Dementia
Dementia is a collective term that is used in nursing to describe different cognitive decline symptoms such as forgetfulness, thinking, and communication. Even though Dementia is associated with the elderly, it is not part of the aging process. Moreover, cognitive function impairment that is a result of Dementia is occasionally preceded and commonly accompanied by deterioration in social behavior, emotional control, or motivation. Dementia mostly results from injuries and various diseases that affect the brain primarily or secondarily, such as stroke or Alzheimer’s disease.
Consequently, according to research, Dementia has been described as the leading cause of dependency and disability among elderly individuals globally. For this reason, therefore, Dementia can be overwhelming for the individuals having it, their families, and their caregivers. Many people across the world are not aware of Dementia, which has increased stigmatization, diagnosis barriers, and care. The effects of Dementia on family, carers, and society, in general, can be social, economic, and psychological.
Challenging behavior
A challenging behavior involves wandering, shouting, throwing objects, biting, destroying personal things, repetitive talking, general anger and agitation, and waking others at night and attacking other individuals physically. Precisely, challenging behavior describes any behavior that patients affected by Dementia portray, which is deemed to be dangerous not only to themselves but also to their fellow patients and their caregivers. Moreover, the behavior is considered antisocial and hostile within environments where dementia patients operate.
The treatment of this behavior over the years has been based on containment and institutional control policies. These policies consist of combinations of mechanical, chemical, or environmental restraint. Nevertheless, presently, these approaches are being challenged because of their inadequate evidence and on the basis of ethics. Because of these reasons, medical practitioners have decided to use antipsychotic drugs to treat patients affected by challenging behavior.
Are Antipsychotic drugs effective in the Treatment of Challenging Behavior?
Managing people affected by challenging behavior remains a complex task in the modern world. As stated above, various ways can be used in the treatment of challenging behavior. Among the ways, psychotropic drugs have been adopted by medical officers to help in the treatment process of challenging behavior, thus making them the most frequently used. However, it is essential to note that other options are grounded on behavior modification procedures, unlike psychotropic drugs. The modification process is conducted by specialized professionals who assess a patient; analyses the factors and the effect of the behavior on the environment, thus developing appropriate strategies for modification purposes. Antipsychotic drugs have been described by researchers to be the easiest to use in terms of administration, time, and cost.
Furthermore, it is essential to state that not all challenging behavior patients are prescribed with antipsychotic drugs. Therefore, its use is based on how challenging behavior impacts the social environment. For instance, if a patient within an institutional setting is seen as destructive and violent, has a high level of motor skills, physical skills, and self-direction. There is a high chance that this patient will be administered with antipsychotic drugs. Moreover, other than behavior, other factors have to be considered before antipsychotic medications are administered to a patient; they include; environmental factors, the perception of the behavior by the surrounding individuals, administrative treatment philosophies, and the staffing ratio. Of all the different challenging behaviors, antipsychotic drugs are strongly administered to patients with aggression. Once individuals are administered antipsychotic drugs, they can use them for many years.
Effectiveness and Safety of Antipsychotic drugs
The Effectiveness and the safety of antipsychotic drugs on managing and controlling challenging behavior is still a topic of discussion. Many researches have been published to address this issue; Nevertheless, many of these studies are methodologically inconclusive or flawed. The recent literature review by Brylewski and Duggan cited over 500 citations examining the effects of antipsychotic drugs on managing and controlling challenging behavior. From these many citations, only three tried to establish substantial evidence, but they did not determine whether the drugs were beneficial or disadvantageous.
There is a need for establishing the Effectiveness of using antipsychotic drugs in managing challenging behavior because its use might be hazardous to the patients. The administration of these drugs can have both long term and short-term side effects. However, short-term effects are not as hazardous as they are self-limiting, and the use of other drugs can manage them, or patients can stop taking antipsychotic drugs. Our primary concern is grounded in the long term and idiosyncratic side effects. Idiosyncratic effects are the most serious, and they are linked with mortality rates. The commonly known long term effect of these drugs is tardive dyskinesia. Moreover, the use of these drugs can result in tardive akathisia.
Antipsychotic drugs are advantageous because they are easy to use, have a sedative effect, and provide rapid calming. These advantages make them more reliable to be used as compared to other methods. Moreover, few professionals are trained specially to manage challenging behavior using the various proven behavioral procedures; this, therefore, increases the reliance on antipsychotic drugs.
