DEMENTIA THE MINDS ERASER CRYSTAL JOHNSON
THE AFFECTS OF DEMENTIA The Desalvo family recently learned about dementia and its lasting significance on their family member. Warren (2016) “Dementia is a group
of symptoms a cognitive dysfunction, resulting in problems with memory, language, attention, thinking, orientation, calculation, and problem-solving”(p. 17). The matriarch of the family 78 year old Maria Desalvo has been in and out of the emergency room the last few months due to her declining health. Maria lives with her older daughter Julie her caretaker who is looking for answers as to why her mother has become increasingly confused, incontinent, and unwilling to eat. “Dementia affects each individual differently and can cause a wide range of symptoms” ( Ryder, 2016, p. 465). Julie’s husband Mark 52 a construction worker and their 17 year old son John a senior in high school also partake in the care of Maria.
The Desalvo family finds solace in attending church on Sundays. Their Catholic belief has helped keep the family together and has brought hope to a dismal situation. The family has found strength through religion and cohesiveness in sharing the responsibilities of Maria’s disease. The family culture holds high regard for their elders including taking them in and caring for them. Julie’s family has embraced the role of caretaker. The role of caretaker has many challenges. Simpson (2010) “A lack of knowledge rather than cultural beliefs influenced the participant’s first response to the disease, but the cultural beliefs of familial responsibility and the importance of home-based care influenced their decisions regarding ongoing care” ( p. 168). Some challenges the Desalvo family has encountered are lack of resources, knowledge, and respite. Julie is the main caretaker she knows all of Maria’s medications, what works for her, how to communicate with her, and her needs.
APPLICATION OF FAMILY THEORY The Family Systems Theory will be used to address the issues at hand the family faces with Maria’s illness. “The Family Systems Theory is constructed of concepts and propositions that provide a framework for thinking of the family as a system” Kaakinen, Coehlo, Steele, Tabacco, & Hanson, 2015, p.76). Julie has expressed concerns with the care and the direction to take with her mothers regression of health. Maria has refused to eat and drink in one week with assistance and has become increasingly aggressive at night. Julie has brought her mother into the emergency room several times in one month trying to figure out why her mother is not eating and why she is having abdominal pain. Both Julie and her son are exhausted and are not sure what the next step is for Maria’s care.
NURSING PROCESS The first problem to address with Maria’s care is the inadequate food intake. This is done by assessing who in the family is taking part in meal times and offer intervention strategies to assist the family. Julie is the main caretaker and mealtime provider, her son John is in school and her husband Mark works long hours. A study by Liu, Galik, Boltz, Nahm, and Resnick (2015) looked into optimizing eating in older adults with dementia and found that , “Mealtime assistance offered by nursing staff (e.g, verbal prompts and cues, positive reinforcement, appropriate praise and encouragement) also showed effectiveness in improving eating performance”( p. 228). Some interventions for Julie and the family in managing Maria’s eating is to weigh her weekly, make the environment comfortable and assessing the need for artificial feeding through a GTUBE. Hopefully the outcome will increase Julies ability to provided nutrition for Maria, and the needed resources if artificial feeding is required.
NURSING PROCESS CONTINUED Next for Maria’s family is to address there response to the possibility of a home health nurse or skilled nursing facility care. The family would likely agree to home health versus a skilled nursing facility due to their strong beliefs of caring for their elders. Maria’s disease has progressed along with her care making her needs around the clock. Offering Julie options for home health nursing care that can provided Maria with her daily ADL’s and feeding would hopefully ease the responsibilities of Julie and her family. Lastly, addressing Julie’s son John’s role in the care of his grandmother. Giving John options to help on a set schedule like the weekends will hopefully help balance his time focused on school and give him his own personal time. “The goal of using a family systems perspective is to help the family reach stability by building on their strengths as a family”(Kaakinen, Coehlo, Steele, Tabacco, & Hansen, 2015, p. 79).
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Liu, W., Galik, E., Boltz, M., Nahm, E., & Resnick, B. (2015). Optimizing Eating Performance for Older Adults With Dementia Living in Long-term Care: A Systematic Review. Worldviews On Evidence-Based Nursing, 12(4), 228-235. doi:10.1111/wvn.12100
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Simpson, C. (2010). Case studies of Hispanic caregivers of persons with dementia: reconciliation of self. Journal Of Transcultural Nursing, 21(2), 167-174. doi:10.1177/1043659609357630
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