Dementia Care: Assessment, Intervention, and Evaluation

This study focuses on the assessment, intervention, and evaluation of dementia care using physical exercise therapy. It includes a dialectic analysis of dementia and identifies mobility and ability to perform daily activities of living as the primary patient health need. Literature review highlights the effectiveness of physical exercise therapy in improving physical and cognitive functions. Implementation and evaluation of the exercise program are discussed, and the study concludes with implications for future practice. Subject: Healthcare, Course Code: N/A, Course Name: N/A, College/University: N/A

Running head: DEMENTIA CARE
Dementia Care
Name of student:
Name of university:
Author note:

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Introduction
Dementia is a neurodegenerative disorder causing progressive decline in the mental and
cognitive function of the individual suffering from it. Research indicates that dementia’s fit with
the social model of disability implies that care for dementia patients goes beyond clinical
approaches. The hallmarks of person-centered care are approaches for addressing physical
dexterity, loss of recognition ability, and cognitive impairments. At the core of person centered
care lays the need of conducting an accurate assessment of the patient to understand his current
mental and physical health status. The rationale is that a whole-person approach is ideal since it
takes into consideration all ability, needs, preferences values and qualities of the individual. A
dialectical analysis is helpful in the process of providing dementia care since it helps in
clarifying the interventions adopted as per the best interests of the people. The present paper
constructs an assessment of a dementia patient using the dialectic model and discusses how one
area of need had been addressed. The patient considered for the assessment was Mrs. Jones who
had been diagnosed with dementia and struggling to cope up with it. The paper includes the
dialectics of dementia as applicable to the patient. One area of health need was identified through
thorough analysis. Literature review has been done to understand the effectiveness of
interventions applicable for the client. Implementation and evaluation of activities form the next
part of the paper. Implementation for practice and conclusion ends the paper in a systematic
manner.
Dialectic of dementia
The research of Kitwood indicates that diagnosis of dementia is linked with changes
physical and mental changes. Different factors that influence the persona of a dementia patient

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are personality, biography, neurological impairment and social psychology (Manthorpe and Iliffe
2016).
Personality- Patients suffering dementia are often seen to undergo personality changes. Such
changes are a key feature of the disease and chances of undergoing such changes increases as the
diseases progresses (Terracciano et al. 2017). Mrs. Jones had a drastically different personality
previous to her diagnosis of dementia. She had been a social personal all her life. She was a
working woman who opines that she had a fulfilling career. This indicates that she had a healthy
relationship in the workplace, a feature that is a result of pleasing and warm personality.
Health status- Changes in health status of a dementia patient is linked with a number of other
factors such as physical exercise and mobility. The extent to which the patient is functional
influences the progress of the disease (Dewing and Dijk 2016). In the present case Mrs. Jones
had retired long back thus implying that she developed a sedentary lifestyle that progressed with
the passing years. Living alone also brought limited scope to carry out extensive activities in
daily lives. She also received limited support with the activities of daily living. All these factors
contributed considerably to the poor health status. The risk of fall is essentially linked with
impaired mobility as in case of Mrs. Jones. It is also noted she had suffered urinary tract
infection in the recent past along with previous history of chest infections. These two diseases
also have lead to poor health status.
Neurological impairment- Neurological impairments are due to decreased functionality of body
parts with passage of time. Such impairments usually develops over a considerable period of
time which be resisted under certain circumstances. For the case of Mrs. Jones it can clear that
the life events had a direct relation to her neurological impairment. She mentions that she has no

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major role in her household after her retirement. This had been the situation for more than ten
years, a time frame adequate to increase the risk of poor neurological condition.
Social psychology- Social isolation and feelings of being lonely are associated with the higher
chances of decline in clinical dementia condition in later stages of life. Such social psychology
has been noted to be a major risk factor for depression, vascular diseases and other conditions.
Signs of depression are a signal to a prodromal stage of dementia. Vulnerable populations need
appropriate interventions to reduce depressive symptoms (Butcher et al. 2018). Mrs. Jones has
been living alone in her apartment with minimal visits from her only son. Due to decreased
mobility her social life is not noteworthy. It was clear from the patient assessment that feelings
of depression were a result of social isolation as she lacked contact with family members and
other members of the community. It is rightfully an objective state as her condition could be
measured by her statements.
Intervention delivered and evaluation
A thorough analysis of the condition of the patient brought into focus that the primary
patient health need was mobility and ability to perform daily activities of living in an
independent manner. Based on current knowledge of dementia care practices it was understood
that physical exercise therapy could act as the suitable intervention for Mrs. Jones.
Literature review of physical exercise therapy
Physical exercise therapy brings significant improvement in balance, strength, endurance
and mobility in patients suffering from dementia and cognitive impairment. A number of studies
have indicated physical exercise training is beneficial for improving the quality of life of
patients. Exercise training has been denoted to bring positive changes in physical as well as

