MODULE #3

GROUP B2
Abidog Bernales Cando Dayandante
Espeleta Galang Ignacio Nilo
Ocampo Sanchez Visaya
C A S E P R E S E N T A T I O N:

Mrs. Williams is an older woman who has been having

severe memory problems for the past seven years. Mrs.
Williams lived on a Native American reservation in Arizona
before moving in with her daughter, Delma, in Los Angeles.
In many tribal communities, obtaining an Alzheimer’s
diagnosis is a challenge; for example, tribal communities
may not have a word for dementia. Native American
cultures have historically considered aging and signs of
Alzheimer’s (memory issues, forgetfulness, getting lost) as
part of the cycle of life: people begin life as children and
leave as children.
C A S E P R E S E N T A T I O N:

Mrs. Williams’ daughter did not know what Alzheimer’s

disease is because no one ever talked about it. Once in Los
Angeles, Mrs. Williams’ memory problems grew increasingly
worse. Mrs. Williams began wandering and becoming lost.
During moments of lucidity, Mrs. Williams begged her
daughter to return her to her home on the reservation.
Eventually, Delma and her family moved back to the
reservation. Mrs. Williams has 13 other children who live in
that area, but Delma is the only one who cares for their
mother. Delma is not sure why her siblings do not visit their
mother.
A S S E S S M E N T:

Prior to Assessment:
☞ Mrs. Williams has been having
severe memory problems for
the past seven years.
☞ The patient looks like she's
trying to complete a puzzle and
then gives up and falls asleep.
☞ She must be led to the kitchen
to eat and to her bed to sleep.
A S S E S S M E N T:

Prior to Assessment:
☞ Mrs. Williams has been having
severe memory problems for
the past seven years and seems
to be getting worse.

Prior to Assessment:
☞ The patient did not show any
signs or symptoms that might
indicate depression.
A S S E S S M E N T:

Prior to Assessment:
☞ The patient’s daughter did not mention
any significant medical history that might
associate with the following.

Prior to Assessment:
☞ The patient does not have problems in
dietary intake nor anemia for she often
sleeps and eat at the right time.

Prior to Assessment:
☞ The patient has no significant past
medical history that would indicate
cardiovascular risk factors.
A S S E S S M E N T:

Prior to Assessment:
☞ The patient’s daughter mentioned that
she is having difficulty coping because
she does not know what the disease is.

Prior to Assessment:
☞ The patient’s daughter did not show any
symptoms of depression or in a
depressed mood.

Prior to Assessment:
☞ The patient’s daughter did not mention
any financial issues/problems.
A S S E S S M E N T:

Prior to Assessment:
☞ The patient’s daughter stated that
“I was sleeping in the living room
and I remember waking up and
watching her walk into the
kitchen. And she just looked up.
She looked around, and she was
wondering where she was at.”
M A N A G E M E N T:

☞ Ask people assessed with dementia

whether they wish to know the
diagnosis and with whom it should
be shared.
– Tailor the explanation of the
illness so that they can understand and
retain the information.
– Give basic information. (Do not
overload them with too much!)
M A N A G E M E N T:

☞ Identify events or factors that may precede, trigger,

or enhance problem behaviors. Modify these
triggers if possible.
☞ Provide peaceful and calming environment
☞ Avoid surrounding the patient with too many
staff at one time, minimize multiple assessments
and provide the same staff.
☞ Consider environmental adaptations such as
appropriate seating, safe wandering areas, signs.
☞ Encourage soothing, calming, or distracting
strategies. Suggest an activity the person enjoys
especially when feeling agitated.
M A N A G E M E N T:

☞ Plan for ADL in a way that maximizes independent

activity, enhances function, helps to adapt and
develop skills, and minimizes the need for
support. Facilitate functioning and participation in
the community involving people and their carers
in planning and implementation of these
interventions. Assist in liaison with available social
resources.
☞ Recommend physical activity and exercise to
maintain mobility and reduce risk of falls.
☞ Refer for occupational therapy, if available.
M A N A G E M E N T:

☞ Advise recreational activities (tailored to stage and

severity of dementia).
☞ Tap into memories of past events- A sense of
movement and rhythm is often retained. Listening
to music, dancing, or contact with babies, children
or animals provide positive feelings.
☞ Continue to go on outings as long as you and the
patient are comfortable with them- People in the
early stages of Alzheimer's disease may still enjoy
going out to places they enjoyed in the past.
☞ Try simple crafts- producing items that give the
person with dementia a sense of satisfaction and
the chance to see it ‘in use’, gives the
activity purpose.
M A N A G E M E N T:

☞ Encourage carers to:

☞ Provide regular orientation information (e.g.
day, date, time, names of people) so that the
person can remain oriented.
☞ Use materials such as newspapers, radio, or TV
programs, family albums and household items
to promote communication, to orient them to
current events, to stimulate memories, and to
enable people to share and value their
experiences.
☞ Keep things simple, avoid changes to routine,
and, as far as possible, avoid exposing the
person to unfamiliar and bewildering places.
M A N A G E M E N T:

☞ Encourage the patient to:

