SNPG 955 Dementia Care Across Settings: A Case Study of Jean's Care

This case study analyzes the dementia care needs of Jean, a 67-year-old woman recently diagnosed with Alzheimer's disease. Utilizing Kitwood's model, the study assesses Jean's personality, biography, health status, neurological impairment, and social psychology to understand the impact of demen...Read More

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DEMENTIA CARE ACROSS SETTINGS
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Dementia Care across Settings
Introduction
The healthcare needs of the elderly have continued to change with a continued decrease
in the mortality rates of this patient population. This group of individuals comprising people
above the age of 65 has been faced with a number of medical conditions that have often proved
to be incurable. For instance, the prevalence of dementia, a psychological condition that
deteriorates the emotional status of individuals has risen to alarming levels thereby presenting
considerable challenges not only to the patient, but also to the caregivers of these individuals
(Gilleard & Higgs, 2014, p. 242). As such, this condition has raised major public health concerns
with various studies attempting to investigate the best forms of interventions that could enhance
the recovery process and ease the daily living conditions of these patients.
Jean is 67 years old and she has recently been identified as an individual with
diagnosis through her diagnosis. The specific condition is Alzheimer’s disease. Jean has
admitted that this condition has significantly affected her social life since she has found it
difficult to associate with her friends let alone her husband and her two boys. Even though Jean’s
condition is still in its early stages, the patient admitted that the condition is taking an emotional
toll on her given the difficulties she experiences in her social and family relations. Taking ethical
considerations into perspective and specifically the need to get consent from Jean as well as
protecting her confidentiality, this paper analyses Jean’s condition and reviews the most
appropriate intervention that can address Jean’s condition.
Evidence-Based Summary

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Jean has lived in the country side most of her life. Occasionally, Jean would relocate to
different cities for education purposes and after finishing her college education, she returned
home and focused on her career as a high school teacher. At that time, she also got engaged and
married, as she says, the love of her life, Mark. The two have been happily married for more than
thirty years where they also had two boys. Jean attests that her family is the most important thing
in her life. Additionally, Jean has maintained a social life being surrounded by a lot of friends
from her neighborhood and the town as well. In this case, she is well known as a friendly person,
one who is always willing to help out and the students too have really warmed up to her during
her years of teaching prior to retiring.
After retirement, Jean remained affiliated with the school as she was nominated to be a
special member of the board. All had been going so well for Jean until she began to experience
the first symptoms of dementia. Jean began to forget simple things including names and places
that she had grew fond of. Her husband closely observed as Jean’s condition was slowly
revealed. At one time, upon Jean’s insistence, she forgot her favorite cooking recipe and she
completely didn’t know how to cook the food. As these signs became more and more evident,
the two decided to visit a medical facility where Jean was diagnosed with dementia. The decision
however did not sit well with Jean as she initially refused to accept the diagnosis she became
worried of the outcomes of this condition. Consequently, Jean became severely depressed
necessitating the need to check in to a nursing home.
An Outline of the Healthcare Needs
A dialectical analysis for Jean’s condition can be established based on Kitwood’s model
that premises five main factors namely; personality, social psychology, neurological

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impairment biography, and health status (Kitwood, 1990, p. 178). These factors are essential
in explaining the elements that contribute to the emanation and escalation of dementia.
Personality
Throughout her life, Jean has been sociable keeping her friends and family very close.
She has further confided in her husband and friends her conditions and they have been willing to
offer support to her. However, even though this support has been fundamental in helping Jean to
cope with her condition, Jean has progressively felt withdrawn especially when she began to
forget some of her friends during their visits. This forgetfulness has left Jean in owe of her
condition thereby exacerbating her emotional trauma.
Biography
Aside from being sociable, Jean maintained deep fondness for her husband, their two
children, and her daughter in law and her grandchild. They would often stay indoors and read
stories or alternatively listen to old country songs that they loved. The condition has however
deprived Jean and her family this happiness given that Jean began to forget these stories as well
as the name of these songs.
Health Status
Jean’s condition has been detrimental to her mental status given that she has continued to
experience psychological distress. Recently, she would often stare through the window for hours
wondering what would happen if she completely forgets her family and friends. Based on these
effects, the formulated treatment plan should therefore focus on addressing the emotional trauma
that has impacted Jean by enhancing Jean’s togetherness with her family.

