Assessment and Care Management for Dementia Patients

Assessment

When assessing for dementia, it is important to determine the persons baseline cognitive status. Nurses, family members, and caregiver play an important role when it comes to this task. They know the person well and can observe for precise changes in behavior. They can be helpful when giving information about whether certain behaviors are normal for the individual. Assessing for these behavioral changes can be challenging if the individual lives alone. If the individual lives alone the responsible party, neighbors, friends, or the institution that provides transportation services may be able to provide this information.

Early detection of symptoms is important. In many cases, the exact type of dementia an individual has may not be confirmed until death. This is when the brain can be closely examined. Medical assessments provide vital information when assessing older adults for dementia. Nurses are essential when assessing patients with dementia. A nursing assessment involves the holistic evaluation of all facets of a patient’s lifestyle, including a comprehensive review of current functioning levels, mental abilities and limitations ((Bewick, 2016).

Determining whether any underlying treatable conditions are present should initially be assessed. A thorough medical history and physical exams are important roles of the nurses, physicians, and the health care team. Neurological test that assess balance, sensory response, reflexes, and other cognitive functions can help identify conditions that may affect the diagnosis or may be treatable with medications. Laboratory tests are just as important. They can test levels of various hormones, chemicals, disorders, vitamins, fluids, and can help with ruling out possible causes of symptoms. Lab testing should always be a required part of the initial assessment process.

 It is imperative not to attribute dementia to older age. Assuming that dementia is present should also never occur. All older adults need to have a formal assessment when assessing for the presence of dementia. Performing cognitive and neuropsychological tests are critical parts of the assessment process. The Mini-Mental State Exam (MMSE) is considered a general test of cognitive status that assists with identifying mental status impairment.  Although this test alone is not adequate for diagnosing dementia, it represents a brief standardized method to assess mental status and can provide a baseline from which to track changes. Other tools that can be used when conducting dementia assessments during doctor or nurse visits include the Mini-Cog, Memory Impairment Screen, GPCOG Screening Test. These tests are very useful tools that can be utilized by nurses. They examine orientation, attention, memory, language, praxis, and visuospatial function. 

Care Management Goals

Nurses provide care for people with dementia in hospitals, long-term care facilities, and the community.  Nurses should work with families and staff to teach best practice approaches to care and providing education and support. Due to the increasing rise in Dementia, nurses have a huge role in the design and implementation of evidence-based practice and provision of education, counseling, and supportive services to individuals with dementia and their caregivers (Touhy & Jett, 2018, pp. 340-343).

 Maintaining function, preventing excess disability, and maintaining physical and in-home safety are some of the overriding goals for older adults with dementia.

Nurses can assist with the creation of a therapeutic milieu that nurtures the individuality of the person and maintains quality of life. It is important that nurses provide and perform in-home safety checklist monthly and/or as needed. Being mindful of potential hazards outside of the home is also considered a nursing care management goal.

Nurses are responsible for implementing and supervising most of the activities of daily living for patients that have dementia. It is important that nurses encourage physical activity involvement. Physical activity has many benefits that include preserving strong joints and muscles, reducing the onset and progression of dementia, decreasing risks of cardiovascular disease, and improving cognitive function and overall well-being. Nurses can help with educating patients and determining realistic exercise goals that are appropriate for each individual.

Proper nutrition is vital for dementia patients. Nurses need to ensure that a well-balanced diet is provided. Foods that are high in saturated fat, cholesterol, refined sugars, and sodium should be limited. As dementia progresses, loss of appetite and weight loss can become a problem. Doctors may suggest supplements between meal to add calories. Nurses need to always be aware of any signs of imbalanced nutrition and must intervene appropriately.

  Nurses should also be sure to encourage fluids often. One of the biggest issues that dementia patients face is dehydration. Their ability to recognize that they are thirsty can be impaired. Dehydration can be very problematic and will further increase confusion in older adults which can exacerbate symptoms of dementia. Making sure that water is accessible when needed is important. Nurses and/or caregivers should have the individual take sips of water frequently. Help from a dietician or nutritionist may need to take place.

Providing support for families and caregivers is a very important role nurses have. Family often have moral obligation to take care of their loved ones that have dementia. Family members may experience many different emotions and feelings throughout the different stages of dementia. Nurses can prepare families with educational material regarding respite services and community support services that are available within the community. Nurses can also recognize and address caregiver role strain and coping mechanisms. Nurses are in a unique position to offer care that maintains dignity and comfort throughout all stages of dementia including when individuals can no longer meet their own personal care requirements (Bewick, 2016).

Overall, nurses have powerful roles and can make all the difference when it comes to care management goals.

Pharmacologic Therapies

Most types of dementia cannot be cured. However, there are ways that symptoms can be managed. According to an article written by (Mayo Clinic, 2019), medications currently licensed for use in treating dementia include cholinesterase inhibitors such as Galantamine, Rivastigmine, and Donepezil. Cholinesterase inhibitors work by boosting levels of a chemical messenger that is involved with memory and judgement.  Common side effects that must be considered include nausea, vomiting, diarrhea, fainting, and slowed heart rate. NMDA antagonist such as Memantine is another medication that is commonly used for dementia. Memantine works by regulating the activity of glutamate. Glutamate is another chemical messenger that is involved in brain functions, such as learning and memory. Memantine is sometimes prescribed with a cholinesterase inhibitor. Dizziness is the most common side effect of Memantine. It is important that fall precautions are implemented and maintained. Unfortunately, these medications do not stop the progression of dementia but it has the potential to slow it down.

References

• Basics of Alzheimers Disease and Dementia. (2017, December 31). Retrieved November 29, 2019, from https://www.nia.nih.gov/health/what-dementia-symptoms-types-and-diagnosis.
• (NIA, 2017)
• Bewick, T. (2016, December 6). Nurses can make a difference: caring for those living with dementia. Retrieved November 29, 2019, from https://journalofdementiacare.com/nurses-can-make-a-difference-caring-for-those-living-with-dementia/.
• (Bewick, 2016)
• Dementia. (2019, April 19). Retrieved November 29, 2019, from https://www.mayoclinic.org/diseases-conditions/dementia/diagnosis-treatment/drc-20352019.
• (Mayo Clinic, 2019)
• Touhy, T., & Jett, K. (2018). Gerontological Nursing & Healthy Aging(5th ed.). St. Louis, MO: Elsevier Mosby.
• (Touhy & Jett, 2018, pp. 340-343)