Providing Quality of Care for Long Term Care Residents Living with Dementia
Introduction
In the United States, there are approximately five million people who have age-related dementia. The number is expected to double by year, 2050 (Keouch, 2016). In Western New York, there are approximately 400,000 people living with dementia (Alzheimer’s Association,2019).
Dementia is a disease that affects the brain and causes memory loss, thinking, and reasoning skills. The Alzheimer’s association has provided ten signs and symptoms to watch out for. Memory loss that disrupts daily life, challenges in planning or problem solving, difficulty completing familiar tasks, confusion with time or place, trouble understanding visual images and spatial relationships, new problems with words in speaking or writing, misplacing things and losing the ability to retrace steps, decrease or poor judgement, withdrawal from work or social activities, and changes in mood and personality (Alzheimer’s Association, 2019). Examples of dementia include, problems with short term memory, loosing purse or wallet, losing keys, problems paying bills and making meals. One of the scariest for family members is when the person diagnosed with dementia/Alzheimer’s is found wandering the neighborhood, or forgets how to get home (Alzheimer’s Association, 2019).
Along with memory loss, residents with dementia, begin to need help with activity of daily living, or ADL’s, eating, grooming, and mobility. If the resident remains in the community, they will also need help with meal planning, shopping, financial and medication management (Long, 2015). There are many tools and education materials available to care givers in the community, and also for the nursing staff that care for the residents in long term care.
Topics covered in the paper pertaining to quality of care include routines. Short term memory is affected in residents with dementia, leaving the long-term memory. For residents with dementia, there should be a daily routine remaining as similar as possible. What time they get up, how and when they wash up, what, how, and where they eat breakfast, and activities they do during the day should also remain relatively the same (Heerema, 2019). Digital photography is used to help residents with dementia, looking at photographs with recordings of the events surrounding the activities help the residents remember events that took place in their lifetime, also help with ADLS (Karlsson, 2017). Music therapy is beneficial to the quality of care with residents with dementia. It helps decrease anxiety and fear, and music increases social interactions, communications, cognition, movement, and conversations (Keough, 2017). Reminiscence is important for the staff and residents in long-term care, reminiscence can be used when residents are anxious, to help them recall happy memories, and when re-orientation is needed. Reminiscence can give the resident a sense of purpose (Kris, 2017). Physical activity promotes quality of care in the resident with dementia. It can help decrease the risks for developing dementia, it helps with inactivity, which can lead to other morbidities such as hypertension and diabetes. Physical activity helps keep the mind sharp. Activities should be resident centered as much as possible, they can be moderate to high intensity, or can be a simple as gardening or crafts (Lee, 2018). Meals for residents with dementia should be resident specific, and level of assistance should be goal orientated. Nutritional intake is dependent on level of assistance needed (Mann, 2019). Social connections are important to quality of care, connections can be between resident to resident, family with resident, and staff with resident. Connections vary, for example, nurse to resident, this connection is medical based, activity department connections are getting residents involved physically, socially, and mentally (O’Rourke, 2017). Lastly, this paper covers evidence-based interventions for quality of care. It helps caregivers know what to look for, how to put interventions in place, and what supports are available (Logsdon, 2007).
Purpose
This paper will show the quality of care of residents living with dementia in long term care facilities if staff is given the proper training and tools needed. Residents living with dementia should receive the highest of care to improve their quality of life. This paper will bring to light signs of Alzheimer’s disease and dementia, interventions for care givers and staff in long-term care, goals for resident’s living with dementia, and programs available that long-term care facilities can utilize for residents with dementia.
