Within a hospital setting physiotherapists are exposed to a vast variety of conditions. Some patients are admitted due to a simple femur fracture with no complications and another a femur fracture with detrimental effects.This however is based on individual factors with age being one of them. correlating to the picture of the dying rose, with an increase in age comes an increase of many disease. Dementia is one age related disease that describes symptoms associated with a decline in memory and thinking which could be debilitating as to reduce a person’s ability to perform everyday activities.
During my orthopedics block I was exposed to the two situations mentioned above, more recently the latter. A 79 year male patient admitted due to a femur fracture secondary to a fall. This patient was known to Tygerburg for his dementia and was treated for his fracture accordingly. Although he had a poor baseline and minimal awareness of his surroundings he still verbalised his thoughts. Although his use of foul language was copious he was still unaware of his situation and or setting he was in and what was being done for him. I noticed how the professional nursing staff took this foul language personally and ill treated the patient instead of doing the best they could to make him comfortable for his remaining time in TBH. This led me to reflect on the topic of meaningful life and death and how younger patients are always prioritised. The neglect of geriatric patients can all be seen in vast majorities of old age homes, all based o subjective experience. Over the past decade, research has found that patients with dementia do badly in hospital settings with frequent adverse events resulting in the geriatric syndromes of falls, delirium and loss of function with increased length of stay and increased mortality. Contributory factors include inadequate assessment and treatment, inappropriate intervention, discrimination, low staff levels and lack of staff training. Unfortunately there is no one simple solution to this problem, but what is needed is a multi-factorial, multilevel approach at the seven levels of care –patient, task, staff, team, environment, organisation and institution(George, Long & Vincent, 2013). This could be addressed by clinical ward rounds having all multi-disciplinary teams aware of what each patients condition presents like and how to appropriately manage and care for them.
In the events that occurred with the patient with dementia, the patient passed away two days later. Although his prognosis was poor there is no evidence proving that the added environmental factors were adding to his sooner passing and it would be dangerous water to thread in making such assumptions. However, patient safety should be at the heart of quality in medicine. It is crucially important in our modern, caring society to provide high quality and safe care to the more disadvantaged sections of our population, including patients with dementia. In the past, patient safety efforts have concentrated on younger patients, especially in litigious areas and where problems are perhaps more clear-cut, such as surgery or obstetrics. Now is the time to turn our attention to frail, older patients with dementia. Improving the safety of patients with dementia will also have benefits for all patients, especially by improving the hospital environment and encouraging person-centered care. In order to address this challenge, we need to think more closely about the design of systems of acute care for complex patients with multiple co-morbidities. We need to increase awareness and understanding of the ways in which the manifestations of healthcare related harm are different in these patients, often presenting as the geriatric syndromes such as falls, delirium, incontinence and functional decline. The subtlety of presentation and detection of adverse events in patients with dementia is compounded by a culture of ‘low expectation’, which opposes the required ‘safety culture’. There should be the same attention to preventing delirium in an older patient with dementia as there is for preventing a wound infection in a young surgical patient. in a famous quote by Maya Angelo her words describes how we should always be the light in a dark world.
“My wish for you is that you continue. Continue to be who and how you are, to astonish a mean world with your acts of kindness. Continue to allow humor to lighten the burden of your tender heart.”
References
George, J., Long, S., & Vincent, C. (2013). How can we keep patients with dementia safe in our acute hospitals? A review of challenges and solutions [Ebook] (pp. 356-361). Journal of the Royal Society of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3758672/pdf/10.1177_0141076813476497.pdf
3 thoughts on “Meaningful Life and Death: A Case of Dementia”
Thank you for allowing me to read your work Chandre. I like how your post starts with the picture of the rose, it sets the mood for your piece of writing and by the time you finish reading your piece the relevance of such image is confirmed. This topic is relevant to clinical practice as we are always being exposed to although similar cases different circumstances in a clinical setting in which we work.
