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Approaches for Addressing Dementia in Elderly: Literature Review Assessment 2 Answer

ASSIGNMENT 2 – LITERATURE REVIEW

This assignment will require you to prepare a literature review which encapsulates the findings of the literature and other information you have gathered. The literature review to be conducted is a narrative review. This is different to a systematic review which is usually undertaken in order to perform a statistical analysis of the findings of previous research. A narrative review involves performing thorough literature searches, describing how these were done, grouping findings according to themes and showing how the articles relate to those themes. It is important to accurately reference all material used. 

Specific assessment criteria In this assignment you should: • Succinctly state your aim for the literature review. • Succinctly your search strategy (this is to include databases, search engines, key words, time frame of search, inclusion and exclusion criteria, people who you will contact to discuss their work on this particular issue and any other strategies you have used to conduct a systematic search). • State the range of literature you obtained (number of articles and main focus). • Group findings according to themes and describe the process you used to identify the themes.

Answer

Literature Review


What are effective approaches to addressing dementia in the elderly in assisted living residences & nursing homes in Australia? The target population will be Aboriginal & Torres Strait Islander elderly.

Introduction

The rate of incidence of Dementia in the Aboriginal and the Torres Strait Islanders are 3 to 5 times higher than that of other Australian populations. As per statistics from the OECD, out of every 1000 elderly people in Australia, 33.7 individuals are known to suffer from dementia (Oecd.org, 2019). Flicker and Holdsworth, (2014) showed that the severity of the problem in unrecognized in many regions despite the efforts of the governments to mitigate the issue. It is important to provide certain care services to the indigenous people suffering from dementia in Australia to decrease the health gap. The latest reports from the Australian Health Depart highlight that currently 376,000 people are suffering from Dementia and the number will increase to 550,000 people by 2030. This is responsible 11,000 deaths among the elderly indigenous population which is the second most probable cause of death (Aihw.gov.au, 2019). It is essential to provide effective management of food and nutrition for the indigenous population in the assisted living and nursing homes (Radford et al. 2015). It is also important to support pain management in the chosen population given the frailty of their health.Psychosocial support needs to be provided to patients with dementia among the Aboriginal and Torres Strait Islander population to prevent social isolation. Geriatric patients with dementia have a tendency to obtain fall-related injuries which need to be prevented in the assisted living and nursing care homes. 

Research Aim: The aim of this research is to provide a literature review for analysing the approaches that could be undertaken to treat patients with dementia among the Indigenous population in assisted living and nursing care homes.

  • To review the nursing databases and finding academic research support to deliver better treatments to elderly patients with dementia
  • To analyse the gap in the health outcomes of the elderly patients among the Aboriginals and the Torres Strait Islanders
  • To review the effective intervention strategies for providing better health outcome for the patient population

Methodology

Search Strategy

The databases considered for the study are CINAHL, MEDLINE, Emcare, PubMed, Web of Science and Scopus. These databases are advanced nursing database where the nature of the journals are very high with precise relevance to topics. Appropriate matches with respect to the keywords were searched in these databases. 

Keywords: The content, title and abstract were searched for the selection of the subject of the article. The specifications were considered with respect to the nursing approaches for the dementia care in assisted and nursing homes. “Older patients with dementia”, “indigenous population Australia”, “Dementia care in nursing homes” etc. were some of the key words used for the study. The Boolean Phrases emphasised for this study were “AND”, “OR”, “NOT”. 


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Statement of search timeframe: All the literature evidences were considered for the study was between 2014 to present date to create emphasis on the current strategies. The precise current approaches were the main focus of the study and hence this timeframe was selected for the search. The recent approaches of the nursing strategies to provide care for the people suffering from dementia and the needs of the sensitive Australian population are effectively seen in the study. 

Inclusion and Exclusion Criteria: The selection of materials only the published articles between 2014 to present date were considered which focussed on health care approaches towards patients with dementia. The health needs of the Aboriginals and Torres Strait Islander people were already determined so the focus was on the extent of the care regimes in nursing and assisted living homes. The exclusion criteria were the articles published before the 2014 and related other care approaches in diseases other than dementia.  

