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Studies related to dementia and caregivers burden nursing essay

Financial Concerns Family caregivers frequently seek advice about financial concerns, but they are often overlooked by health care providers Widera et al. The role of healthcare providers is to educate patients and families about the need for advanced financial planning; recognize signs and assess for financial impairment; and know when and to whom to refer Widera et al.

There are three approaches to a clinical assessment of financial capacity: The Financial Capacity Instrument is a useful clinical instrument to assess financial capacity in older adults with dementia Marson et al. The instrument assesses eight domains: In addition, the National Institute on Aging provides more information in a fact sheet about legal and financial planning for people diagnosed with AD National Institutes of Health, Nurses can play an active role in helping family caregivers acknowledge and anticipate such financial challenges and referring them to elder law attorneys; area agency in aging officials; state legal aid offices; the state bar association; and social service agencies.

Health Care Considerations The role of healthcare providers is to educate patients and families about the need for advanced financial planning; recognize signs and assess for financial impairment; and know when and to whom to refer.

Nurses are key advocates to help family members to begin the sensitive process of open communication in order to document advance care planning.

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Two nurse-led interventions aimed at improving the process of advance care planning suggested a unique opportunity to extend the roles and function of nurses in this process. These studies highlight the importance of broadening the concept of advance care planning from completion of a document to an ongoing process of understanding values and goals and also the role of nursing in this transition.

Nurses can leverage their unique relationship of trust with patients to facilitate this process. There are resources online to help patients and families identify and document priorities and decisions related to health care. This initiative states a mission to encourage patients to express their wishes regarding health care and for providers to respect these wishes see Table 2.

Caregiver Strain with Alzheimer's Dementia

Driving There is no single diagnostic tool that accurately predicts the time when a person with dementia should no longer drive, therefore family caregivers often struggle with when and how to stop the person with dementia from driving. While many states do not have laws mandating health care providers to report unsafe drivers, there are guidelines available that may be helpful in reaching a consensus on this matter Iverson et al.

These guidelines suggest that the evidence is strongest for a score of 0. Nurses play critical roles in educating and coaching family members through this difficult decision making process.

The American Academy of Neurology has updated guidelines regarding evaluation and management of driving risk and dementia see Table 2.

In most instances, persons with dementia become lost in the community while they are engaged in normal, independent activities that they are performing at appropriate times of the day Rowe et al.

The need to have easily recognizable and proper identification and to investigate the use of radio-frequency locator devices for persons with dementia is important topic that nurses can discuss with family members. Managing Behavioral Symptoms Common troublesome behaviors for families include refusal of care and repetitive vocalization. Research found that an intervention such as Advanced Caregiver Training ACT was effective to reduce these behaviors, and thus caregiver upset.

This intervention targets troublesome behaviors and provides strategies for management. Problem behaviors are conceptualized as a consequence of interacting factors. Some factors were patient-based, such as unmet needs or discomfort, and others were caregiver-based, such as stress and environment clutter.

Nurses can educate family caregivers in non-pharmacologic therapies that may decrease the occurrence of difficult behaviors. That can be made, other treatments e. Changes in Care Setting APNs providing care to residents in nursing homes prevent unnecessary hospitalization. Applications of the Transitions Care Model TCM have demonstrated efficacy in decreasing readmissions, length of subsequent hospitalization, and overall costs Naylor et al.

Likewise, APNs providing care to residents in nursing homes prevent unnecessary hospitalization McAiney et al. Additional information on transition care models is available at the National Transitions of Care Coalition see Table 2. Similarly, nurses can play a studies related to dementia and caregivers burden nursing essay role in identifying older adults with dementia who are at high risk for hospital-acquired complications e.

The Hartford Institute for Geriatric Nursing provides exceptional online resources on many geriatric topics including issues related to caregiving and hospitalized older adults with dementia.

Dementia care giving does not end with nursing home placement. Family caregivers remain involved in regular visits, ongoing provision of instrument forms of direct care and interaction with staff. These families may benefit from psychosocial interventions during the admission process to ease the transition from home to long term care.

Transitions in Dementia Care: Theoretical Support for Nursing Roles

End of Life Nurses play an integral part in orchestrating end-of-life care, particularly in nursing homes Lopez, b. In addition, family caregivers studies related to dementia and caregivers burden nursing essay satisfied with end-of-life care provided by nurse practitioners working in nursing homes Liu et studies related to dementia and caregivers burden nursing essay. However, there are still challenges for nurses guiding patients and families in this transition.

