Case Study: Support and therapeutic care for people affected by dementia

The following case study (from Rachel Thompson, Admiral Nurse) provides an example of how Admiral Nursing intervention provided support and therapeutic care for a family affected by dementia.

Mr and Mrs Clifton had been married for 54 years and were living independently at home. Mr Clifton had a diagnosis of dementia and was being cared for his wife but recently Mrs Clifton had been experiencing hallucinations and showing signs of cognitive changes. Risks had been highlighted for the couple due to self-neglect, reluctance to accept support and recent conflicts in their relationship. Their two daughters, who visited 2–3 times a week, were concerned and anxious about the recent deterioration in both parents and their ability to continue living independently.

This case presented a number of challenges including facilitating accurate assessment of Mr and Mrs Clifton, helping the family understand symptoms, diagnosis, treatment options and enabling optimal emotional support and care for the whole family. Following a few visits and development of a therapeutic relationship of trust, biopsychosocial assessments of individual needs were carried out by the Admiral Nurse for Mrs Clifton, both as caregiver for her husband and someone with possible dementia, for Mr Clifton whose cognitive abilities as a result of his advancing dementia and physical health had deteriorated, plus an assessment of their daughter’s needs.

The complexity of the Admiral Nurses work can be seen in this family in the need to address multiple needs. For Mrs Clifton the Admiral Nurse facilitated a cognitive assessment via the memory assessment service, which resulted in diagnosis of Lewy Body dementia. Encouragement to accept cognitive stimulation therapy plus commencement on Reminyl reduced the distress of hallucinations and improved her mood. For Mr Clifton, the Admiral Nurse facilitated liaison with the GP to improve treatment for his untreated diabetes and heart failure. They also assisted in linking with social services and home care was gradually introduced to provide personal care.  This also provided some respite for Mrs Clifton in caring for her husband. Educational interventions, emotional support and advice re coping strategies were also offered to the couples daughters who were supporting both parents.

Case-work coordination by the Admiral Nurse helped to reduce risk, alleviate anxieties for the daughters, enhanced coping strategies and communication both within the family and between services and ultimately delayed the need for a move into a care home.