Health of an Individual with Dementia-Free-Samples for Students

Questions: 1.What is Dementia and how modified environment and can be applied in dementia care? 2.What are sensory stimuli and how the sensory stimulation through light can improve the health of an individual with dementia? 3.Effect of Bright sun light therapy on sleeping pattern (circadian rhythms) among dementia patients. Answers: 1.Dementia is a multifactorial condition that results in affecting the functions of the brain. Brain dysfunction causes loss of memory, problems with reasoning and communication, mood changes and decreased ability in carrying out activities of daily life (Lash, 2014). It can be said that dementia affects social, physical as well as emotional health of an individual. Prevalence of dementia is rising with the growing number of aging population. Bringing changes to the physical environment is increasingly become very significant and important aids for providing care to people with dementia (Ganguli, 2017). Modified environment can also be considered as the therapeutic resources to promote functionality and well-being of people suffering with dementia. Study of Fleming et al (2016) also explains that quality of the environment provided to people suffering with dementia can significantly improve the quality of their lives. The link between the environment and the people suffering with dem entia can be established through environmental cues and sensory stimuli. 2.There is a significant inter-relation between the personal competence of the individuals facing dementia and the environmental demands that they experience (Dewing, and Dijk, 2016). There is a very significant demand of the combination of pharmacological, behavioural and environmental approaches for improving the well-being of such people (Yates-Bolton et al, 2012). Sensory stimulation is also considered as an important part of increasing senses and evoking positive feelings. Sensory stimuli could be anything in the environment that results in influences or arouse one or more the senses (sight, smell, touch, hearing and taste) of the individual. Sensory stimulation can help in improving the mood, self-esteem and well-being of the individual suffering with dementia, because it allows such individuals to connect with their current environment and develop a sense of belonging (Maseda et al, 2014). Bright light is considered as very effective in sensory stimulation and also very important in managing behavioural problems among people with dementia (Strm, Ytrehus, and Grov, 2016). Light is the most easily accessible stimulus and can be easily adapted in providing care to elderly people suffering with dementia (Talebzadeh, and Lang, 2017). Evidences have shown that a building environment could be more than a shelter and support, as it can provide many therapeutic approaches. Improving the light in the living areas of old people have resulted in improving self reported quality of life (Figueiro, 2017). Elderly living in residential care also have higher level of sleep and behavioural problems in comparison to community dwellers. This is because elderly living in residential homes are exposed to very limited light which is very less bright to improve circadian rhythm and vitamin D (Barton et al, 2016; Munch et al, 2017). According to the study of Hanford and Figueiro (2013), in mammals, circadian rhythms are generated and regulated by an internal biological clock located in the suprachiasmatic nuclei (SCN) of the hypothalamus of the brain (p. 913). The biological clock of the humans is affected and improved through light and dark patterns and also help in synchronizing the behavioral and physiological rhythms with external environment (Hanford and Figueiro, 2013). A recent visit to the local nursing home for the elderly people suffering with dementia, it was found that the physical environment lack proper lighting. Therefore, a hypothetical rationale could be implemented in the nursing home in order to encourage the elderly residents to sit outside under the sun light for at least one hour every day. This will help in reducing the sleep and behavioural problems (agitation and depression) among the elderly people and will also improve circadian rhythms (Gimnez et al, 2017). Action Planning Template Brief Description of the aspect to be modified and the current impact on people with dementia Improving the quality of life for the people suffering with dementia is a very significant aspect of providing care to them. Modifying the physical environment by improving the lighting can help to improve their health and reduce risk of falls. People facing dementia often suffer from the problem of sleep disturbance that negatively affect their daytime functions and also increases depression and agitation (Hanford and Figueiro, 2013). The modifications will be carried out in terms of improving the lighting and exposure to sun. It is very significant for the people living with dementia, to see their environment and make sense of it. With the use of sun light therapy the social, physical and psychological condition of the dementia patients can be improved. Deficiency of vitamin D can result in rapid progression of disease. Therefore, daily exposure to sunlight can help in gaining environment orientation and also improves the physical well-being. Aims of Goals (maximum of 3 goals) 1. Elderly patient will be encouraged to participate in sun-light therapy 2. To improve the mental and physical health of the dementia patients and increasing their alertness during day time. 3. To reduce the risk of falls and agitation by increasing Circadian Rhythms Key steps and activities to be taken to achieve aim/goals (include timescales and others who can offer support). Key steps and activities Resources (including personnel) Timeline 1) Discussion about the therapy will be done with the local dementia care home and the potential benefits will be discussed. -Management of Nursing Home - Involvement of Staff members -Evaluator Initial discussion and consultation prior to the planning of intervention 2) Organizing the activity of one hour sun light exposure every day at 10 am time of brunch -Involving nursing staff to encourage patients -Promoting the sun-light therapy Activity will be conducted every day at 10 am for two weeks. 3) Agitation symptoms will be evaluated to understand if symptoms have reduced by the use of Cohen-Mansfield Agitation Inventory (CMAI). Cornell Scale for Depression in Dementia (CSDD) will be used to identify decrease in rate of depression. Circadian Rhythms will be measured at night. -Nurses will maintain the diary for recording the sleep and wake time of the patient. -Experienced healthcare professional will measure CMAI and CSDD. Circadian Rhythms can be checked every night, while CMAI and CSDD will be measured after two weeks. 