Access And Review Literature

Dementia is defined as progressive deterioration of mental capability, including understanding, memorizing, and interpreting, to the point that it conflicts with an individual’s everyday lifestyle as well as actions (Jones et al. 2019). Sometimes dementia patients are unable to manage their feelings, and their identities may shift. Advance Care Planning shortly known as ACP is seen as a critical element of high-quality palliative treatment, particularly for persons that start losing the ability to initiate judgments towards the terminal phase. On December 30, 2015, the President approved the Assisted Decision-Making (Capacity) Act 2015. The Act modernises Ireland’s Capability Act which has remained in force throughout the nineteenth century (Voss et al. 2019). It offers a contemporary regulatory structure to assist persons who already experience trouble making judgments on their own. ACP is presently a continual, dynamic practice of initial assessment and communication among an individual having dementia, people near to individuals, and appropriate medical providers about the patient’s choices and ideals for potential medication as well as therapy, such as palliative care (Mataqi and Aslanpour 2020). The purpose of this study is to identify the difficulties that medical practitioners face while adopting advanced medical planning for patients experiencing dementia.

According to Harrison Dening, Sampson and De Vries, 2019, Advance care planning with dementia is a difficult procedure; as dementia advances, the capacity to evaluate forthcoming ideas and behaviours gets reduced, impacting judgement skills. Household caregivers are growingly finding themselves in positions whereby they must explain or initiate judgments on account of the individual having dementia. As dementia advances, family caregivers may face greater pressures in making judgments, and investigations have revealed various psychological and technical challenges, such as the foregoing: Challenges in making decisions regarding day-to-day treatment. Anxiety when it comes to making health-related choices. Inadequate knowledge of any potential possibilities and associated consequences. Frustration, remorse, and self-doubt are all unfavourable mental repercussions. According to Sellars et al., 2019, Throughout the framework of advanced treatment management including end-of-life care, individuals with dementia as well as their caregivers felt unsure about selecting medical choices. Advance care planning solutions that address people’s hesitation in judgement might aid in the empowerment of persons suffering from dementia including caregivers, as well as the strengthening of person-centred treatment in this setting. Insufficient interaction, capability issues, missed chances, and the idea that dementia is not a terminal condition could all contribute to difficulties. Tsang, Xie and Zhou, 2019 stated that Dementia poses a distinct set of different diagnostic issues due to dementia becoming a persistent as well as a progressive group of disorders. Advanced Medical Planning For Patients With Dementia In Ireland Essay Paper  With a dependence on self-reporting or accounts from family, detecting and diagnosing the early phases of dementia and perhaps Mild Cognitive Impairment (MCI) remains difficult. Prospective instances of dementia are often identified 24 to 30 months after commencement. This is owing to indications being hidden by the normal consequences of ageing. Lag in treatment leads to unregulated deterioration. This also reduces the efficiency of medical care provided upon identification as well as treatment. Such enigmatic indications also raise the dilemma of clinicians to provide proper treatment. This lead clinician to become hesitant to provide a firm identification of dementia and, as a result, request complete cognitive evaluations, costly neuroimaging, or intrusive procedures including surgical intervention.  The existing widely accepted clinical model is the Mini-Mental State Examination shortly known as MMSE as well as the Consortium to Establish a Registry for Alzheimer’s disease shortly known as CERAD intelligence tests. However, contemporary cognitive evaluations continue to be troublesome, with the MMSE being questioned as a useful diagnostic metric.

An Overview Of The Potential General Benefits And Any Potential Risks

The ACP is based on modifying the care planning depending on the needs of the patients. In most cases, the different types of psychological treatment create different types of outcomes (Yumoto et al. 2019). So same treatment does not work properly in all the patients suffering from Dementia. So here to solve these issues, ACP is modified in a way that based on the outcome of the patients the next step of the treatment procedure is planned. According to Assisted Decision-Making (Capacity) Bill 2015, The Department of Health’s General Scheme for Advance Directives have to find the below benefits in the people having this ACP to cure Dementia in Ireland (Miranda et al. 2019). The main benefits found in this treatment procedure are the increased success rate. As this treatment is fully based on doing modifications based on every different patient so here the overall success rate to cure the issue increases. Another benefit is this treatment plan increases the satisfaction level of the patients and their families very much. As this Dementia is mainly observed in old people so this extra satisfaction from ACP through extra mental and social support increase the patient’s mental strength which helps them more in finding a positive outcome.

