Caring for an adult with cognitive impairment can be overwhelming. For many people, caring for family members with some form of mental disability is challenging. Cognitively impaired people have difficulty thinking clearly. They may suffer from memory loss, poor concentration, poor reasoning abilities, and difficulty communicating. The impaired person has difficulty expressing their needs, which on the other hand makes it harder for caregivers to understand their illnesses or physical behaviors in its entirety. Family caregivers play an important role in these individuals’ lives. Educational intervention from legible resources can guide family members to improve quality care and assessment that will slow down the illnesses and other complications. According to the article “In some cases, older adults with cognitive impairment can be more appropriately assessed and treated away from an ED, as evidenced by data cited by the Agency for Healthcare Research and Quality (AHRQ) showing better outcomes at less acute levels of care.” Nurses who work in a variety of practice including nursing homes, memory care facilities, rehabilitation centers, and community nursing commonly provide care to older adults with cognitive impairment and other comorbidities. Although nurses are educated to assess, evaluate and implement care, it’s important for nurses to involve family members because they are the primary caregivers. Many caregivers do not have the knowledge they need to make critical decisions about patients’ situations. Providing them with tools of how to assess cognitive impairment individuals will prevent a trip to the emergency room or hospitalization. Technology has improved tremendously throughout the years. Medical technology has designed as a guide for health care professionals, patients, and families. Encouraging family members and patients how to access information through technology will meet the needs of individuals with cognitive impairment and reduces the caregiver’s stress. Providing patients and families with outpatient information and community therapeutic activities will also eliminate caregivers’ stress. Improving communication between health care professionals, patients and family can help build a trustworthy relationship between both parties. Just because a person with cognitive impairment have a problem with though process or deficits does not excuse nurses or health care professional from communicating with them or involving them in the plan of care. In conclusion, the research article states “It’s important for health care professionals to ensure that family caregivers of cognitively impaired older adults can access professional guidance readily when facing decisions about a loved one’s care, especially when there is an acute onset of new symptoms. Teaching caregivers how to recognize such symptoms early in order to prevent exacerbations of chronic illness and subsequent hospitalization should be a high priority.”
References:
Steis, M. R. (n.d.). CE: Original Research: New Acute Symptoms in Older Adults… : AJN The American Journal of Nursing. Retrieved from https://journals.lww.com/ajnonline/fulltext/2019/03000/CE__Original_Research__New_Acute_Symptoms_in_Older.26.aspx
According to the Family Caregiver Alliance (n.d.), most people will become caregivers—or need one—at some point in their lives. Caregivers assist with various tasks of daily living that comes naturally to some, but frustrating to others especially when the patient has communication difficulties, perseveration, aggression, paranoia, lack of motivation, incontinence, poor judgment, and wandering. I work with elderly patients with behavioral issues from time to time and can relate. Amazingly, the breakthrough in the management of this vulnerable population is communication and care plans.
Kapryce, is this your current area of practice, and if yes, what is your motivation? Have you found communication and care plans to be effective strategies in the care of these group of patients?
Reference
Family Caregiver Alliance. (n.d.). Caring for adults with cognitive and memory impairment. Retrieved February 25, 2020, from https://www.caregiver.org/caring-adults-cognitive-and-memory-impairment
Hi Cowolawi, I have been working with geriatric and cognitive impairment patients for 10 years. The rehabilitation and memory center where I’m currently working has implemented a new butterfly program for cognitive impairment patients. This program helps us to acknowledge patients for who they were in the past and not who they are now. For instance, if the patient was a medical doctor, the staff will continue to address that member as Dr. Doe instead of Mr. Doe. Staff also encouraged the family to bring every item that would remind the members about their past activities or career such as their special stethoscope or any other memorable items. The program was developed in the UK and my facility in GA is the first to adopt the program in the USA. Our goals for cognitive impairment members to thrive well and maintain their mental ability in a nurturing environment. Communicating with members can be different depends on the severity of the individual’s impairment status. When members with severe memory loss engage in a conversation with staff and say his or spouse came to the room an hour ago, instead of redirecting the member and say the wife or husband died a year ago, the staff would play along and ask the member questions pertaining to the wife or husband. Never give negative answers to cognitive impairment individuals because it may lead to anxiety or further confusion.
