Introduction

Dementia is a serious disease of the brain. When someone has dementia, the brain cells are damaged and they die more frequently than normal. When an individual looses brain cells, this means that he will gradually start to loose all of his abilities. Often the first thing you loose is memory, sometimes people just cannot remember their husbands’ and wives’ names. When the disease worsens, the patient may become disorientated and does not know what date or day it is. Moreover when the disease has the patient firmly in its grip, the effected person can change in many aspects and can even change their behaviour. Patients with dementia loose most of their abilities and therefore find it difficult to live alone. For this reason many people end up in elderly homes because they find it impossible to cope. This assignment will be discussing the impact of dementia on the patient and carer. Also how the patient and the carer will be empowered to live with the consequences and outcomes of dementia. (Gilliard, J. (2001)

Impact on the Patient

Patients diagnosed with moderate and severe dementia typically need a lot of care, ideally round the clock care. This is because when you take care of these types of patients one must make sure that neither the patient nor the carers come to any harm. These persons usually require a lot of assistance in almost all activities of daily living such as nutrition and hygiene. These patients tend to forget important things like how to shower or how to eat with a fork and knife.

A previous safe home environment can become one full of obstacles and danger for a patient with dementia. There are many hazards around the house like sharp knives, tools and chemicals. They should be removed so as to make the home as safe as possible. Since people suffering from dementia can become disorientated, it is very important that locks in the home are more secure than usual and even stairs are guarded by the gate. Furthermore the carer of patients with dementia should put some sort of identification on the individual, in case he wanders around alone and is lost.

Since persons with dementia are prone to change in their behaviour, they get frustrated and certain situations irritate them a lot. Comprehending, adapting or avoiding the conditions that set off these actions may assist to make life more pleasant for the person with dementia as well as his or her caregivers. For example the person may be confused or irritated by the intensity of movement or sound in the nearby environment. Reducing pointless movement and sound, such as limiting the amount of visitors and turning off the television when it’s not in use may make it easier for the person to be aware of needs and carry out simple tasks. Reducing clutter in the home may be help the person feel less confused in his surroundings. It is also essential to maintain familiar objects close, and encourage the person to follow an expected routine throughout the day. Calendars and clocks may also assist patients in familiarizing themselves.

Persons with dementia should be encouraged to go on with their ordinary leisure time activities as long as they are secure and do not effect disturbance. Activities such as skills, games, and music can offer significant mental stimulation and improve mood. Some studies have proposed that participating in exercise and intellectually stimulating activities may lower the decline of cognitive function in some people. (Current Alzheimer Research ISSN: 1567-2050 – Volume 8, 8 Issues, 2011)

A lot of studies have found that driving is insecure for people with dementia. They frequently get lost and they may have problems recalling or following policies of the road. They in addition may have difficult handing out information rapidly and dealing with unpredicted conditions. Even a second of uncertainty while driving can lead to an accident. Driving with impaired cognitive functions can also put others in danger. Some experts have proposed that normal screening for changing in intellectual functioning might help out to decrease the number of driving accidents among elderly people, and some states now demand that doctors report people with dementia to their state motor vehicle department. However, in many cases, it is up to the individual’s family and friends to make sure that the human being does not drive. (Current Alzheimer Research ISSN: 1567-2050 – Volume 8, 8 Issues, 2011)

The emotional and physical load of caring for somebody with dementia can be devastating. Support groups can frequently assist caregivers in dealing with these difficulties and they can also suggest supportive information about the disease and its treatment. It is significant that caregivers rarely have time off from endless nursing demands. Some communities supply respite facilities or adult day care centres that will take care for dementia patients for a period of time, giving the primary caregivers a break.

Early on in the illness, loads of individuals may require aid such as reminders and memory assistance, and help with controlling money or making decisions. Later, they will need increasing amounts of help with their daily activities. In the later stages of the illness, people with dementia are likely to require a lot of assistance with usual daily activities such as eating, washing, dressing and going to the toilet.

