Dementia: Symptoms, Assessment, and Management

This article provides an overview of dementia, including its symptoms, assessment methods, and management strategies. It discusses the three stages of dementia and highlights the importance of health assessment in identifying and addressing the needs of patients. Additionally, it explores effective communication strategies for patients with dementia. The article also includes a literature review on the prevalence of mental disorders, particularly dementia, and emphasizes the significance of prevention in reducing the incidence of these disorders. Finally, it offers problem-solving approaches for addressing the challenges faced by patients with dementia.

Introduction.
Dementia is an example of common mental disorders in the world. Common mental disorders
are highly prevalent in the world and it affects all people across all regions of the world.
According to Steel et al., (2014), in their journal, International journal of epidemiology, a 12
months survey was conducted and it was evident that approximately one out of Five respondents
interviewed, was identified to meet the criteria for a common mental disorder. This gives a
prevalence of 17.6% of the total world population has characteristics of common mental
disorders such as dementia. Moreover, in the study, it was evident that a consistent gender had a
prevalence of the common mental disorder. For example, the rates for mood disorders and
anxiety disorders were found to be higher in women compared to the rates in men. The
prevalence of mental disorders worldwide tends to resemble an individual nation, and in this
case, it is Australia. In the Australian nation, there has been a minimal decrease in the prevalence
of mental health disorders. It is therefore believed that the prevalence of 16% that is found in the
American journal of geriatric psychiatry authored by Trollor et al., (2007) whom in their study
included 1792 respondents, is still approximately the same prevalence right now. And the reason
for the constant prevalence is because Australia has focused on the treatment of mental disorders
while neglecting its prevention. (Jorm, 2014).
Dementia is mostly referred to as a clinical syndrome rather than a disease. Usually defined as
an acquired condition that involves multiple cognitive impairments that are sufficient to interfere
with the performance of daily activities for a living (Barkhof & van Buchem, 2016). Apart from
memory impairments being the most common deficit, language, praxis and visual-perceptive are
also related to dementia. Dementia is usually but not necessarily progressive. The most common
causes of Dementia have an age-related incidence (Harper et al., 2014). However, 48.4% of

dementia cases in Australia are attributed to modifiable lifestyle factors (Ashby-Mitchell et al.,
2017). “… a systematic review of the literature on the subject “cognitive impairment in
indigenous elderly population” in the databases MEDLINE via PubMed, Lilacs, and Scopus
showed that the prevalence of dementia in indigenous populations between 45 and 94 years old,
originally from different countries, varied between 0.5% and 26.8% for age 60 and older” (de
Souza-Talarico et al., 2016).
Patient introduction.
The current case is about a 67-year-old man named James Longstaff. Who has had a fall in
the nursing home? Mr. Longstaff has been a long-term resident in the nursing home. His wife
passed away. He has two daughters of which the eldest is the one who has Power of Attorney
over her father's affairs. The two daughters live nearby and normally pay Mr. Longstaff a visit
regularly. He has a medical history of Seizures. considering her medical condition of seizures, it
is believed that he has difficulty walking and is very unsteady. Now that he is living in the
nursing home the risks of falls in a nursing home are high. This is due to the fact that the nurses
are limited in the nursing home to ensure that every patient is watched and monitored all the
time. Therefore, the risks of falls are many despite the many risk prevention tools. There is no
evident history of seizure management, any referrals or any models used in the previous
assessment. There are cognitive assessment tools that are used to identify patients who may need
additional evaluation. This includes those who fail any of the suggested tests. Now that Mr.
Longstaff has the eldest daughter as his attorney, I will use Informant tools in the assessment. I
will, therefore, use Eight -item Informant Interview to Differentiate Aging and Dementia. The
tool is abbreviated as AD8 and requires an Informant who can be a close family relative or a
close friend to be the respondent of the interview.