The Alzheimer’s Association gives caregivers the ten most common warning signs to watch out for, with individuals with beginning dementia. Memory loss: memory loss is one of the earliest most common signs of dementia. Individuals in the early stages of dementia forget important dates, events, repetitive statements or questions, and use of lists or writing things down that need to be remembered. Another area that an individual might have trouble with is planning or problem-solving. Residents may have trouble developing a plan or following the plan. They may lose track of time and may take longer to complete tasks. Difficulty completing tasks: individuals may have trouble driving, going shopping, or remembering favorite things. Confusion with time or place: individuals lose track of dates, seasons, and time. They might not be able to understand why something isn’t happening right away. Individuals will have trouble understanding visual images and spatial relationships. These difficulties can lead to imbalance, trouble walking, trouble reading, and may cause issues with color and driving. Individuals may have problems with words – speaking or writing. Calling a watch a hand clock or calling one person by another name are common examples. Misplacing things and losing the ability to retrace steps is another sign of dementia. When this happens, individuals may accuse others of stealing. Poor judgement: individuals pay less attention to money, grooming, or keeping themselves clean. Withdrawing from work or social activities: with impaired memory, people may withdraw from social activity and work to hide their memory loss. Lastly, changes in mood and personality: people become confused, suspicious, depressed, anxious, and get upset easily. Early stages of dementia shouldn’t be confused with the natural aging process or symptoms status post stroke, or other neurological issues (Alzheimer’s Association, 2019).
When changes like the about occur, it might be time for care givers to reach out and get help and support from sources outside the home, such as day programs for the elderly, long term placement in memory care or nursing homes. Once the decision is made for outside day programs, memory care, or long-term placement, it becomes the responsibility of the nursing staff to continue quality of care for the resident with dementia. Education and services are provided for the resident with dementia, nursing staff, and families.
Factors that influence quality of care for residents with dementia include mood, activities, ability to perform ADLs, physical and cognitive functions. Interventions utilized with dementia residents include strategies to increase involvement in activities and prevent depression, to decrease stress, and maintain current level of functioning with ADLs (Logsdon, 2007).
Routines are important to the staff and the resident, routines can be calming and reassuring for the resident with dementia. Dementia affects the short-term memory first, and routines are normally in the long-term memory. Routines remain in long term memory until about the middle stages of dementia (Heerema, 2019).
Digital photography is effective in helping the dementia patient with memory, it brings the caregiver and resident closer together, and helps the resident remember past experiences, and calms the resident down during periods of anxiety (Karlsson, 2017).
Music therapy is very important for residents with dementia, music brings back memories, it helps calm residents during periods of anxiety, and impacted short term moods and behaviors (Keough, 2017).
Reminiscence is used frequently among nursing staff; reminiscence is used to increase social connections. Reminiscence can be used individually with nursing staff, or within a group setting, an activity for example, such as painting or playing bingo. Reminiscence is also utilized in decreasing depression and preventing anxiety (Kris, 2017).
Physical activity is another tool used with residents who have dementia. Physical activity can slow the progression of dementia once the disease has been diagnosed. Physical activity can also help with reducing co-morbidities, such as hypertension and diabetes. Physical activity should be resident based, as older residents can’t perform as younger adults (Lee, 2018).
Other activities that improve quality of care with dementia patients is meals, and social connections. Meals should be resident-centric, and time spent should be focused on meal consumption and helping the resident to maintain independence (Mann, 2019). Social connections are often forgotten about, behind the health and wellbeing of the dementia residents. Interpersonal connections are different from social connections, contact, or loneliness (O’Rourke, 2017).
Background/Significance
I am writing this piece because I do not think that there is enough training for staff, or programs in place for the residents living in long-term care facilities. Quality of care should be a top priority for all the residents, but especially for those with dementia. Staff who works in memory care units have extra training to help care for the resident’s with dementia.
Studies have shown that different stimuli triggers memories, and that if residents can get access to electronic devices, they may be able to record memories that correlate with matching photo. This brings about a sense of self and identity. Current studies are focused on exploring self and identity with digital photography (Karlsson, 20178).
Studies have shown that music therapy in New York consists of music in recreation or activities. These therapies have a limited opportunity to provide assessment-based and individual music therapy services. There is little support for music therapy. This current study aims to encourage music therapists to use small group approaches (Keough, 2017).
The purpose of the current study of reminiscence is to understand the reasons nurses engage in reminiscence activities both personally and professionally, the value they attribute, and the extent in which they enjoy them (Kris, 2017).
