University Case Study: Mental Health and Evidence-Based Intervention

This case study examines an 83-year-old woman, Myra, diagnosed with Alzheimer's dementia, living in residential care. The assignment critically evaluates her case, focusing on symptoms, aetiology, and diagnostic criteria, including the use of the DSM-5 and ICD guidelines. It explores evidence-based interventions, such as animal-assisted therapy, reminiscence therapy, and family engagement, considering the Biopsychosocial model for comprehensive care. The study addresses the impact of stigma, legal frameworks like the Mental Health Act and Mental Capacity Act, and the importance of recovery, emphasizing the need for a multidisciplinary approach and tailored care plans. The case highlights the challenges in dementia management and the significance of promoting patient independence and well-being, including the role of family and healthcare professionals in providing support and ensuring the patient's rights.

Running head: MENTAL HEALTH CASE STUDY ASSIGNMENT
MENTAL HEALTH CASE STUDY ASSIGNMENT- CASE STUDY 4
Name of the Student:
Name of the University:
Author’s Name:

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Dementia is a syndrome that is used for discussing various symptoms that involve a
decline in cognition. Specifically forgetfulness. It is caused due to a number of an underlying
disorder and brain dysfunctioning. Livingston et al. (2017) opined that dementia is not a
single disorder; it is a collaborative term that is used for relating symptoms of diminishing
level of memory, cognitive thinking ability and communication. It can be caused due to the
death of brain cells, neurodegenerative disorder or unknown factors that are still under
research. The case of Myra involves Alzheimer’s dementia, who is 83 years old living in
residential care. Dementia is categorised as a Neurocognitive Disorder (NCD) in the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The category of NCD
incorporates a complex group of diseases that involve deficit in the primary clinical signs
such as cognitive function and impairment. Another major diagnostic guideline is the
International Classification of Diseases (ICD) that was published by the World Health
Organisation (Alz.co.uk 2019). It is similar to DSM-5 and involves neurodevelopment
disorders. According to the condition observed in Myra, it can be seen that she was suffering
from an advanced level of dementia, where she was found wandering 3 miles away from her
houses in her nightdress and slippers in the early morning two years ago. The aim of the
essay is to critically evaluate the case study of Myra and the disease aced by her in order to
formulate an evidence-based intervention for her.
Myra is an older woman having Alzheimer’s dementia and thus, it is important to
formulate an evidence-based intervention that will help her in improving or managing the
condition to a controllable level. After gaining a thorough understanding of Myra’s case, it
can be stated that the onset of the disorder occurred two years ago when she forgets her
address. She exhibited symptoms of confusion and clarity and became more depressed when
she realised her condition. This lead to limited engagement in activities she liked. The last
two weeks were significant distressing for him because her mobility became poor and she had

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fallen a number of times. She had periodic incontinent and thus, found to be on residential
home all the time. The evaluation of her case led to the inference that due to her disease,
Alzheimer’s dementia she felt helpless and worthless. She is not able to cope up with the
stress and the age factor have worsened the situation affecting her movement and social life.
Duff (2018) opined that the NICE guideline for dementia includes diagnosing and
management of the diseases and aims to enhance the care process by making
recommendations on staffs and carers to support the person. As found Myra do not have
anyone to help her in daily routine because she lives alone. Her husband, Sydney, died ten
years ago and contacted with her children, Trevor and Jean are limited as her condition was
slowly progressing. Therefore, according to NICE, the interventions need to promote her
independence, cognition and wellbeing. This may involve a range of activities that would
support in enhancing the wellbeing as per her preference, offer stimulation therapy such as
solving word puzzle and crosswords that is considered as a process of sharping mind (Moyle
et al. 2017). In her early days, she used to enjoy solving these puzzles; thus; promoting
activities that she had interest would be stated to be optimal in this case. She used to love
meeting people and had an active social life; thus, focusing on this aspect, group
reminiscence therapy or interpersonal therapy can be applied to treat her. However, it needs
to be taken into consideration that the use of non-invasive brain stimulation should not be
used as it may deteriorate the condition. The model that can be used in this particular case for
assessing the situation and offer effective care was Biopsychosocial model that involves a
multidisciplinary approach that connects the biological, social and psychology environmental
factors to address the issue thus, promoting human development. According to Revolta,
Orrell and Spector (2016), this model is a tool that helps in motivating the staffs to develop a
personalised treatment and response plan based on the need and demand of the patient. The
prevalence of dementia is found to be rising and it can be seen that 60% of all cases were

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specifically Alzheimer’s Dementia. On a global basis, the prevalence of dementia is
forecasted to be 3.9% among people over the age of 60 years (Jutkowitz et al. 2017). The
multidisciplinary approach needs to be taken in her case, which is highly appreciated in the
clinical practice because a single healthcare expert is not able to deal a myriad of the complex
issue demonstrated by the patient. Gagliese et al. (2018) opined that management of dementia
is one of the challenging tasks for the healthcare practitioner and thus, collaborative approach
by the team is noted to have a positive outcome. The approach chosen for Myra is less based
on standard clinical or pharmacological practice and more based on therapies that would
allow her to gain confidence. One of the factors that need to be taken into consideration is she
worked as a veterinarian and has a passion for animal. Therefore, animal-assisted therapy can
be considered to have a positive impact on her. As per the opinion of Lai et al. (2019), the
therapy has been used in a number of cases related to dementia where improvement in
symptoms and functional ability was observed. Another factor that can be focused on is the
use of family intervention where her children can engagement in the treatment allowing a
rapid development in the scenario. In other to improve mobility, it is important to conduct a
regular exercise that will help in enhancing the functionality of her body. Lang et al. (2018)
opined that exercise for 60 minutes for 2 to 3 days in a week is beneficial for people suffering
from cognitive impairment. Therefore, it can be used in Myra’s case to improve her
movement and gait.
According to Dobbs et al. (2019), the stigma associated with dementia may lead to a
negative impact of the person such as social exclusion, disempowerment and discriminatory
behaviour. It can be seen that symptoms of dementia are perceived in a different manner in
different parts of the world. Even though dementia is a routine part of ageing and mental
illness, it is linked with spiritual belief or supernatural element due to the low level of
understanding. According to the World Alzheimer Report, there was 36 million people had

