer beneficial, then we can focus on a goal of improving her quality of life. That would include the use of validation therapy where we will no longer be focusing on bringing her back to reality but joining her reality. This form of therapy is for patients in the progressed stages of Alzheimer’s disease who have more memory loss. The therapy will be implemented at a time when Ruth can no longer have intellectual reasoning but the current treatment strategies are intended to delay such progression of the disease.
With the intention of meeting the goal of improving her quality of life, we recommended that her caregivers, including her son to enroll in caregiver education programs. By doing so, they would learn more about the disease, what to expect from Ruth, and the best way to deal with her. People with Alzheimer’s need more care as the disease progresses and it is important that the caregivers in her life understand what is expected of them and the options they have if and when they are no longer capable of providing her with the best care at home. During the recommended programs, they will be taught how to help people while keeping their abilities functioning as well as possible. Additionally, the caregivers will understand more about the disease and solve practical and day-to-day problems that are related to the patient. The programs can also refer the caregivers to support groups that are near their places of residence. Sometimes, programs focus more on the patients and they forget that the caregivers need support too. Studies show that caregivers training programs can help in dealing with the challenging behaviors that come with people with dementia and Alzheimer’s disease. Such training can tell them how to reduce challenging behaviors like restlessness and aggression and help them know how to cope when this kind of behavior is exhibited by a patient.
Other recommendations include the referrals about other medical injuries and conditions that we found during her medical examination. It is necessary that we seek the necessary treatment in relation to her burns and fractured elbow. Also, getting prescribed reading glasses would enable Ruth to participate in activities that could help calm her down and participate in activities of cognitive training and rehabilitation. Normally, in the agency, we deal with patients who were brought in during the progressive stages of their disease. In such cases, there is not much we can do but to only improve their quality of life. However, in the case of Ruth, there is much more that we can do for her and ensure her state does not deteriorate very fast. We explained these facts to her son with the intention that he would consider the recommendation provided and most importantly seek the best treatments to improve his mother’s condition. We mostly insisted that he considered the option of taking the caregivers’ education program together with other caregivers in Ruth’s life. By doing so, they would learn the basics of how to help Ruth and what symptoms to look for and when they should seek professional help.
References
Alzheimer’s Australia. (n.d.). Therapies and Communication Approaches. Retrieved from https://fightdementia.org.au/national/support-and-services/carers/therapies-and-communication-approaches
Choi, J., & Twamley, E. W. (2013). Cognitive rehabilitation therapies for Alzheimer's disease: A review of methods to improve treatment engagement and self-efficacy. Neuropsychology Review, 23(1). 48-62. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596462/pdf/nihms444923.pdf
Schmid, J. (2011, June 21). Reminiscence and Alzheimer’s Disease. Best Alzheimer’s Products. Retrieved from http://www.best-alzheimers-products.com/reminiscence-and-alzheimers-disease.html