4) Report will be prepared to find the improvements in patients condition after application of intervention or activity. - Data collected from the nurses - Objective Data will be collected through survey of patients, by asking them that what physical, emotional and mental improvement they have experienced through the activity. This will be done after the completion of the activity of two weeks and collecting all the recordings of data. Criteria for Evaluation (identify up to 5 aspects by which you can measure your success; one of which should be around people with dementia) 1. Patients participated everyday in the activity at the time of brunch and spent one hour every under the sun light to receive sun light therapy. 2. Participants were able to have sounder sleep at night, and total wake time significantly reduced. Sleep duration also increased. 3. CMAI and CSDD scores of the patients had improved and patients displayed very low signs of agitation or depression. 4. Participants felt more happy and satisfied and did not display signs of discomfort in the modified environment. Participants also felt themselves to be more emotionally and physically active. 5. Circadian rhythms of the patient had significantly improved. Summary Statement of what was Achieved Improvements achieved through sun-light therapy are: - Sleep- wake patterns had improved (circadian rythms) - Rate of agitation and depression were also reduced among dementia patients. - Overall mental and emotional behaviour of the dementia patients had improved. - Dementia patients informed about holistic improvement in overall health. - Stress among the staff members, family carers and patients had also reduced. Discussion of the Results The sun light exposure of individuals suffering with dementia was increased. This exposure to direct sun light was done for an hour everyday for two weeks. However, the therapeutic intervention was not employed by the investigator, even though investigator acknowledges the requirement of applying the therapeutic intervention in the local nursing home. Various studies have focused on using light therapy for reducing symptoms of dementia among elderly and for improving their quality of life (Maseda et al, 2014; Hanford and Figueiro, 2013; Forbes et al, 2014). Studies have also explained that morning bright sun light is very beneficial in improving the social, physical and psychological health of the people suffering with dementia. Light therapy has also significant effect on reducing the agitated behaviour among elderly demented people (Figueiro et al, 2014). High intensity light has found to be beneficial for improving circadian rhythm. Improvements in agitated behaviour and depression post intervention through sun light therapy Bright light is found to be a significant treatment possibility for controlling agitated behaviour among the people suffering with dementia. Late morning light therapy (between 10AM to 12PM) has found to be very beneficial as the brightness of this light is 10,000 lux brings significant improvement in CMAI scores when the patients were exposed to such light every day for two weeks (Hanford and Figueiro, 2013). Study of Munch et al, (2017) explained that exposure to bright light improves natural external view, enhances the recognition of place, and also improves activity and social interactions. The results of this intervention also displayed improvement in CMAI scores of patients and proved the earlier findings of impact of bright light in reducing agitated behaviour. Light therapy also displayed positive effects on reducing depression and depressive symptoms among individuals suffering with dementia (Figueiro, 2017). Cornell Scale for Depression in Dementia (CSDD) scores of the patients in long term care facilities have shown that bright light therapy reduces depression and improves social interactions among elderly. Cognitive and non-cognitive functions of the elderly people are improved. This cognitive improvement also reduces the incidence of falls among elderly (Tamrat, Huynh-Le, and Goyal, 2014). Improvement in the visual system through bright light provides sensory information about location of objects, self position and external environment. Therefore, bright light improves the sensory input from the vestibular and somatosensory systems, and helps patients in maintaining their balance, thus reducing falls (Tamrat, Huynh-Le, and Goyal, 2014; Hanford and Figueiro, 2013). After the completion of the sun light therapy intervention, it was found that agitation and depression had reduced among elderly dementia patients CMAI and CSDD results also displayed positive behavioural and psychological change. Although, the study of Wu et al, (2015) has found that bright light can have negative effect on psychological factors and can increase depressive symptoms among elderly suffering with dementia. However, most of the studies have asserted that bright light is beneficial in improving social and physical health as well as overall well-being of elderly (Barton et al, 2016; Tamrat, Huynh-Le, and Goyal, 2014). 3.Bright sun light improves the circadian rhythms among patients, as they are helpful in improving the sensory stimuli and re-establishing the biological clock. This improvement is associated with stable sleep-wake pattern of patients. Bright light exposure during late morning hours has shown to improve the sleep-wake pattern, night time sleep, increasing attention and wakefulness during day time and reducing evening agitation behaviour (Fleming et al, 2016; Hanford and Figueiro, 2013; Wu et al, 2015). This intervention carried for bright sun light therapy also improved the self reported health outcomes for the participants. Exposure to bright sun light improved the functioning and social interaction of participants. Conclusion This paper focused on discussion the environmental modification to improve health and well-being of people suffering with dementia. The sun light therapy has been discussed that was employed in the local nursing home providing care facility to dementia patients. It can be concluded that bright light therapy and exposure to sun light in late morning hours can be very beneficial for dementia patients, as it can reduce agitation and depression and can improve length and quality of sleep. References Barton, C., Ketelle, R., Merrilees, J. and Miller, B., 2016. Non-pharmacological management of behavioral symptoms in frontotemporal and other dementias.Current neurology and neuroscience reports,16(2), p.14. Dewing, J. and Dijk, S., 2016. What is the current state of care for older people with dementia in general hospitals? A literature review.Dementia,15(1), pp.106-124. Figueiro, M.G., Plitnick, B.A., Lok, A., Jones, G.E., Higgins, P., Hornick, T.R. and Rea, M.S., 2014. 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