There are many studies completed on physical activity and dementia. One study stated that if an older adult participated in gardening, then there was a 34% of lower dementia risk, compared to those who did no physical activity. Another stated that there was an inverse association between leisure time physical activities and all-cause dementia. The purpose of the current study is to investigate the relationship between physical activity and all-cause dementia, AD, and vascular dementia based on physical activity (Lee, 2018).
There are studies completed on the influences of dementia, and the factors associated with dementia based on the view of the person with dementia and the care giver. Both views included quality of life, ADL functioning, physical mobility and health, and cognitive ability. The new purpose of the study focuses on depression and pleasant events, ADLs, physical functioning and mobility, and cognitive functioning (Logsdon, 2007).
Mealtime for the resident with dementia can cause weight loss, and poor energy intake. The assistance needed to help the resident with dementia, can determine the amount of malnutrition. The purpose of this current study is to examine the association of mealtime actions with energy intake of long-term care residents. The second component was to determine if physical eating assistance provided by staff is associated with energy intake (Mann, 2019)
Social connectedness is defined as the opposite of loneliness, a subjective evaluation of the extent to which one has a meaningful, close, and constructive relationship with others. The purpose of this study was to support the development on interventions to enhance social for older adults (O’Rourke, 2017).
Comprehensive Chapter Summary
There is a need to develop programs for the staff and caregiver of residents with dementia. Education and in-services should be in place when caring for residents with dementia. Music therapy, reminiscence programs, social connectedness, digital photography, routines, and physical activity are just some examples of the progress made thus far to provide quality of care for residents with dementia living in tong-term care facilities.
References
Heerema, E., MSW. (2019). Verywell Health. The benefits of routines for people with dementia- how consistent caregivers can help in alzheimer’s disease. Retrieved from doi:https://www.verywellhealth.com/using-routines-in-dementia-97625.
Karlsson, E., Zingmark, K., Axelsson, K., & Savenstedt, S. (2017). Aspects of self and identity in narrations about recent events: Communication with individuals with alzheimer’s disease enabled by a digital photograph diary. Journal of Gerontological Nursing, 43(6), 25-31. doi:http://dx.doi.org.trocaire.idm.oclc.org/10.3928/00989134-20170126- 02.
Keough, L., MSED, LCAT, MT-BC, King, B., PhD, LCAT, MT-BC, Lemmerman, T., MS, MT- BC. (2017). Music Therapy Perspectives. Assessment-based small group music therapy programming for individuals with dementia and alzheimer’s disease: a multi-year clinical project. 35(2), 182-189. doi:10.11093/mtp/miw021.
Kris, A. E., Henkel, L. A., Krauss, K. M., & Birney, S. C. (2017). Functions and value of reminiscence for nursing home staff. Journal of Gerontological Nursing, 43(6), 35-43. doi: http://dx.doi.org.trocaire.idm.oclc.org/10.3928/00989134-20170224-02.
Lee, J. (2018). The relationship between physical activity and dementia: A systematic review and meta-analysis of prospective cohort studies. Journal of Gerontological Nursing, 44(10), 22-29. doi:http://dx.doi.org.trocaire.idm.oclc.org/10.3928/00989134-20180814-01.
Logsdon, R., PhD, McCurry, S., PhD, Teri, L., PhD. (2007). Alzheimers care today. Evidence- based interventions to improve quality of life for individuals with dementia. 8(4): 309- 318. doi:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585781.
Mann, K., Lengyel, C. O., Slaughter, S. E., Carrier, N., & Keller, H. (2019). Resident and staff mealtime actions and energy intake of long-term care residents with cognitive impairment: Analysis of the making the most of mealtimes study. Journal of Gerontological Nursing, 45(8), 32-42. doi:http://dx.doi.org.trocaire.idm.oclc.org/10.3928/00989134-20190709-04
O’Rourke, H., M., & Sidani, S. (2017). Definition, determinants, and outcomes of social connectedness for older adults: A scoping review. Journal of Gerontological Nursing, 43(07), 43-52. doi:http://dx.doi.org.trocaire.idm.oclc.org/10.3928/00989134-20170223- 03.