Introduction
Down syndrome or trisomy 21 is an inherent condition that may lead to the occurrence of diverse barriers throughout life. It is a genetic disorder that is closely linked with chromosome 21 and may cause mild intellectual and learning disabilities and physical issues. Even though the disorder may affect both the physical and mental health of the patient, people may lead gull lives despite having trisomy 21. However, conditions may vary significantly depending on the circumstances of each individual case. Therefore, it may be crucial to provide an individual approach to the assessment of every patient to provide holistic care. Moreover, the conditions of patients with trisomy 21 may be complicated by a number of associated disorders and health problems. According to some sources, associated disorders may include diabetes, depression, cardiovascular problems, hearing difficulties, and dementia. In addition, patients with Down syndrome may demonstrate unpredictable behavioral patterns. Hence, it may be vital to develop an individual care plan for each patient.
To develop a comprehensive care plan and set adequate and achievable goals, it may be essential to conduct a thorough assessment of the patient’s conditions. As already mentioned, these conditions may vary considerably from one case to another. Furthermore, many diverse mental and physical disorders may be related to trisomy 21. Therefore, unified assessment criteria were developed in order to not only provide a holistic approach to assessment but also conduct it with high efficiency and in a limited amount of time. Such frameworks are broadly implemented in practice as they may significantly contribute to the development of adequate care plans and their timely implementation.
Assessment
Assessment frameworks may differ slightly depending on the priorities of a concrete patient or general principles of the facility. In addition, modern medicine advances rapidly, and new methods, including assessment techniques, emerge consequently. Consequently, more and more essential factors are added to the evaluation criteria. However, recent sources outline nine fundamental dimensions, including behavior, dementia, diabetes, cardiovascular disease, obesity, atlantoaxial instability, osteoporosis, thyroid, ad celiac disease (Tsou et al., 2020). Each of these nine dimensions requires particular attention during the process of assessment. Sufficient investigation of these elements may lead to a higher quality of care and better patient outcomes.
Behavior is one of the essential dimensions of the assessment of patients with Down syndrome. It should be conducted annually and rely on both the current state of the patient and on history. There are several factors that require consideration, such as the evaluation of the functional and adaptive skills of the patient. It may also be highly beneficial to evaluate significant events that may influence the physical and mental health of the patient. The behavioral factor should include an analysis of personal attitudes and general mood. The functional and adaptive dimension implies considerations regarding the presence of social skills and basic skills, which are essential for everyday life. The absence of rapid behavioral changes may indicate overall mental stability and health. However, behavioral issues and mental disorders are closely related to Down syndrome and may occur frequently. It may be critical to monitor patients’ behavior to diagnose mental health disorders and provide necessary treatment and care. Moreover, consistent monitoring may prevent misdiagnosis and contribute to the understanding of the patient’s health conditions in general.
Dementia is another significant factor that requires consideration when assessing patients with Down’s syndrome. In most cases, dementia is an age-related disorder that occurs more frequently after the age of forty. As Ola Adeyemi is only thirty years old, the above-mentioned criteria may be less relevant than for older patients. However, it may be necessary to address the issue regardless of age, even though it may rarely occur in patients under forty. Timely diagnosis is crucial in terms of care plan development, resource planning, and treatment implementation. It is also essential to provide a holistic approach to assessment as dementia-related misdiagnosis may have a destructive impact on the conditions of the patient. For instance, an adult’s functional decline may be falsely linked with dementia. Consequently, insufficient attention to other possible medical factors may be provided. Dementia-related assessments should include an investigation of both the current conditions of the patient and medical history. It may be beneficial to cooperate with caregivers and interview the patient in order to identify potential decline in everyday skills and provide a timely diagnosis. Hence, a comprehensive behavioral assessment may considerably contribute to the evaluation of other dimensions, including dementia.
