The following Functional Health Pattern assessment is based on a 65 year old Scottish woman who lives independently with her husband in their home at Happy Valley.

The purpose of the interview was explained in addition to an outline of the types of questions which would be asked during the interview. A copy of the interview questions were provided prior to the interview (Appendix 1) so the questions would be familiar, and to minimise any embarrassment.

The importance of maintaining her privacy and the necessity of choosing a pseudonym was discussed which she perceived as great fun. She chose ‘Patricia’ as she thought it was rather a ‘posh’ sounding name and one which she had always liked.

At the beginning of the interview the confidentiality aspects were reiterated to which Patricia indicated verbal permission for her information to be disclosed as applicable and appropriate with due regard to her ethical and legal rights (ANMC 2008, p.4).

Patricia was advised any questions which she did not feel happy answering could be skipped in order for her to feel comfortable within the interview environment. That said however, Patricia stated she was happy to discuss anything and was keen to progress the interview.

Health perception/health management pattern

An outline of the client’s perceived pattern of health and wellbeing and how health is managed (Gordon 1994)

Patricia perceives her health to be reasonably good, not 100%, but fairly good for her age. She stated she has always strived to live a healthy lifestyle and believes that her employment as a Diversional Therapist within an Aged Care facility keeps her young and fit as she walks around the facility countless times throughout the day attending to resident’s lifestyle needs.

Patricia presents as a much younger person than her biological age and attributes this to working fulltime and walking somewhere in the vicinity of approximately 3 kilometres per day 5 days a week. The risks of developing cardiovascular disease are greatly decreased by regular exercises such as walking and aerobic activity in addition to increasing the benefits of physiological and psychological wellbeing (Crisp and Taylor 2005, p.920).

Although Patricia takes medication for the management of Hypertension (High Blood Pressure), diagnosed in 2009, she feels that it is well controlled and does not impact on her ability to perform her role at work, undertake housework or participate is recreational activities with her family on weekends. When not controlled, Hypertension puts strain on the heart, damages blood vessels in the kidneys and damages the retina, resulting in a loss of vision (Herlihy 2007, p.331). As Patricia already suffers vision problems it is imperative her Hypertension is regularly monitored.

Patricia regularly attends her doctor and believes it is important to adhere to any recommendation or treatment administered by the doctor. She advised she would be too scared not to do so in case something bad happened to her so she complies implicitly.

Although Patricia would like to have private health insurance she feels that it is too expensive. She is satisfied with the Medicare system and believes it meets her needs adequately.

The necessity of installing aids or changing any aspect of her home to increase safety or prevent accidents has not been necessary. She believes she has not come to this stage of life just yet and feels confident in her ability to manage her household as is.

Nutritional metabolic pattern

An outline of the client’s pattern of food/fluid intake relative to metabolic need and nutrient supply (Gordon 1994)

During a 24 hour period Patricia usually consumes three main meals and rarely has snacks during the day when working. She believes her job influences her eating pattern during the week as she only has a 30 minute lunch break which leaves little time for large or extended meals.

In the 24 hours prior to the interview Patricia consumed cereal, herbal tea, water, yoghurt, orange juice, fruit, vegetables and muffins. During the week she feels her diet to be balanced and more than adequate.

Patricia is a Vegetarian based on her religious beliefs, she has no food allergies but does modify her diet regularly based on her body image and weight fluctuations. Research suggests people who potentially suffer from a binge-eating disorder have a history of weight fluctuations and obesity (Edlin et al. 1997).

On the weekend when she spends a lot of time with her family and grand children she admits she consumes more snacks, fast food and foods considered to be empty of nutritional value such as potato chips, lollies, ice cream and soft drink, particularly when in company with her grandsons. Patricia laughingly classes herself as a “weekend social eater”. In a recent article (Abedin 2009) indicated, ‘adults tend to eat more when they are around friends and family than when eating with strangers’.

‘Tooth decay is primarily caused by circulatory changes, poor dietary habits and poor mouth or dental hygiene’ (Murray & Zentner 1989, p.470) and as a result Patricia has top dentures although they do not inhibit her ability to eat nor restrict the types of food choices available to her.

There have been no significant changes to her diet as she has aged due to the vegetarian menu she eats for her main meals, however she stressed that she does overeat ‘rubbish food’ with her grandchildren. However, when questioned if this overeating has primarily occurred since becoming a Grandmother she sheepishly admitted it was probably a lifelong habit.

Sometimes she has noticed significantly lower energy levels particularly in the afternoon but Patricia believes this to be based on the expectations of her job and possibly age rather than indications her nutritional intake is a contributing factor. When queried if her Iron and Vitamin intake were sufficient based on the fact she doesn’t eat red meat Patricia stated she didn’t think it caused her a problem, nor had her Doctor ever mentioned any need for additional supplements.

