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Nursing

Dementia: Quality of Care in Assisted Living Facilities

Dementia is a disease with multiple symptoms, such as memory loss, disorientation, decreased ability to perform regular activities such as eating, getting dressed, and bathing.  In addition, symptoms such as depression and psychosis are also observed.  (Tilly and Reed, 2004)

Patients with dementia have increased risks for such things as falls, which can decrease the quality of care at the resident nursing home.  One particular case from an 85 year old female Alzheimer’s patient who lives in a nursing home facility in a small rural facility in Minnesota was examined.  The patient was experiencing impaired balance and decreased weakness, resulting in an increased number of falls.  The physical therapist assigned to the case found numerous clinical findings that resulted in an overall determination that the patient was at high risk for falling.  Therefore, a fall management program was instituted for the patient.  The management program included therapy of the lower extremities, as well as balance and gait exercises.  In addition, the patient received a program that focused on therapy and activities that integrated the memory system to help patients with dementia.  The results from the intervention were positive.  After only four weeks of twelve sessions, the patient’s Assessment Tool score doubled.  In addition, the number of incidents reported from falls decreased to zero.  Overall, a positive outcome resulted from the intervention program and managed care of this dementia patient.  Mirolsky-Scala, G. and Kraemer T. (2009)

The above case study was a good example of the need for individual managed care of dementia patients and its specificity to the types of symptoms and problems that the dementia patient is experiencing.  Individuals with dementia, who live in nursing homes or assisted living facilities, are at risk for negative health effects and negative quality of care outcomes.  The risks could be greatly decreased assuring an increase in higher quality of care for dementia patients.

The purpose of this paper is therefore, to evaluate methods of improving the quality of care in dementia patients through rehabilitation and therapy.

It has been suggested that the care for dementia patients living in long-term care facilities are placed into two different categories, such as Aspects of activities of Daily Living or ADLs and psychiatric and behavioral symptoms.  These two main categories are also further subdivided based on the patient’s physiological needs for eating, drinking, bathroom, hygiene, etc.  Each of the categories and subcategories are important in regard to the quality of care of the dementia patient in a long term facility.  (Tilly and Reed, 2004)  The paper by Tilly and Reed (2004), addressed outcome of quality of care when addressing the dementia patient’s physiological, hygiene, ambulatory, psychiatric and behavioral needs.  The results from the study suggested that environmental changes were necessary, such as making the environment easier for the dementia patients to understand, such as increasing the light intensity in the common areas, and letting the patient have more control over their meals.  In addition, the study found that a more pleasant environment during bathing decreased aggression and agitation in the patients.  Furthermore, an increase in interventions to increase the resident ability for independent dressing decreased aggression as well.   In regard to decreased the amount of falls in the dementia patients, results indicated that behavioral and environmental activities decreased the amount of harmful activities exhibited in dementia patients, such as pacing and wandering.  (Tilly and Reed, 2004)

Tilly and Reed’s (2004) evaluation of behavioral and psychosocial aspects of quality of care in dementia patient led to the conclusion that there are treatment principles and guidelines that must be followed for these patients.  For one, a detailed assessment with potential causes for agitation, depression or aggression should be evaluated and the determination for a treatment method should be analyzed.  Secondly, environmental techniques should be applied in order to treat any agitation, depression or aggression before pharmacological uses.  Thirdly, if the non-pharmacological approach does not work, medications therefore should be evaluated and considered if it has the potential to decrease harm and increase the quality of life in the dementia patient.   The authors also clearly indicate that medications should be a last result in order to avoid any type of adverse effect.  Overall, the authors have indicated that following these types of programs increase overall functioning of the dementia patient, which in turn increases the quality of care.  (Tilly and Reed, 2004)

Gitlin and Earland, (2013) have also promoted the increase in the quality of care of dementia patients with the use of non-pharmacological approaches.  It is indicated that non-pharmacological therapy approaches, such as music, touch, exercise, pleasant events and cognitive therapies suggest a more promising approach to the increase in care.  In addition, their research has shown that results in quality of life are beneficial to both the patient and their family members.  The authors have outlined five characteristics of the non-pharmacological therapy approach as customizing to identify the capability of the dementia patient, involvement of the family, use of problem solving to identify factors contributing to behavioral problems, use of communication and environment to increase ability of the dementia patient, and use of habilitative versus restorative treatment plan.  (Gitlin and Earland, 2013)

Overall, in regard to quality of care of a dementia patient, rehabilitation techniques of non-pharmacological uses seem to have a positive effect or response from the dementia patient.  As seen in the case study, the patient positively responded to the non-pharmacological approach of physical therapy.  Therefore, more research should be conducted in order to outline specific non-pharmacological approaches for individuals living in long-term dementia facilities, in order to increase their quality of care and quality of life.

References

Gitlin LN, Vause Earland T. 2013. Dementia (Improving Quality of Life in Individuals with

Dementia: The Role of Nonpharmacologic Approaches in Rehabilitation). In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation. Available online: http://cirrie.buffalo.edu/encyclopedia/en/article/28/

Mirolsky-Scala, G. and Kraemer T. (2009)  Fall Management in Alzheimer-related dementia: a

case study.  J. Geriatr Phys Ther.  32(4):181-189.

Tilly, J. Ph.D. and Reed, P. Ph.D.  (2004).    Evidence on Interventions to Improve Quality of

Care for Residents with Dementia in Nursing and Assisted Living Facilities.  The Alzheimer’s Association.   Retrieved from: http://www.alz.org/national/documents/dementiacarelitreview.pdf

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