An alternative for Antipsychotic drugs
From the analysis above on the Effectiveness and safety of antipsychotic drugs, it is clear that the drugs have side effects that pose risks to individuals’ health. Research has demonstrated that Dementia can be overcome without the administration of drugs. Researchers have also established that it is vital for clinicians to try alternative psychiatric treatments before prescribing antipsychotic drugs to patients. One of the alternatives that scholars have determined to be effective in the treatment of Dementia in the use of a multi-pronged approach. This approach combines many different therapies to treat Dementia. For instance, through talk therapy, individuals can express themselves honestly, face their fears, understand their illness better, and easily identify triggers, thus learning how to control and prevent them. Moreover, cognitive behavioral therapy is also crucial because it helps patients undo healthy or negative thought behavior patterns and rationalize anxieties and fears, balance their moods, and gradually realize their internal peace.
Australia Dementia Association Guideline
Dementia is given a healthy priority in Australia. As the Australian population ages, the number of individuals with Dementia also increases. As aforementioned, people living with Dementia have deficits in attention, communication, memory, judgment, and thinking. In Australia, the dementia care quality varies in terms of clinical practice. This happens because the availability of quality services to sustenance diagnosis, workforce training, ongoing care, and support for families with Dementia is inconsistent. To improve the consistency and the quality of dementia care, there is a need for research findings to be synthesized, and research evidence should be disseminated to clinicians.
In 2013, the government of Australia established the National Health and Medical Research Council. In partnership with the Centre for Dealing with Cognitive and Related Functional Decline for the elderly, this department was tasked with the mandate of developing Australian Clinical Practice Guidelines for Dementia. These two departments adapted some guidelines through the use of ADAPTE methodology, which reflected the available evidence and the context of Australia with regards to Dementia.
The main reason as to why the guidelines were formulated was to help in providing recommendations on how to manage and diagnose people with Dementia. The guidelines addressed the gaps in caring for dementia patients in the community, hospital settings, and residential care. Moreover, the guidelines were also relevant to nurses, medical practitioners, allied health professionals, and aged care workers. Consequently, these guidelines were also crucial for educators, researchers, decision-makers, and policymakers. The committee established a total of 109 recommendations, and they categorized them in terms of evidence-based, consensus-based, and practice points recommendations.
How the policy in a nursing home can protect and help patients with Dementia
Nursing home policies for dementia patients are based on an individual-centered perspective. Moreover, these policies emphasize maximizing the quality of life for the patients. Individual- centered care is described as the care that is personalized and adapted to the changing abilities, preferences, and needs of every individual. The quality of life is a multidimensional and complex concept that involves domains of social functioning, comfort, functional status, personal agency, security, and physical and emotional health. When patients with Dementia progress to the severe stages of the disease, their quality of life decreases. Many reasons contribute to their poor-quality life, including depression, functional impairment, and behavioral symptoms.
Therefore, the policy for enhancing and protecting the patients in nursing homes relies on various components. For instance, the nursing home must have proper staffing. Staff training, adequate staffing, and the quality of staff-patient relationships strongly impact the quality of life for patients with Dementia. Consequently, thorough and regular assessments policy is also crucial in determining the patient’s state. Furthermore, through the assessments, patients are given the required attention, which is vital in improving their lives. Once the health professionals have assessed the health of the patients, it is easier for them to manage their symptoms easily. Studies have established that psychological and behavioral symptoms of Dementia are troublesome. Therefore, the nursing home policy dictates that patients should be assessed regularly so that these symptoms can be easily managed, minimizing the chances of the patient behaving violently and abnormally.
In conclusion, clinicians need to comprehend that patients with Dementia are prone to behavioral disturbances, and therefore they should be anticipated. Moreover, before the clinicians prescribe drugs such as antipsychotics to the patients, there is a need for them to look for alternatives that have minimal side effects. The administration of the drugs should be the last step. The paper has subsequently examined Australian dementia guidelines, which have developed a deep insight into how people living with Dementia should be handled. Furthermore, from the paper, it is also evident that for nursing homes to protect and help patients with Dementia, various components such as staffing and regular assessment should be done appropriately.
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