Symptoms.
The symptoms of dementia do not follow a particular trend as they normally vary greatly.
Dementia affects people differently. Dementia, is a progressive disease mostly, its symptoms are
categorized into three stages. We have symptoms during the early stage, those for the middle
stage and those that are obvious during the late stage. The dementia symptoms are mostly
overlooked in the early stages, this is because the onset is gradual. The symptoms during the
early stage are forgetfulness, losing track of time, and becoming lost in familiar places. When the
disease progress to the second stage, the patient may start forgetting recent events and people's
names, getting lost at home, start increasing difficulties in communication, behavior change
starts including wandering and repeating questions that were asked before. At this stage, the
patient may start needing help with personal care. When the disease progress to the third stage
called the late stage, this is the stage of mere total dependence and inactivity and memory
disturbances become more serious. it is therefore manifested by the following symptoms;
unawareness of time and place, difficulty in recognizing time and place, difficulty in walking and
behavior changes. In this stage, the patient may have an increased need for assisted self-care
(Batsch & Mittelman, 2015; Wergeland et al., 2014; Wortmann, 2012). In the case study, Mr.
Longstaff has reached the third stage and cannot do things on his own that's why he is in a
nursing home and as well as her eldest daughter as his Power of Attorney, thus can decide
everything concerning his health now that Mr. Longstuff is considered "incapacitated," meaning
he is not in a position of making medical decisions for himself. (Fetherstonhaugh. Et al. 2017;
Brinkman-Stoppelenburg. et al.,2014). Health assessment is the first step in identifying the
patient’s problem. It helps in identifying the medical need of patients. It is a plan of care that
identifies the specific needs of a person and how those identified needs will be addressed by the

healthcare system or the skilled nursing facility. Inn health assessment, physical examination
evaluates the health status of the patient. There are different types of assessments including
initial assessment, this one determines the nature of the problem or the condition and prepares
the way for ensuing assessment stages. Focussed assessments expose and treat the condition.
Then we have Time-Lapsed Assessment, this ensures that the patient is recovering and the
condition has stabilized. The wrong diagnosis could directly impact a patient's treatment. It could
also lead to improper patient care (Ginsberg et al., 2014). Misdiagnosis results in patients
receiving inadequate or inappropriate treatment that will not alleviate the symptoms or
impairment of the disorder (Barbesino, 2016).
Health assessment.
Advanced health assessment is core in patient care. It includes systemic methods of patient’s
data collection. The data collected systematically can be used by healthcare providers to
determine the patient's current and ongoing health status, predict risks to health and identify
health-promoting activities.
The advanced health assessment procedure for the test selected for Mr. Longstaff is simply
the procedure for AD8 Dementia Screening Interview. This test involves the respondent who can
be a close relative or a close friend as mentioned earlier. The eight questions are given to the
respondent on a clipboard or self-administration (Hendry et al., 2014). Alternatively, they can be
read aloud to the respondent. The respondent Is then asked to rate change in the patient. There
should be a one second delay before moving to the next question. The final score for this is a
sum of the number of items marked "YES", a change. It should be noted here that a "YES A
change" indicates that there have been noticeable change in the last several years caused by
cognitive (thinking and memory) problems. A normal individual will have a summation score of

0-1 out of 8 while a person with cognitive impairment is likely to have a summation of 2 or
greater. Establishing a healthy relationship between the nurse and the patient by using some
techniques such as greeting the patient, making eye contact and displaying confidence and
relationship is vital in nursing care practice. Nurse-patient relationships build helps the patient
feel at ease and relaxed. This also ensures patient physical and psychosocial safety. It should be
noted that communication in the healthcare system is among the tools that are important in
providing great patient care and improving their satisfaction (Al-Abri, & Al-Balushi, 2014). For
effective Nurse-patient relationship development, therapeutic communication is key. This is
according to Adler, Rodman & Du Pré, (2016), who defined communication as a process that
leads to interaction and connectedness between human beings while exchanging information.
Moreover, if the nurse wants to know more about the patient and make the interaction
interesting, he/she can apply the therapeutic communication techniques. This way the nurse will
be focusing on advancing the physical and emotional well-being of the patient (Davis Boykins,
2014).
Communication strategy.
As it has been outlined earlier, the symptoms of dementia patients progress with time. This
may also include the patient's ability in perceiving information, processing and responding
accordingly, with time it progressively becomes weaker. The communication strategy with
dementia patients who have reached the last stage should then revolve around five aspects. These
are orientation, environment, body language, words and the use of simple language that can be
understood with ease (Bramhall, 2014). The first aspect, therefore, requires right positioning
while having a conversation with a patient diagnosed with dementia. An example of a body
language is maintaining eye contact, this brings maximum concentration and follows up (Berger