Your introduction is very short only being two lines and does not fully introduce what your piece will be discussing. I suggest introducing the topic of dementia or care for older patients in this introduction to set the tone for what is coming in the following paragraphs.
After working alongside other health professionals I have also observed some of them treating or speaking badly of some patients. As you have mentioned age should not play a role and I agree that all patients should be treated equally.
You mentioned that “there is no one simple solution to this problem, but what is needed is a multifactorial, multilevel approach at the seven levels of care – patient, task, staff, team, environment, organisation and institution” and used an appropriate reference to support this, however how do you think this could be implemented?
Consider including ethical content discussed in class such as “meaning of life” or human rights when looking at this case from the patient’s point of view and the care he was or was not receiving by the nursing staff to strengthen your writing. What was the patients “meaning” or “quality” of life and whether the hospital environment could have influenced this.
Consider reviewing the structure of your paragraphs, there seem to be long gaps between words in the middle of sentences. A correction in this will make the paragraphs flow better and make it easier for the reader to follow and read. Overall I found it a bit difficult to follow the argument throughout the writing, however changing the structure of the paragraphs as mentioned above and adding to the introduction would make a significant difference.
I think this is a good topic to be writing about, well done and keep up the good work.
Hello, Chandre, thank you for sharing your argument about complicated geriatric patient care. I myself have noticed the lack in sufficient care to any patient that presents with a slightly more challenging problem. Again, any situation has its good and bad side and all people have their own opinions, that’s why facts are important.
Content: Your heading and topic relates perfectly to some of our discussions in ethics. Your argument is clearly stated with a smooth read. I liked the personal thoughts and experience that you supported with facts. well done.
Argument: You made your claims, you explained your personal experiences and feelings towards the situation and everything was supported with appropriate facts. I noticed your picture on top of the fading rose- you didn’t mention its importance to your argument but I am assuming it’s as I said above, a fading rose in relation to how a beautiful life just fades away before your eyes especially with a condition like dementia?
References: Good referencing. Appropriate in text referencing used. Alphabetical order reference list. More than enough facts to support your claims.
Writing: Some grammar errors where found.
1. “recently the latter” should it rather be ‘recently than latter’?
2. ” due to a femur fracture due to a fall.” maybe you can consider limiting the use of ‘due’ in this sentence by replacing the second ‘due to’ with ‘from a fall’?
3.”thoughts. although ” capital letter missing.
4. ” the professioal nursing” typo from spelling ‘professional’
5.” best the could” typo- it should probably be ‘they’
6. “earth.Over the past decade reaserch” space needed between ‘earth. Over’ and typo ‘research’
7. “later. although” capital letter needed.
8. “assumptions. however,patients” capital letter needed and space after the ‘,’.
Just a few simple errors found, easily corrected. Furthermore it was a delight to read and reflect on.
I do hope you found some guidance in my comment.
Wiana Muller
Hi Chandre,
Thank you for sharing this piece with us. I believe the above mentioned situation is something that unfortunately is something many of us have faced. The topic discussed is relevant and does link to topics discussed, however to make your argument stronger, it may be beneficial to link it to a ‘meaningful life’ or ‘human rights’ of a patient.
Your introduction is currently not very concise. I would suggest introducing your topic in more detail right from the start so that your reader is more engaged right from the start. A suggestion could be to link the image to your writing piece here, as this is not discussed in the piece.
Towards the end of paragraph one you write ‘ but what is needed is a multifactorial, multilevel approach at the seven levels of care – patient, task, staff, team, environment, organisation and institution’. I would suggest you expand on this statement and discuss your viewpoint on this. What do you think should be done/implemented to prevent this from happening again?
I would also suggest that you correct the structure of your writing: currently, there are big gaps between sentences and this makes it difficult for the reader to follow. Ensure each paragraph links to the previous one.
Grammer and spelling errors: please see annotations on post.
Overall a good piece!