Mental health assignment on potential evolving problems for Mrs B

Question

Task: Mrs B had been living in an aged care facility for approximately 3 years. She initially was doing well in the facility until she was hospitalized 2 years ago with agitation. At that time, she was diagnosed with moderate degree of Alzheimer’s type dementia with delusions, depressed mood, and behavioural disturbance. Using the evolving clinical scenario for Mrs B, prepare a mental health assignment. Discuss the potential evolving problems for Mrs B. Identify and describe the appropriate assessment tool/s to complete an appropriate, comprehensive assessment for Mrs B. Discuss the physical and physiological factors that may affect the assessment. Identify and critically analyse four models of successful aging in relation to Mrs B. Discuss the potential psychiatric diagnoses for Mrs B. Discuss the most appropriate treatment & management plan for Mrs B.

Answer

Potential evolving problems discussed in the mental health assignment
Mrs. B has been experiencing moderate symptoms of dementia associated to Alzheimer’s in the aged population. As per the details of the mental health assignmenther symptoms included depression, cognitive dissociations, and agitation. The recent problems she is experiencing on the other hand, involve delusional thoughts and paranoia, hallucinating visuals, massive agitation, and unrest leading to difficulty in psychological and physical re-orientation. The late symptoms suggest advanced stage of Alzheimer’s in the aged patients. In DSM-5, these symptoms are generally termed as Neurocognitive Disorder (Vance et al., 2019). Mrs. B might experience a decline in her cognitive performance in the coming days due to the increased agitation of neurotic receptors caused by the disease of dementia and its advanced stages as Alzheimer’s. Delirium, inability to perform daily chores and increasing agitation leading to physical violence are some of the potential problems Mrs. B might experience in gradually until appropriate treatment for her condition is effectively explored (Achterberg et al., 2020). As per the mental health assignmentthe symptoms of dementia at the age of 85 largely suggest Alzheimer’s in the patients. The psychiatric condition affects the brain cells of the patients resulting in increasing loss of memory and inability to basic cognitive functioning. Reasoning, orientation of space and situation, verbal communication, and delusional thoughts are some major problems that Mrs. B might have to experience in this condition. Besides the cognitive malfunctioning, anxiety, agitation, aggression, and psychosis are common and recurrent problems in Alzheimer’s, suggestive of Mrs. B’s symptoms and potential problems. The symptoms Mrs. B is probably going to experience are common to Schizophrenic disorders among younger people, as she has past record of experiencing visual hallucination and paranoia. The symptoms become severe due to her age and turns to those of Alzheimer’s. If remains untreated as mentioned in the mental health assignment, this disease may cause her loss of memory to the point of her inability to recognize people.

Assessment tool/s discussed in the mental health assignment
Mrs. B needs to be assessed on her individual problems comprehensively. As per the mental health assignmenther symptoms are clearly suggestive of age-related psychological disorders following the loss of her husband. Her medical history is common to the discourse of Alzheimer’s in the aged population. There are two types of screening tools applicable for dementia or Alzheimer’s patients – the General Practitioner Assessment of Cognition (GPCOG), and the Eight-item Interview to Differentiate Aging and Dementia (AD8) (Rashedi et al., 2019). The first tool is appropriate for Mrs. B, as the detailed history of her medical complications is available from the time before her admission to care facility to the present onset of symptoms related to dementia. This screening tool mentioned in the mental health assignmentinvolves three consecutive phases of assessment – the three word registration, clock drawing, and three word recalling. In the first phase, the patient will be asked to repeat three words after the counsellor. The words must be common and easy to memorise, for instance, banana, sunrise, and chair make a basic set of mnemonic words for the patients with cognitive impairment (Xu et al., 2019). The second step includes drawing a clock using a circle printed on a paper. The counsellor will ask Mrs. B to put the numbers clockwise and draw two hands of the clock at a certain time, say half past 9. As per the mental health assignmentin this phase, the instruction can be repeated, as it is not a memory test. In the third and final phase, the patient will be asked to recall the words uttered in the first phase. A scoring system with zero to 3 pointers for the third phase, and 2 pointers for the second phase, and 5 pointers for the total score summing up the results of recall and clock phases determine the condition of the patient (Rashedi et al., 2019). If the results of this screening are unsatisfactory, the eight item interview of the informant can be included (Xu et al., 2019).

Physical and physiological factors
Physical factors that might affect the assessment process are correlated with the psychological factors in the case of Mrs. B. Tremor, for instance, is one of the most common physiological replication of anxiety caused out of Alzheimer’s (Kandiah et al., 2019). reduced cognitive activeness, delusion and depression may reflect in delays or inability to register the instructions of the psychologists during the screening test. As per the mental health assignmentage plays a crucial role in determining the efficacy of the assessment procedure in the patients of Alzheimer’s, as advanced age naturally reduces the capacity to register instructions and act accordingly. Patients with history of dementia and depressive episodes are likely to reject cooperation in the process of screening, making the identification of the intensity of the disease more difficult. Apart from some pain manageable by Paracetamol, the patient does not report any physical condition adverse to the screening process (Vance et al., 2019). As per the mental health assignmentdetails the neuro-psychotic medications administered to her immediately after the loss of her husband causing her show the symptoms of depressive psychotic episodes did not cause any massive physiological changes, as reported by her son. However, due to the presence of cognitive challenges and mood disorders, the patient may refuse to cooperate in the screening process. In such situation, the informant will need to be screened about the patient. As per the mental health assignmentthe persistent agitation and aggression in the patient may create further trouble to the screening as there is a possibility of violent outburst due to inability to follow the instructions (Achterberg et al., 2020). However, for better security, a primary medical assessment of the patient’s systolic and diastolic functions and pacing time need to be documented.

