How Dementia Affects Daily Activities of Living

Case Study on Mrs. Brown

Older Adult Case Scenario

Mrs. Brown is a 75-year-old individual who is came to the health clinic for follow-up after she had a fall in her home and suffered some minor injuries to her wrist and bruising to her hip. Mrs. Brown also states that she has occasional memory loss and dizziness when she stands up. She was diagnosed with early Alzheimer’s Disease a year ago but is still able to perform all her activities of daily living (ADLs) independently. She is a widow and lives alone in an apartment. She has 2 adult children who live away with their own young families, but they are very supportive and visit her frequently as they live close by. Mrs. Brown tells the nurse that she is not ready to move into a long-term care (LTC) facility because she enjoys spending time with her grandchildren and meeting up with her retired friends for tea. Moving into a LTC facility would require her to move further away from them.

1. Discuss the stage of psychosocial development that describes Mrs. Brown. Discuss whether she is successful in meeting this stage or not.

Drawing on Erikson’s stages of psychosocial development, Mrs. Brown at age 75 years is in the final stage of integrity versus despair. This developmental stage involves reflecting back on one’s life and either feeling fulfillment from a life well-lived (e.g., integrity) or regret over missed opportunities (e.g., despair). In this regard, Mrs. Brown demonstrates some integrity in recounting meaningful relationships with her children, grandchildren, and friends which contribute happiness to her life. Her ability to still live independently also provides Mrs. Brown with a valuable sense of life satisfaction. It is important to note, though, that Mrs. Brown’s early Alzheimer’s diagnosis and physical injuries represent losses that could understandably lead to despair over diminished capabilities compared to earlier times. Her reluctance to move into long-term care may indicate attempting to hold onto her autonomy.

Taken together, it is reasonable to suggest that Mrs. Brown is transitioning towards more despair but still demonstrates psychosocial strength in finding purpose through family relationships. Moreover, her support system plays a key role in promoting integrity by allowing her to retain a sense of connection and joy in daily life. With care and assistance tailored to her evolving needs, Mrs. Brown can hopefully achieve ego integrity despite physical and cognitive challenges arising. Her case represents the complex balance many elders navigate between finding acceptance and meaning versus functional decline and despair in advanced age.

2. What are the implications for a diagnosis of Alzheimer’s Disease for someone like Mrs. Brown?

Despite a growing body of research, many aspects of Alzheimer’s Disease remain unclear and the disorder manifests itself differently. Therefore, identifying specific implications for Mrs. Brown at present is somewhat premature, but they will likely include progressive memory loss and periodic confusion. Consequently, over time, Mrs. Brown is likely to experience worsening disorientation, impaired recall, and confusion even in familiar settings. This can be frightening and may lead to safety issues like forgetting if she cooked or other accidents. Likewise, as her cognition declines, Mrs. Brown will gradually lose the ability to perform all of her ADLs, including self-care, household duties, managing her finances and accessing medical care independently (Palacios-Navarro et al., 2022). As a result, relying on others, most especially for basic needs, can be very difficult, particularly since her adult children may not be readily available to help with transportation for initial and follow-up visits to healthcare providers.

Therefore, a corresponding implication of this disorder may be family member burnout. Mrs. Brown’s family supporting her frequently may start to feel overwhelmed, leading to tension or issues with adequate care management. Likewise, Mrs. Brown may feel like a burden and her existing friendships could also fade as her elderly friends become debilitated or pass away. Because she lives alone, Mrs. Brown is also at high risk of increasing depression in response to her changing life conditions. Consequently, in spite of her natural preference to remain at home and live independently, her dementia will likely necessitate moving to a specialty memory care facility in coming years as her symptoms progress and constant supervision, especially fall prevention, becomes necessary.

3. Based on the information in the case study, identify a priority health promotion topic for Mrs. Brown and her family. Provide rationale for why you think they require this education.

Based on Mrs. Brown’s current situation, a critical health promotion priority for her and her family would be receiving relevant and timely education concerning the effective management of Alzheimer’s disease and caregiving approaches. This type of knowledge is essential given Mrs. Brown's recent diagnosis which means her dementia symptoms will worsen over time without proper management. Therefore, learning strategies to maximize current cognitive function and self-care skills would optimize her independence as abilities decline. Education helps ease uncertainty by identifying and clarifying realistic expectations concerning what her conditions means for her future lifestyle (Czekanski, 2017).

Likewise, providing Mrs. Brown with learning integrated therapeutic opportunities such as memory training, music, art and adapted exercise can prolong the types of engagement she finds meaningful. In addition, Mrs. Brown’s family caregivers need guidance concerning how best to meet her evolving needs for supervision, medical care, emotional support and creating safe home environments. This is important because shared learning protects both patient dignity and caregiver mental health (Snoun et al., 2022). Finally, even though her adult children live in geographic proximity, they will require learning skills such as care coordination to ensure Mrs. Brown’s well-being while living alone. Relevant and appropriate preparatory training will help ready them for their intensifying involvement in Mrs. Brown’s care (Snoun et al., 2022).

4. What type of nursing interventions would you implement for Mrs. Brown based on your identified health promotion topic?

Given the priority health promotion need is Alzheimer’s disease education and caregiving training, key nursing interventions for Mrs. Brown and her family should include referral to community-based dementia workshops, support groups and government resources on practical disease management techniques. This links them with specialized training and social connections. In addition, another nursing intervention should include private counseling sessions that are focused on adapting home environments, implementing cognitive stimulation, simplifying tasks, and fostering receptive communication to maintain Mrs. Brown’s ability to live independently as long as possible (Bachmann & Hruska, 2022). Finally, a useful nursing intervention should include providing Mrs. Brown’s adult children with appropriate print material concerning Alzheimer’s management and caregiver advice as well as providing them with hands-on caregiver skills such as supporting activities of daily living, providing supervision for safety, accessing respite services, and regulating healthcare and finances on Mrs. Brown’s behalf (Pérez-González et al., 2023).