Self Management Of A Patient With Dementia

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Self Management Of A Patient With Dementia

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Introduction

Based on the self-efficacy theory, patients have the ability to successfully manage their chronic illnesses through utilization of self-management programs. The self-management programs of chronic illnesses involve solving the arising problems, making properly informed decisions, finding as well as utilizing resources, the formation of a partnership with health care providers and taking the necessary actions towards the management of chronic illnesses. This article will discuss how a patient with dementia should utilize the self-management program to manage this chronic illness at the community level. There is the various factor that supports the use of self-management approaches in the management of dementia. The most important factor is the desires of patients living with dementia to manage and control their own care and lives. The notions of empowerment, partnerships, and control of dementia also contribute to the championing of self-management of dementia patients (Martin, Turner, Wallace & Bradbury, 2013). Therefore, it can be said that self-management of dementia is the tool, skills, strategies as well as the connections that persons with the early stages of dementia and also their families garner in order to control and manage their independence as well as maintain a quality of life. This paper will include main causes of dementia and a brief pathophysiology, the impact of dementia on the patient, family, and caregivers, empowerment, cultural safety, health promotion, the formation of partnerships with the health sector among others.

Main Causes Of Dementia
There are two main causes of dementia which are: brain cell death that results in vascular dementia and brain injury that causes post-traumatic dementia. However, dementia also has a genetic undertone and is associated with advanced age. It should be noted that although the likelihood of one having dementia increases with increase in age, this illness is not part of a normal part of aging. Vascular dementia is also known as multi-infarct dementia which occurs due to the death of brain cells that is caused by various conditions such as the cerebrovascular illnesses, for instance, stroke. The cell death prevents normal blood flow hence depriving brain cells oxygen which leads to the development of conditions that result in dementia. The post-traumatic dementia is caused by traumatic brain injury which causes brain cell death. To a lesser extent, dementia can result due to prion diseases, damage of the brain cells by HIV infection and as a result of reversible factors such as thyroid abnormalities, vitamin deficiencies, depression, and drug interactions.
Pathophysiology Of Dementia
Dementia results from brain cell death due to head injury, stroke, brain tumor, and as a result of a neurodegenerative disease that causes the progressive death of brain cell that occur over time. Dementia is a collective word that is used to refer to the various symptoms that cause a decline in the cognitive functions such as loss of memory, impaired communication, and thinking. Therefore, it is said to be the symptom of many underlying illnesses and brain disorders.
The Impact Of Dementia On The Patient
Dementia has psychological, functional, behavioral, emotional and cognitive impacts on the patient. A diagnosis of dementia causes a huge difference in the life of the patient as one experiences a range of emotions. The main symptoms associated with dementia include memory loss, inability to understand and complete familiar tasks, the problem in communication and language, misplacing things, disorientation, and a problem with abstract thinking. The patient may also show mood changes, personality changes such that one becomes easily irritable, angry, fearful or suspicious, and loss of initiative whereby the patient shows less interest in starting something new or even going somewhere. Some individuals struggle to deal with some of these emotions hence may move between emotions in the attempt to adjust. Therefore, these people may feel terrified about the future, afraid about moments of forgetfulness and confusion, and the feeling of being upset due to the impact of dementia on their lives. Therefore, self-management approaches to ensure the support of dementia patients by advocating that caregivers, family members, and healthcare providers try to understand the feelings of the patient. These parties should also listen to the worries and concerns of the patients to show them that they are not alone (Bunn et al. 2014).