et al., 2018). Environment chosen for the conversation should be friendly and free from any kind
of noise. It should, therefore, be an environment with minimal distractions (Ellis & Beattie,
2017). Words chosen should be friendly and which someone can understand with ease. They
should be words that will not require a lot of thinking to understand. This is because the patient
already has impairment in thinking therefore, friendly simple words will be appropriate (Downs
& Collins, 2015).
Literature review.
Dementia is an example of common mental disorders in Australia. Literature and
publications say that there is a possibility of reducing the incidences of mental disorders in
Australia and in the world at large can be reduced. According to Van zoon et al., (2014), it is said
that it is possible to reduce the prevalence of mental disorders such as depression by 21%. This
can be effective if the prevention is carried out with 20 people then one new case of depression
will be prevented. In incidences of mental disorders in Australia are not declining with time.
Australia has focussed on treatment bulk but neglecting prevention (Jorm, 2014). In the literature
(Yap et al., 2014), it is said that there is good evidence that what parents do while raising their
children can have an impact on the children's risk for a whole range of mental health disorders
later in life. However according to (Withall et al., 2014), mental disorders have got a different
distribution of etiologies and the prevalence of the disorders in early age, that is below 65 years
is higher. While prevalence for those who are 65 years and above is 9% (Laver et al., 2016).
Among the guidelines recommended for clinical management of patients with dementia in the
literature (Laver et al., 2016), is maintaining and promoting independence through activities of
the daily living and continuation of exercises. However, one of the symptoms of dementia is

immobility due to decreased coordination and he has increased need for assisted self-care
(Batsch & Mittelman, 2015; Wergeland et al., 2014; Wortmann, 2012).
Management.
Prevention is key when it comes to mental disorders including dementia as an example.
Since according to (Withall et al., 2014), it is said that mental disorders have different etiologies,
it is therefore believed that it can sometimes be difficult preventing some of the etiologies and
that’s too unfortunate because we may end up suffering from the condition. Therefore,
management is key to those with dementia. The management can be as follows. Nurses can
promote and maintain the patient's independence through the daily living activities, a
continuation of exercises and supporting the patient (Mr. Longstaff) to pursue activities that are
of interest and of interest to him (Tobiano et al., 2015). The nurse can ensure Mr. Longstaff is
well hydrated and with adequate nourishment by ensuring that the patient maintains a healthy
balanced diet. The nurse can monitor the weight of the patient and his nutritional status accessed
regularly. A number of pharmacological management is also recommended to a patient with
dementia (Stinton et al., 2015). Analgesics can be administered whenever pain is suspected,
agitation can be managed by administration of selective serotonin reuptake inhibitors.
Depression in people with dementia can be managed with administration of antidepressants. The
social model approach of dementia care can also be applied when there is a need to focus on the
patient's cognitive needs rather than on medical or physical needs. This one concentrates on the
remaining skills and abilities of Mr. Longstaff. The activities involved with this model is
centered on stimulating the mind and this will make them feel a greater sense of belonging,
comfort, and security. (Livingston et al., 2017). another management is patient education

whereby the attorney of Mr. Longstaff will be educated on the causes of dementia, the risk
factors of which include age, family history, and other etiological factors. The onset of dementia
signs and symptoms can also be discussed. Safety and lifestyle issues for people with dementia,
how it is diagnosed and lastly the treatment just in case the interventions for prevention have
failed (Edwards, Voss & Iliffe, 2014).
Problem-solving Approaches.
A patient with dementia has impairment in communication, mobility, memory loss and
cognitive ability loss. For communication, the nurse should ensure effective communication
skills and use simple language that does not require deep thinking to understand what has been
said. Many times, clients are forced to do some activities that are beyond their capabilities.
Some of the approaches that can solve some of the problems with Mr. Longstaff include
physiotherapy to strengthen his muscles due to his immobility (Moore et al., 2016).
Conclusion.
The essay has described dementia, one of the common mental disorders. Its prevalence in
Australia and worldwide has been outlined and found that they are almost the same. A
prevalence of approximately 17%. A case study of an old male patient named M. Longstaff has
also been outlined and different kinds of management outlined. Some works of literature have
outlined that the prevalence can decrease we the Australian Nation focus on prevention too rather
than medical management only.

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