This paper will discuss a case study of Loretta, a 72-year-old Australian diagnosed with dementia, describing a woman’s clinical condition by using ICF terminology and structure and outlining the measures which need to be imposed for providing her with effective interventions and enhancing the professionalism of the involved exercise physician.
Description of a clinical condition
Body structures and functions
Loretta is a 72-year-old Australian citizen living in Melbourne who is diagnosed with dementia. The pathological neurofibrillary changes in her central nervous system caused the structural impairments and had a devastating impact upon her cognitive functions, including the impaired memory and semantic processes which in their turn affected Loretta’s communicative abilities. The conversational difficulties in Loretta were caused by the decline of the mental processes essential to the communicative functions, including the functions of recognition and usage of language signs. The impairments of declarative memory resulted in communication difficulties, repetitive questions, and word-finding problems.
Activities and participation
The impaired cognitive abilities in Loretta significantly reduced her skills of learning applying knowledge and communicating with others. The communicative difficulties limited Loretta’s participation in the community and social life and threatened her interpersonal interactions and relationships. It made Loretta passive and uninvolved in domestic and community life.
Environment and contextual factors
Loretta’s communication disability can be regarded as the outcome of her ineffective interaction with her environment. She lacked interpersonal support because her husband and children perceived her clinical cognition as the loss of self. Having problems communicating with large groups of people and strangers, Loretta isolated herself and rejected any contacts.
Intervention project
An effective treatment program for Loretta’s condition requires developing multi-component interventions with special emphasis put upon physical training, psychosocial and emotional support through educating the family caregivers and involving the community in the treatment of patients with dementia. This approach would allow considering the body structures along with the environmental factors for providing complex treatment for the patient diagnosed with dementia.
Taking into account the fact that elderly individuals with dementia are under the threat of decline in their physical functioning, it can be stated that the physical training component is significant for developing an effective intervention program for Loretta. The multi-component physical training interventions, including the exercises intended to enhance the patient’s endurance, strength and balance have proven to be effective for improving the participants’ physical functioning, regardless of the stage of disease (Blankevoort, van Heuvelen, Boersma, Luning, and Scherder, 2010, p. 393; Flicker, Liu-Ambrose, & Kramer, 2011, p. 466). Moreover, the best intervention outcomes can be received from the programs with the largest training volume.
Due to the significant impact of environmental factors upon the condition of patients diagnosed with dementia, their passivity and segregation from the rest of the community, educating their relatives and community members and encouraging them to provide the patients with psychosocial support is of paramount importance for receiving a positive outcome from the intervention program. Burton (2010) pointed out the importance of creating dementia-friendly neighborhoods instead of focusing on the internal environment of dementia care homes. Taking into account the fact that conversational difficulties caused by cognitive impairments traditionally result in the patient’s passivity, understanding, and support of the surrounding people are critical in terms of palliative care. Another influential factor is the people’s misconceptions concerning the patients with dementia, their communicative needs, and abilities. These stereotypes need to be overcome through educational measures.
Three characteristics of professionalism
The three characteristics of professionalism that are essential for conducting the above-discussed intervention program successfully include the skills of an exercise physiologist to develop an appropriate training program for every individual patient, inter-professional collaboration, and addressing exercise as medicine clearly understanding its role in a complex intervention program.
Recognizing the significant impact that physical exercises can have upon the patient’s condition, an exercise physiologist has to make the right prescription for each person (Boone, 2011). Thus, Loretta’s physical functioning at the moment when the prescription is made needs to be taken into consideration for developing an appropriate multi-component physical intervention project.
With the current tendencies of professionalization in the exercise physiology domain, exercise physiologists need to gain a clear understanding of their role in the overall system of modern healthcare services. It would allow them to convince the patients with dementia and their relatives of the importance of appropriate physical training for the palliative care of patients with dementia, Due to the fact that dementia interventions require a complex approach and a combination of measures, it can be stated that inter-professional collaboration is critical for developing effective projects. Thus, exercise physiologists should realize the importance of their role in developing the intervention programs without understating the importance of inter-professional collaboration with other specialists.