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The main risk factor of making a decision by the ACP for the people suffering from Dementia is making wrong decisions. Here the carer does not know the patients personally before giving treatment. So all of the assumptions of their personality analysis are mainly based on the characteristics of the patients after having Dementia and from the description of the people living surrounding them. So in this process, it becomes very hard to properly analyse the patients (Mitchell et al. 2018). So in this ACP, the possibility of making wrong decisions increased very much. So these risk factors become a major hurdle in giving support to the patients. Also for the older people risk of dying increases from the wrong decision making of the carers. For various kinds of emotions as well as personal reasons the patients may hide different kinds of information from the carer which also can increase the overall risk factor in this type of treatment plan (van Boekel et al. 2019). Also in the training process unprepared professionals may make wrong decisions which can lead to the wrong outcome and give mental harm to the patients.

There are various kinds of challenges are observed in ACP for patients suffering from Dementia in Ireland. Ireland is a very small country and most of the local people living in Ireland are very rigid in nature. So one of the major challenges is to find the patients who are properly eligible to take this care plan. After the identification of the patient’s majority of the patients refuses to have this care mainly for personal as well as financial issues. But the government of Ireland tried to reduce the financial issues with the help of the Assisted Decision-Making (Capacity) Bill 2015 in getting the proper advanced care planning. But the personal insecurity has become the hardest challenge in this care plan. The next challenge is to engage persons having dementia along with their relatives in ACP (Hill et al. 2018). In the proper care procedure, the involvement of both the person as well as their families in the whole care plan is very important to provide the proper care to the patients and get the proper outcome. But most of the time it is observed that either the patient or their relatives are not available or agreed to have this care. So this creates a huge gap in getting the proper information about the issue which creates a lacking in the outcome. Health Belief Model is one of the most used tools used in this process to identify the overall beliefs of the patients as well as their family members in this treatment procedure (Bryant et al., 2021). As this health issue is a mental issue so believing in the treatment procedure is very important to get the proper outcome. So based on the results of this HBM tool the application of the Advance Care Planning is confirmed. The next major challenge is adapting proper clinical routines which do not give extra burden to the patients. Other related challenges are having difficulties in Communication with the residents and the patients, overall very lengthy time to provide the proper amount of ACP continuously and proper providing training to the staff to maintain the confidentiality with giving proper care (Sampson et al. 2018). Among these, the most affected challenge is the communication barrier. Here Ireland is one of the most developing countries in the whole world. Therefore, so many people having different types of languages and cultures come and live in Ireland for education, and career purposes. So this increases the overall language barriers among the caregivers and the patients. So here to understand the issues and solve the difficulties the carers need to understand all of the different types of language and provide them solutions in the patients’ understandable language.

Challenges To Implementing The Process Of ACP

The legal factor which mainly helps to overcome the financial issue in the whole treatment procedure is the involvement of the government of Ireland. The Assisted Decision-Making (Capacity) Act 2015 helps all the poor people who do not have the proper amount of financial support to get this treatment to cure their mental issues (Brazil et al. 2018). The personal factor which can be used to overcome the above-mentioned challenges is increasing the overall belief in the treatment procedure of the patients and their families. As described above with the help of the Health Belief Model the carer can identify the overall beliefs of the patients and the close ones during the whole treatment procedure. So after analysing the proper reason and amount of the personal disbelieves in the whole treatment procedure the carer needs to give mental counselling to them to increase their personal beliefs. The professional factor that helps to overcome the challenges is increasing the quality of the services done by the professional. This can be done by providing the proper amount of training on the treatment procedure as well as cultural knowledge (Poole et al. 2018). To gain the trust of the patients suffering from Dementia it is very important to know about their culture very well. With the help of this knowledge, the caregiver can also get an idea about the proper decision making preferable by the patients. This can help them to overcome the challenge of the gap between the caregiver and the sufferers. To solve the communication difficulties the caregivers should be given training in both the local language as well as the international language. In Ireland, there are so many people from different parts of the world who come to get study and their career purpose. So in general there is a mixture of people using all types of languages are seen (Niedderer et al. 2020). So to solve this language barrier and understand the issues and give proper decision making the caregivers must be given training in all languages.

