PATIENT CARE ASSESSMENT

Patient Care Assessment

Patient Care Assessment

Case Background

Mrs Ruby Diamond is an 85yr old woman who has been widowed for just over a year. Mr & Mrs Diamond lived in the same borough as their only daughter Jane, who is married and has a four year old child. The grand parents used to child mind their grand child twice a week while Jane went back to work on a part time basis.

After Mr Diamond died Mrs Diamond told her daughter that she wished to carry on with her life as usual, like going to bingo, having lunch two days per week with friends and childminding her grand child. She however seemed less communicative and 'bubbly' as she used to be. Her friend confided in Jane that her mother was reluctant to socialise and appeared not to be coping with the grand child. Mrs Diamond never complained.

One afternoon Mrs Diamond looked pale and was unwell and she agreed for Jane to take her to the GP. Mrs Diamond was diagnosed with chest infection and admitted to hospital, where she was prescribed antibiotics for two weeks. After two further admissions with chest infections and a fall (which affected her confidence to walk) a family decision was made for Mrs Diamond to live with her daughter. Her house was sold and the money put into her bank account.

Life seemed to go well with the family until Mrs Diamond's behaviour appeared to change e.g. asking the same questions repeatedly; loosing her handbag all the time ; blaming others and confusing family members' names etc. This caused some tension in household, and to alleviate family stress, Jane suggested that her mother goes to her room during the evenings and have meals by herself. With time Mrs Diamond's behaviour worsened, she started walking naked, not eating well and being tearful.

The GP provisionally diagnosed Mrs Diamond with dementia and she is now admitted to an assessment ward for further investigations to confirm the diagnosis.

Amnesia and dementia are the two major classes of memory disorders seen in clinical populations. Amnesia refers to a specific, acquired difficulty in learning new information and/or remembering information from the past. The memory disturbance may be strikingly circumscribed and may occur in the absence of significant impairment of other cognitive or social skills. Dementia is a more broadly defined cognitive disorder, of which amnesia is the primary feature. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV; APA 1994) describes dementia as "the development of multiple cognitive deficits that include memory impairment and at least one of the following cognitive disturbances: aphasia, apraxia, agnosia, or a disturbance in executive functions" (p. 134).

By definition, the cognitive disturbance seen in dementia must reflect a decline from a higher premorbid level of functioning and be severe enough to interfere with social or occupational responsibilities. Prevalence estimates for dementia increase significantly with age, and approximately 6% of individuals over age 65 and 20% over age 80 suffer from a ...