Care Planning for Dementia: A Case Study Analysis and Review

This assignment presents a case study of a 70-year-old woman, Sharon, recently diagnosed with dementia, detailing her medical history, symptoms, and living situation. The assessment phase involved the 6-CIT and MMSE tests to evaluate the cognitive impairment level. The assignment analyzes the rationale for using these assessment tools, highlighting their roles in diagnosis and care planning. Two key nursing care priorities, malnutrition and depression, are addressed with specific interventions. These include nutritional assessments, dietary recommendations, and referrals to dieticians, as well as psychotherapeutic interventions like mindfulness and cognitive behavioral therapy, tailored therapies, and potential antidepressant administration, supported by evidence-based rationales. The assignment emphasizes the importance of establishing therapeutic relationships, effective communication, and the use of community-based services for long-term support.

Running head: CARE FOR DEMENTIA
Care for dementia
Name of the student:
Name of the university:
Author note:

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Introduction:
Dementia can be defined a mental health disorder, that has a huge impact on the health
and well-being of the patients, and this progressive disease targets the elderly population. There
are various different risk factors that are predominating in case of dementia include age, family
history, heavy alcohol use, hardening of the arteries, high blood pressure, diabetes, high
cholesterol, and smoking. Elaborating more, intrinsic damage to the neurons leads to the loss of
communication network among the neurons and results in the clinical manifestations associated
with dementia (Brooker and Latham 2015). Hence, undoubtedly, dementia is a healthcare
complexity that is associated with various different implications on the lifestyle and living
conditions of the patient and there is a need for specialized care planning and implementation
program in order to address the different concerns that are caused by dementia in the patient;
taking into consideration the overall concepts of health including physical, emotional, spiritual,
physical and cognitive health and wellbeing. Although, it has to be mentioned in this context that
in most cases, early, quick, and effective assessment structures are very important for the care
plan to be effective and patient-centered (Gauvin and Lavis 2013). This assignment will attempt
to discuss a case study including the assessment procedure and tools utilized, the rationale for the
assessment procedure and techniques chosen for the case study, the care interventions planned
and implemented, the rationale for their choice and effectiveness of the care provided for the
dementia patient.
Case scenario description and details:
The case that will be discussed in the assignment is a 70-year-old woman who had
recently received a diagnosis of dementia. In order to honor the privacy of the patient and

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confidentiality of the information that the patient has shared, the patient will be addressed as
Sharon in the assignment. It has to be mentioned in the context that while designing the care plan
and the assessment program for a dementia patient, it is crucial for the care team to explore and
analyze the background, lifestyle, and past history of the patient (Robinson et al. 2013). Sharon
had been a widow who used to live with her only daughter in her house; her daughter is named
Sarah who had recently moved upstate after her wedding a year and a half ago. The patient stated
that she had been in touch with her daughter over phone, however, the physical distance from her
only daughter and the loneliness she lived with after the demise of her husband 25 years ago, her
depression and insecurities caught up with her and she soon started to neglect her health and
started excessive smoking and drinking. The past medical history of the patient revealed that she
had been diagnosed with hyperlipidemia a decade ago and along with that ever since her
daughter’s moving away, he had forgotten to diligently take her medication and go for checkups
in the past year. According to the subjective and objective data shared by the patient, she
confirmed to be having mild memory problems from 6 months ago, which started with forgetting
her car keys, forgetting to take her medications. However, the patient resented to the healthcare
facility with the symptoms of lack of memory, inability to focus and be attentive and Confusion
and disorientation.
Assessment of dementia:
Assessment is a very important aspect of planning and implementing dementia care.
According to the Sabbagh et al. (2010), the progression of the disease can be very different in
different individuals. While the disease can progress at a fairly rapid pace and for certain others,
the progression of the disease can be more time taking and gradual. As a result it has to be
mentioned that for proper diagnosis and care planning for a patient it is very important for the