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Neurological impairment
Jean has emotionally detached herself from friends and family leading to mood and
behavioral changes as evidenced by Jean’s sadness and gloomy character. Her cognitive
functioning has also been significantly disrupted causing sufficient impairment in her everyday
life (Dewing, 2008).
Social Psychology
Jean has maintained a crucial role in taking care of her family and to the community
where she her input in the board of the school has greatly been valued. Her family and the
community as well have therefore been supportive by allowing Jean to maintain her roles. For
instance, she is allowed to cool for her family and attend the board meetings. Relieving Jean of
these duties could further worsen her condition.
Literature Review
In order to prevent the escalation of dementia, studies indicate that cognitive impairment
should be focused upon comprehensively since its clinical significance is easily distinguishable.
As such, several approaches that are based on prevention trials therefore comprise enrichment
strategies. These strategies are further based on genetic risk factors or biomarkers (Solomon et al,
2014, p. 229). However, the effectiveness of such strategies has come under much scrutiny given
the adverse side effects that are associated with these pharmacological interventions (Feldman et
al, 2014).
Available research indicates that music therapy is both inexpensive and a safe
intervention method for people with dementia. Most importantly, this intervention method has

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proven to yield credible benefits for the treatment of dementia. Unlike drug therapy which is in
most cases used for the treatment of dementia, evidence further indicates that music therapy has
limited side effects compared to drug therapy which produces severe complications that arise
from hypersensitivity of the brains of demented persons (Du, 2017, p. 1).
Another similar study aimed to review the effects produced by group music intervention
on the psychological and behavioral signs of AD. In their findings, the authors of this study
illustrate that the available date evidences an improvement in regards to agitation and also
improvements in the emotional well-being of both the patients as well as their caregivers. From
the 15 sessions of music therapy conducted over a five week period, the study concluded that
music improves the psychological signs and behavioral symptoms in patients with dementia
(Choi et al, 2009, p. 472).
A similar study also indicates that the benefits of music therapy are realized by both the
patient as well as the caregivers. Hence, caregivers should be wary of not using music as a form
of intervention given the barriers that could emanate from such an action. Such barriers could
involve hearing loss problems, functional disabilities and unmet needs of elderly individuals
(Logsdon, McCurry & Teri, 2007, p. 310). Another peculiar study indicated that music therapy is
majorly important since it elevates the mood of elderly persons diagnosed with dementia. In this
study, it was further revealed that music therapy enhances positive emotions and also brings
remote memories to the patient (Besha, 2015). In addition, evidence also indicate that leisure
activities that encompass music activities can provide social as well as cognitive benefits to
individuals with dementia or rather those suffering from cognitive functioning disabilities
(Rakesh et al, 2017, p. 121).

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Intervention and Impact of Dementia
Implementation of the Intervention
Given that dementia is viewed as both an individual and family problem, Jean and her
family were included in the decision making process. Furthermore, the family’s responsibility to
take care of Jean was essential in promoting Jean’s independence as a demented individual. The
economical essence and moral value of Jean living in their home was also realized. In this case,
allowing Jean to stay at her home was viewed as being economically feasible for the family.
Also, this environment was assumed to be familiar to Jean, comforting and secure (Golden,
2010, p. 15). Hence, it was conclusively decided that the music be played in Jean’s room early in
the morning allowing Jean to feel comfortable, secured in her own way and familiarize with the
environment.
Jean was also to spend most part of her day in her room surrounded by a number of
novels. As she read, it was proposed that a soft soothing music would play in the background. In
the afternoons, Jean would be allowed to see visitors most of whom were her friends and socially
interact with them. Later in the afternoon, an inclusive music listening session was scheduled for
Jean and her family. Ideally, this session would comprise listening to some of Jean’s old favorite
music at her own will. Group singing was also emphasized upon during this session (Gotell,
Brown and Ekmam, 2009).
For observation of Jean’s behavioral changes, it was decided that Jean’s son maintain a
journal or rather diary which would document the changes in mood that were exhibited by Jean
during these sessions. The information would then be discussed with a medical professional on a
two week basis during their visit to monitor Jean’s progress and how she was responding to the

