The term “ Alzheimer,” according to Alzheimer’s Association (2017), refers to a type of dementia in which behaviour, memory, and thinking problems are born. The present study aims to describe the effects Alzheimer disease has on an individual cared for and observed in a practice placement in terms of the biological, psychological and social aspects and in relation to holistic care. It will also define the term biopsychosocial. In accordance with the Nursing and Midwifery council’s code of conduct (NMC 2015), a pseudonym Mrs Hanks will be used to maintain confidentiality throughout the essay. The present work will also include a reflective piece, describing how what the writer has learnt might affect future practice, in terms of knowledge, skills and attitude and finally, a brief conclusion summarising the key aspects of this piece of work will be discussed.
Miles (2013) points out that George L. Engel advanced the biopsychosocial model in 1977 views the human health and disease as the product of natural, mental and social variables. This viewpoint is quite opposite the biomedical model that views the disease as deviation in resulting from normal biological functioning. The approach of biopsychosocial in the training programmes puts more focus on the significance of understanding human illness and health in their complete contexts. On the other hand, the focus of the traditional biomedical model of clinical medicine remains on pathophysiology as well as other biological approaches towards the disease.
Mrs Hanks is a 59 years old female patient admitted for treatment under section 3 of the Mental Health Act 1983 which is necessary her health and safety and protecting people around her (Jones, 2016). Mrs Hanks was diagnosed with an early onset of Advanced Alzheimer dementia in the 2013. Her husband reported 3 months ago that Mrs Hanks has become aggressive to him and that she almost smashed him with a hot pan of food. Recently, it was reported also by Mrs Hank’s husband that she put her hands around her daughter’s neck trying to strangle her and the police was called. Mrs Hanks is observed to become anxious and obsessed with things and at risk of self-neglect, poor sleep, dietary intake and aggression.
The symptoms of Alzheimer’s disease most often develop gradually and become worse over the period of time, becoming severe to restrict the daily tasks. On the other hand, the word “ dementia” is used to describe a set of symptoms pertaining to difficulties with thinking, memory loss, language or problem solving (Korolev, 2014). Lava (2017) discusses the seven stages of the Alzheimer’s disease and counts them as: Normal Outward Behaviours, Very Mild Changes, Mild Decline, Moderate Decline, Moderately Severe Decline, Severe Decline and Very Severe Decline.
In the light of the definition of Alzheimer’s disease, the health condition of Mrs Hanks can be identified as Severe Decline. This is particularly because she becomes aggressive towards her husband by grabbing hot pan with food and almost smashing it on her husband. Sometimes, she is not able to identify her own daughter and treats her strangely.
Biologically, the disease affect patients in different ways but in Mrs Hanks’s case, the disease has impacted on her in some areas which includes her thinking skills, her ability to carry out a simple task; for example her personal hygiene which has exposed Mrs Hanks to urinary tract infection causing her pain, fever and abdominal discomfort. The Urinary Tract Infection occurs when bacteria mostly E. coli gets in the urinary tract from faecal matter into the urethra and multiplies in the bladder. If Urinary Tract Infection is left untreated, it can result to permanent kidney damage and also become life threatened when spreads to the blood stream (Mortensen, 2009). Mrs Hanks is unable to express her needs as she tends to be forgetful due to memory loss and cognitive impairment which puts her at risk of dehydration and poor dietary intake (Korolev, 2014). According to Selkoe 2012, human body is controlled by the brain and the brain consists of cerebrum, cerebellum and the brainstem. The outer part of the cerebrum is also called with the cerebral cortex which becomes clamped in a patient with Alzheimer resulting to memory loss, inability to think and plan. However, the brain of an individual with Alzheimer has fewer nerve cells as the healthy nerves are becomes clustered with strange protein which is also known as plaque. This plaque grows between nerve cells which gradually get twisted in strands of another protein also called the tangles. Hence this plaques and tangles are usually formed in the area of thinking, planning and memory which has an effect on Mrs Hanks as they are suspect to be the cause of cell death and loss of tissue in the brain (Shankar et al., 2008).