Four models of successful aging discussed in the mental health assignment
Mrs. B needs to follow the Kahn Model of Successful Aging which emphasises on four fundamental conditions for effective and disease-free aging (Rakt&Mccarthy-Grunwald, 2021). These conditions are minimization of risk and disability, engagement in activities, maximization of physical and mental functions, and optimization of positive spiritual attitude (Kooij et al., 2020). As per the mental health assignmentrisk minimisasion depends on health management and security of the living condition of the patient. Mrs. B has the access to a secure and safe environment in the care home. She receives support from her son too, which helps ensure her physical and physiological wellbeing even in the care facility. Maximisation of physical and mental ability is possible by engaging Mrs. B in age-appropriate physical and cognitive improvement activities. As per the mental health assignmentit is known that she enjoys the Hydrotherapy in community service facility. Hydrotherapy has high potential of relieving pain and agitation in the aged patients with advanced dementia (Van de Rakt&Mccarthy-Grunwald, 2020). It offers them a sense of activity without insecurity or fear of getting hurt (Geard et al., 2021). The duration of hydrotherapy needs to be regulated effectively to prevent the possibilities of physical ailment as Mrs. B is of a vulnerable age in terms of immunity and resistance to diseases. It will calm her agitation down and offer scope to re-orient cognitive capacity. As per the mental health assignmentengagement in active life functions like movements, communication, enjoying sensory reception of arts like listening to a music that soothes mind are useful measures for successful aging in this case. Music therapy is a potential savior in re-orientation of the patient’s cognitive abilities and maximization of spiritual positivity (Van de Rakt&Mccarthy-Grunwald, 2020). However, medication for managing the symptoms of Alzheimer’s is necessary for the primary phase of treatment to Mrs. B, as she is showing severe violent behavioral changes lately.

Potential psychiatric diagnoses
The potential diagnosis of psychiatric problem in Mrs. B is Alzheimer’s. as per the mental health assignmentthe disease is common to the people of her age bracket. In this disease, the patients show all the common symptoms of schizophrenia. While Schizophrenia is common to younger people, the severity of these symptoms in older people above the age of 65 turn to Alzheimer’s. Though Mrs. B has an external influence on developing her first psychological disorders, which manifested after the death of her husband, the present symptoms have little to do with the experience. The disease causes gradual but steady decline to the cognitive capacity of thinking, and behaving in socially acceptable ways. General functionalities of human brain are largely affected by dementia caused by Alzheimer’s disease. As per the mental health assignmentthe ability to receive and register the messages from around the environment gets challenged due to dementia. The patients may often collapse into a vegetative state due to their inability to receive messages and react accordingly to those (Vance et al., 2019). Gradual damages to brain cells cause a state of trance in this condition. The aggression, agitation, and violence is a replication of the brain’s fight to perform normally against the malfunctioning neuro-messages. Medications help managing thee anxiety, aggression, and violence among the patients of Alzheimer’s disease, but cannot offer a cure to the condition (Kandiah et al., 2019). As per the mental health assignmentmanaging the aging process by active indulgence in physical and cognitive functioning is a useful method of calming the symptoms of dementia. Mrs. B’s preference to hydrotherapy, is thus useful in managing her agitation and other troubles caused by the disease. Ensuring security in terms of medical and living condition is crucial for such cases as the patients suffering from Alzheimer’s disease cannot take care of their own nutrition and safety. Malnutrition, dehydration, and severe infections in any form may result in fatal consequences for the patients if left unchecked (Achterberg et al., 2020). Hence, the patients require very particular care from their immediate environment.

Appropriate treatment & management plan
Mrs. B needs both medication and personal care to manage and deal with the symptoms of Alzheimer’s disease. As per the mental health assignmentthe complexities of the disease demands specific consideration of the patient’s medical conditions before medications. The common medications for the disease include Galantamine, Donepezil, and similar anti-depressants or anti-anxiety drugs under the groups of Selective Serotonin Reuptake Inhibitors (SSRI), and Serotonin and Norepinephrine Inhibitors (SNRIs) (Kabir et al., 2020). These medications or drugs help control the cognitive disabilities to some extent and effectively manage the anxious and violent outcomes of the physiological triggers of dementia. As per the mental health assignmentmore than the medications, lifestyle management is crucial for helping Mrs. B in her present condition owing to her advanced age. Regular practicing in memorizing and rational thinking by mild therapeutic activities such as recalling words, and connective different phenomenon in a coherent format may help the patient in re-orientation of cognition, and reduce her agitation. It is suggested to refrain from using drugs with potentially severe side-effects like that of Aducanumab on aged people suffering from advanced symptoms of dementia (Kabir et al., 2020). Managing the aging process depends largely on the preference of the patient in lifestyle activities and engagement (Kettunen et al., 2019). As per the mental health assignmentMrs. B., for instance, prefers the experience in hydrotherapy, which helps the people of her age to feel active without the fear and anxiety of physical trauma. Determining the appropriate drug for the management of symptoms depends on the physiological conditions of cardiac and pulmonary functions along with neurological and nephrological complications in the patient (Qin et al., 2022). As per the mental health assignmentthe effective planning for Mrs. B’s treatment including the medication and personal care will depend on the result of the screening and medical assessment of the patient following both physiological and psychological check-ups.

References
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