Research has shown (Hunt 2003) people on a vegetarian diet get all the iron they need by eating iron rich foods, including legumes, green leafy vegetables and fortified breads/cereals although iron will be less available for absorption than in diets which include meat. Hunt (2003) suggests, ‘vegetarians should consider consuming vitamin C, or citrus fruits to improve absorption ratios in order to balance out nutritional requirements’.

No issues were identified in terms of hair loss, increased facial hair growth, skin disorders or nail growth. Patricia maintains a regular skin regime to promote health, elasticity and prevent wrinkles. Her skin appears well hydrated. Patricia’s hair and nails were similarly maintained.

Elimination pattern

An outline of the client’s pattern of excretory function in relation to the bowel and bladder (Gordon 1994)

When reflecting on her voiding pattern Patricia stated she voided approximately three times per day dependent on her daily schedule and her fluid intake, and about the same amount at home in the evening.

Patricia experiences no problems with bowel elimination and has never utilised suppositories, supplements or other medication for either constipation or diarrhoea. She uses her bowels twice a day and believes the amount of fruit and vegetables consumed within her diet coupled with her fibre based cereal every morning sufficiently meets her needs. Alteration in elimination patterns can sometimes indicate signs or symptoms of issues within the gastrointestinal system (Crisp and Taylor 2005, p. 1325), but this does not appear to be applicable in Patricia’s case.

Activity exercise pattern

An outline of the client’s pattern of exercise, and physical activity (Gordon 1994)

Exercise which keeps the heart pumping and working steadily for about 20 minutes per day improves fitness, reduces the risks of heart disease, obesity and maintains mobility (Peterson 2004, p.625).

As discussed in the health perception/health management pattern Patricia walks reasonable distances during the day at her place of employment. In addition to the walking she conducts gentle Exercise Classes for the residents at the Aged Care facility twice a week. She feels she has sufficient energy to participate in, and conduct, these classes and they form the basis of her regular exercise pattern.

Sleep/rest pattern

An outline of the client’s pattern of sleep, rest and relaxation (Gordon 1994)

Patricia says she thoroughly enjoys sleeping and will generally achieve 8-9 hours per night which she thinks provides her with ample rest and recuperation from her daily activities. According to Crisp and Taylor (2005), ‘the amount and quality of sleep decreases in the older adult’, however Patricia has neither noticed nor experienced any significant change to her sleep pattern in many years.

When Patricia was approximately 10 years old she used to sleep-walk but has since outgrown this problem. She states she awakens at 0300 every morning ‘regular as clockwork’ to go to the bathroom but experiences little difficulty returning to sleep.

Cognitive/Perception pattern

An outline of the client’s cognitive and sensory perceptual patterns (Gordon 1994)

The average brain shrinks approximately 5-10% in weight between the ages of 20 and 90 resulting in a decrease in working memory, however, the brain can adapt and grow new cells, but this is dependant on physical activity, stimulation and learning (Santrock 2006). Patricia believes the constant mental and physical stimulation of her job keeps her brain active as evidenced by the successful completion of recent study. She is a keen crossword puzzler and novel reader which she feels supports her cognitive functions.

Of the five sensors the most significant change has been to Patricia’s vision as she has aged. Patricia wears glasses for reading, computer work and magnification for everyday activities. She has her vision tested every three years and upgrades her eyewear as recommended by the Optometrist.

Patricia has not noticed any change in her ability to smell, hear, or touch but admits to a taste change over the years from sweet to savoury flavours.

Self perception/self concept pattern

An outline of the client’s self concept and perceptions of self in relation to body image, self worth and feeling states (Gordon 1994)

Of the most interest and focus, and highlighted throughout this assessment, was Patricia’s image of herself. Although she states she is reasonably satisfied with her current status in life and what she has achieved for herself and her family, her perception of how she looks demonstrates issues around physical dissatisfaction, possible low self esteem and a lack of confidence in social situations. Erikson (1965) theorises ‘maintaining a positive self image and feelings of self worth is essential in order to achieve a successful transition to old age despite changing abilities and limitations’.

She clearly states she doesn’t feel old at 65 years however she believes her weight issues affect her ability to feel confident when she pursues recreational and social activities. Physical ideals and social stigma value a thin body, which society symbolises as ‘people’s ability to discipline their appetite and restrain themselves from overeating’ (Germov 2005). Patricia states when she is at work and performing tasks which she perceives are within her capabilities she feels competent and happy within herself.

It is only when she is required to enter the social arena she is faced with unhappiness and dilemma about her body image. Those who are overweight are subject to stigmatism for being different and falling outside of the social norm (Germov 2005).

