Case Study on Global Burden of Disease

Running head: CASE STUDY
CASE STUDY
Name of the student:
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Introduction:
With the global burden of disease, non-communicable chronic disease has emerged as
one of the leading cause behind premature mortality and morbidity. In Australia, Currently, 9 out
of 10 individuals experience deaths where non communicable chronic diseases are
the underlying cause. Dementia is one such chronic disease that impacted thousands of lives
every year in Australia. In Australia, dementia was the second leading cause of death in 2017
where 9 out of 10 dementia hospitalization involve at least one overnight stay
(Www.aihw.gov.au. 2020). The rate of dementia was 376000 in 2018 which expected to increase
up to 550000 by 2030 (Www.aihw.gov.au. 2020). While Australian population experience
dementia associated morbidity, the comorbid situations are also common amongst the patients
suffering from dementia. The case study involves an 85 years old woman, Mrs Jones who
admitted to the hospital due to dementia. She had a long history of anxiety, COPD and require
assistance in her daily activity. This essay aims to provide an in-depth discussion regarding the
pathophysiology of one of the medical condition along with contributing factors with the
assistance of ageing theory. This essay will also incorporate relevant ageing theories and ethical
consideration while providing care. Two medications along with their side effects will be
incorporated in the essay. Lastly, this essay will discuss the model of care and strategies that can
provide Mrs Jone with a purposeful and quality life.

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Discussion:
Pathophysiology of dementia and associated risk factors:
While the case study highlighted a range of diseases experienced by the patient, dementia
has been chosen for discussing the pathophysiology, risk factors and relevant theories associated
with ageing. Dementia has emerged as a symptom of arranging of structural brain diseases where
Alzheimer’s disease is the most frequently occurring dementia. As observed in this case study,
the patient had a long history of Alzheimer which might be the reason behind the development of
dementia. Considering the pathophysiology of dementia, dementia is caused by the damages to
the brain cells which interfere with the ability of the brain cells to communicate with each other
(Karas et al., 2016). Due to risk factors of dementia, the damage to the vasculature observed
amongst patients which resulted in cerebral occlusion, hypoxia and hyperperfusion along with
deposition of amyloid protein which resulted in cognitive impairment. Apart from the vascular
Dementia, all forms of dementia include extracellular plaques of the amyloid and intracellular
tangles of hyper-phosphorylated tau which resulted in a neural loss, synapse and atrophy
followed by cognitive impairment (Ashby-Mitchell, Burns, Shaw & Anstey, 2017). According to
the amyloid cascade hypothesis, due to the presence of genetic, environment and lifestyle factors,
altered Amyloid Precursor Protein processing resulted in overproduction of amyloid-beta and
plaque formation (Ricciarelli& Fedele, 2017). The simultaneous oxidative stress and
neuroinflammation are also common in case of Alzheimer associated dementia amongst the
patients. Consequently, patients experience neural loss, difficulties in involving in daily
activities, limited mobility, confusion and anxiety.
Harrison (2020), highlighted that the cognitive decline and dementia are multi-causal
where risk factors such as smoking habit, age, family history dementia, high cardiac risk factors,

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physical inactivity, diabetes and increases the risk of developing late-life dementia amongst the
patient. The researchers suggested that the majority of the patients with a high risk of developing
dementia exhibit anxiety, hypercholesteremia and lung diseases, indicating these are the common
risk factors of developing dementia. Taking a deep insight into the situation, the patient had the
medical history of hypertension, hypercholesterolemia, type two diabetes, anxiety and
osteoarthritis. Patients with hypertension are at high risk of developing dementia since high
blood pressure damage and narrow the blood vessels of the brains as observed in this case.
Moreover, since the patient had diabetes where the brain cell has limited ability to use insulin, it
might be the risk factor for dementia (Martins, 2017). The patient had a history of COPD due to
severe smoking which might be the risk factor for developing dementia. The underlying reason is
that low level of oxygen, carbon die oxide along with cerebrovascular damage by smoking
resulted in oxidative stress followed by dementia (Cherbuin, Walsh & Prina, 2019). The case
study suggested that the patient is 85 years which might be the contributing factor behind the
development of dementia. This can be explained through the theory of oxidative stress which
suggested that due to obesity, smoking cigarette and ageing, increased imbalance in redox state
increase oxidative stress that resulted in neural dysfunction followed by dementia (Liguori et al.,
2018). On the other hand, sociological theory such as disengagement theory of ageing suggested
that ageing is inevitable and mutual disengagement with the society is common with ageing
which resulted in social exclusion and low physical activity. In this current context, it can be said
that she is 85 years widower which limited her physical activity and social connections as she
used to visit gardens with his husband.

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Impact and ethical consideration for dementia:
The diagnosis of dementia has a huge impact on patients and caregivers. McCabe, You
and Tatangelo (2016), suggested that patients diagnosed with dementia often experience shock,
fear, loss, anger, disbelief and grief along with depression and anger. Therefore, Mrs Jones may
experience disbelief, grief, anger and loss. The patient may experience financial loss due to long
hospital stays, limited mobility, social isolation, confusion and difficulties in locating resources
along with a change in personality (Donnelly, 2016). Due to dementia, the patient may lose the
capacity of rational thinking which may interfere day to day activities as observed in this case.
The physical health impact is the loss of appetite, difficulties in swallowing and difficulties in
toileting (as observed in this case study).
Since patients experiencing dementia often exhibit an inability of making rational decision
making, ethical dilemma regarding autonomy and beneficences are the common challenges
raised in the clinical setting. In this context, while caring for the patient suffering dementia, the
nursing professionals must comply with the care that can restore the autonomy of the patient and
family members and beneficence for the patient. Therefore, before providing her with the care,
informed consent must be obtained from her family members as she was incapable of making a
decision under the mental capacity act (Donnelly, 2016). On the other hand, the nursing
professionals must provide advance care for the best interest of the patient (beneficence) without
harming the patient (non- maleficence) (Blake, Doray & Sinclair, 2017).
Medications of the patients:
This section will discuss the mechanism of action of two medications provided to the patient
along with their side effects associated with the disease experienced by the patient.