Unlike dementia, diabetes may occur in adults with Down syndrome regardless of their age. Therefore, it may be essential to conduct regular screenings in order to diagnose diabetes and prevent diabetes-related complications. Adults over thirty with Down’s syndrome but without characteristic symptoms of diabetes and without diabetes-related disorders should be assessed at least once every three years. Patients with related problems such as obesity require screening every two years regardless of their age. Recent research has shown that diabetes occurs much more frequently in patients with Down syndrome than in adults without it (Alexander et al., 2016). Provision of early diagnosis and implementation of necessary treatment plans may have a considerable positive impact on outcomes in adults with Down syndrome. The benefits of timely identification of diabetes outweigh the potential problems related to treatment imperfections. Another significant benefit of regular diabetes screening is the possibility of diagnosing adults with pre-diabetes. In such cases, relatively minor procedures and care plan adjustments may prevent further development of the disorder. Even though regular blood draws may cause discomfort for patients and require additional resources, the possible advantages of timely diagnosis cover these costs.
Cardiovascular disease assessments and considerations represent another essential dimension closely linked with the age of the patient. However, it may be necessary to conduct regular screenings for adults with cardiovascular disease history or related disorders regardless of their age. Some sources state that cardiovascular disease represents the highest cause of death in the United States (Centers for Disease Control and Prevention, 2021). Therefore, it may be vital to provide comprehensive criteria in order to assess potential risks and inform patients with Down syndrome and their families. Even though conditions related to trisomy 21 may influence the cardiovascular system, the impact is insignificant and current studies provide insufficient knowledge regarding this subject. Hence, heart assessment frameworks for adults with Down syndrome do not differ from frameworks developed for patients without it.
Obesity also represents a significant factor of health-related considerations in patients with Down syndrome. As already mentioned, trisomy 21 may have diverse effects on behavior patterns. In many cases, these behavior variations may lead to a lack of exercise and an unhealthy diet, which may cause obesity. Therefore, it may be critical to evaluate potential risks and introduce an appropriate care plan that includes diet regulations and exercise recommendations. Moreover, it may be essential to address possible health-related consequences of obesity in order to provide a timely response and reduce them. In order to achieve these goals, regular monitoring should be conducted in order to track weight change. It is also critical to calculating the body mass index annually to diagnose the early stages of obesity and prevent its development. In addition, adults with Down syndrome may face a number of barriers that prevent needed physical activity. Hence, the U.S. Preventive Services Task Forse Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults should be implemented.
Atlantoaxial instability by radiographic criteria may occur in patients with Down syndrome. Hence, it may be beneficial not to use cervical spine X-rays to assess adults with trisomy 21. Moreover, the screening may lead to significant expenses, which, in some cases, may be unnecessary. The process may also involve restriction of patients with Down syndrome, which may be complicated by behavioral limitations and the need for physical activities. However, it may also be critical to conduct an assessment in order to identify potential risks of spinal cord injury in patients. The screening should be performed annually and should involve a physical exam and targeted history analysis. Such an approach may avoid the high cost yet provide sufficient data to introduce a timely diagnosis. Avoiding spinal injury is particularly important due to the possible risks of morbidity and death.
Osteoporosis considerations in patients with Down syndrome remain a highly debatable topic. There is no sufficient scientific data that would support the need for existing osteoporosis assessment frameworks. However, osteoporosis represents a considerable risk for adults with trisomy 21, and hence screenings should be conducted. It may be beneficial to introduce an individual approach for every patient in terms of decision-making about the necessity of assessments. Osteoporosis is an age-related disorder that may lead to deterioration of the bone structure, increasing the risk of fracture. Therefore, older patients may require more frequent screenings designed to diagnose osteoporosis. Furthermore, adults who experienced fragility fractures should be examined with osteoporosis-related screenings.
Adults with Down syndrome should be screened for thyroid annually starting at the age of 21. The condition emerges in adults with trisomy 21 and develops throughout the patient’s life. Hence, it is essential to conduct regular screening in order to provide a timely diagnosis, treatment, and care. However, patients with trisomy 21 are frequently exposed to obesity, fatigue, and constipation, which may significantly complicate the process of screening based on symptoms. In order to improve diagnostic accuracy and medical history analysis, it may be beneficial to use a thyroid-stimulating hormone test. Some sources also state that such an approach to assessment may provide additional information that might be valuable in terms of treatment plan development (Woodward et al., 2020). Better outcomes may be achieved by utilizing regular tests and subsequent treatment rather than providing a response after the occurrence of noticeable symptoms. Recent studies have also shown that hypothyroidism is more frequently observed in patients with Down syndrome than in other patients (Alexander et al., 2016). Hence, it may be particularly important to provide comprehensive and timely treatment with thyroid hormone as well as an individual approach to care plan development.