The Impact Of Dementia On The Family And Caregivers.
Toms, Quinn, Anderson and Clare (2015) states that dementia often becomes a burden to the family members and caregivers as the patient requires more attention and resources. This consumes time as well as resources and can be a difficult experience to the those will low incomes. However, self-management of dementia reduces the financial burden as the family can take care of the patient without hospital bills or having to put the patient into a facility (Wimo et al. 2013). The families and caregivers of patients with dementia can also experience guilt, loss and grief, and anger. Guilt is commons for the way the person with dementia was treated in the past, lost tempers and even guilty for not wanting to be given the responsibilities of caring for the individual with dementia. Grief can be said to be a response to lose. If a person develops dementia, family members are usually faced with grief due to the loss of the person they used to know which would mean the loss of a relationship and the loss of the future they had planned to have together. The family members may also feel angry and frustrated for having to be caregivers to the family member suffering from dementia. The anger can also result as a result of other family members who seem not to be helping out, or due to the behaviors of the patient and also angry with the support services .
Self-management approaches offer strategies on how the family members and caregivers can manage and overcome these emotions such as perseverance, counseling and seeking support from other institutions like the community. This helps the family members and caregivers to see caring for their loved one as a rewarding experience that strengthens bonds and ties by ensuring close and intimate relationships. The self-management approaches also ensure that the family members and caregivers are informed on the progress of the patient by the healthcare providers who also advises them on the actions to take hence ensuring the formation of partnerships.
Formation Of Partnerships Within The Health Sector
Self-management of dementia advocates for the formation of partnerships with all the stakeholders who include: the patient, family, caregivers, and health personnel. The involvement of stakeholders leads to better outcomes since there are proper decision making and proper management of dementia. Through partnership formation, the patient is able to manage the physical as well as the cognitive aspects of dementia through strategies that are provided by the healthcare providers to the patients and family members for compensation of memory loss and the stimulation of cognitive capabilities as well as physical activity procedures and requirements. Through partnerships, dementia patients are able to receive emotional management which includes a positive attitude and an approach that aims at day-by-day management of dementia. There is role management which includes social support and system support such as the Alzheimer Society.
Empowerment Of People Living With Dementia
Siriaraya and Ang (2014) argue that empowering dementia people to manage their own signs and symptoms as well as bringing them together helps them feel confident about controlling and managing daily life with the condition. Empowerment of dementia patient involves group-based interventions that are aimed at helping patients manage their own conditions. Patients are encouraged to attend self-management group sessions which encourages discussion, socialization, problem solution and setting goals that foster independence and promotion of social support. The trained facilitators aim at providing persons with a better understanding and comprehension of their dementia and offering ways to manage it. Research shows that empowering patients with dementia to take control and manage their own conditions is beneficial as the patients feel more involved in matters concerning their health. The empowerment involves supporting and educating patients to manage their own symptoms, treatment, and suggestions on lifestyle changes with reliable information as well as expert help. The patients attending the support groups and group counseling sessions are encouraged to share various ideas and approaches for dealing with their conditions. They are also encouraged to record notes and writing reminders in a handbook to help them remember.

Health Promotion
Health promotion towards the persons suffering from dementia is aimed at risk reduction and keeping healthy. Individuals living with dementia need information, education, resources, and support to be able to successfully undertake self-management strategies. As stated earlier, dementia is not a normal part of human aging. Therefore, persons especially those at high risks of developing the conditions are educated and informed on ways to reduce risks. The people with dementia are also given information on how to carry out self-management approaches to manage and control the condition. The patients through health promotion are encouraged to keep the body, mind, and spirit active so as to reduce complications related to dementia and also reduce the symptoms. To ensure healthy aging, dementia patients are advised to eat a balanced diet, stay connected spiritually and socially (Haber, 2013).
Through health promotion, dementia patients should be informed on the disease and its progression, strategies for self-management such as physical activity and balanced diet, and given emotional and social support since self-management advocates for the formation of a partnership among the involved parties: the patients, family members, caregivers, and healthcare providers. Health promotion also advocates for personal planning that involves both health and community services for help and support. The dementia patient should be advised to keep his or her brain active since dementia reduces cognitive abilities and also impairs the functioning of the brain which leads negative changes that affect many aspects of the individual and the society. The patient should keep the brain engaged and be socially active. The patient should also be encouraged to keep fit and healthy through healthy eating by consuming balanced diets, and participating in a regular standardized physical activity for a healthy body and brain so as to reduce dementia symptoms.
Cultural Safety
In healthcare, cultural safety refers to an environment that is safe for patients: free of assault, challenges or even the denial of their identity. Therefore, cultural safety in the self-management of dementia involves respect, shared knowledge, preservation of dignity truly listening to the concerns of the patients which include the cultural values, identity, and practices. Cultural safety is considered to be well beyond cultural sensitivity and cultural awareness as it is the experience of the dementia patient receiving care (Jones, Moyle & Stockwell?Smith, 2013). Cultural safety gives a dementia patient the power to comment on care in terms of their preferred values and cultural practices which leads to the reinforcement of positive experiences and consequently improves self-management of the illness. It also helps in making the changes in all the services that are found to be negative. For instance, the Australian Dementia Society advocates for cultural safety in the management of dementia patients. This has helped in the creation of an environment where the Torres Strait Islanders and the Aboriginal are treated well and in a culturally respectful way hence empowering them to actively participate in the self-management of dementia since they believe that they are valued, taken seriously and understood.