Hello there. My mother was recently diagnosed with Alzheimer’s disease. Her symptoms became apparent to me a couple of years ago and as expected has worsened over the years. When I would confront her about it she just denied it, therefore not seeking treatment. I finally made her see a doctor about six months ago and she is on Namenda without any significant improvement. It makes me so sad to see her go through these changes as she has been like a best friend to me in my adult life. Conversations just aren’t the same. It is also heartbreaking to see my dad, who has a very sound mind and memory get frustrated with her and their daily activities. After reading your article about caregiver education I thought my dad should have these resources. I looked up the Central and Western Kansas Chapters of the Alzheimer’s association and found many educational classes and support groups both he and my mother can attend. Thanks for pushing me to check this info out.
This is a great topic. Having resources available for families is so important. Living in a rural area, it can be difficult to find resources that are close to home. Luckily with advances in technology this is becoming easier. There are many challenges to Alzheimer’s care that include; overwhelming emotions as your loved one’s capabilities decrease, isolation and loneliness, financial and work complications, and fatigue and exhaustion. There are also rewards. These include your problem-solving and relationship skills improve, your bond with your loved one/patient deepens through care, companionship, and service, you form new relationships through supports groups and unexpected rewards develop through compassion and acceptance to name a few. I found some tips to share for people that are in this situation. 1.) Prepare for the road ahead. The more you know about the disease and how it will progress, the better you will be able to prepare and handle the future challenges. 2.) Develop a personal support plan. Make sure you are getting the emotional and physical support you need in order to be able to provide the best level of care. 3.) Cope with changes in communication. Try to avoid becoming frustrated and keep communication short, simple, and clear. 4.) Develop day-to-day routines. This will help caregiving run more smoothly. 5.) Deal with problem behaviors. By making some simple changes, you can help ease your loved one’s stress and improve their well-being, along with your own caregiving experience. 6.) Make time for reflections to help with acceptance. By accepting each new reality and taking time to reflect on these changes, you can better cope with the emotional loss, and deepen the feelings of satisfaction in your caregiving role.
Resource:
Robinson, L. (M.A.), Segal, J. Ph.D., Wayne, M. (M.A.). (2019). Tips for Alzheimer’s and Dementia Caregivers. Retrieved on February 26, 2020, from https://www.helpguide.org./articles.
The information provided in your journal club article is pertinent above and beyond the environment in which the study was performed. As the parent of a childhood cancer survivor, one critical aspect in her treatment was the degree of information and education which the children’s hospital provided. Prior to discharge, I received teaching and re-teaching and teachback and demonstration until the nurses were satisfied. As a hospice nurse, I have found that patients and patient families who received thorough but well paced information on the dying process were more capable of handling their loved one at home through the end of life process.
In a study called the FAMILY study, the impact of involving family in promoting self-care for heart failure patients determined that family care giver education and empowerment led to lower readmission rates and higher self-care scores (Deek et al., 2017). The involvement of family members and/or caregivers can have a positive impact on post-care delivery, and I do believe that it is important for nursing staff to consider the family unit when providing discharge and/or condition education to patients.
Deek, H., Chang, S., Newton, P., Noureddine, S., Inglis, S., Arab, G., . . . Davidson, P. (2017). An evaluation of involving family caregivers in the self-care of heart failure patients on hospital readmission: Randomised controlled trial (the FAMILY study). International Journal of Nursing Studies, 75, 101-111.
Patient and family education is so important to any nursing field. I find it especially important in rehab nursing where the patient may be going home with an impairment that will not improve beyond a certain point and now they have to learn to adapt to it. I work in acute rehab and transitional care currently. In the past I worked in a brain injury unit within a larger stand-alone rehab hospital. In cognitively impaired patients with family caregivers, education and access to professional advice helps them to make appropriate decisions regarding their family member’s health.
New acute symptoms in older adults with cognitive impairment: What should family caregivers do? (2019), American Journal of Nursing, 119(3). doi: 10.1097/01.naj.0000554006.31272.d1