Celiac Disease represents another threat for people with Down syndrome and hence, requires regular assessment. Recent studies proved the interrelation between trisomy 21 and higher chances of celiac disease prevalence (Sharr et al., 2016). Both gastrointestinal and non-gastrointestinal indicators and symptoms should be evaluated annually during assessment procedures. In addition, it may be highly beneficial to utilize behavioral symptoms and medical history in order to improve diagnostic accuracy. However, there is no sufficient scientific evidence that human leukocyte antigen may be effectively used to diagnose celiac disease in patients without trisomy 21. Hence, further research may be needed as well as the implementation of other supplementary methods of diagnosis. If medical history and physical examination indicate possible risks of celiac disease, it may be necessary to conduct additional tests without delay.
Achievable Goals and Care Plan Development
In Ola’s case, it may be essential to develop a set of adequate, desirable, and achievable goals in order to ensure and support the transition to a more independent life. However, during the process of development, it may be necessary to address a wide variety of factors, including health conditions, personal goals, and choices. Therefore, it is vital to provide preliminary assessments in order to better understand Ola’s health-related needs and available opportunities. As already mentioned, there are nine fundamental assessment dimensions that require consideration. Achievable goals may significantly depend on Ola’s health conditions, and hence, it might be highly beneficial to consistently address all nine factors.
The case study states that Ola is a thirty-year-old man with Down syndrome. He is relatively young, and hence, several age-related risk factors may not require in-depth assessments. First, the risk of dementia becomes significant after the age of forty, which reduces the need to address the issue in Ola’s case. Second, cardiovascular problems are also normally observed in older age groups. However, it is vital to analyze Ola’s medical history in order to identify if he has any cardiac conditions, which may increase health risks. It is recommended to conduct diabetes-related assessments in patients with Down syndrome beginning at the age of thirty. Therefore, it may be necessary to evaluate the possible risks of diabetes in Ola’s case.
There are some other health considerations that should be assessed in order to identify Ola’s general well-being. As obesity is relatively common among adults with Down syndrome, it may be critical to address the issue in Ola’s case. Unfortunately, the case does not provide sufficient information to draw any conclusions regarding this subject. However, it is stated that Ola never learned to prepare and cook food for himself. The issue may be closely linked with one of the desirable and achievable goals. It may be highly beneficial not only to teach Ola how to prepare and cook but also to develop an appropriate diet that uses calorie management techniques and may prevent obesity. Such a goal may not only contribute to more independent life but also to healthy dieting.
It is also necessary to conduct annual assessments in order to address such risks as atlantoaxial instability, osteoporosis, thyroid, and celiac disease. Even though these factors may significantly influence care plan development, further assessments are needed. Nonetheless, one of the most significant factors that influence achievable goals and care plans is Ola’s behavioral models. As Ola attended school until the age of 18, there is a high probability that he has sufficient social skills and may take further steps towards independence. Moreover, it may be essential to consult with Ola and develop achievable goals in cooperation. Providing choice for patients is one of the fundamental principles of holistic caring. In addition, it may also contribute to the development of Ola’s self-confidence and independence. Socialization is the key element that may help Ola use public goods and start working. Recent research has shown that patients with down syndrome are able to acquire new skills (Oxelgren et al., 2019). Hence, it may be possible to help Ola learn to dress and use public transport. These critical activities of daily living should form the basis of achievable goals.
Attending social groups and communicating with people who have Down’s syndrome may also encourage independence. In addition, some sources state that the general well-being of adults with Down syndrome is closely linked with their social functioning (Robles-Bello et al., 2020). Ola might be able to achieve his desirable goals by sharing his experiences with other people. Moreover, a prime example of adults with Down syndrome who are currently working may encourage Ola to bring his independence to a new level.