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healthcare provider to employ assessment techniques and tools to assess the exact stage that the
patient is in so that the care provider can employ care activities and interventions that will suit
the exact needs of the patient (Machiels et al., 2017).
In this particular test, two particular assessment tools or techniques were used in case of
Sharon. The preliminary assessment test that was performed was the 6 item cognitive impairment
test or the 6-CIT test which is a very commonly utilized test for the dementia settings, and along
with that this particular type of test is very common assessment tool used in conjunction with the
MMSE test to assess the level of organization and planning in the patient according to the UK
national Dementia Strategy (Abdel-Aziz and Larner 2015). The second assessment tool utilized
is called Mini-Mental State Examination (MMSE) test. It has developed as a screening
instrument which helps in the diagnosis of dementia symptoms such as memory, language, and
visuoperceptual function..
In order to describe the procedure, first and foremost, the patient had been informed regarding
the both of the assessment procedures performed and their benefits. In the beginning, Sharon was
a little nervous regarding the type of assessment and sharing personal information, however,
when she was informed about the need of the assessment procedure and how it will benefit
inefficient and correct diagnosis and a patient centred and targeted care plan that will help her
significantly. Along with that, she was also informed about the confidentiality and privacy
protection policy of the healthcare facility and soon she was comfortable and convinced enough
to share her woes. The preliminary test was the 6 item cognitive impairment test where the
patient is asked 7 different questions and the patient is required to answer all the different
questions and on the basis of the answers that the patients is going to be scored. In case the
patient attains a score from 0-7, then the patient is considered to be having no cognitive

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impairment, at score 8-9 the patient is considered to be having mild cognitive impairments and at
score 10-28, the patient is considered to be having significant cognitive impairment. The patient
scored 8 in the 6 cognitive impairment test (6CIT) indicating the fact that the patient had only
mild cognitive impairment however she still will require intervention for it (Jefferies and Gale
2013). The second and more advanced assessment that was performed was the MMSE test which
began with asking her 12 questions in total and two diagrams. The entire questionnaire took
close to 15 minutes to complete and after this test was completed the patient was given 5 minutes
to relax before commencing with the second test. The patient scored 19 on the MMSE test
indicating that she is suffering from mild to moderate dementia.
In rationale for the type of assessment tools utilized in case of the patient, it has to be
mentioned that Sharon had been exhibiting the signs of cognitive impairment. The first
performed test was 6CIT, a brief and simple cognitive screening instrument that emphasizes on
the cognitive status of the patient particularly and is used mostly in the primary care setting.
According to Jefferies and Gale (2013), this particular test had been designed and in use to assess
the global cognitive status of the dementia patients. This test utilizes the combination of one
memory oriented question, 2 calculation based questions, and three orientation based questions;
and the brevity of this test makes it simple and easy as a primary assessment taking only 2
minutes or lesser to complete and provides a valid preliminary assessment for more extensive
screening to be employed (Upadhyaya, Rajagopal and Gale 2010). The most detailed and useful
assessment tool for judging the exact state of cognitive impairment is MMSE is a very important
tool for diagnosis of dementia. As per the NICE guidelines the result of an MMSE that assists in
the determination the appropriateness of pharmacological interventions (Nice.org.uk. 2018). The

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combination of tools is recommended for use in acute, primary, community and residential Care
(Price et al. 2011).
Interventions and rationale:
Nursing care
priority
Nursing goal Intervention Rationale
Malnutrition The patient will
understand the
relation of
malnutrition and
dementia and will be
adapting strict and
healthy nutritious diet
to regain healthy
weight as well.
Assessment of the
nutritional status of the
patient with respect to the
body weight and body
mass index (Nice.org.uk
2018).
Exploring and
understanding the
mealtime routine and
preferences for the patient.
According to the authors,
malnutrition is a very common risk
to the dementia patients and regular
and continual assessment is a
necessity in order to ensure that the
patients are under a constant
vigilance regarding weight loss and
nutritional status of the patient
(Nice.org.uk 2018).
Dementia patients can have a
peculiar eating pattern and mealtime
preferences due to altered eating
behavior, memory and emotions due
to the atrophy of the mesial
temporal cortex. Hence, it is crucial
for nursing professional to explore
and analyze the eating pattern and