Some nurses did not perceive guiding families within their scope of practice. Therefore, to enhance the role of nurses in guiding end-of-life decision making, nurse leaders and educators must ensure that nurses remain up-to-date with the most recent best practices; understand their scope of practice related to end-of-life decision making; and appreciate the moral agency that nurses possess as experienced and knowledgeable clinicians.

At the end of life, family caregivers commonly confront difficult decisions about the goals of care, eating problems, studies related to dementia and caregivers burden nursing essay decisions about hospitalization. Family care givers must decide whether their goal of care is to attain comfort or to prolong life.

Using evidence-based interventions, this model of care gives priority to attaining comfort and maintaining personhood for the patient with dementia and his or her caregivers.

One very complex, emotional decision is that of feeding a person with advanced dementia. Nurses can play an important part in anticipating this problem and providing family caregivers with current research evidence so that they may plan for this complication. In addition, nurses can work with an interdisciplinary team that includes nutritionists, speech and language therapists, and occupational therapists to implement strategies to help maintain food intake.

Nurses need to help peers and families understand the evidence that supports careful consideration of the decision to make a hospital transfer. Another challenging decision is whether or not to hospitalize nursing home residents with advanced dementia.

The main advantage of hospitalization is access to more rapid diagnostics, surgery, and intensive care units. However, disadvantages of hospitalization e. Recommendations for Further Research The field of transitional care research is still in its infancy.

Evidence-based, best courses of care throughout the dementia trajectory are needed, as well as the identification of best practices for supporting families and caregivers through the transitions in dementia care. The role s of nurses working in collaboration with other health care providers and with family members needs to be emphasized in these projects. Finally, research studies aimed at translating the findings of best practices in to health care environments, including home, hospital, adult day care, and long-term care, are needed.

Conclusion It is imperative that nurses take a proactive role to provide anticipatory guidance for older adults with dementia and family caregivers as they transition along the dementia trajectory. Family caregivers of people with dementia provide the bulk of long-term care and often develop stress, burden, poor health, and financial strain as a result. Therefore, we believe that these family caregivers of persons with dementia deserve the same level of anticipatory guidance that parents of young children receive to ensure that they are prepared for each new transition.

It is imperative that nurses take a proactive role to provide this anticipatory guidance for older adults with dementia and family caregivers as they transition along the dementia trajectory. Using the transition theory as a framework for the development and implementation of clinical and educational approaches, nurses can play a pivotal role in the health and well-being of persons with dementia and their family caregivers.

She recently completed a 2-year post-doctoral Claire M. Fagin Fellowship with funding from the John A. Hartford Foundation where she focused on interventions to reduce sleep disturbances in persons with dementia and their family caregivers.

As such, she has completed research studies in the areas of complementary and alternative therapies to ameliorate distressing caregiver symptoms sleep disturbances, depressive symptoms, negative caregiving appraisalthe feasibility and efficacy of a meditation intervention for caregivers and persons with dementia, and in secondary analysis of large databases focused on quality of life in older adults.

These experiences make her qualified to author this paper that addresses transitions in persons with dementia. Ruth recently completed a 2-year post-doctoral Claire M. Hartford Foundation where she focused on nursing home organizational culture and the use of feeding tubes for those with advanced dementia.

In addition, she is a certified gerontological nurse practitioner with more than 25 years of clinical practice These experiences contribute to her expertise in the area of transitions in persons with dementia. References Alzheimer's Association The Journal of the Alzheimer's Association, 6 2 Seven stages of Alzheimer's. Lethality of Alzheimer disease and its impact on nursing home placement. Management of agitation and aggression associated with alzheimer disease. Nature Reviews Neurology, 5 5 Disclosing a diagnosis of dementia: International Journal of Geriatric Psychiatry, 19 2 Outcomes of infection in nursing home residents with and without early hospital transfer.

Journal of the American Geriatrics Society, 53 4 Family care experiences following long-term dementia care placement. Journal of Clinical Nursing, 18 22 Let me talk—an advance care planning programme for frail nursing home residents. Journal of Clinical Nursing, 19 The importance of family relationships with nursing facility staff for family caregiver burden and depression.

The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 62 5P School of Nursing Departmental Papers, 9. Nonpharmacologic interventions for inappropriate behaviors in dementia: A review, summary, and critique.

American Journal of Geriatric Psychiatry, 9 4 A telephone-delivered psychosocial intervention improves dementia caregiver adjustment following nursing home placement. International Journal of Geriatric Psychiatry, 26 4 Transitioning from driving to driving cessation: The role of specialized driving cessation support groups for individuals with dementia.

Topics in Geriatric Rehabilitation, 25 1 Learning to become a family caregiver: Efficacy of an intervention program for caregivers following diagnosis of dementia in a relative. The Gerontologist, 51 4 ,