Impact of Ageing on Psychological Health

Impact of Ageing on Psychological Health It should be noted that all names of individuals and places in this report have been changed in order to protect the patients confidentiality (Nursing midwifery council 2009). Therefore the patient will be known as Mrs.Brown.Mrs Brown is an 86 year old lady who lives with her elderly husband. According to Mrs Brown husband they have two sons together and 3 grandchildren, they both visit occasionally. She used to work as a secretary until she retired in her early 60s. She clearly had a good memory. She enjoyed travelling abroad, with her husband. For many years she had attended services at the local church where she was well known .as a kind, warm-hearted popular lady in her town for the good things she did. Mrs Brown clinical notes written by her community mental health nurse states that she was diagnosed with dementia the Alzheimer disease 12 years ago. Alzheimers is a brain disease that causes problems with memory, thinking and behaviour. Symptoms usually develop slowly and get wo rse over time, becoming severe enough to interfere with daily tasks (online www.alz.org/alzheimers_disease 21/02/11). Her husband has been her main carer ever since. She attends a day centre once a week and has carers coming in twice a week to assist with personal care. The staff at the day centre has also reported that Mrs Brown now showed no interest and was reluctant to comply with activities which showed that she had lost sense of pleasure. Mr Brown stated that before the diagnosis, they were several episodes when she got lost and was picked up by police to be returned at home.Mrs Brown become disorientated about where she was because of her dementia. She became confused about time. She will also miss her doctors appointments .Mrs Brown couldnt even remember her sons names later on recognise her husband and would lose track of conversations.Mr Brown stated that he made an appointment then to see the general practitioner (GP) who then referred them to the memory clinic where she was diagnosed with Alzheimer. In the last year Mrs Browns mental and physical health has deteriorated rapidly. She can no longer do her activities of daily living and she needs support with personal care. Her behaviour has gradually become more and more eccentric that her husband is no longer copying.Mrs Brown was recently admitted to hospital with chest and urinary tract infection, which would also increase her level of confusion and lack of orientation (Adams 2008).Although now discharged from hospital Mrs Browns sleep pattern was disturbed, she now wanders around at night. She has become more physical and verbally aggressive towards her husband, Mr Brown has raised concerns that he can no longer cope with her behaviours to her CPN.The community mental health team have been monitoring Mrs Brown condition for some time now and liaising with the family, GP, social worker and psychiatrist regarding her care and support as required by the Department of health (DOH 2001), in relation to older people (over 65yrs) with mental disorder.Mr Brown was considering looking for permanent placement in a nursing home for his wife. Mrs Brown was prescribed the following for her dementia Donepezil hydrochloride/Aricept 10 mg once daily at bedtime: is a reversible inhibitor of acetylcholinesterase.They are for the adjunctive treatment of moderate Alzheimers disease. Like all other medication donepezil has its side effects which are nausea,vomiting,anorexia,diarrhoea,insomnia,dizziness and agitation just to mention a few.(Source :British National Formulary 2007) There is currently no cure for Alzheimers disease. However, they are some drug treatments are available that can ameliorate the symptoms or slow down the disease progression in some people such as donepezil, Exelon ,reminyl and galantamine these drugs maintain the supplies of the acetylcholine The (National Institute for Health and Clinical Excellence: NICE 2011) available online, states that these drugs are recommended as an option for people in the mild-to-moderate stages of Alzheimers disease. Older person presentation Dementia is the general term used for diseases affecting the brain, including Alzheimers disease it is characterised by progressive cognitive impairment and the emotional and behavioural problems that result from the cognitive decline (Sungaila Crockett,1993 citied in Tappen,R 1997). There are many different types of dementia although some are far more common than others. They are often named according to the condition that has caused the dementia. They are Alzheimer disease which is the most common cause, followed by the vascular dementia, dementia with lewy bodies and fronto temporal dementia these are the common ones. To rule out that someone has dementia test has to be carried out .Winter (et al 2001) states that there are different illnesses that appear to affect the brain in ways that can cause symptoms similar to dementia. Winter (et al 2001) describes these as people with underactive thyroid gland, deficiencies of certain vitamins and general physical illness can give rise to symptoms of dementia, poor concentration and poor memory ln the case study Mrs Brown was diagnosed with Alzheimers below the author describes what Alzheimer is and its features which lead to the diagnosis. Miriam (1994) describes Alzheimers disease as a brain disease accompanied by characteristics microscopic structural changes in the brain tissue leading to the death of brain cells.lt is the most common cause of dementia in the UK. The first signs of Alzheimers disease include lapses in memory and problems with finding the right words (Alzheimer society available on line) .In normal ageing memory lapse are common as we get older. Also the person mood changes: Particularly as the parts of the brain that control emotion becomes affected by disease. Memory loss is the most common potential impact on the psychological ageing. Remembering everyday tasks becomes a chore. People with dementia may also feel sad, frightened or angry about what is happening to them. The person with Alzheimers may start to have communication problems like inability to recall names quickly, decline in co-ordination and control of speech and action. Feeling and becoming lost in familiar surroundings. Some of these symptoms where noticed in Mrs. Brown. Depression is other symptom for dementia (Tappen R, 1997) states that many individuals in the early stages of Alzheimers disease are also clinically depressed. Some of the behavior exhibited by Mrs. Brown may have been caused by that