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cognitive functions. As pointed out by de Souto Barreto et al. (2017) effects of physical exercise
on physical functioning has been noteworthy in case of dementia and the main areas of
development include balance, step length, improvement of strength, TUG, and walking speed.
Though the evidence supporting improvement in BMI, and dual-tasking ability as a result of
physical exercise therapy is poor, the evidence supporting reduction of falls is valuable. It is to
be remembered that specific training is more importance for impairment level outcomes. Thus, it
is crucial to carry out a comprehensive assessment of the patient’s physical functioning for
determining the particular areas of deficit. The rationale is that such an assessment ensures that
the appropriate form of exercise is integrated into the program for addressing the impairments
that the patient faces (Lamotte, et al. 2017).
Lam et al. (2018) carried out a systematic review with studies with meta-analysis of
randomized trials to understand whether physical exercise training is effective in improving
quality of life of patients suffering from dementia. The study also aimed at understanding which
training protocols are useful for improving physical functioning. The key inference drawn from
the study was that regular multimodal exercise in adjunct with aerobic, resistance, balance,
functional and flexibility training for one hour a day, 3 days a week, brings in much
improvement in physical function. The chosen intervention is thus a feasible option for dementia
patients as the benefits clearly outweigh the risks. Long term effects of the intervention are to be
further analyzed through research. Suttanon et al. (2010) carried out a study to assess whether
balance exercise programs can improve balance as well as related physical performance
measures in dementia patient. The systematic review considered studies where participants were
assisted with physical, balance or exercise activities. Findings suggested that feasibility of

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conducting exercise programs with older dementia patients is justified. Balance performance is
improved in patients as a result of whom the risk of suffering falls is reduced significantly.
The study of Zeng et al. (2016) was based on the research that activity in a suitable
clinical environment is responsible for exciting the brain on a cognitive and bodily level which is
beneficial for achieving improved brain plasticity in dementia patients. The meta analysis
focused on assessing the impact of physical exercise on dementia patients. It was concluded that
physical activity training can successfully improve the condition of Time up and go (seconds),
Function Reach (cm), NPI-caregiver total score, steps/min, Cadence, and Berg Balance Scale.
The studies also reflected that physical activity training brings in a number of advantages for
dementia patients such as better athletic ability, balance ability. For healthcare professionals, the
outcome is beneficial since they reduce the burden on the care givers to a considerable extent. In
this regard the study of Lindelof et al. (2017) is to be brought into limelight. A qualitative
interview study was conducted to explore the experiences and views of dementia patients who
underwent high-intensity functional exercise (HIFE) program in nursing homes. 21 individuals
took part in the study. All of whom were older dementia patients, and the program comprised of
exercises performed in functional weight-bearing positions. These included movements used by
individuals in everyday tasks. The exercise was individually designed and performed during four
months in the respective nursing homes. The four themes that emerged from the interviews were
“Exercise is challenging but achievable; Exercise evokes body memories; Exercise gives
pleasure and strength; and Togetherness gives comfort, joy, and encouragement”. The study was
a valuable one since it was clear from the results that the tailored exercise enabled the patients to
adapt to it. Further, the exercises gave them pleasures and patients could rediscover bodily

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capabilities. The study emphasized that the patients were given an opportunity to develop
feelings of safety, coherence and encouragement.
Lamb et al. (2018) recommends that exercise training program is carried out by a
professional who can supervise the program with desirable skills and knowledge. For those who
suffer from mild to severe dementia, the training is to be received from those who have received
training in the same field. It is further required to focus on the training protocol and adhere to the
guideline outlined for different patient scenarios.
Implementation
The literature review highlighted the suitability of implementing physical exercise
therapy for Mrs. Jones given that she needed improvement in her mobility and ability to carry
out daily activities of life. The exercise training implemented thus had three crucial
considerations. The first consideration was to minimize the problems arising due to the decline in
the physical health of the patient that is decreased mobility. The second consideration was to
recognize behavioral changes that might arise when the patient is agitated with the intervention
implemented. The third consideration was to support the patient’s willingness to continue with
the exercise program. Assessing the condition of Mrs. Jones and her age, it was thought
appropriate to implement a low-intensity exercise program at the usual level of activities of daily
living. Aerobic exercise was the mode of training for the patient in order to address her
condition. This included enjoyable aerobic activities that involved large muscle exercises. The
patient was also encouraged to walk on a regular basis. The goal was to bring improvement in
the functional health of the patient. Further, such exercises increase endurance that is necessary
for community ambulation (Brooker and Latham 2015). The sessions continued for 40-60

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minutes and such sessions were carried out three times a week. The sessions were broken down
into smaller 20 minutes activities. The emphasis was on enjoyment perceived by the patient so
that adherence to program was achieved. Further focus was also given to increase the duration by
increasing the time of walking exercise. The program continued for two months.
Evaluation
During the early stage of the program, it is recommended to support to patient to take part
in the physical activities. Motivation is pivotal to commence with the program. In case of
dementia patients, this is more crucial since patients tend to show distracting behaviors (Muller
et al. 2017). In the present case the patient did not show any such reluctance to take part in the
activities outlined. Willemse et al. (2015) highlight that vital problems related to implementation
of training programs for dementia patients is that patients suffer memory loss. As a result they
forget how to perform certain activities or the series of activities to perform. In order to avoid
such scenarios a reminder session was taken at the end of each meeting for making the process
effective. Mrs. Jones at certain points in time showed depressive symptoms and did not show
much faith in the potential of the exercise program. Keeping in mind this concern empathy and
emotional support was provided to her. The cornerstone of the whole program was patience,
enjoyment and consistency (Sullivan, Mannix and Timmons, 2017). As a professional it was
appreciable to provide verbal encouragement to maintain interest of the patient in the program.
At one certain session the patient showed outburst of aggression. However the behavior lasted
for only few minutes and later on she forgot about the incident. It was acknowledged that the
outburst was only a symptom of the disease suffered. Professionals are not to take emotional
outbursts of dementia patients personally and act in an unprofessional manner.