The role of another professional
As it has been stated above, the recognition of the role of other professionals is significant for improving the outcomes of the intervention projects. Thus, the role of social workers and nurses in the implementation of an effective intervention project is as important as the role of exercise physicians (Perry, Draskovic, Lucassen, Vernooij-Dassen, van Achterberg, & Olde Rickert, 2011; Stevens, Lancer, Smith, & McGee, 2009 ). In that regard, their successful teamwork, information exchange, and recognition of the fact that the interventions need to be multi-component are essential to the quality of the provided services. To develop a specific training program for Loretta, an exercise physician will need to consider the impact of other interventions to make the components complementary.
Two strategies for making the practice person-centered
Taking into account the fact that the conversational difficulties in individuals diagnosed with dementia predetermine their passivity and segregation from the community, the person-centered approach is the most appropriate strategy for creating more comfortable conditions for individuals with dementia. The two strategies of person-centered care include looking at the world from the point of view of a patient diagnosed with dementia and creating a positive social environment for them.
There is evidence that person-centered strategies have a positive impact on the intervention outcomes (Kontos, Mitchell, & Baloon, 2010; Robinson, Bamford, Briel, Spencer, & Whitty, 2010). Empathy is critical for effective care for Loretta and other patients diagnosed with dementia. Looking at the surrounding world and community through the patients’ eyes would enhance understanding of the underlying problems and processes. Regarding the strategy aimed at creating a positive social environment, it should be noted that the community involvement and recognition of the problem of dementia in elderly people is critical for arriving at an appropriate resolution.
Two strategies for professional development
The two strategies which can be implemented for the professional development of an exercise physician include an evidence-based approach to professional practice and enhancing one’s knowledge in the related disciplines. Implementing the results of the recent research in professional practice can be beneficial for improving the outcomes and increasing one’s professional level. As to the importance of acquiring knowledge on the related professional domains, it would allow enhancing the effectiveness of the teamwork and improving the patients’ outcomes from the complex interventions in general.
Conclusion
In general, it can be concluded that interventions for Loretta diagnosed with dementia should comprise several components, including those of physical training educational and social work, and effective inter-professional work is required for improving the patient’s outcomes.
References
Blankevoort, C., van Heuvelen, M., Boersma, F., Luning, H., and Scherder, E. (2010). Review of effects of physical activity on strength, balance, mobility and ADL performance in elderly subjects with Dementia. Dementia and Geriatric Cognitive Disorders, 30(5), 392-402.
Boone, T. (2011). Contemporary exercise physiology: The big picture. Professionalization of Exercises Physiology Online, 14(3), 1-17. Web.
Burton, E. (2010). Designing dementia-friendly neighborhoods: Helping people with dementia to get out and about. Journal of Integrated Care, 18(6), 11-18.
Flicker, L., Liu-Ambrose, T. & Kramer, A. (2011). Why so negative about preventing cognitive decline and dementia? The jury has already come to the verdict for physical activity and smoking cessation. British Journal of Sports Medicine, 45(6), 465-467.
Kontos, P., Mitchell, G., & Baloon. B. (2010). Using drama to improve person-centered dementia care. International Journal of Older People Nursing, 5(2), 159-168.
Perry, M., Draskovic, I., Lucassen, P., Vernooij-Dassen, M., van Achterberg, T & Olde Rickert, M. (2011). Effects of educational interventions on primary dementia care: A systematic review. International Journal of Geriatric Psychiatry, 26(1), 1-11.
Robinson, L., Bamford, C., Briel, R., Spencer, J., & Whitty, P. (2010). Improving patient-centered care for people with dementia in medical encounters: An educational intervention for old age psychiatrists. International Psychogeriatrics, 22(1), 129-138.
Stevens, A., Lancer, K., Smith, E., & McGee, R. (2009). Engaging communities in evidence-based interventions for dementia caregivers. Family & Community Health, 32(1), S83-S92.