Data Analysis and Themes

The final selections of 15 articles were chosen for the most effective approaches of addressing the dementia and providing care in the assisted nursing homes in Australia. Some of the approaches are in relation to the health and care needs within the population of Aboriginals and Torres Strait Islanders. In relevance to the nursing approaches the different articles the consideration of the different countries were also selected. Similar themes were identified across the literature evidence that was found to be common in some of the articles. Some of the themes considered before thematically analysing the findings were as follows: Food and Fluid Consumption, Pain Management, Social Engagement, Fall Prevention and Prevention of Medication Error. 

   DatabasesPrimary search foundAfter applying keywords   shortlisted        cited
Scopus4325135
MEDLINE201372
CINAHL3727102
PubMed3232124
Emcare352092
Web of Science7020700
Total2351375815

Group Findings and Discussion

Food and Fluid Consumption

The disproportion in the economic burden and the age-related distribution of chronic diseases among the Indigenous Australians make it difficult for assessment. Morris et al. (2016) studied the effects of protein-energy malnutrition conditionsamong the Indigenous Australians in their study. The authors pointed out the patients suffering from dementia are at greater risk of malnutrition than others. This might give rise to additional health deficits as well as chronic diseases. This is in relation to the high cost of transportation and living conditions within Australia, which cannot be obtained by the Indigenous population. Volicer and Simard (2015) proposed that in assisted living and nursing homes the care providers can initiate a conversation with the patients to stimulate their appetites. The assisting nurses would be able to help the patients to the lunch area or bring them their lunch in cases of patient immobility. In order to prevent health deterioration among patients with dysphagia, the authors suggested the tube feeding technique to be most useful. The discomfort of tube feeding might be taken into consideration since the geriatric population is usually frail. This is generally is seen in the case of patients with severe dementia, later in the disease progression. This is supported by Hooper et al. (2014) who suggested offering water and other beverages to people with dementia is essential to keep them hydrated. Geriatric patients with dementia are known to lose water more easily than healthy individuals. This form of fluid and food management services is important since the terminally ill patients often refuse nutrition to succumb to voluntary death. Bolt et al. (2015) surveyed that the voluntary refusal of food and fluid by the patients increased the chances of death in assisted and nursing home living conditions. This occurs when the patient loses the motivation to continue better quality for living.

Pain Management

The direct consequence of dementia is not associated with pain, but it can be initiated among the patients due to chronic diseases and underlying conditions. Careful monitoring is required for managing pain initiation among dementia patients. Volicer and Simard (2015) opined that diabetic neuropathy and osteoarthritis are the common causes of pain among dementia patients. The deficit in the cognitive senses of the dementia patients makes it difficultfor them to report cases of pain as well as the development of aphasia when they refuse to report painful sensations verbally. Usually, in these scenarios, the patient expresses discomfort by the rejection of care and crying, which is essential to be monitored by the care providers in nursing homes. Hadjistavropoulos et al. (2014) suggested that the assessment of the pain in dementia patients should not be limited to intensity. Collaborative informing solutions should be initiated by the care providers to ensure that the proxy reports are generated and help in future assessments. Intervention is required in cases where the individualised approach to pain management. Peisah et al. (2014) surveyed in 15 assisted living facilities across the Northern Sydney Local Health District to find the pain management strategies for dementia patients.35% of the respondentsshowed signs of behaviour changes when the pain was triggered in them, and the care providers could identify each of the patients' pain triggers. The use of psychotropic and other drugs was a common practice among the assisted nursing staffs in the facilities and the common choice being oxycodone. The study of Veal et al. (2014) showed that the control of the altered behaviour of the patients triggered by pain could be controlled by familiar nurses as they could identify the discomfort easily. The dosage of the paracetamol and opioids are generally lowered for the patients with dementia regardless of the pain severity. The regular dosage of paracetamol is generally recommended to patients with dementia.