According to Bemelmans et al, (2016), the psychological effects of Advanced Alzheimer Dementia on a patient include anxiety, test-related distress, depression, memory and coping functioning. Cobos (2012) points out that both the patients and their family members or caregivers usually experience serious psychological functions that ultimately determine the future development of the illness. From this perspective, Mrs Hank’s family members experienced a significant change in her behaviour. It would not be wrong to state that they were not able to recognize her emotions and feelings. She has become accustomed to be aggressive towards her husband which in one of the incidents she grabs the hot pan with food and tries to smash it on her husband this reveals her worse psychological condition (Li et al, 2015). This disease has psychologically affected her marriage. However, Mrs Hanks’s husband understands her condition as her husband on one occasion broke down in tears and said “ I miss my wife and I understand this is not my wife but the disease”.
Ledger and Baker (2007) points out that the term “ behavioural disturbance” is used in the context that refers to the psychological or behavioural syndrome. In the same manner, behavioural disturbance also refers to the pattern that is connected with the subjective distress, impaired interactions, or functional disability with the environment or others (Imtiaz et al, 2014). For example, she treats her own daughter in a very odd way. One day, she put her hands around her neck trying to strangle her. The incidents rose too much that police had to be called for making the situation calm.
Fox (2008) states, “ Alzheimer’s disease is one of the most feared diseases associated with aging. The reconstitution of senility as Alzheimer’s disease transformed the meaning of cognitive impairment associated with age from an inevitable process to a medical condition that might be delayed or avoided altogether” (p. 5). Any problem that is associated with memory loss is called as a social response as it is viewed as a natural part of the aging process. Nevertheless, when the same issue is considered as a disease, it required responses become clinical. In other words, the anxiety and fear that are associated with the Alzheimer’s disease usually take place due to the reason of disability to function socially in a normatively acceptable way. This particular situation actually contributes in creating the notion of “ malignant social psychology” that refers to a situation in which unintentional deficiency of social self may occur through various ways, including infantilizing, disempowerment, labelling, invalidation, stigmatization, and banishment. It would not be wrong to state that all of the mentioned ways might result in the excess disability that leads an individual with Alzheimer’s disease to the unnecessary constriction of social roles and lives (Terracciano et al, 2014).
The social condition of Mrs Hanks can be described in the same context. For example, there has been an observed deterioration for the last one month when Mrs Hanks has become anxious and obsessed with things. In other words, Mrs Hanks puts herself from not only the social life but also her own family members. The example of the Mrs Hank’s case illustrates the concept of “ social disenfranchisement” that usually happen with the people suffering from the Alzheimer’s disease. Similarly, the symptoms of the Alzheimer’s disease are the source of obliteration for selfhood resulting in making the mind of the individuals with Alzheimer’s disease that they are socially undesirable group of people.
In the light of the scenario of Mrs Hanks and her disease, I have learnt ways for my future practice in terms of knowledge, skills and attitudes that can be used to make the communication smoother and effective since only communication can help me cope with the situation in all biologically, psychologically and socially aspects besides the other medication and preventions. I would like to connect with the individual through making eye contact and encourage a two-way conversation for as long as possible. Speaking effectively with such individual can also help me in taking care. For example, it is always effective to say “ Let’s try this way” in the place of pointing out mistakes. If communication creates any issue, it is equally important to distract the individual. For example, fun activity can be offered like walk around the neighbourhood.
In conclusion, the symptoms of Alzheimer’s disease often develop gradually and become worse over the period of time. The condition of Mrs Hanks, as per the observation of the past few years, has gradually become critical. This is particularly because she becomes aggressive towards her husband by grabbing hot pan with food and almost smashing it on her husband. In the light of her condition, it can be concluded that she needs psychologically as well as socially, as she feels herself alone and requires an individual who can care for her by understanding her. The example of the Mrs Hank’s case illustrates the concept of “ social disenfranchisement” that usually happen with the people suffering from the Alzheimer’s disease.
