INTRODUCTION:

Aging is a continuous and a dynamic process that begins from birth and ends with death. Older people are becoming an increasingly significant proportion of populations around the world. In 2010, there are 3.7 million Indians with dementia and which is expected to doubled by 2030. Elderly people do tend to require a certain amount of assistance with age. Needs of the elderly can be of various types such as financial needs, health needs, nursing requirements, etc. Dementia is the most common psychiatric disorder on the later age. Dementia is a non-specific syndrome in which affected areas of brain function may be affected, such as memory, language, problem solving and attention. The assessment and management of dementia is complex. The goal of treatment is to control the symptoms of dementia. Treatment depends on the condition causing the dementia. This article will be discussing the comprehensive assessment and nursing interventions for dementia.

What is dementia?

Dementia is characterized by generalized Psychological dysfunction of higher cortical functions, without impairment of consciousness. In fully developed dementia the higher cortical, functions affected include memory thinking, orientation, and comprehension, calculation, learning capacity, language and judgment.Many diseases can cause dementia, the most common being Alzheimer disease. Other common forms include vascular dementia, dementia with Lewy bodies, frontotemporal dementia and mixed forms of dementia. The critical clinical points of dementia are the identification of the syndrome and the clinical workup of the cause. The disorder may be progressive or static permanent or reversible. An underlying cause is always assumed, although in rare cases it is impossible to determine a specific cause. The potential reversibility of dementia is related to the underlying pathological condition and availability and application of effective treatment. Approximately 15 percent of people with dementia have reversible illness, if treatment is initiated before irreversible damage takes place.

Assessment of Dementia:

The management of dementia starts with a full assessment of the patient. This includes a history, mental state examination, physical examination and investigation. In assessing the presence or absence of dementia special care should be taken to avoid false, positive, identification motivational or emotional factors. Dementia produces an appreciable decline in intellectual functioning, interference with personnel activities of daily living such as washing, dressing, eating, personal hygiene, excretory and toilet activities changes in role performance occur such as lowered ability to keep or find job should not be used as criteria of dementia because of the large cross cultural difference exist in appropriate because frequent, externally imposed changes in the availability or work. The assessment should also include search for treatable, often minor, medical conditions that are associated rather primary causes. Treatment of these conditions can reduce distress and disability.

Assessment of dementia requires a set of skills and knowledge that span several clinical domains. The nurse assessing the patients should be familiar with normal aging, brain anatomy, brain pathology that produces dementia and common disorders that mimic dementia. She or he should combine basic clinical evaluation skills with other disease-specific assessments to provide accurate high-quality dementia assessments. The symptoms of dementia re divided into cognitive, functional, and psychiatric. The proper assessment of dementia requires that the nurses understand the four or five most common diseases that produce cognitive loss in the elderly as well as the neuroanatomy of cognition, four or five medical problems that mimic dementia, and basic assessment strategies that capture essential information. Recent advances in the understanding and treatment of dementia underscore the importance of adequate assessment. New treatments for Alzheimer’s disease are most effective when employed in the earliest stages of the disorder.

Management of Dementia:

Unfortunately, no curative treatment for dementia is currently available. Some medications, however, can temporarily improve symptoms and functioning and may slow the progression of the basic disease process. Recently the evidence for non-pharmacological approaches to dementia care is increasing. Non-pharmacological interventions include the provision of therapeutic activities and education and psychological support; and there is increasing evidence of the benefits of psychosocial and behavioural interventions. Cognitive stimulation therapy is really beneficial intervention for people with mild-to-moderate dementia. The management of people with dementia requires many different tasks to be undertaken. It is not usually appropriate for one person to carry out all of these tasks and effective teamwork is vital. The nurses as a key member in this team need to perform the general care of in-patients and nursing home residents; carrying out behaviour modification regimes; education and counselling of relatives; coordination of community services. The Nursing care should be given according to its cause, onset of illness and severity. The main aim of nursing care is to make the patient’s life easier and pleasant.

Nursing care for dementia:

The Nursing care should be given according to its cause, onset of illness and severity. Nurses need to be aware of the full range of interventions, know which ones may be most appropriate for an individual, and understand how to recognise whether an intervention is helping while planning care. According to Weyerer S et al. (2010) the principal focus of care should be on maximising independent activity and enhancing function. Often this will involve helping patients to adapt and develop the skills to minimise their need for support. This should start in the early stages of the condition and may involve many services and the patient’s carers and wider social network. Good communication is at the heart of all effective psychological interventions. This entails being aware of non-verbal cues and speaking appropriately for patients’ levels of comprehension, sensory abilities and culture. The written word or pictures may also be helpful.

Any environmental modifications that might aid independence, including assistive technology, should be considered. Perry et al (2008) suggested that nurses should provide an environment that is modestly stimulating, avoiding overstimulation that can cause agitation and increase confusion, and understimulation that can cause sensory deprivation and withdrawal. Utilize patient identifiers, eliminate any environmental hazards and modify the environment to enhance safety; provide environmental cues or sensory aides that facilitate cognition; maintain consistency in caregivers and approaches. Physical exercise should be facilitated and encouraged where possible, with assessment and advice from a physiotherapist when needed. Exercise is thought to help improve continence, slow loss of mobility and improve strength, balance and endurance. It is also used in falls prevention. Interventions for cognitive symptoms of dementia comprise psychological and pharmacological treatments. However, providing supportive care that encourages patients to maintain as much independent functioning as possible is perhaps as important as any specific interventions for cognitive symptoms.

To sum up, dementia is a chronic progressive disorder Dementia is the most common disturbance of brain function in elderly. It is characterized by the disturbances in memory, thinking, judgment and behavior. The supportive care and enhancing the brain function is the methods to lead a quality life in dementia patients. Having a sound knowledge and skill base and understanding the issues relevant to dementia is key to conduct comprehensive assessment. The nurses should maintain mobility and encourage independence as long as possible, provide graded assistance as needed in daily activities.

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Received on 25.08.2014 Modified on 08.09.2014

Int. J. Adv. Nur. Management 2(3): July-Sept.,2014; Page 180-182