Numerous people are concerned about memory failure and may become concerned that it is the beginning of dementia. However, in many cases, there may be another cause. Illnesses and infections, as well as depression, nervousness, bereavement, tiredness and the side effects of some prescribed medications can all cause memory problems which can be taken care of.

Generally dementia is a progressive and degenerative disease and patients will need more care as the disease worsens. When the disease is in the initial stages, more commonly referred to as mild, the patient will find it hard to manage in their employment, might find it hard to make certain decisions or might forget to pay bills or attend appointments. As the disease progresses, and is at the moderate stage, the affected person may find it hard to recognize his own family members and may also need guidance in their everyday activities like dressing and toileting. In the final stages, the disease will take hold of brain function and hence problems with memory, co-ordination and communication will certainly increase. Physical abilities are also likely to be affected.

There is no cure for dementia; however there is a lot to be done to ease the impact of the disease on the patient and his carers. It is most important that the person has the best quality of life possible and people with dementia should try to keep up with their daily activities and interests. They should also be given choices as much as possible so as to maintain their grip on normal life as much as possible. Carers should also make sure that the patient’s eyesight, hearing and general well being are taken care of.

Dementia can have an effect on the performance of a lot of the body system and, therefore, the capability to carry out day-to-day tasks. Dementia may increase problems. One of the main problems is inappropriate nutrition. Almost everybody who has dementia will at some point lessen or discontinue eating and drinking. Frequently, advanced dementia causes people to have less control of the muscle that is used to masticate and swallow, placing them in

danger of obstructing or aspirating food into their lungs. If this occurs, it can obstruct breathing and cause pneumonia. People with advanced dementia also lose the sense of hunger and, with it, the wish to eat. Depression, side effects of medications, constipation and other conditions such as infections also can reduce a person’s significance in food. Another important factor which can be affected in dementia is reduced hygiene. In the moderate to severe stages of dementia, the patient looses the capability to autonomously complete everyday living everyday jobs. The patient may not be able to cleanse, put on clothes, brush your teeth and go to the toilet on your own. The patient suffering from dementia will have trouble in taking medications. This is because a person’s memory is affected; keeping in mind to take the correct amount of medications at the exact time can be tough. Worsening of emotional health is one of the main concerns. Dementia alters performances and personality. A number of the changes may be caused by the definite weakening occurrence in a person’s brain, while other deeds and personality changes may be responded to the emotional confronts of coping with the worsening changes. Dementia may lead to despair, violence, misunderstanding, irritation, anxiety, a lack of embarrassment and uncertainty. Having difficult in communicating is also a problem. As dementia advances, the skill to keep in mind the names of people and belongings may be lost. This makes communication hard at all stages, whether to let a caregiver be acquainted with what need and how patients experience or only to communicate within society. Trouble communicating can guide to feelings of disturbance loneliness and hopelessness. Delirium is the state in which it is distinguished by a turn down in attention, understanding and mental clarity. Delirium is regular in people with dementia, particularly when admitted to the hospital. It emerges that the unexpected transformation in surroundings, activity level and other routines may be the cause. Dementia patients have problems in sleeping. Disturbance of the normal sleep-wake cycle waking up at night and sleeping during the day is very frequent. Insomnia is another ordinary difficulty, as are agitated legs syndrome and sleep apnea, which also can interfere with sleep. Another concern is personal safety challenges. This is because of a reduced ability for decision making and problem-solving, some everyday circumstances can present protection subjects for people with dementia. These include driving, cooking, falling and discuss impediments. (Ritchie K, et al (2010)

Impact on the Carer.