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Explore whether the
patient has difficulty
swallowing or
remembering or
recognizing the sensation
of hunger and thirst
(Evans and Best 2015).
Discussing and
recommending the patient
to a nutritionist or
dietician to adhere to a
targeted and specialized
diet plan for the patient.
Establishing a mealtime
routine, collaborating with
the patient and the
mealtime behaviors to understand
the need for nutritional delimitation.
Dysphagia is a common
manifestation of dementia and along
with that the ability of recognizing
the different sensations such as
hunger and thirst can also gradually
diminish in dementia. exploring
these factors will also help in
designing the care plan and
interventions (Evans and Best
2015).
The specialized diet plan rich in
antioxidants and fiber will help in
replenishing the nutritional status of
the patient and will help in
improving the weight of the patient
(Koyama et al. 2016).
Dementia is associated with loss of
ability to recognize hunger and
thirst. A thorough routine will help
the patient to remember when to

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dietician to which the
patent will optimally
adhere to (Koyama et al.
2016).
what and what to eat as well.
Depression The patient will be
free from the low
mood and will be
able to overcome the
depression that she
has been feeling as
well.
Assessing the level of
negative though patterns in
the patient and explore the
presence of lack of self
worth or thoughts directed
at self harm (Nice.org.uk
2018).
Discussing and referring
the patient to
psychotherapists to
commence on different
mindfulness based
therapies and cognitive
behavioral therapy (NICE,
2018).
Depression and cognitive
impairment are intricately
associated with each other and is
often known as vascular depression
facilitated by vascular changes and
loss of neurotransmitters. The
assessment will help in identifying
the patterns of negative thought
processes and whether they are
associated with any possible
chances of self harming tendencies.
The patient in this case has been
going through depression due to
dementia and the separation of her
daughter. The psychotherapeutic
intervention will positively distract
her from the loneliness and will
help her focus on optimistic aspects

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Providing tailored
interventions such as the
reminiscence therapy,
multisensory stimulation,
animal-assisted therapy
and exercise.
Administration of mild
antidepressants after
thorough risk benefits
analysis and discretion of
a medical practitioner
(Nice.org.uk 2018).
Discussing about different
inpatient services and peer
support groups with the
patients.
of life (Evans and Best 2015).
The tailored interventions have been
reported to be extremely helpful to
address the negative thought
process and elevate the low mood of
the dementia patients suffering from
depression.
In case of moderate to severe
depression, administration of oral
antidepressants are effective
interventions as per NICE
guidelines (NICE, 2018)
Community based inpatient services
and peer support groups serve as
long term strategies for providing
the opportunity for the dementia
patients to overcome social isolation
and withdrawal.
In order to evaluate the assessment and intervention followed in the case scenario, it has
to be mentioned that the care professionals were able to establish a therapeutic relationship with
Sharon and were able to employ effective communication skills to help her understand the need
for the assessment and intervention activities and contribute to the entire care program

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(Ihpa.gov.au. 2018). Along with that, the two assessment programs utilized MMSE and 6CIT
tests are two very abundantly used and NICE guideline approved diagnostic tools which were
successfully utilized in the case scenario (NICE, 2018). Although, one major mistake that
occurred in the care scenario was the fact that when the patient becomes somber and sad,
effective compassionate and empathetic communication was not performed. In case of
interventions, the use of medication administration education has been a fundamental step to help
Sharon understand the need for the medication. Although, the medication remembering routine
was not prepared for Sharon, which is another fundamental error in the care scenario. The
nonpharmacological interventions included both cognitive behavioral therapy and tailored
interventions which will help the patient overcome the impact of dementia. In the future, the
nurse will need to focus on compassionate and empathetic communication with the patent and
perform inclusion so that the patient can feel valued and empowered (Aguirre et al. 2013). Along
with that, as both malnutrition and depression are major concerns for the patient care should be
taken to include different activities to make routines and reminders for eating regularly, taking
medicines, and other related care activities (Azheimers.org.uk 2018).
Conclusion:
Dementia can be defined as the amalgamation of a few healthcare adversities that mostly
target the elderly population. This disease is an amalgamation of different neurotic disorders that
lead to clinical manifestations such as memory loss, word-finding difficulties, impaired
judgment, and problems with activities of daily living. There are two most common types of
dementia, Alzheimer’s and vascular dementia. On a more elaborative note, dementia can be
defined as the collective term that describes the use of different correlated cognitive disorders
such as memory loss, word-finding difficulties, impaired judgment, and problems with activities

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of daily living. The most common type of dementia is Alzheimer's disease which constitutes
almost 50 to 70% of the cause. This essay was able to explore and evaluate a complete care
scenario and the different aspects associated with future recommendations for improved care
quality and better health outcome for the patient.

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