On occasion she will refuse to go out with friends or feels upset about her selection of clothing and fit, negatively believing she will be an embarrassment to friends and family due to her size.

When she does socialize outside of her immediate family circle she tends to sit quietly and not draw attention to herself especially if the social event has a number of well dressed and slim women in attendance, and particularly if she sees them as being of a similar age bracket to herself. A thin body is viewed by society as the essence of beauty, sexual attractiveness, social status, health and occasionally moral worth (Germov & Williams 2004).

In recent years Patricia states although she does not perceive herself as being either ‘old or tired’ she admits to using her age as an excuse to decline invitations to attend social functions based purely on the fact that she is not comfortable with her body image.

Although she is eligible for a ‘Seniors Card’, which is based on age, Patricia refuses to apply for it stating adamantly that she is ‘not old’ and does not like the connotations that ownership of such a card implies. She says she does not class herself as a ‘Senior’ and therefore a ‘Senior’s Card’ is not required. When the possible benefits of the Card were discussed her prompt response was a definite, ‘no thankyou, maybe when I’m 80’.

Role/relationship pattern

An outline of the client’s pattern of relationships and role engagement (Gordon 1994)

Patricia is a mother, grandmother, aunt, wife, sister, friend, employee and work colleague. She views her primary roles at this stage of her life as being a wife, grandmother and employee. She enjoys close relationships with her three daughters. Since the recent death of her only sister, her husband, children and two nieces are the only remaining family in Australia as her parents are deceased. She has no contact with distant relatives in Scotland.

Patricia has a select group of friends but feels as a result of her work commitments during the week, coupled with family commitments, she has little spare time to socialise with friends. She does not belong to any social groups and mentioned that she thought social groups were a waste of her time. Murray and Zentner (1989) state some factors may inhibit older people from pursuing recreational activities based on a perceived poor usage of time, conditioning to appear busy, fears about the future and the lack of previous opportunities to pursue a hobby or new interest.

Sexuality pattern

An outline of the client’s reproductive and sexuality pattern (Gordon 1994)

At the age of 16 years old Patricia began menstruating. Patricia experienced no difficulty during her three pregnancies and has never suffered a miscarriage. Since she began menopause at the age of 45 years Patricia has experienced minimal interest in being sexually active and cites a definite loss of libido however she did indicate her sexual needs were ‘abundantly’ met.

Eden (2002, p.53) argues ‘women’s sexual desires fluctuate over the years with highs and lows, commonly coinciding with major life changes such as menopause’.

Patricia says she has a ’tilted uterus’ which causes her no problems, pain or issues during sexual intercourse. The uterus normally lies in an anteverted position with statistics showing approximately 20% of women have a retroverted or ’tilted uterus’ without experiencing any problems during their life (Andrews 2005).

She experiences no embarrassment when openly discussing issues of a sexual nature, nor did she find it difficult to talk about sex education with her daughters. Patricia believes due to it being a taboo subject with her parents when growing up it has influenced her to be very open with her own children.

A good health maintenance plan includes regular health screenings, including Pap Smears, self breast examination and mammograms (Leifer & Harrison 2004, p.215). Patricia states she consciously adheres to preventative health measures.

Coping/stress pattern

An outline of the client’s general stress tolerance and coping mechanisms pattern (Gordon 1994)

The stress Patricia feels when she is at work relates to her supervisor who Patricia states is not as supportive as she would like. She does however have other colleagues at work with whom she can debrief as required. She cites her husband as being her primary support and states they have always talked through as a family any issues which may impact on her coping mechanisms.

A recent significant stressful event was the marriage and untimely death of her only sister whilst on honeymoon and the subsequent fight over her sister’s Last Will and Testament which occurred between the new husband and her nieces. Again her husband and daughters were her primary means of support during this time although she did consider accessing professional counselling.

Being aware of what causes stress, how you react and having a network of support are all strategies which can help you to manage and control stressful events (Andrews 2005, p.59). Patricia feels she has accepted the outcomes from this event and moved forward.

Patricia does not drink alcohol, use medication or take drugs to relieve stress but will comfort eat and compensate with food on occasion resulting in weight gain and subsequently poor body image and what she terms ‘mild undiagnosed depression’ which she says never lasts for very long.

Value/belief pattern

An outline of the client’s pattern of values, spiritual beliefs and goals determining choices or decisions (Gordon 1994)

An individual’s sense of spirituality can be influenced by culture, life experiences and religious beliefs (Brush 2000). Patricia is a practicing Mormon and spiritual person. Her family and faith have always been the most important part of her life. She has been married to her husband for 42 years and values her relationship with him.

Recent goals have included completing a TAFE Course at age 63 years and resettling into a newly purchased home which she feels have all been guided by her faith and spiritual beliefs.