Ultimately, it may be possible to divide Ola’s care plan into two essential elements. The first element includes his behavioral patterns, skills related to daily activities, socialization, and mental health. The second element is based predominantly on Ola’s physical health conditions and involves regular testing and care. Recent studies have found that the quality of life of patients with trisomy 21 is closely linked with health conditions and social life, which supports the importance of these two elements (Haddad et al., 2018). Moreover, healthy relationships and social activity correlate significantly with the physical health of the patient. Therefore, it may be vital to address both of these factors in order to improve Ola’s quality of life and help him achieve more independence.
Reflection on Individual Role in the Implementation of Care to Meet the Needs of Service Users
As modern medicine develops, new methods and approaches are implemented into practice. Such transformations are relevant regardless of the field of implementation as technological advancements, social frameworks, and principles emerge and influence every aspect of medicine. For instance, broader attention was provided to such topics as the significance of an individual’s personal values and beliefs. It may be essential to introduce caring services in accordance with the concepts of holistic care. According to some sources, holistic care relies on such factors as the physical, psychological, social, emotional, economic, and spiritual wellness of the patient (Cook et al., 2021). These fundamental principles of holistic care correlate significantly with current frameworks designed to assess patients with down syndrome and develop care plans. In order to achieve the goals of holistic caring, it may be vital to introduce a unified approach that addresses all factors. These goals emphasize the individual role of the person who is responsible for assessments and care planning. It may be necessary to introduce a comprehensive approach to meet the needs of the patient and improve outcomes.
My role in devising and implementing the care plan for Ola Adeyemi correlates significantly with the principles of holistic care. I tried to address as many significant factors as possible in order to improve both the physical and psychological health of the patient. Moreover, the social and emotional wellness of the patient represents essential elements that receive consideration. However, further assessments and care plan development may be required in order to address the economic factors and spiritual wellness of Ola Adeyemi. The concepts of patient-centered care also increase the individual role in the implementation of care to meet the needs of service users. During the process of care plan development, insufficient personal information served as the main barrier. Such a barrier may indicate the importance of healthy, trusting relationships between the patient and the social worker. It may be vital to collect as much data as possible in order to provide a comprehensive multi-factor assessment, which may serve as a basis for further care plan development.
This assignment helped me transform my understanding of principles related to the process of devising and delivering care. Even though I was familiar with the concepts of holistic care, this practical assignment encouraged me to use additional sources and provided broader knowledge. I also acknowledged the importance of such elements of holistic care as the social and psychological wellness of the patient. The “meeting the needs of service users” assignment served as a prime example of how different physical and psychological well-being aspects may interrelate and influence each other. It also helped me understand the significance of both hard and soft skills for social workers. For instance, health-related assessments rely predominantly on complex medical knowledge and skills. In contrast, behavioral evaluations and care provision are closely linked with interpersonal skills. A combination of comprehensive medical knowledge, empathy, sociability, and desire to help and support people in need represents an inseparable part of holistic, goal-oriented caring.
Reference List
Alexander, M. et al., 2016. Morbidity and medication in a large population of individuals with down syndrome compared to the general population. Developmental Medicine & Child Neurology, 58(3), pp.246–254.
Centers for Disease Control and Prevention, 2021. Heart disease facts. Centers for Disease Control and Prevention.
Cook, N.F. & Elliot, M.L., 2021. Providing holistic care. In B. McCormack et al., eds. Fundamentals of person-centred healthcare practice. John Wiley & Sons, pp. 148–156.
Haddad, F. et al., 2018. An investigation of the determinants of quality of life in adolescents and young adults with down syndrome. PLOS ONE, 13(6).
Oxelgren, U.W. et al., 2019. An intervention targeting social, communication and daily activity skills in children and adolescents with down syndrome and autism: A pilot study. Neuropsychiatric Disease and Treatment, Volume 15, pp.2049–2056.
Robles-Bello, M.A. et al., 2020. Preliminary study on emotional competence in adults with down syndrome. International Journal of Disability, Development and Education, pp.1–19.
Sharr, C. et al., 2016. Detecting celiac disease in patients with down syndrome. American Journal of Medical Genetics Part A, 170(12), pp.3098–3105.
Tsou, A.Y. et al., 2020. Medical care of adults with down syndrome. JAMA, 324(15), p.1543.
Woodward, J.F., Jan, S. & Ciccarelli, M.R., 2020. Guidelines for care of adults with down syndrome. JAMA, 324(15), p.1509.