she was depressed. Some of these features led to the diagnosis that Mrs Brown was suffering from Alzheimer as she was exhibiting these problems. Once a diagnosis of dementia has been made, the next stage will be to assess its cause.Mrs Brown had a series of tests and examination to exclude disease in the rest of the body and to rule out some other brain conditions. The persons memory will be assessed, initially with questions about recent events and past memories. Given these problems Mrs Brown was exhibiting, and the in-put from the community nurse it was agreed that she required further assessment to determine her level of cognitive impairment. This was done by using the mini mental state examination (MMSE) developed by Folstein et al (1975), with consent; Mrs Brown scored 12, which indicated severe cognitive impairment. According to Miller (1999) to examine specific cognitive impairment a Mini Mental state examination is used .The National institute of health and clinical excellence (2011) recommend s that this tool be used for determining a persons suitability for the anti-dementia drugs such as Aricept which was prescribed to Mrs Brown.Aronson M,k (1994) suggests that it is appropriate to include a short list of complete blood count, vitamin B12 level, thyroid function test and brain scan as MMSE may not offer clues to their presences. A brain scan may be carried out to give some clues about the changes taking place in the persons brain. There are a number of different types of scan, including computerized tomography (CT) and magnetic resonance imaging (MRI). Vascular dementia Alzheimer society (2010) describes vascular dementia as a type of dementia caused by problems in the supply of blood to the brain. There are two main types of vascular dementia: one caused by stroke and one caused by small vessel disease. It is the second most common form of dementia The risk factors associated with Vascular dementia, as indicated ,are those associated with cardiovascular disease and include High blood pressure Diabetes Deficiencies of certain vitamins High cholesterol levels Dieses in arteries elsewhere in the body and rhythm abnormalities (Soucers: Martin 1998, Gould 2002, Taylor 2006). People with Vascular dementia may experience these symptoms problems concentrating and communicating depression accompanying the dementia symptoms of stroke, such as physical weakness or paralysis epileptic seizures Periods of acute confusion hallucinations (seeing things that do not exist) delusions (believing things that are not true) physical or verbal aggression restlessness Incontinence. Dementia with Lewy bodies Dementia with Lewy bodies (DLB) is a form of dementia that shares characteristics with both Alzheimers and Parkinsons diseases Person with lewy bodies may have these symptoms A person with DLB will usually have some of the symptoms of Alzheimers and Parkinsons diseases. fall asleep very easily by day, and have restless, disturbed nights with confusion, nightmares and hallucinations Faint, fall, or have funny turns. (Source: Alzheimer society 2010) Legal and ethical issues surrounding people with dementia Dementia raises difficult ethical issues for people with dementia, for their formal and informal carer and for society in general. Formal carers are paid and trained to perform their caring role; those involved in Mrs Brown care were GP, community mental health nurse, and social worker. Informal carers usually is provided by family and in Mrs Brown case it was her husband and children. Tappen R (1997) states that ethical issues include the often painful decisions that must be made about restrictions on freedom, or end of life decisions and the legal issues include patients rights, abuse, neglect and incapacity. Myron F and Wiener M (2004) suggested that legal issues are best addressed while patients still have the capacity to understand and communicate while ethical issues begin at the time of diagnosis and may include whether to tell patients about their diagnosis. The key pieces of legislation surrounding people with dementia The Mental health Act 1983 amended 2007:-it protects the rights of people who have been assessed as having mental disorder including dementia.lf a person with dementia is behaving in a way that is risking other and his/her health can be detained in hospital using this act. The Mental capacity act 2005 (implemented 2007) designed to protect people who cant make decisions for themselves or lack the mental capacity to do so.Recognised that in some circumstances ,being placed in a hospital or care home may deprive someone of their liberty. Deprivation of liberty safeguards code of practice (2008)-DOLS in practice provide guidance for professionals involved in administering and delivering the safeguards. The Code is also intended to provide information for people who are, or could become, subject to the deprivation of liberty safeguards, and for their families, friends and carers, as well as for anyone who believes that someone is being deprived of their liberty unlawfully (department of health online). Before Mrs Brown dementia became severe, when she still had capacity, they had sat down with his husband .They discussed about future plan on what to do with everything including her care.Mrs Brown choose her husband to be her durable power of attorney for all her health care needs and property. Myron F Weiner, M (2005) states that with appropriate durable power of attorney, Mrs Browns husband can consent to her medical care, but the patients wishes if known, must be respected. Mrs Brown capacity was limited to live independently or make her own choices, inorder to respect her autonomy her husband and family were involved in taking active steps to act as advocates and to try and promote her autonomy. As Mrs Brown diagnosis was early she and her family had time to plan about her preferences on treatment and facilitate support from community organisation.Mrs Brown was treated or care for justly by everyone involved in her care. Everyone worked together to create an environment that is safe, sustaining her dignity and optimizing opportunities for independent decision making and functioning. Ethical problems carers Balancing risks and freedom Avoiding telling the truth to prevent distress How to manage conflict between caring for the person with dementia and other commitments. Those caring for people with dementia face ethical problems in caring out day to day care, these problems are important and stressful, those providing care receive little support and providing such support will improve good dementia care. Conclusion

