Older patients suffering from dementia admitted at care facilities are not accorded the best of care because of their complex needs. This category of patients struggle with progressive cognitive decline, functional decline and challenging behaviors that impacts their quality of life. Dementia not only impacts the patients' but also their families, healthcare systems and the larger society. The patients are not accorded the best care mainly because the healthcare providers lack the understanding of the causes of cognitive impairment (Joosse, Palmer, & Lang, 2013). The care providers also appear overwhelmed because of the misperception of the problem. Cognitive impairment is categorized into chronic cognitive decline or the diagnosable dementia and acute cognitive changes that occur as a result of dementia. It is imperative that timely and accurate identification of the impairment is done because failure to do so often leads to suboptimal care. For patients with benign conditions whose compensatory abilities are compromised by impairments in multiple domains cascade iatrogenesis is ideal. An acute change in cognition is an indication of the presence of systemic illness. Difficulty in identifying cognitive status in older patients calls for coming up with a best known evidence to assess, interpret findings and treatment plan creation that can lead to improvement of quality of lives of these patients.
Delirium is a confusional state caused by an underlying physical condition. It has prevalence of 14.2% in care homes across the United Kingdom (Peacock, Hopton, Featherstone & Jill, 2012). It is however, absurd that with such high prevalence rates it is still under-recognized by nurses (Siddiqi, Clegg & Young, 2009). People with dementia are a greater risk of delirium. Acute confusion associated with delirium may be mistaken as part of their dementia. It is quite a challenge differentiating between dementia, delirium and depression. The situation has further been complicated by the fact that there is a considerable overlap of depression and delirium in older people. Depression affects at least 40% of patients admitted in care homes across the UK. When people are depressed it is more likely that caregivers will overlook symptoms like withdrawal and sleepiness that are associated with delirium (Mitchell & Kakkadasam, 2011). It is imperative that caregivers in care homes learn to distinguish between dementia, delirium and depression because delirium can actually be prevented. This can be done by identifying key changes in patients' behavior however subtle it may be. In this regard, it is important to understand residents' unpredictable behaviors. Long-term care staffs in care homes are in a unique position to recognize subtle and slight changes in a resident's usual behavior that may be associated with delirium. Their knowledge of conditions, causes and triggers enables them to capitalize on their proximity to and relationship with residents as a critical element in care delivery. Because the rate at which the staff working in this care homes come and go is very high, significant proportions of untrained and inexperienced staff cannot provide the best care to residents with complex needs because they are not technically qualified.
The two studies delve into care that should be accorded to elderly patients with dementia while giving an insight into the skills needed to identify and detect differences between delirium, dementia and depression.
Joosse, Palmer and Lang (2013) have explicitly stated why they conducted the study. They endeavor to address the challenges in providing care to hospitalized patients suffering from dementia. They are seized of the fact that despite the gains that have been made in the realms of medical care, older patients still suffer from progressive cognitive decline, functional decline and challenging behaviors that impact the quality of their lives. Because of lack of availability of evidence-based practice on how best these patients should be taken care of in healthcare facilities they still continue to receive suboptimal care. Elderly patients suffering from dementia are an at risk group because caregivers lack the understanding of the causes of cognitive impairment they suffer from. The situation is further compounded by misrepresentation of their condition. In a bid to address difficulties faced in recognizing challenges pertaining to cognitive status and changes in older adult population the study avers that nurses must use best known evidence to guide assessments, interpretation of findings and treatment plans in improving quality of life of patients suffering from dementia. The study was commissioned by the University of Wisconsin-Milwaukie's Colleges of Nursing and Nursing Knowledge-Based Nursing. The study's objectives are describing challenges in providing care to hospitalized patients; nursing assessments, problem identification and interventions; and synthesized recommendations to guide clinical practice. The study has dependent and dependent variables. Diagnosis with dementia was dependent on history of cognitive impairment, history of chronic cognitive decline and signs and symptoms of confusion. Joosse, Palmer and Lang (2013) hypothesize that cognitive impairment is often overlooked in diagnosis and treatment plans. The literature reviews 610 abstracts with the publication of Hong given much prominence it ably illuminated the best known evidence on the topic of dementia and how the practice helped enhance the quality of life and nursing care given to hospitalized adults with progressive cognitive decline, functional decline and challenging behaviors.
Peacock, Hopton, Featherstone & Jill (2012) address challenges that caregivers in care homes face when it comes to differentiating between dementia, delirium and depression. The situation if further complicated by the existence of an overlap between depression and delirium in older patients (Featherstone, Hopton & Siddiqi, 2010). The overlapping symptoms are withdrawal and sleepiness. A major step towards improving care given to care home residents is the prevention of delirium. Delirium is nevertheless, very difficult to detect in patients with dementia. In a bid to stop delirium, the facilitators of the study conducted feasibility study interviews and finally did an analysis where five themes were identified namely: triggers and knowledge; detection and observation; effect of closed contact; changes in management of care; and communication and team work to overcome difficulties. These themes gave some insight into how caregivers identified a potential episode of delirium. They also indicated the steps that might be taken to manage residents' care. The study established the important role communication and teamwork played in delirium prevention and appropriate management.
The two articles have some striking semblance in the sense that both seek to come up with evidenced-based care that should be accorded to elderly patients especially those suffering from chronic cognitive decline which erodes the quality of their lives.
The most outstanding difference in these two articles is that where as Joosse, Palmer and Lang (2013) underscore the need for recognizing the challenges that elderly patients in health care facilities go through in order to develop tools that help in comprehensive assessment planning, interpretation of findings and treatment plans that are already available in literature, Peacock, Hopton, Featherstone & Jill (2012) focuses on prevention of delirium where they identify five themes namely triggers and knowledge; detection and observation; effect of closest contact; changes in management of care; and communication and teamwork. They identify communication and teamwork as the most appropriate step towards delirium prevention and appropriate management. Hopton et al., aver that people with dementia are at greater risk of delirium. Their focus encompasses delirium, dementia and depression because they feel that the three are kind of related. Joosse et al. On the other hand specifically focus on dementia and how it affects older patients admitted in health care facilities.
The difficulty experienced by caregivers in care homes in identifying dementia, delirium and depression is a big challenge to the management of care home services. This can be enhanced if the management of these facilities ensures that they don't change their human resource quite often. Caregivers who have worked long enough in these facilities are capable of distinguishing between these three distressing conditions. They are also capable of detecting…