The caregiver of the patient with dementia often has as many needs as the patient with dementia. Through the process of the disease the ability to control and maintain ones self stability is somewhat overwhelming and can lead to depression of the nurse caring for the patient in most cases. Depression and frustration usually comes from the fact that the dementia’s patient’s mental and physical health is gradually dwindling away, and the caregiver or nurse feels helpless. This helplessness comes from the fact that the nurse or caregiver is showing care, compassion, and using all the knowledge he or she has, yet the nurse sees little to no progress in the person because the disease process is taking over. “One caregiver described the disease as being a long journey in which the undeniable end is death, no fixed route, and no estimated time of departure” (Morton, 2003 p.262). Philosophy Nursing is the art of caring. Nursing is the concept of adaptation, self actualization, knowledge, and the ability to use and demonstrate these ideals in every situation. Holistic nursing is the idea that you understand and perceive the patient’s state of health. Dementia puts the nurse in a situation that in reality he or she has no idea what it is like to actually understand what the patient is going through. Through the process of this disease the nurse must overcome their own emotions and realize that they are there for one reason. This one reason is simply to care for the patient. The patient over time will change mentally, emotionally, and physically which will not only challenge the nurse and their ability to understand and care for the patient, but these factors will also affect the family of the patient.

Caring for an elderly person with dementia is a major life challenge and it entails emotional, physical, social and financial burden (Morris 1998).It also has been described as one of the most difficult situation met by caregivers. (Teusing JP, Mahler S., 1984).

Caregivers of dementia patients can experience various emotional problems during the course of the illness (Rabins PV.,1984).One such disorder, that is frequently overlooked and not treated, is carers depression (Harwood,et al,1998).It is well documented that family caregivers of persons with dementia have significantly more depressive symptoms than age and gender-matched non caregivers(Gallagher,et al,1990).Caregivers of persons with dementia report more emotional strain and depressive symptoms than caregivers of persons who are not demented (Hooker,et al,1998).

Empowerment of the Patient and the Carer

Empowerment is seen as a mainly important approach in allowing more marginalized groups of society, those who may be ‘powerless’ in many other aspects of their lives as well as in regards to control over their health (Bergsma, 2004).

The confront of linking people with dementia is in essence the challenge of dealing with the social exclusion by which people with dementia: “… are disempowered in a variety of ways. They have limited choice and control over their lives, they may have difficulty participating in the decisions that affect their lives and ultimately their fundamental rights as citizens and human beings may be infringed.” (Cantley and Bowes, 2004,)

The common-sense model (CSM) of self-regulation of health and illness was developed in the 1980s by Howard Leventhal and his colleagues (Diefenbach & Leventhal, 1996). It was supported on Leventhal’s research from the earlier decade that studied the effect of fear in relation to health related behaviours. It’s main goal and purpose is to give details how a person processes an illness risk. The CSM is centered on the human being and his or her idea of health and illness. It works underneath the idea that the individual is “an active problem solver.” CSM also theories an individual’s demonstration of the illness will be the primary cause of their accomplishments and manners and the method of illness representation will lead the individual to make common sense health behaviours. (Diefenbach & Leventhal, 1996) Self-regulation is the giving out of information by a patient concerning their health and the actions that an individual takes to go back to a normal position of wellbeing.

The participation of people with dementia should be established on values of personhood, relationship and citizenship, and on the principles of ethical practice. Participation activities with people with dementia can get position at a diversity of organisational levels with purposes or plans ranging from influencing the operation of individual services to influencing social approach all over the country and globally. Contribution can have individual advantages for people with dementia who regularly tale increased self-esteem and assurance happens from being incorporated in taking part in activities and feeling that they have somewhat to donate. Approaches to connecting people with dementia comprise individual discussion, group consultation, contribution and group act. With every of these advances a numeral of activities or means can be used. It is vital to be familiar with that some participation activities are further empowering of people with dementia than others. Loads of existing dementia contribution proposals has been service started with people with dementia being engaged more as “passive suppliers of opinion” as contrasted to “active negotiators of change”. There are good quality reasons for ‘starting small’ and building on accomplishment, above all when the contribution of people with dementia is still a fairly fresh and developing part of work. On the other hand, the processes by how interest expands and power relationships alter are compound and need vigorous thought and management by all concerned. (Cantley et al 2005)