Simulation †Case Study

Kathy, the project manager, obviously did not have the people skills or knowledge of the culture needed to be successful on this project. Had she researched the culture, listened to her team members, and worked with them rather than over them, this project would have been more successful. Also she should implement incentives for the team. The problems facing Kathy are that her team resented her, drug their feet, and caused the project to not meet the deadline. Her team resented her because she pushed them too hard as she did not take her people’s culture, feelings, expectations, and work habits into consideration. This caused the team to drag their feet, as a short term problem, and cause the long-term problem of ultimately missing the deadline. The decision facing Kathy was how to get the team to work more efficiently. Since Kathy did not take her team into consideration and cause her team to resent her. Without the ability to read people and sympathize with them, it is difficult to effectively manage people. Lacking this ability cause Kathy’s team to resent her and drag their feet. Had she taken the time to get to know her team and their work habits, she would have known that pushing them without giving them breaks would not have worked. They became bitter toward her and her ethics and caused more problems for her than necessary. Instead of working a round-the-clock schedule, and pushing and demanding the team to work beyond their capability, Kathy could and should have taken different approaches. Above all she should have worked harder to understand her team better and work with them rather than above them, or given them incentives for their work. Unfortunately, giving incentives can cause people to cheat through their work instead of doing their best, but most people would use the incentives as a means for motivation to do their best and meet the expectations of the project. Working long hours is usually a given when working with close deadlines, but requiring the team to work round-the-clock is a bit much. Kathy could have petitioned to hire more people or extend the deadline. Hiring more people could put the project over budget, but the project could have been completed more efficiently and on time. Moving the deadline could cause people to relax more, but if given more time to complete from the beginning, it could have reduced a lot of the stress put on Kathy and the team. If I were Kathy, I would take time to understand the people she works with, implement incentives for making deadlines, and petition to hire more people. As soon as she met with her team she should have gotten to know them and taken the time to understand their work ethic. As soon as the team started to fall behind, more people should have been hired to make up the time. The project manager should get their hands dirty and dive in to help make the deadlines. Cut the project into phases. Say the foundation has to be done by a certain time. Let the team know that if they make that deadline the will receive an incentive, and if the team surpasses that expectation, they get a better incentive. I would make it a dinner if deadline met, and an afternoon off if the team has started the next phase before the deadline of the first phase has come. This would cause the team to want to do better and go beyond their expectations which would cause the project to be complete by the deadline and hopefully within budget.