☞ Dance to music from their generation.
☞ Take a walk.
☞ Create a memory bag- Fill the bag with items
reminiscent of their late teens/early twenties.
Scented products work well for this, as scents
are strongly tied to memory.
☞ Help with clean-up around the home.
☞ Prepare food.
☞ Color-by-numbers or memory card games.
☞ Coin sorting.
☞ Incorporate art and music in the daily routine
whenever possible.
M A N A G E M E N T:

☞ Assess the impact on the carer and the carer’s

needs to ensure necessary support and resources
for their family life, employment, social activities,
and health (see »DEM 1).
☞ Acknowledge that it can be extremely frustrating
and stressful to take care of people with dementia.
Carers need to be encouraged to respect the
dignity of the person with dementia and avoid
hostility towards, or neglect of, the person.
☞ Encourage the carers to seek help if they are
experiencing difficulty or strain in caring for their
loved one.
☞ Provide information to the carer regarding
dementia, keeping in mind the wishes of the
person with dementia.
M A N A G E M E N T:

☞ Provide training and support in specific

skills, e.g. managing difficult behaviour, if
necessary. To be most effective, elicit
active participation, e.g. role play.
☞ Consider providing practical support when
feasible, e.g. home-based respite care.
Another family or suitable person can
supervise and care for the person with
dementia to provide the main carer with a
period of relief to rest or carry out other
activities.
M A N A G E M E N T:

☞ Consider medications only in settings

where specific diagnosis of Alzheimer’s
Disease can be made AND where
adequate support and supervision by
specialists and monitoring (for side-effects
and response) from carers is available.
☞ If appropriate: For dementia with
suspected Alzheimer's Disease, and with
CLOSE MONITORING, consider
cholinesterase inhibitors (e.g. donepezil,
galantamine, rivastigmine) OR memantine.
Q U E S T I O N S:

☞ Cultural humility gives us a greater understanding of

cultures that are different from our own and helps us
recognize each patient's unique cultural experiences. One’s
culture has and will always be a big part of us. Cultural
humility and respect is one of the most biggest influence
when it comes to health communication. It influences how an
individual might view an illness or treatment, for example, and
affects how a physician should address an older
patient. Culture may also affect the decision-making process.
Q U E S T I O N S:

☞ Cultural diversity makes communication difficult as the

mindset of people of different cultures are different, the
language, signs and symbols are also different. We agreed
that Language and Values & Beliefs are the main cultural
barriers in this case. Because the patient often reverts to her
native language which made it hard for the carers to
understand her and explore her feelings. There is a difficulty
in the diagnosis because there's a cultural notion within the
community. People begin life as a child and end life as a child.
Q U E S T I O N S:

☞ The worse thing you can do is ignore people with Alzheimer’s

disease. stigma and misinformation is a very important topic
because it is a barrier, because many people don't
understand the disease and often try not to talk about it. and
talking about it and understanding it is most important. The
most important thing that the public health can do is provide
utmost support to those patients and their family. Educate the
people using simple words that they can truly understand.
Q U E S T I O N S:

☞ When a family member is diagnosed with Alzheimer's disease or

other dementia, the effect on your entire family can be
overwhelming. Every family also has its own history of
relationships, roles and challenges that can affect how individuals
react to a diagnosis and how members see their roles in providing
care and support. Successful communication. Keep in mind that
speech, language and other communication difficulties vary from
person to person and may vary from day to day, or even moment
to moment. Supplement words with gestures, touch, smiles,
nods, and eye contact.
Q U E S T I O N S:

☞ Outreach programs are important tools for bringing health

education and screening services directly to community
members and serve to contribute to reducing health
disparities. Support groups, Apart from the social and
emotional benefits of participating, disease specific support
groups enable the exchange of valuable professional and
personal information and advice. They are also gateways to
understanding and sharing, enabling people to cope better
and for longer.
 REFERENCE:
• W.H.O. (2019b, June 24). mhGAP Intervention Guide - Version 2.0. World Health
Organization. https://www.who.int/publications/i/item/mhgap-intervention-guide---
version-2.0
• Stringfellow, A. (2019, March 20). Activities for Dementia Patients: 50 Tips and Ideas
to Keep Patients with Dementia Engaged. SeniorLink.
https://www.seniorlink.com/blog/activities-for-dementia-patients-50-tips-and-ideas-
to-keep-patients-with-dementia-engaged
• Alzheimer’s Disease Underdiagnosed In Indian Country. (2015, December 28). Npr.
https://choice.npr.org/index.html?origin=https://www.npr.org/transcripts/458041798
?storyId=458041798
• Trinitycarefoundation. (2019, May 8). Outreach Health Program.
https://trinitycarefoundation.org/preventive-outreach-health-programs/
• Gonzalo, A. B. (2021, March 5). Madeleine Leininger: Transcultural Nursing Theory.
Nurseslabs. https://nurseslabs.com/madeleine-leininger-transcultural-nursing-
theory/#:%7E:text=The%20Transcultural%20Nursing%20Theory%20or%20Culture%
20Care%20Theory%20by%20Madeleine,cultural%20values%20health%2Dillness%20
context.
• Alzheimer’s Associatiom. (n.d.). A GUIDE FOR FAMILIES CARING FOR SOMEONE
WITH ALZHEIMER’S DISEASE OR A RELATED DEMENTIA. Alz.Org.
https://alz.org/media/manh/documecnts/Alzheimer_s-Family-Care-Guide-(FCG).pd