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At the end of the session Mrs. Jones demonstrated better functional mobility and
behavior. Her physical fitness was found to be improved as she was better able to carry out
activities such as personal care. She could dress and clean without support from care giver.
Maintaining independence for a longer time was an achievement. Further, there was
improvement in sleeping behavior. She could sleep adequately at night when provided with a
peaceful environment. The other noted changes were increased confidence and low signs of
depression.
Implementation for practice
Dementia care entails person centered care as in the present scenario it was vital to reflect
on how the quality of life of Mrs. Jones could be improved. While caring for her, collaboration
with physical exercise therapist was valuable in achieving patient outcomes. Clinical settings
demand professional collaboration between individuals that promotes service delivery in the
same direction. Strategies for care intervention are to be aligned with the input of professionals
who are highly skilled and efficient (Brazil et al. 2018. The patient assessment and care planning
gave a valuable opportunity to understand how dementia patient needs can be addressed.
Difficulties faced and successes achieved have important implications for future practice. In
future, I would ensure to show more empathy and affection towards my patients to fulfill goals
of interventions within the stipulated time frame. I plan to engage in continual learning to
understand more about how physical exercise training programs can be modified as per the
evolving needs of the patients. Professional development is based on continuous research and
translation of theory into practice (Gilbert, Ward and Gwinner 2017).

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Conclusion
Converging evidence suggest that dementia is linked with a number of cognitive and
physical health changes leading to comorbid conditions. The condition is an impairment which
cannot be reversed through pharmacological and non-pharmacological interventions. Present
practices revolve around behavioral and psychological approaches that aim to address the
comprehensive care of patients. Treatment of a dementia patient as a collection of symptoms is
not appropriate. Nursing care for dementia has to be responsive to the care needs of the patient
and has to be culturally sensitive at the same time. The present scenario focused on
implementing physical training exercise as the intervention for addressing the primary health
need of the patient which was mobility. The completion of the goals highlighted that person-
centered care could be delivered that was sensitive to the needs of the patients. In future,
improvements can be brought about in such interventions so that comprehensive client needs
could be addressed after a dialectic assessment of the patient.

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Biography
Dementia care has the key feature that in addition to physical health status it is
elementary to understand the cognitive status and mental health status of the individual. For this
purpose the care giver is obliged to understand the life history of the individual prior to
commencement of treatment. The understanding of the life history helps in understanding how
different life events and societal factors have influenced dementia diagnosis and progression ().
Mrs. Jones is a 73 year old lady who lived alone in her two storey apartment after her husband
died thirteen years back. The couple has one son and two grandchildren who live in the nearby
city, coming to visit her occasionally. She states “I had a fulfilling career as a secretary until I
retired a decade back. I so miss my workplace”. She further mentions that she enjoyed her life as
she travelled to many places and had a busy social life. What further kept her active was that she
had attended services at the local church. “Everyone calls me as a kind and warm hearted person.
I am so glad for that”.
Mrs. Jones was diagnosed with dementia five years back. Prior to the diagnosis, she
states that she had suffered more than one episode in which she could not find the way to her
house and the police had to help her get back home. She had become disoriented and could not
differentiate between places due to her condition. Mr. Jones mentions that she thinks her
condition has deteriorated in the past ten months. She often misses the appointments made with
the doctor. Further, she faces difficulty in remembering her husband’s name and her son’s name.
While conversing, Mrs. Jones lost track of the conversation. This was a sign of the
decline in her cognitive ability. At present she is no longer able to carry out the daily activities of
life. She needs support with personal care. “I feel so depressed all the time”, she reports. Mrs.

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Jones is found to be in a low mood and does not show much interest in conversing. She
understood that her behavior was not the same as before. Moving further with the conversation it
was noted that Mrs. Jones had recently been admitted to the local healthcare unit for urinary tract
infection and chest infection. This further increased her lack of orientation and significant level
of confusion. Mrs. Jones remembers that she has poor sleeping habits and has disturbed sleep at
night. As a result she moves about in the house at night. This increased her risk of suffering
injury. She had recently suffered a fall from the stairs and suffered injury to her legs. This has
reduced her mobility as she faces difficulty in moving about. She urges to mention that she had
not shown any aggressive behavior towards any individual in the recent past. Upon asking about
personal interest it was noted that she enjoys reading and knitting. She also likes spending time
with her son though he comes to visit infrequently.

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