Advanced Health Assessment for Dementia Management

This essay discusses the procedures for advanced health assessment aimed at the management of elderly patients suffering from dementia. It explores the use of the unmet needs model, behavior charts, incident reports, and corrective action reports. The essay emphasizes the importance of a multidisciplinary approach and patient-centered care in dementia management.

Running head: ADVANCED HEALTH ASSESSMENT
ADVANCED HEALTH ASSESSMENT
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1ADVANCED HEALTH ASSESSMENT
For the deliverance of quality nursing and achievement of positive health outcomes in the
patient, nurses must engage in the conductance of health assessment - one of the most basic and
yet essential components of nursing practice (Shen, 2015). An advanced health assessment aims
to incorporate a holistic perception towards patient needs by evaluating underlying
psychological, behavioral, social and familial and social factors which may have contributed to
the existing patient condition. Such comprehensive assessments hence, direct the execution of a
holistic management and care plan for the concerned clients (Ndiwane et al., 2017). Dementia is
a neuro-degenerative disease and comprises of age-associated deficits in cognitive functioning,
memory, thinking, logical reasoning and thinking. However, dementia associated with emotional
issues and symptoms of discomfort in patients is beyond merely physiological in nature but is
also a result of underlying behavioral and social factors – hence, necessitating the conductance of
a comprehensive, advanced health assessment framework which may dictate future execution of
quality care and management standards for the elderly residing in an aged care facility (Fry &
Wolfe, 2018). Hence, the following essay aims to discuss procedures for advanced health
assessment aimed at management of elderly patients suffering from dementia, using the ‘unmet
needs model’, and associated usage of behavior charts, incident report and corrective action
reports. The administration of such advanced health assessment tools comprising of inclusion of
unmet needs model, behavior charts, incidence reports and corrective action will contribute to
the client management plan by instructing gerontological nurses on the need to adopt
multidisciplinary, patient centered approaches for administered comprehensive screening and
treatment for dementia patients (Braun, 2019).
The purpose of an advanced health assessments lies in its ability to screen relevant
causative factors underlying the physiological, behavioral and social conditions dictating the

2ADVANCED HEALTH ASSESSMENT
behavior of a concerned patient. Hence, prior to the development of an advanced health
assessment tool, understanding and evaluating the present behavioral issues and shortcomings
affecting the patient is of utmost importance (Tepeil et al., 2017). As researched by Kar (2009),
dementia is accompanied by an amalgamation of detrimental psychological and behavioral
symptoms which not only hinder the achievement of positive health outcomes in the patient but
also disrupt the performance of associated clinical staff and aggravate care expenditures. Hence,
the advanced health assessment framework aimed at care management of elderly dementia
patients must seek to address, assess and target the psychological and behavioral symptoms to
ensure deliverance of quality care (Maidment et al., 2018). Dementia patients, due to their
experienced loss in cognitive functioning and reasoning skills, resulting in behavioral issues of
violence, aggression, restlessness, agitation, attention-seeking behavior, coupled with associated
psychological symptoms of depression and apathy (Kar, 2009). Lack of timely mitigation and
conductance of required assessments result in aggravation of such condition leading to
psychosis, social isolation and alterations in personality such as screaming, reduced perception,
decreased optimism, speech abnormalities and compromised abilities to perform activities of
daily living. In addition to the physiological implications of dementia, the associated behavioral
symptoms are often the resultant of a trigger due to surrounding environmental and social factors
– hence calling for advanced assessment frameworks (Azermai, 2015). Hence, as researched by
Kar (2009), it has been implicated that non-pharmacological interventions aimed at
encouragement of social interaction, environmental modification, minimization of sensory
deficits and behavioral interventions have been proven to beneficial in the management of the
above identified issues in dementia patients. Hence, to administer the same, an assessment of the
external causative factors underlying aggressive and violent behavior is of utmost importance

3ADVANCED HEALTH ASSESSMENT
which is why the advanced health assessment framework of dementia management must
incorporate a multidisciplinary Aged Care Assessment Framework which may comprise of an
Aged Care Assessment Team (ACAT) and comprehensive assessment tools of behavior charts,
incident reports and corrective action reports (Carthwright et al., 2015). The amalgamation of n
advanced health assessment framework consisting of an unmet needs models and behavior,
incidence and corrective action reports will aid in client management by dictating gerontological
nurses and ACAT on the need to adopt patient centered, shared decision making approaches to
address the underlying causative factors of BPSD in dementia (Rapaport et al., 2018).
As a gerontological nurse, working in a nursing home involved in the provision of
specialist residential services, for the management of dementia patients, collaborative
functioning with the ACAT is of utmost importance. Considering the multifaceted nature of
behavioral and psychological symptoms administered by dementia patient, a key responsibility
of the ACAT and gerontological nurse is to understand and assess factors which may be causing
BPSD (behavioral and psychological problems in dementia) hence necessitating inclusion of the
‘unmet needs model’ as a key assessment tool coupled with multidisciplinary ACAT assessments
of behavior charts, incidence reports and correction action reports (Black et al., 2019). As
postulated by the unmet needs model, emergence of problematic behaviors in individuals result
due to an interplay between factors such as sub-optimal environment, presence of current
physiological and psychological issues and lack of equilibrium between present personality and
lifelong habits (Muñoz et al., 2019). Hence as per the unmet needs model, dementia patients may
be engaging in acts of violence, aggression, pacing and speech abnormalities as an attempt to
communicate unmet and unaddressed biological needs such as alleviation of discomfort, social
needs such as eagerness and want of engagement in social interactions and psychological needs

