Complex Care Essay Sample

A secondary or long-term health condition is any health condition that lasts for six months or longer. Many of the secondary health conditions are a result of various health factors resulting at a similar time, take longer to develop, and last for a more extended period. More than fifteen million people in England are experiencing secondary health conditions. Due to a large number of people with long-term health conditions, the NHS has challenges in the effective management of such conditions (DH, 2009). To manage the pain of long-term illness, the patient should take pain-relieving medication and undergo therapies. This case study will present the effect of multiple health on a person and their carers by focusing on a primary and a secondary health condition and their interaction and influence on the caregivers.

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The Patient

This case study involves Mrs. A. who is a seventy-year-old Black American woman who was working as a certified nurse assistant at a secondary care hospital. She stopped working after her husband developed signs of prostate cancer. Mr. A has a history of long-term illnesses such as stroke and hypertension while Mrs. A has no history of long-term illnesses though, in recent days, she was detected to having high blood pressure though she reluctant of taking any medication. During a visit, the nurse taking care of Mr. A notice that Mrs. A appeared thinner, tired and reported reduced sleeping hours at night. Mrs. A told the nurse that she was having so many thoughts in her mind. The physical appearance, disturbed sleeping patterns, avoiding usual activities, and the unwillingness of sharing her feelings indicated that Mrs. A was suffering from depression. Mrs. A has been taking calcium supplements and thyroid replacement therapy.

The Primary Condition- Depression

Depression is a common medical disease affecting the feelings, thinking, and the actions of a person. The symptoms associated with depression include feeling sad, sleep difficulties, increased fatigue, loss of appetite, suicide thoughts, and loss of concentration. Depression can be mild or severe and can occur in weeks or even years (Rabins, 2012). Depression causes many diseases in many western countries thereby affecting millions of people. Depression that has reversible cognitive impairment might be a symptom of dementia instead of separate or unique disorder (Kee, et al, 2008). It is vital to identify and treat related mental symptoms because they end up increasing the mortality rate and health care expenses.

Treatment of Depression

Depression is one of the most treatable mental disorder because many of the individuals suffering from depression respond positively to treatment. The practical tests for screening dementia are serial administration of the MMSE that plot the cognitive loss over time and the second method is the clock-drawing test documents the cognitive changes throughout dementia (Guzior, et al., 2015). A thorough diagnostic evaluation is conducted by a health professional before the patient is diagnosed or treated. The diagnostic evaluation is performed through an interview or physical examination. In some instances, blood testing is conducted to ensure that depression was not caused by medical circumstances such as thyroid problem (Hotopf, 2018). Evaluation helps in determining the specific symptoms, medical and family background, and cultural and environmental factors leading to the arrival of diagnosis and planning for a course of action (Canter, Penney, & Tsai, 2016).

In the hospital, Mrs. A is prescribed with antidepressants with no low or high-intensity intervention. The medicine was ineffective because the symptoms persisted making the doctor to refer Mrs. A to a specialist in a day hospital probably because they thought she had another disease other than depression. After one month, Mrs. A presented signs of forgetfulness as she had problems in remembering the names of her relatives hence was diagnosed with an early stage of Alzheimer's disease. The specialist used the clock-drawing test that helps in the identification of depressed patients with Alzheimer's disease. Mrs. A had a low score on clock drawing, copying, and reading the clock.

Antidepressants may be prescribed to depressed individuals for modification of the brain functioning. It takes one or two weeks for the antidepressants to show some improvement and full recovery is experienced after two to three months (Glassman, & Bigger, 2010). For mild depression, psychotherapy is used for treatment while a combination of psychotherapy and antidepressants are used for moderate or severe depression. Cognitive behavioral therapy is efficient in depression treatment as it enables an individual to identify distorted thinking and after that change behaviors and thinking (Mendiola-Precoma, et.al, 2016). Electroconvulsive therapy is applied on individuals with severe depression who fail to respond to other treatments. ECT is the short electrical stimulation of the brain conducted by highly trained medical individuals when the patient is under anesthesia (Schlander, 2007).

The Secondary Condition- Alzheimer's Disease

Alzheimer's Disease is a commonly known form of dementia-causing memory loss, loss of time and place bearing, and reduces the capability of learning or understanding information. The early sign of Alzheimer's disease is difficulties in remembering latest conversation while decision making challenges characterize the advanced stage, confusing or getting lost in familiar areas, speech and language problems, hallucinating, and becoming moody or anxious. Alzheimer's disease affects 60% from an estimation of eight hundred thousand people with dementia in the United Kingdom (Health Committee, 2014). The most vulnerable age group to suffer from Alzheimer's disease is age above 65 though some percentage of people between forty to sixty-five years can also have Alzheimer's disease (DH, 2009). It is essential to identify, create awareness, understand, minimize stigmatization, ensure improved diagnosis, and improve healthcare services (Brooks et al., 2017).