Conclusion

From the above study it can be concluded that based on Assisted Decision-Making (Capacity) Bill 2015, Advance Care Planning has become the best treatment procedure for the patients suffering from Dementia in Ireland. In this illness, the patients lose their ability to make proper decisions suitable for their health as well as lifestyle. So in this case the main support which is needed by the patients most is getting proper decision making from the caregiver. As this is a mental illness so there are so many different kinds of barriers seen in this ACP. Most of the time, the patients and there do not want to believe the caregivers and share all of their important information with them. To overcome this issue the caregivers need to culturally support the patients as well as give proper medication to solve their mental workings. Therefore based on the evidence-based analysis supported by various literature above it can be concluded that to find the best possible benefits from the Advance Care Planning in the treatment of the patients suffering from Dementia the challenges must be analysed and based on the best possible solution must be implied as discussed above.

References

Brazil, K., Carter, G., Cardwell, C., Clarke, M., Hudson, P., Froggatt, K., McLaughlin, D., Passmore, P. and Kernohan, W.G., 2018. Effectiveness of advance care planning with family carers in dementia nursing homes: a paired cluster randomized controlled trial. Palliative medicine, 32(3), pp.603-612.

Bryant, J., Waller, A., Bowman, A., Pickles, R., Hullick, C., Price, E., White, B., Willmott, L., Knight, A., Ryall, M.A. and Sanson-Fisher, R., 2021. Junior Medical Officers’ Knowledge of Advance Care Planning and Substitute Decision Making For People With Dementia: A Cross Sectional Survey.

Harrison Dening, K., Sampson, E.L. and De Vries, K., 2019. Advance care planning in dementia: recommendations for healthcare professionals. Palliative Care: Research and Treatment, 12, p.1178224219826579.

Hill, E., Savundranayagam, M.Y., Zecevic, A. and Kloseck, M., 2018. Staff perspectives of barriers to access and delivery of palliative care for persons with dementia in long-term care. American Journal of Alzheimer’s Disease & Other Dementias®, 33(5), pp.284-291.

Jones, K., Birchley, G., Huxtable, R., Clare, L., Walter, T. and Dixon, J., 2019. End of life care: a scoping review of experiences of advance care planning for people with dementia. Dementia, 18(3), pp.825-845.

Mataqi, M. and Aslanpour, Z., 2020. Factors influencing palliative care in advanced dementia: a systematic review. BMJ Supportive & Palliative Care, 10(2), pp.145-156.

Miranda, R., Bunn, F., Lynch, J., Van den Block, L. and Goodman, C., 2019. Palliative care for people with dementia living at home: a systematic review of interventions. Palliative medicine, 33(7), pp.726-742.

Mitchell, S.L., Shaffer, M.L., Cohen, S., Hanson, L.C., Habtemariam, D. and Volandes, A.E., 2018. An advance care planning video decision support tool for nursing home residents with advanced dementia: a cluster randomized clinical trial. JAMA internal medicine, 178(7), pp.961-969.

Niedderer, K., Tournier, I., Coleston-Shields, D.M., Craven, M., Gosling, J., Garde, J., Salter, B., Bosse, M. and Griffioen, I., 2020. Designing with and for people with dementia: developing a mindful interdisciplinary co-design methodology.

Poole, M., Bamford, C., McLellan, E., Lee, R.P., Exley, C., Hughes, J.C., Harrison-Dening, K. and Robinson, L., 2018. End-of-life care: a qualitative study comparing the views of people with dementia and family carers. Palliative Medicine, 32(3), pp.631-642.  Advanced Medical Planning For Patients With Dementia In Ireland Essay Paper