4ADVANCED HEALTH ASSESSMENT
such as need to feel comforted, secure, empowered or optimistic (Choi & Park, 2016). Hence,
taking insights from the research by Cohen- Mansfield et al., (2015), advanced health assessment
with the aid of the unmet needs model as a collective, comprehensive assessment tool can be
used by the gerontological nurse and the ACA T to assess and identify the unaddressed needs of
the patient which may have been misinterpreted as BPSD due to ineffective communication and
dementia associated impairments in patient cognitive functioning. Hence to identify the same, as
researched by Park et al., (2018), an assessment as per the unmet needs model must comprise of
multiple assessment tools such as administration of cognitive measurements such as Mini Mental
State Examination (MMSE) and Pain Assessment in Elderly Persons (PAINE), agitation and
affect measurements such as Agitated Behaviors Mapping (ABMI), Lawton’s Modified
Behavior Stream, nursing observation of patient behavior and Type of Unmet Need Assessment
(TUNA) in order to identify unmet needs of social interaction, discomfort, pain or additional
psychological needs for the overall assessment of BPSD and risk assessment of engagement in
violent and aggressive behaviors among dementia patients. Incorporation of such unmet needs
assessment tools will aid gerontological nurses and the ACAT in the evaluation of the risks
underlying dementia patient safety and discomfort levels as part of client management in
advanced health assessment (Braun, 2019).
It has been implicated that that administration of non-pharmacological interventions
comprising of modifications of the environment, initiation of social interactions, minimization
of sensory deficit impact, behavioral interventions, provision of training for carers and staff have
been proven to be beneficial in the management of BPSD in dementia patients (Kar 2009). As
researched by Cohen-Mansfield (2004), the concept of progressively lowered threshold states
that patients suffering from dementia, with disease progression, lose their capabilities of coping

5ADVANCED HEALTH ASSESSMENT
and hence, result in their perception of the surrounding environment as stressful. Hence, taking
insights from the unmet needs model as well as the above threshold concepts, geronotolgical
nurses must collaborative function with the ACAT team, to not only comprehensively assess
unmet needs and factors initiating patient stress, but must also seek to be trained followed by
implementation of care management techniques of re-stimulation of an non-stressful
environment to the dementia patient (Dyer et al., 2018). As researched by Azermai (2015), non-
pharmacological interventions such as music, massage and animal assisted therapies, ADL and
cognitive stimulation and deliverance of psychosocial support educational programs
disseminated to care givers and nurses, have been implicated to be advantageous in dementia
care management due to their administration of a holistic, comprehensive and multidisciplinary
principles of care targeting multifaceted needs of the dementia patient. Such non-
pharmacological interventions are currently recommended as first line interventions of dementia
care management in comparison to pharmacological interventions (Barton et al., 2016).
Pharmacological interventions at present, are recommended to be administered due to their
ability to mitigate dementia associated BPSD for only immediate or short term time periods
and provision of the same in the first line of treatment result in lack of consideration of long
term emotional, psychological and social needs of the patient further escalating to BPSD
symptoms of anger, aggression and discomfort (Morrin et al., 2018). Additionally,
pharmacological interventions are associated with negative health consequences such as decline
in cognition, falls and associated fractures, stroke and deep vein thrombosis which are majorly
absent in non-pharmacological interventions. Hence, advanced health assessment framework for
dementia management must encompass formulation of care priorities in terms of identification of
the required non-pharmacological and pharmacological interventions as per the identified unmet

