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This essay will focus on an individual the writer has been involved in caring for during a community practice placement. It will give a brief and relevant history about the patient. It will describe the term ‘biopsychosocial’ and how it is related to holistic care with specific reference to Dementia. For the purpose of discussion, the essay will focus on an individual with early onset dementia and will discuss biopsychosocial factors affecting this client group and the prognosis of the condition. In line with Nursing and Midwifery council (NMC, 2008) confidentiality will be observed throughout this work. However for the facilitation of discussion, the client will assume the name Gonzo.
It has been highlighted by Campbell and Rohrbaugh (2006) that the term biopsychosocial refers to the relationship amongst biological, psychological and social aspects of an individual. It is imperative to look at the patient as a whole when caring for patients as it entails embracing the spiritual, social, emotional, physical and intellectual needs during assessments and treatment as they are necessary to all human beings as indicated by Clarke and Walsh (2009).
Gonzo is a 64 year old male patient who was diagnosed in year 2000 with Alzheimer’s type Dementia (Young Onset) according to World Health Organisation (WHO, 2007). However his wife also reported that he had been presenting some of the symptoms about four years prior to his diagnosis and it is also around the time he had a cardiovascular accident on his right side which slightly affected movement of his right eye and speech. He had reported to his wife that his parents gave him away at a very young age thus leaving him growing up in an orphanage until the age of thirteen. He did very well at school and prior to him being diagnosed with this condition he had been running his own business. He had stated to his wife that he does not wish to end up in an institution. His wife finds it difficult to cope and feels he now needs a respite so she can have a break.
Through reading his notes I found that due to the progression of his condition his wife started managing the finances of the business but he felt like she was taking over. Already he had started avoiding his friends and relatives. Furthermore he had held his wife tightly in an angry manner leaving her bruised which is something he had never done previously. At the moment he attends a day centre where he used to play table tennis when he first attended but now he cannot even raise the bat.
However dementia is a condition due to disease of the brain cells usually of a long lasting or progressive nature. The brain changes by decreasing and shrinking showing that some of the nerves connection established early in life and die later in life (Norman I and Ryrie I, 2009). There are many types of dementia and manifestation of dementia can only be taken into account by the relationship between neurological impairment, physical health and social resources (Woods and Clare, 2008). Stroke is known to step up the risk of dementia and to advance the onset of degenerative disease such as Alzheimer’s disease (Bridges J, 2005). Neurotransmitters’ activity in turn affects how the individual processes information in turn may affect behaviour as indicated by his physical aggression towards his wife.
Health psychology deals with the physical health in association with the psychological health. When cognition has been affected it means the physical wellbeing will also suffer in the sense that people would end up not attending to their activities of daily living and eventually basic activities (Gross and Kinnison, 2007).
It has been indicated that the declining of cognition maybe a precursor to people with dementia as they will come to experience changes in their cognition, language, behaviour and personality limiting their daily functioning (Warren M, 2008).
Hence all the changes Gonzo has been exposed to make feelings of anxiety and frustrations worse.
Woods (2007) indicated that people with early onset dementia are encouraged to face familiar immediate environment and building up of memory and maintaining cognitive functioning. Moving to a nursing home for respite would make it difficult for Gonzo to have social interaction with friends as some of them might have difficulties to visit mainly because of distance. Furthermore (Bercedis, 2008) stated that relocation and life events can lead to deterioration for people with dementia as this is associated with depressive or disturbed behavioral. However Mittelman et al, 2006, indicated that living at home has some positive advantages for the person with dementia yet a nursing home placement has been reported to create a more confused state. Although this would have a big impact on this client group their caregivers are also exposed to some stressful situations as they would be experiencing a loss.
According to Perren et al (2006) states that where there is a loss or threat of resources stress occurs and may improve when there is a resource profit. Providing day care services for example a day centre would not only be including the patient but also taking some of the burden from the caregiver. Furthermore the psychiatric needs of patients with dementia not only do they affect the individual with the condition. They also affect the health and well being of their caregivers as well as all those in the household for they would be vulnerable to suffering from psychological burden because they would be providing constant care (Boustani et al, 2007).
It is felt that there are several factors that affect people with different types of dementia. Woods and Clare (2007) highlighted that the sense of self is known to be threatened by the disintegration as a result from symptoms and loss of functioning, loss of social networks and reduced personal interactions. These early stages have been described to be very painful by Gonzo as he is aware of the painful changes (Balfour, 2006). For instance Gonzo has already started avoiding his friends and feels his wife is already taking control of his life. Woods and Clare (2007) went on to state that care and support can be drained from a psychosocial knowledge of the dementia process which entails. Whereas this would be including the holistic care that would meet all the needs of an individual. For example Gonzo had already expressed that he would not want to end his life in an institution but he had been lacking some of those social interactions other spending more time with his wife.
Furthermore his wife would need a respite of which this would have been contradictory to his beliefs. According to Woods and Clare (2007) the progression of dementia has major impact on relationships and a sense of loss regarding the future as people would no longer be able to do things together like they used to in the past. However Jacoby stated that the risk of dementia progression increases as people get older with increasing social isolation and minimum contact with friends and relatives. The writer feels this would have an impact on Gonzo as he still has slight insight of his illness because of the connotations linked to the most developed stage of this condition. The stigma attached to the term dementia leaves patients with this diagnosis being seen as no longer having any psychological needs leading on to patients using behaviour to communicate unmet needs.
Sociology is the understanding of the world we live and aspects of human behaviour (Haralambos et al, 2000). According to Dilts (2001), in life there is ample evidence which suggests that the loss of confidentiality, public’s view and knowledge, perception, isolation and discrimination from social interaction has harmful effects to humans. According to Clark & Bond (2000) caregivers are exposed to restricted lifestyles, loss of privacy, lack of social interaction, reduced commencement of social activities and limited time for hobbies when the people they care for have been diagnosed with dementia. In situations like this it is best to provide patients with home care or day care packages or respite so as to give their carers a break.
In view of the above I have learnt that biopsychosocial and holistic care all play an important role in healthcare and should use them when carrying out patients’ assessments as they focus on the needs and presentations of an individual without leaving any aspect of need as it may affect the actual reason why people respond the way they do. When looking at the holistic approach in nursing care, this extends to the dimensions that are looked at when looking at an individual. Biopsychosocial factors all play an integral part to all individuals with dementia and they should be treated as individuals with their rights. It is difficult to point at one perspective as the causative to Dementia. I have also learnt that biopsychosocial factors affect family and significant others who live day in day out with the patient and that they should be included when addressing the needs of the patient. If its believed to be from a biopsychosocial perspective then interventions should take the same approach to address the problem.
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