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Rivastigmine :
Rivastigmine is a parasympathomimetic or cholinergic agent used for treating mild to moderate
dementia of patients as observed in this case.
Considering the mechanism of action, it is carbamate derivative analogue to
physostigmine which binds to the cholinesterase in a reversible manner for inactivating
cholinesterase. Consequently, inhibition of cholinesterase increase the level of brain
acetylcholine and allow nerve cells to communicate with each other (Ray et al., 2020).
Consequently, it improves memory, awareness, and concerns along with the ability to perform
daily activities. Considering the ADME Principle, while absorption of the medication is not well
understood, Volume of distribution of 1.8 to 2.7 L/kg. Approximately 40% of the drug binds to
plasma proteins. G it is rapidly processed by cholinesterase-mediated hydrolysis which
eliminated through renal excretion. Less than 1% of the drug is excreted thorough faeces.
Considering the side effects of the drug, the common side effects of the medicine
experienced by the patient include Nausea, vomiting, weakness, loss of appetite, frequent
diarrhoea, drowsiness, along with shakiness (Ray et al., 2020). Since the patient had dementia
and GORD, these factors are required to consider while administrating the medication.
Spiriva:
Tiotropium bromide is sold under the Spriva which is a long-acting bronchodilator provided to
the patient for the management of Chronic Obstructive Pulmonary Disease of patients as
observed in this case.
Considering the mechanism of action, it acts as a bronchodilator which relaxes muscles in
the airways and maximizes airflow to the lung. It acts as an antagonist of muscarinic receptors
M1 to M5. M3 receptor inhibition in the smooth muscle of lungs resulted in a relaxation of the

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smooth muscle followed by Broncho-dilation. Reddel et al. (2017), suggested that 33% of an
inhaled solution reaches the systemic circulation, while oral administration has a bioavailability
of 2-3%. Considering the ADME Principle, after absorption, it reaches to the maximum
concentration within 5 to 7 minutes. The volume of distribution is 32L/kg and approximately
72% of the drug in the plasma is protein bound. The route of elimination for the drug is through
urination where 74% of the drug remains unchanged.
Considering the side effects of the drug, the common side effects of the medicine
experienced by the patient include dry mouth, vomiting, constipation, nose bleeding and muscle
pain. Since the patient had dementia and GORD, these factors are required to consider while
administrating the medication.
Model of care and strategies for improving the quality of life:
As discussed in this case study Mrs jones who admitted to the hospital due to dementia
and had a long history of anxiety, COPD. In this context, butterfly model of care would be an
appropriate model of care for providing the best possible care. Petriwskyj et al. (2016), suggested
that the Butterfly Model include compassion and empathy into the care by designing a house
with bright colours, intimate space for the energetic care process. The model incorporates
emotional intelligence and core belief that each person with dementia can live a purposeful life
as a whole. Additionally, the patient can be provided with reminiscence therapy which is a
treatment used for all assisting patients for remembering the events through senses such as smell,
touch, sound and sight (Elias, 2018). The patient can be supported with the respite care along
with the caregiver who will assist patient in the activity of daily living (ALD) such as eating,
bathing, getting dressed, toileting, transferring, and continence (Rathnayake, Jones, Calleja &
Moyle, 2019). On the other hand, she can be provided with housing facilities as a resource with

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proper lighting and non-skidded floor for preventing sudden fall as the patient had a history of
delirium and cognitive impairment. An occupational therapist can be recruited who will assist the
patient in enhancing the functioning and social participation as she used to love music and she
was an active member of PROBUS. The patient can be involved in mild to moderate physical
activities which will improve symptoms of diabetes, hypercholesterolaemia and hypertension as
physical activities improve insulin sensitivity, reduce cholesterol and improve blood pressure
(Brett, Traynor, VStaple & Meedya, 2018)... She can be supported with psychotherapy such as
cognitive behavioural therapy for reducing anxiety. Technological support such as wire-based
device can be provided as a resource can be provided to her for preventing fall and wandering.
Her family members can be involved in the care process for promoting collaborative holistic care
and they can be provided with health literacy to support the patient. Dementia Australia is one
such as a national organization that can provide support to such patients and she can be referred
to the organization for better management.
Conclusion:
On a concluding note, dementia has emerged as one of the leading cause that impacted
Thousands of life. Dementia is caused by the damages to the brain cells which interfere with the
ability of the brain cells to communicate with each other. According to the amyloid cascade
hypothesis, due to the presence of genetic, environment and lifestyle factors, altered Amyloid
Precursor Protein processing resulted in overproduction of amyloid-beta and plaque formation.
Due to dementia, Mrs Jones may experience disbelief, grief, anger and loss. The patient may
experience financial loss, limited mobility, social isolation, confusion and difficulties in locating
resources. In this context, while caring for the patient suffering dementia, the nursing
professionals must comply with the care that can restore the autonomy of the patient and family

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members and beneficence for the patient. In order to support the patient, butterfly model of care
would be an appropriate model of care for providing the best possible care since it includes
compassion and empathy into the care by designing house with bright colours. The patient can be
provided with reminiscence therapy which is a treatment for retrieving senses. It will empower
her and provide her with a purposeful life.

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