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the disease in 2010 and it may increase to 66 million by 2030 and even more (115 million) by
2050 (Alz.co.uk 2019). Stigma is stated to be an issue that causes an individual to be
distinguished from others in a stereotypic and undesirable manner. The misconception or
myths related to dementia as well as the mind-set of people are considered as the real issue in
the world. The stigma linked to dementia has gained public awareness; however; the causes
or factors were not taken into account. This lead to the development of confusion and lack of
information results in discriminatory behaviour or inaccurate assumptions. The impact of
stigma on service users like Myra is detrimental in nature because, in many time, it does not
allow in social participation; thus, isolating the person from the community. This affects the
social well-being of service user as a result; treatment of such individual is limited. It has an
impact on the family of service users as they are discriminated by society and often due to
lack of information, the members are exposed to various kinds of bias attitude. Even though
medical professionals are informed people and do not believe any form of stigma or
discriminatory behaviour, however, an insignificant level of stigma is attached to them that
affect the care process (Harper et al. 2019). In recent time, the use of media such as
newspaper article, magazine, social media and others helped in spreading awareness among
people about dementia, thus, reducing the impact of stigma. In this specific case of Myra, no
such stigmatic behaviour or attitude was found; however, it could be found that due to
deterioration of her condition, her children distanced from her indicating that they were not
comfortable with her.
The recovery process is one of the prime importance that needs to be focused in case
of Myra, as the major objective of the treatment is to offer a rapid recovery that would allow
her to live independently. Maki et al. (2018) opined that the recovery process is to enhance
the quality of life of the patient that will allow living at an optimal level. As per the
understanding of Myra’s case, the use of old photographs can be used for reminding of her

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past, which would help in thinking and remembering. Specifically engaging in hobbies that
Myra liked or enjoyed with or without support can be useful because it will allow in calming
down her and progression in the quality of life. In the critical situation, the collaborative
efforts of healthcare professionals and family members are one of the most effective because
it will focus on all the factors that were concerning in her case. After regaining mobility and
allowing her to conduct her daily routine without any support, she can opt for day-care or
home care services that will allow living at her home without any form of hesitation or fear.
Moreover, her family must visit her at times that will allow her to feel wanted, which will
have a positive impact on health and wellbeing.
In consideration, Myra’s case, lucid stated, is one of the most detrimental aspects in
this case and require certain legal frameworks that will help her and family member to
safeguard her rights. The Mental Health (MH) Act was enacted with the objective of
abolishing the distinction between psychiatric hospitals and other health settings as well as to
deinstitutionalise of mental patient and treatment of them for community care (Chavez et al.
2018). Mental Capacity Act was formulated for empowering and protecting the patient that
have diminished mental ability to make decision-related to care and treatment (Nhs.uk 2018).
A part of the Mental Capacity Act is the Deprivation of Liberty Safeguards (DoLS) aimed to
protect the people residing in the care home or residential home that offer freedom. Myra
lives in a residential care home; therefore, it is important to consider this aspect and in case of
any inappropriate action, this framework can be used (Leedssafeguardingadults.org.uk 2020).
The basic human rights is also a legal aspect that can be applicable in Myra’s case. While
offering care and support to her, the fundamental human rights such as dignity, respect,
autonomy and beneficence need to be employed by the healthcare professionals (Umbreen
and Jabeen 2019). It is vital to consider the needs and demands of the individual for
appropriately addressing the issue. At the initial phase, she could not make decisions related

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to treatment; therefore, the involvement of the family; in this case, her children need to be
done.
From the essay, it can be summarised that Myra was suffering from a severe disorder,
Alzheimer's dementia and was demonstrating signs and symptoms for over two years. At
present, she is 83 years old and living in a residential home where the treatment of her disease
was conducted. After evaluation and assessment using diagnostic criteria of ICD and DSM-5,
it was found that condition was severe and thus, she requires an evidence-based intervention
that would address biological, psychological and social factors identified in her case. A
multifaceted treatment was formulated that included animal-assisted therapy, use of preferred
hobbies, family engagement and medication to improve her mental status. It can be seen that
stigma play an influential role in the treatment of dementia, as a result, increase the level of
awareness needs to be given to the society that would support the individual rather than
discriminating. The specific recovery process that can be adopted for Myra, as well as the
legal aspects including act and law that govern the care or treatment process, has been
highlighted that allowed in development of an on-going and comprehensive care approach
apprehending all the variables found in the specific case.

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References
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Chavez, L.J., Kelleher, K.J., Matson, S.C., Wickizer, T.M. and Chisolm, D.J., 2018. Mental
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Dobbs, B.M., Stites, S.D., Sajatovic, M., Buckwalter, K.C. and Burgener, S.C., 2019. Stigma
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