Americans with a Better Cause (Abc), a Nonprofit Organization Essay

According with what we learned so far and the book, there are 4 sources of American law. The U.S. Constitution and the constitutions of the various states. Statutory law—including laws passed by Congress, state legislatures, or local governing bodies. Regulations created by administrative agencies, such as the Food and Drug Administration. And finally, case law and common law doctrines. In the case of a federal statute conflicting with the United States Constitution then the Constitution will take priority as it has throughout history of the U.S. Supreme Court. If a federal law is in direct conflict with a state statute, where the â€Å"supremacy clause† is valid, such as interstate commerce for example, then the federal law will be superior. However, if the federal law is NOT one that the federal government has exclusive control over, then the state constitution will control unless the federal government can show there is government need that is greater, as in the case of a national emergency, for example. The U.S. Constitution will always have priority if any law is in violation of it regardless of what its source. If a state constitution does not violate the U.S. Constitution of federal law then it is supreme within the state’s borders, thus in both cases the U.S.Constitution will always prevail. Hence in the case above the DOJ enforcing the constitutional laws trumps the ABC suit conflicting with state law. The U.S. Constitution will always trump any federal statute but it is irrelevant if a federal statute conflicts with a state constitution due to the supremacy clause. US Constitution Art VI, Clause 2 â€Å"This Constitution, and the Laws of the United States which shall be made in Pursuance thereof; and all Treaties made, or which shall be made, under the Authority of the United States, shall be the supreme Law of the Land; and the Judges in every State shall be bound thereby, any Thing in the Constitution or Laws of any State to the Contrary notwithstanding.† Therefore, in settling the constitutional question would, if upheld, eventually by the U.S.Supreme Court if necessary, end the case. But, if not upheld or thrown our of court, then it would have to go to the state court and this might set up another Constitutional challenge, involving again, taking it to the U.S.Supreme Court again.

Of Fog and War A Comparative Analysis of Two Japanese...

Of Fog and War: A Comparative Analysis of Two Japanese Bombing Attacks on the United States during WWII Warfare, unfortunately, is an essential part of mankind. It has been witnessed since time immemorial. What is comforting to know, however, is that it does not always end with blood baths, or similar devastation. Sometimes warfare ends with two enemy forces forgiving one another. This happened years after the Lookout Air Raids, when the Japanese bomber who carried out a series of bombings over the Siskiyou Mountains in Oregon, returned there years afterwards to apologize. During the early stages of World War Two, the Japanese engaged in warfare with the United States numerous times. Two of these engagements had many similarities†¦show more content†¦It was a blessing in disguise for the Japanese, because they unknowingly avoided interception from the American Warhawk Fighters on that cloudy night. The series of circumstances seemed favorable for the two Japanese flyin g boats, except the fog of war was relentless: The air raids commander, Lt. Hashizume, radioed his wingman to make an unexpected left turn around the island to attack its northern side. The wingman, whose name was Sasao, did not hear the message, and flew to the southern coast of Oahu, instead (Op. K n.pag.). Although both pilots realized they lost one another, they bombed Hawaii on their own volition. As the American P-40 Warhawks unsuccessfully searched for the bombers within the obsidian blankets of night clouds, Lt. Hashizume loomed skyward over Honolulu at 15,000 ft., and prepared to drop his bombs. He could barely see a thing since Hawaii was in the midst of a blackout for reasons of war. Hashizume released four bombs anyway, and they all fell off the target of Honolulu and landed on Tantalus Peak, an extinct volcano. The bombs did land near Roosevelt High School, shattering some of its windows. Lt. Sasao could not locate his bombing target in the cloudy night, and trie d to bomb a lighthouse he managed to see. His bombs fell into the Pacific, causing no damage. Both pilots flew to safety, and returned 6 days later to attack again. This time Hashizume was shot down by an American fighter jet. U.S. militia had