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The words Alzheimer’s Disease and dementia are frequently used interchangeably and synonymously. However, dementia is not a specific disease, but more of an umbrella term that represents the inability to think, remember or make decisions regarding daily tasks and everyday activities.
There are many types of dementia including Alzheimer’s, Parkinson’s Disease, Lewy Body Dementia, Vascular Dementia, and Frontotemporal Dementia.
Alzheimer’s disease is the most common form of dementia and progressively impairs one’s cognitive ability to retain information, react to the environment and eventually have conversations altogether. It usually begins with mild memory loss, followed by loss of rationale, hallucinations, change in personality and frequent references to one’s own younger days, past events and to people present during those days, who have since passed (memory regression).
This cognitive impairment eventually destroys one’s ability to manage even the simplest tasks such as bathing, eating, and toileting. Therefore, a well-thought-out nursing care plan for dementia patients will help to improve the quality of life for both patients and family members.
Caregivers are frequently required to give up their jobs in order to take care of their loved ones with dementia. Many end up trying to work from home.
Table of Contents
Living With Dementia
An elderly lady smiling at the camera
Alzheimer’s Disease (AD) is the fifth leading cause of death for people over the age of 65 in the United States. While it is more prevalent in older adults and in the ageing population, this does not mean that one is bound to get it when one grows old. Until today, the cause of dementia has not been fully determined, and medications can only help to slow down the progress of the disease to a certain extent.
As cognitive function declines, a patient with dementia experiences:
- Self-care deficit: Describes the inability to groom, bath, eat and use the toilet properly
- Memory deficits: A person’s ability to remember faces, facts and names of the people around them
- Social isolation: The inability to interact, make conversation or have any form of verbal communication. In the early stages of dementia, the patient may also experience expressive aphasia – where they are able to understand what is being said to them, but have difficulty responding fluently
- Increased risks for falls: Older patients and those in later stages of AD or dementia are more prone to falls and accidents due to muscle weakness and loss of strength in limbs
- Chronic confusion and anxiety: These are typically major symptoms of AD and worsen as AD advances
A strong care team and a support system are very much needed when it comes to helping family caregivers cope with the cognitive decline of their loved ones. Healthcare professionals try to come up with the best plans that allow the patient to maintain a decent quality of life while providing the family members and caregivers support through these difficult times.
Taking care of a patient with dementia can be incredibly challenging and exhausting, physically, mentally and emotionally. Without a proper long term goal and consistent help from support groups such as relatives, friends and social workers, care providers can easily experience caregiver burnout – a situation where one starts to feel resentment, anger and impatience at having to give up a huge portion of one’s social life to care for the patient.
Dementia Care Plan: A Personalized Nursing Care Plan For Dementia Patients
Care plans for patients with dementia cover a myriad of possibilities, taking into account their:
- Risk factors (underlying health issues such as heart disease, diabetes, impaired kidney function, cholesterol level, asthma and more) and the types of medication they’re on
- Limited physical mobility – patients in the last stages of AD are usually completely wheelchair-bound and are unable to walk on their own
- Individual needs – some patients may have other issues such as blindness, severe dry eye symptoms, eczema, back pain, and more
Impaired Physical Mobility Care Plan
Symptoms:
- Facial and verbal expressions of discomfort and pain when trying to move or do certain movements
- Refusal to move
Assessment and diagnosis:
- Limited range of movement
- Inability to complete a full set of movement instructions
- Decreased muscle strength
- Heavy reliability on walking and movement aids and equipment
- Unstable gait and posture
Nurse’s Role(s):
- Make an accurate assessment
- Note the patient’s willingness to participate
- Assess the need for equipment
- Assess the need for long-term care facilities
Intervention:
- Giving medication for the pain, such as analgesics, ice packs, plasters
- Providing necessary equipment that makes the transition from immobility to movement easier for the patients
- Giving encouragement and showing patience
- Repositioning the bed-ridden patient regularly and when necessary
- Working with physiotherapists to come up with the best exercise routines that are helpful and not overwhelming
- Ensuring proper nutrition and that the patient is taking in necessary vitamins and minerals
- Working with the family members to ensure important information regarding the patient is properly shared and understood, how special attention should be given at certain times such as during showering and toileting, and why the patient’s safety should always be taken into consideration.