Conclusion
From the discussion above, it can be concluded that the burden of chronic illnesses is greatest among individuals living with dementia, a group of patients that is on the rise as the population is aging and lifestyle changes. These changes have adverse effects on the patient, family members and caregivers hence calls for their intervention. To ensure optimal management of this chronic illness, there needs to be an effective patient self-management plan. Self-management is an intervention strategy that offers approaches that help the people living with dementia to play an active role in the management of their condition. Consequently, dementia patients are empowered through health promotion mechanisms to have the ability to manage dementia symptoms through treatment, lifestyle changes, physical and psychological engagement. The self-management approach advocates for the group based psychological interventions for dementia patients. Management of dementia is a collaborative activity that requires formation of a partnership among the patient, family members, caregivers, and clinicians. Therefore, the self-management strategy expects that the health care providers work with the patients, and family members to assess the current capabilities of the patients, identify any barriers to successful self-management and try to adjust the information given according to the skills of the patient (Martin, Turner, Wallace, Choudhry & Bradbury, 2013). Self-management also ensures cultural safety as patients are given the opportunity to incorporate culturally significant practices in their treatment hence preserving their identity and dignity.

References
Bunn, F., Burn, A. M., Goodman, C., Rait, G., Norton, S., Robinson, L., … & Brayne, C. (2014). Comorbidity and dementia: a scoping review of the literature. BMC medicine, 12(1), 192.
Haber, D. (2013). Health promotion and aging: Practical applications for health professionals. Springer Publishing Company.
Jones, C., Moyle, W., & Stockwell?Smith, G. (2013). Caring for older people with dementia: An exploratory study of staff knowledge and perception of training in three Australian dementia care facilities. Australasian journal on ageing, 32(1), 52-55.
Martin, F., Turner, A., Wallace, L. M., & Bradbury, N. (2013). Conceptualisation of self-management intervention for people with early stage dementia. European journal of ageing, 10(2), 75-87.
Martin, F., Turner, A., Wallace, L. M., Choudhry, K., & Bradbury, N. (2013). Perceived barriers to self-management for people with dementia in the early stages. Dementia, 12(4), 481-493.
Siriaraya, P., & Ang, C. S. (2014, April). Recreating living experiences from past memories through virtual worlds for people with dementia. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems (pp. 3977-3986). ACM.
Toms, G. R., Quinn, C., Anderson, D. E., & Clare, L. (2015). Help yourself: perspectives on self-management from people with dementia and their caregivers. Qualitative health research, 25(1), 87-98.
Wimo, A., Jönsson, L., Bond, J., Prince, M., Winblad, B., & International, A. D. (2013). The worldwide economic impact of dementia 2010. Alzheimer’s & Dementia, 9(1), 1-11.

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