Social Engagement

Patients with dementia usually have troubles maintaining her self-esteem and dignity in social interactions. Hall et al. (2014) showed that the nursing assistants in care homes increase the goal achievement in this regard. The patients in assisted and nursing care homes should be provided with personal space and opportunities of relaxation to enhance the quality of life. Aboulafia-Brakha et al. (2014) suggested that the involvements of the family members for the patients with dementia decrease the secretion of diurnal cortisol and hence the psycho-physiological activities associated with dementia. In this regard, the cognitive behavioural modification techniques can be compared with the results of the patient education program. The overall health of the patients would be increased with the utilisation of both patient education and CBT treatments. Abraha et al. (2017) proposed another method that assisted nurses can adopt in treating behavioural treatments among dementia care patients. The authors proposed that sensory stimulation practices like acupressure, aromatherapy, massage, light therapy could be consideredfortreatingbehavioural aggression among dementia patients. 


Fall Prevention

Veal et al. (2014) observed that the concurrent use of falling in elderly dementia patients is commonly observed. Certain sedatives have been associated with the risk of falling, which could lead to fracture and other associated injuries. Anxiolytics/Hypnotics, when provided to the patients in combination with conventional opioid drugs, increased the risk of falling. This is why the care providers need to be aware of the consequences of the combination of drugs being incorporated to the patients in assisted living and nursing care facilities. Phelan et al. (2015) addressed the issues when the elderly patients face with dementia. Distraction and rushing might induce the risk of falling among such patients and is the most commonly observed reason for falling. It is the duty of the assisted nurses to prevent the falling risks and assist the patients with their daily activities. The maintenance of environmental and contiguous safety needs to be provided by the assisted caregiver in the facility. The nurses need to assist the dementia patient in mobilityassociated activities like housekeeping, defecating and dressing. 

Prevention of Medication Error

The ageing population is one of the challenges of the healthcare industry in all countries including Australia. The complexity of the diseases and the multi-morbidity among the patients give rise to the errors of polypharmacy. Pérez-Jover et al. (2018) pointed out the major concern among the administrators of the healthcare facilities are the polypharmacy issues. Inappropriate medications give rise to multi-pathological conditions which can be devastating for the geriatric population. The study investigation revealed that half the patient population were not aware of the use of the polypharmacy and consumed it giving rise to health risks. The polymedicated condition of the patient population took more than five different medications without knowing their health issues. The reduction of the errors has given rise to the introduction of the elderly patient condition. In the case of dementia this problem could be increased since the cognitive skills of the patient is lowered in comparison to others. Therefore the assisted nurses would need to ensure that the patient's medication regimen is properly managed and organised. Patient education can be provided to help them understand their medication regimen among early-stage care users. Another study Notenboom et al. (2014) pointed out that 95% of the patients did not know the use of their medication regiment and caused errors. This also increased the chances of developing the risk of erroneous medication consumption. The patients pointed out the instruction in the packaging are difficult to read, and usage is sometimes unknown. The handling and packaging, recapping after medication usage are also not known to the patients. The clinical consequence causes immense issues among patients and severe clinical deterioration. The suboptimal solution to medication management among geriatric patients makes it difficult to manage their health. 

Conclusion

The above literature review showed that the initial challenge for the Aboriginal and Torres Strait islander people with dementia was getting the proper nutrition. The nursing care providers in the nursing and assisted living homes need to provide effective feeding practices to ensure that patients are not nutrition deprived. The next challenge was pain management in the Indigenous Australian population was the pain management which need clear communication and effective sedative management to help them overcome their pain related discomfort. The third challenge was the management of the social behaviour of the dementia patients and helping them improve their quality of life through social interaction. Fall prevention was the next and one of the most critical issues being faced by dementia patients in the Indigenous population chosen. Effective monitoring and assisted activities decreased the chances of fall associated risks.  Lastly the prevention medication error is also important approach in managing the dementia patients among Aboriginal and Torres Strait islander population. 

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