Social Isolation And Care Plan
Symptoms:
- Declining cognitive ability (one of the most popular symptoms of dementia)
- Inability to recognize or remember faces and names and other signs of memory impairment
- Difficulty talking and significantly impaired communication skills
- Difficulty in responding as vocabulary skill decreases
- Disorientation to time and places
- Lack of concentration and focus
- Rapid mood swings and changes in behavior – becoming more aggressive, belligerent, restless and irritable
- Depression
- Lacking a sense of reality and inability to take part in active conversation
Assessment and diagnosis:
- Patient forgetting names and dates
- Inability to drive
- Paranoia and hallucinations, coming up with fantastic stories
- Disturbed sleep patterns
- Changes in appetite
Nurse’s Role(s):
- Determining mental limitations and barriers
- Assess the patient’s ability to talk and communicate
- Assessing if the patient remembers close friends and family members – checking for memory problems
Intervention:
- Providing an environment for social interaction, but not forcing the interaction
- Preparing games and activities that are easy to understand and not too tiring
- Playing music from their time
- Making to chat and draw them into small talk
- Reminding them about their lives and their personal information
- Letting them tune in to radio programs
- Family members play a key role in always trying to include the patient in their day-to-day conversations
- Planning out a sleep routine for patients
Self Care Deficit
Symptoms:
- Inability to bathe or clean properly
- Difficulty putting clothes on or grooming
- A tendency to pee and pass motion at random places
- Inability to manage most basic self-care activities such as brushing teeth, washing hands, eating cleanly
Assessment and diagnosis:
- Assessing patient’s appearances
- Assessing the patient’s body odor
- Checking to see if the patient knows how to utilize items meant for personal care, such as a comb, a toothbrush, a soap
- Ability to make the proper decision with regard to dressing
Nurse’s Role(s):
- Assist patient with personal care activities, such as making sure the temperature of the water in the bathtub is suitable
- Inspecting patient’s cleanliness in terms of teeth, skin (after a bath)
- Reminding and coaching the patient
Intervention:
- Maintaining a simple schedule and routine for self-care tasks
- Ensuring that the washroom has the necessary tools to help patients – a handlebar, reminders, a help button
- Providing help whilst maintaining the patient’s dignity
- Opting for easy-wear clothes for the patient that does not require the use of a zip or buttons
- Training the family members so they can clean and bathe the patient competently
- Using signages around the house, such as post-it notes, labels, whiteboards, clocks, and more. These notes help a lot, especially in a patient’s first stage of AD
- Maintaining a high quality of care and professional support because many of these activities are incredibly personal
Risk For Falls
Symptoms:
- Unstable gait and walk, especially in older patients
- Needing to use the wall or equipment constantly as support while walking
- Sitting down very suddenly (legs giving way)
Assessment and diagnosis:
- Assessing the patient’s muscle strength and coordination
- Assessing reaction and judgment
- Assessing the patients’ eyesight, hearing and alertness towards their surroundings
Nurse’s Role(s):
- Offer support when necessary
- Assess hazards around the patient in terms of objects and remove them
- Assessing patient’s visual acuity and judgment
Intervention:
- Keeping items within reach
- Removing unnecessary items that may lead to falls and accidents (uncluttering the environment)
- Making sure walking aids, glasses, hearing aids and supporting equipment are always available
- Having family members install protective guards over electrical outlets, stoves and thermostats to reduce the risk of electrocution and burns
- Having family members ensure locked access to pools and staircases
- Ensuring that the house is always well-lit to ensure good visibility
- Ensuring that floors are dry with no wet patches to reduce the chances of slipping and falling
Compromised Immunity
Symptoms:
- Patients that have difficulty breathing
- Patients in constant discomfort and pain
- Patients that are heavily dependent on their regular medication
Assessment and diagnosis:
- Assessing the patient’s medical history. Patients with a history of asthma and eczema, for example, may need to stay away from rugs and house pets.
- Patients with a history of stroke or irregular heartbeats may get them again and will need close monitoring
Nurse’s Role(s):
- Perform regular checks such as blood glucose tests, blood pressure tests, and more
- Ensuring patients with chronic conditions are regularly checked by a health care provider
- Reporting and administering first aid when necessary
Intervention:
- Making sure patients with health conditions are on their regular medication
- Taking precautions to not expose immunocompromised patients or weak patients to unnecessary visits and contact
- Older people are at greater risk of mortality when it comes to acute viral infections, hence masks should always be worn around them
- Ensuring a clean and safe environment to reduce the risk of community-acquired infections
Important Goals
Elderly people smiling together
Patients with dementia need the best care possible. Both family members and nurses as well as healthcare providers play important roles in providing great hospice care to not only give these patients emotional support and make them feel loved, but also to ensure a smooth passing especially when patients are in the last stages of dementia.
While it is not easy for family members to watch a loved one’s cognitive decline and imminent passing, understanding what dementia is, recognizing dementia symptoms and learning how to manage them are extremely important. Caregivers need support and guidance as well, so always reach out to nurses and doctors as well as support groups for more advice and assistance.