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intervention (Moyle et al, 2007). In addition, it was essential that the careers be taught coping
strategies since it was expected that during the provision of care, it was likely that they would
face physical as well as emotional difficulties.
Impact of the Intervention
The availability of family including Jean’s husband, son and daughter in law as carers for
Jean proved to be essential in reducing the likelihood of Jean being admitted into the care home.
Although this was the initial plan, financial constraints raised a major concern thereby
warranting alternative form of treatment plan. Hence, by assigning the family members the
primary role of caring for Jean, the healthcare cost associated with the treatment of dementia was
significantly reduced thereby easing the financial burden associated with health and social
workers. Moreover, the use of music therapy was also less costly compared to pharmacological
treatments which could further result to side effects (Whitehouse, 2014, p. 678).
The use of music intervention provided the best alternative mode of treatment given
Jean’s early diagnosis of the condition. This is mainly so since, music intervention was not only
a non-pharmacological form of treatment, but it also resulted to no side effects and was pivotal in
managing the distressing behavior that was exhibited by Jean (Feldman et al, 2014).
However, the caring role assigned to the family members progressively proved to be
emotionally and physically challenging. In some way, the carers felt that they were put under
pressure to care for Jean. They therefore required professional support from health professionals
which primarily involved counseling and medical checkups to determine Jean’s emotional and
physical well-being(Sung et al, 2011, p. 1778). Also, the coping strategies were emphasized

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upon and in this case, the carers were provided with skills and confidence to take on the task of
caring as substitutes to home care workers.
In some cases and as anticipated, the family members would succumb to excessive
grieving given the health deterioration of Jean as an individual with dementia. Ideally, the
demented person would seem to be physically present but emotionally absent. Moreover, the
interaction between the carer and the demented person would be distressingly incoherent thereby
disrupting their daily relationships. Consequently, the carers would perceive themselves as being
powerless and overwhelmed to make any decisions that would result in positive changes in the
life of the demented individual. In these cases, professional monitoring was identified as the
most efficient course of action where a medical professional would offer support for the carers
thereby propping them up to continue caring for the demented individual.
How the Intervention Promotes Person Centered Care
It was imperative that Jean’s independence be respected and protected by the intervention
plan. Jean’s caregivers primarily comprising of her husband, her daughter in law and one son
were effectively advised on the form of communication that they should use while
communicating with Jean. In this case, non-verbal cues as well as the use of certain terms were
emphasized upon in order to enhance Jean’s comprehension. It was also decided upon that Jean’s
favorite songs be played very early in the morning after she woke up in order to kick-start her
days (Hammar et al, 2011, p. 971). This decision was made after realizing that Jean spent most
of her mornings confused and worried as she often gazed through the window in utter oblivion of
what was unfolding in her life.

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By ensuring that Jean listened to her favorite songs every morning, this would relieve
Jean of the distress of having to worry of what had become of her life (Gilleard& Higg, 2014, p.
242). Additionally, a music session late in the afternoon coupled with storytelling session would
ideally promote Jean’s integration into the family and also enhance her emotional attachments to
the individuals that she had grown fond of.
Evaluation Criteria
To evaluate the Jean’s progress, regular interviews were scheduled with Jean, medical
professionals and Jean’s family. One of the interviews would comprise a session where the
health professional would review the Jean’s diary and ask Jean’s family questions in relation to
the progress that Jean would ideally be making. Another interview will involve all the three
parties and which will be open ended thereby giving room for advice from the health
professional as well as allowing for concerns or issues to be raised by the family members
regarding Jean’s health status (Strooper & Karran, 2016). Additionally, the evaluation process
would further involve education on coping skills and strategies for the family members thereby
enabling them to carry on with the caregiving task and giving value to Jean as a person
suffering from dementia.
Conclusion
Dementia condition is a major public health concern affecting predominantly individuals
at an old age. This condition presents major challenges to the individual affected as well as their
family members especially when taking into consideration the healthcare cost and, physical and
emotional challenges that are experienced when providing care to the demented person. In
regards to Jean, a 67 year woman recently diagnosed with AD, this condition has impacted

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negatively on the physical and emotional well-being of the individual given that she has become
emotionally withdrawn from her family and friends despite valuing these two groups of
individuals all through her life.
In order to provide care to Jean and subsequently improve on her health status, it was
decided that music therapy be used as the most efficient form of intervention for Jean’s
condition. This approach was implemented at Jean’s home where the environment was deemed
to be secure, comfortable and familiar to Jean. During the implementation, Jean would primarily
listen to her favorite song very early in the morning when she woke up. In the afternoon, Jean
would be involved in group singing with her family and dance at her own will. A diary detailing
Jean’s behavioral changes would be maintained by her son for evaluation purposes which would
be conducted during visits that would be made by health professionals. Additionally, it was
critical that Jean’s family as the primary caregivers be educated and trained on coping strategies
in order to enable them deal with the overwhelming and distressing nature of their caring task.

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