Treatment of Alzheimer's Disease

A well-timed diagnosis of Alzheimer's disease provides excellent opportunities for preparing for the future and ensures timely treatment (Bullock, 2004). Individuals who have Alzheimer's disease lack acetylcholine which enables the transmission of messages around the brain. Acetylcholinesterase inhibitors like Donepezil are recommended to a person with mild dementia (Carrasco et al., 2011). Donepezil raises the amount of acetylcholine within the brain and seems to delay the development of Alzheimer's disease effectively (Seltzer, 2004). However, the benefits of this medicine differ from different people, and some individuals get no benefits from it. The patients who do not respond well to Donepezil have been prescribed Memantine hydrochloride which blocks the impacts of a chemical within the brain (Schlander, 2016). Aggressive patients were given antipsychotic medicines which are used for some time with a lot of carefulness as they increase the cardiovascular challenges (Cummings, 2004). For some people, the cost, headaches, and diarrhea that associated with the medicine outweigh any probable benefit.

The doctors prescribed Donepezil to Mrs. A. to repay the lost brain cells. She did not experience any side effects, and the drug functioning was high. Mrs. A's health appears less deteriorated, and the caregiver burden is lessened. Other alternative medications are available in case the donepezil turns less effective. If the medication is stopped, the patient's health deteriorates very fast, and the patient becomes very weak like they never took any medication. If the medication were not effective on Mrs. A, her health would have deteriorated as soon as possible.

Designed group cognitive stimulation programs are recommended for patients with mild or moderate dementia. The groups that use Cognitive Stimulation Therapy positively impact the group members through increased confidence, improved memory, and interaction between group members provides an opportunity to share common challenges (Stanley, Balasubramanyam, & Kunik, 2007). These groups are offered in health care facilities that specialize in Alzheimer's disease (Guimon, & Basaguren, 2011).

Mrs. A attended the cognitive group stimulation program within Hope hospital because she understood the importance of group therapy based on her previous experience while working as an assistant nurse. The cognitive stimulation helped Mrs. A heal from depressed and subsequently relieved some stress from the carer. The cognitive stimulation is recommended by the National Institute for Health and Care Excellence (NICE).

The Complexity of Managing both Conditions

Mrs. A got a referral to a day hospital for depression treatment and to also manage Alzheimer's disease. Day hospital that Mrs. A attended offer therapeutic assessment and management of mental; health diseases such as depression and Alzheimer's disease. In addition to medication, successful treatment of dementia involves psychological treatments such as cognitive stimulation that assist in the improvement of memory, communication abilities, and fast decision making. Psychological therapies like cognitive behavioral therapy and art therapy help to manage stimulating behaviors like depression, hallucinating, agitating, and being anxious which are associated with Alzheimer's disease (Hopkinson, et al., 2018). These groups are offered in the day hospital that Mrs. A attended and she is able to engage well with the peers thereby yielding positive outcomes. Psychological therapies have enabled her mood to improve. The day hospital appears to be a convenient intervention for treating Alzheimer's disease (Lock, 2013). Nonetheless, depression and Alzheimer's disease are both complex diseases; therefore, it is hard to resolve them making it is crucial to consider ongoing care needs.

Talk therapy can be considered in Mrs. A case for a long term treatment although cognitive behavioral therapy needs the individual to recognize and participate in the therapy cognitively. It is very challenging for a dementia patient to undergo talk therapy since they have impairment in retaining information and learning (Kruger, 2013). In the early phases of diagnosis, patients can engage although when depression is triggered; cognitive behavioral therapy becomes inefficient (Fane, et al., 2013). Research shows that it is hard to treat depression when it is linked to dementia (Kobayashi, & Kato, 2011). Nevertheless, every person is entitled to these services; hence they must be given the opportunity to choose the services they want. It is essential to offer treatment interventions to people having cognitive impairment, and carers should also be included in cognitive behavioral therapy treatment of depression (Nehrig, et.al. 2019). Individuals with dementia express their feelings freely with more sincerity; hence, psychotherapy may be more beneficial to them (Blacioti & Luiza, 2011).

The burden on the person caring for the dementia patient increases gradually about the loss of functional independence. The fear of being left alone may limit the care provider's convenience of free time and impair their psychological health (Eun, 2013). To prevent this, the psychiatrist may arrange for daycare to ensure that the caregiver is healthy because they are the critical primary care managers of Alzheimer's disease patients (Juangco, 2016). Primary carers are vital because they provide a clear status of the patient to the medical professionals in case the patient is not able to present herself.