6ADVANCED HEALTH ASSESSMENT
needs in the patient followed by administration of the same using multidisciplinary collaboration
between the gerontological nurse and ACAT (Harrison, Aerts and Brodaty, 2016). However,
additional research and findings are required to support and evaluate the underlying procedures
or evidence directing claims of the beneficial effects associated with pharmacological
interventions. While the benefits associated with music or animal assisted therapy in dementia
may be implicated to the resultant effects of increased circulation of well-being and memory
enhancing serotonin in dementia patients, negligible evidence exists to strengthen such claims
(Ray & Mittelman, 2017). Alternatively, non-pharmacological interventions such as providing
training to support as well as administration stimulation training may prove to be beneficial due
to their association with a patient centered approach to treatment (Cabrera et al., 2015). Patient
centered approached to treatment encompasses direct involvement of patient’s needs and
preferences in the care management. Considering that BPSD in dementia is associated with
unmet needs of social interaction, cognitive abilities and need for comfort and security – the
incorporation of a patient centered approach characteristic in these interventions may implicate
there advantage (Foster et al., 2019). Administration of a patient centered approach has been
associated with enhancement of positive perceptions of empowerment, dignity and comfort in
the patient along with treatment emphasis on unique disease symptoms. Hence, taking insights
from the association between cognitive-social deficits and unmet needs assessment in dementia -
identification of required non-pharmacological techniques must be incorporated in the advanced
health assessment for dementia management by the gerontological nurse and ACAT since it will
aid in patient centered based management of BPSD in dementia clients (Ballard et al., 2018).
Considering prevalence of BPSD symptoms of violence and aggression among dementia
patients, the gerontological nurse and multidisciplinary ACAT team, must seek to assess unmet

7ADVANCED HEALTH ASSESSMENT
needs of security, comfort and communication in dementia patients, as per the unmet needs
model, by performing additional assessments such as behavior charts, incident reports and
corrective action reports (van der Steen et al., 2015). Using the Department of Health’s
recommended Poole’s Algorithm assessment tool, the gerontological nurse can formulate
behavior charts of dementia patient which seek to screen and discuss the underlying medical and
non-medical factors causing violent behavior hence resulting in addressing unmet needs of safety
and security in the patient (Department of Health, 2019). Additionally, multidisciplinary
documentation activities by the collaborative work between the ACAT and gerontological nurse
such as incident and corrective action reports may also prove to be beneficial. Such
documentation strategies coupled with behavior charts, not only address the unmet needs of the
patient, the underlying causes of falls and recording of aggressive patient situations according in
the nursing home – but also adopt patient centered approaches by considering underlying
preferences, perceptions and unmet needs of social interaction in the patient (Campbell, 2017).
Hence, as researched by Traynor, Inoue and Crookes (2011), advanced health assessment must
incorporate patient centered care and shared decision making for conductance of the above
multidisciplinary assessments since these address unmet needs of patient safety and security as
per the unmet needs model assessment. To incorporate the same, the Alzheimer’s Australia has
necessitated training health professionals on skills of effective communication, meaningful
activities and strategies using webinars, workshops and training frameworks as part of their
nationally accredited Vocational Educational Training program (Layer et al., 2016). Hence, the
gerontological nurse and ACAT must consider incorporation of such vocational programs in
advanced health assessment so as to adopt patient centered approaches in dementia BPSD
management (Rapaport et al., 2018).

8ADVANCED HEALTH ASSESSMENT
However, despite the presence of such as quality nursing and care standards of dementia,
the same is not without shortcomings. As reviewed by Dening, Jones and Sampson (2011), it has
been observed that there continues to remain a lack of nursing guideline emphasis on the need to
address unmet psychological needs of dementia patients. The review also noted excessive
nursing emphasis on cognitive diagnostic assessments and end of life care as emphasized by
proxy of power of attorney in healthcare organizations resulting in consideration of patient
centered unmet needs. Further a lack of sufficient evidence validating benefits of non
pharmacological interventions as per their pharmacological counterparts for dementia
management is a key shortcoming as well. Hence, the need of the hour is to administer a patient
centered multidisciplinary approach to dementia management by using assessment frameworks
such as ACAT and the unmet needs model (Klapwijk et al., 2018). Further to strengthen claims
on non-pharmacological interventions and their benefits, conductance of further evidence based
research is of utmost importance. Further, to administer quality dementia management, usage of
behavioral charts, incidence and corrective action reports is recommended (Chow et al., 2019).
The gerontological nurse can do the same by using behavioral assessment frameworks such as
Poole’s algorithm. Likewise, collaboratively working with the ACAT to draft underlying causes
of aggressive behavior, case control and incident reports can be formulated using frameworks
like the six sigma and PDSA cycles (Plan Do Study Act) (Berry, Young & Kim, 2017). Hence,
to conclude gerontological nurses and the ACAT, must provide a patient centered, shared
decision making collaborative client management practices, for which, conductance of an
advanced health assessment consisting of assessment frameworks like the unmet needs mode,
behavioral charts, case control reports and incident reports is of utmost importance (Braun,
2019).

9ADVANCED HEALTH ASSESSMENT
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