Eleanor is a 77-year-old white female resident of a skilled nursing facility
Eleanor is a 77-year-old white female resident of a skilled nursing facility. Recently her daughter requested an evaluation from the staff psychologist because she noticed that her mother’s Alzheimer’s symptoms appeared to be getting worse. Eleanor was admitted to the facility six months ago with moderately severe cognitive and physical decline and had to be placed in a skilled facility since she could no longer manage herself at home. Her daughter is a single mother of four teens and works too many hours to care for her mother in her home. She had attempted to care for her until Eleanor left the stove on, resulting in a minor kitchen fire. Eleanor has no history of mental illness, but she began to show signs of cognitive decline in her late fifties. The symptoms became much more pronounced after her husband’s death five years ago.
Recently her daughter and other members of the nursing staff noticed that Eleanor has become rather restless and combative. When she gets confused over her surroundings, she wanders through the halls attempting to open fire doors. When nurses attempt to redirect her back to her room, she swears at them and even struck one of them in the face. Her PCP authorized the use of restraints one day after she managed to wander out the front door and was found standing in the middle of the street trying to take a dog away from a woman who was walking it. She yelled at the woman, telling her that she needed the dog to protect her from people who were stealing her clothing in the nursing home.
Eleanor is a 77-year-old white female resident of a skilled nursing facility
It appears that Eleanor is exhibiting symptoms of agitation and aggression, which are common behavioral symptoms associated with Alzheimer’s disease and other forms of dementia. Given her history of cognitive decline and recent worsening of symptoms, it is crucial to conduct a comprehensive evaluation to determine the underlying cause of her behavior and develop an appropriate management plan.
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Psychological Evaluation:*
The request for a psychological evaluation by Eleanor’s daughter is a prudent step in assessing her cognitive and emotional functioning. The staff psychologist can conduct various assessments, including cognitive testing, to evaluate the severity of her dementia and assess for any underlying mood disorders contributing to her symptoms.
Medical Evaluation:**
Eleanor’s symptoms may also be exacerbated by underlying medical conditions or medication side effects. A thorough medical evaluation by her primary care physician (PCP) is necessary to rule out any acute medical issues and review her current medications for potential contributors to her agitation.
Behavioral Management Plan:**
Based on the evaluation findings, a multidisciplinary team comprising the nursing staff, psychologist, and PCP should collaborate to develop a comprehensive behavioral management plan for Eleanor. This plan should include strategies for managing agitation and aggression, such as environmental modifications, verbal de-escalation techniques, and pharmacological interventions if necessary. It’s essential to prioritize non-pharmacological approaches whenever possible to minimize the risks associated with medication use in older adults.
Family Support and Education:**
Eleanor’s daughter plays a crucial role in her care, but it’s evident that she may need additional support given her caregiving responsibilities and the challenging behaviors exhibited by her mother. Providing education and support to family caregivers can help them better understand and cope with the challenges of caring for a loved one with dementia. Additionally, respite care services should be explored to provide the daughter with much-needed breaks from caregiving responsibilities.
Ongoing Monitoring and Adjustment:**
Agitation and aggression in dementia patients can be complex and may require ongoing monitoring and adjustment of the management plan based on Eleanor’s response to interventions. Regular follow-up appointments with her healthcare providers are essential to assess her progress, address any emerging issues, and provide support to both Eleanor and her family.
In summary,
a comprehensive evaluation and collaborative approach involving healthcare professionals, family caregivers, and Eleanor herself are essential for effectively managing her behavioral symptoms and improving her quality of life in the skilled nursing facility. By addressing the underlying causes of her agitation and implementing appropriate interventions, Eleanor can receive the support and care she needs to navigate this challenging phase of her dementia journey.
Eleanor is a 77-year-old white female resident of a skilled nursing facility
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