She believes she has enjoyed a rewarding life and has always been a ‘big, happy, bubbly person’. As indicated in previous patterns Patricia’s body image pervades all patterns of her life suggesting a lowered perception of self.

Conclusion

Patricia presented as a reasonably healthy woman for her age. She is active and mobile, she feels healthy, her skin, hair and nails look nourished, and her living environment is clean, well maintained and comfortable.

Patricia is aware of the need to maintain her health and undertakes preventative measures in order to continue her good health record. The diagnosed hypertension she experiences is appropriately monitored and medication is religiously taken and reviewed regularly. Similarly her need for glasses to assist with vision is regularly checked with her eyewear strength updated as required.

She has excellent support, and gains spiritual strength, from her husband, family, friends and religious beliefs. She enjoys positive relationships with many of her work colleagues and has sourced alternative mechanisms for debriefing when work becomes stressful. The benefits of Patricia’s continued working lifestyle assists in her remaining physically and mentally active, slows her aging decline, provides a social aspect which she enjoys, and allows her the financial means to ensure a comfortable lifestyle.

Although Patricia carries an excess amount of weight primarily at her thighs, hips and buttocks, this does not appear to detract from her general feeling of physical wellbeing although her body image and perception of herself were highlighted negatively in more than one pattern.

Interestingly, when discussing her self concept pattern Patricia displayed a number of behaviours suggestive of altered self concept, i.e. avoidance of eye contact during such discussion, putting herself down, and being overly critical of her appearance (Crisp and Taylor 2005, p.500). However, Patricia believes she recognises when she needs to diet or make efforts to reduce her calorie intake and assume more restrained eating habits.

Patricia states she felt comfortable throughout the interview and believes the assessment process ‘effectively established, maintained and concluded interpersonal communication openly’, and in a friendly and supportive manner (ANMC 2008).

Overall Patricia felt the questions allowed her to positively reflect on her health and wellbeing status (Puentes 2002) thus, reinforcing her belief that she is aging well and maintaining her lifespan appropriately.

Abstract

Human immunodeficiency virus (HIV) is a retrovirus that may lead to the progression of acquired immunodeficiency disease (AIDS) if untreated. The virus attacks the body’s immune system, which eventually leads to the individual being very susceptible to acquiring opportunistic infections. There is currently no cure for AIDS, and although there are treatments for it, your body can never fully get rid of the virus. Thus, infected individuals should take antiviral therapy medications to help prevent transmission to others via bodily fluids. The disease often causes extensive emotional, physical, and financial hardships on those affected by it, but there are ways health care providers can help ease these burdens.

Keywords:

HIV, AIDS, virus

Human immunodeficiency virus (HIV) is a retrovirus that infects and diminishes part of one’s immune system. The virus is found in bodily fluids, so it can be transmitted via sexual activity, IV drug use, mother to child transmission during birth, etc. (McCance & Huether, 2019, p.312). Once an individual contracts the virus, they will have it for the rest of their lives as the human body can’t fully get rid of it (“HIV Basics,” 2019). Moreover, these immunocompromised individuals are extremely vulnerable to other infections and diseases. Once they become infected with these opportunistic diseases, it is indicated that they are in the final stage of the infection, AIDs (“HIV Basics,” 2019).

One of the largest risk factors for HIV is sexual activity. “The CDC estimates that 91% of new HIV infections in the United States result from sexual activity with those who are undiagnosed or diagnosed but not treated for HIV infection” (McCance & Huether, 2019, p.312). Specifically, homosexual men are the most at-risk population for contracting HIV, especially when protection is not properly used. In fact, “in 2017, gay and bisexual men accounted for 66% of all HIV diagnoses and 82% of diagnoses among males (“HIV Basics,” 2019). Another major risk factor is intravenous drug use and the sharing of needles (McCance & Huether, 2019, p.312). Since HIV is transmitted through bodily fluids, most of the risk factors are related to risky behaviors that can lead to the sharing of these fluids. Additionally, African Americans and Hispanics account for more cases of HIV. According to the CDC, African Americans account for 43% of those diagnosed with HIV and Hispanics account for 26% (“HIV Basics,” 2019).

HIV is a retrovirus, which means it transports genetic information in the form of two duplicate RNA copies (McCance & Huether, 2019, p.311). There are seven stages of the HIV life cycle: binding, fusion, reverse transcription, integration, replication, assembly, and budding (“The HIV Life Cycle,” 2019). The virus must first gain entry into its target cell, which is predominantly C4+ T-helper cells. Nonetheless, macrophages and dendritic cells may also become infected with the virus. The lymph nodes are the predominant sites of infection in the beginning stages (McCance & Huether, 2019, p.312). Once the virus is attached to the CD4 cell, it fuses with the cell to gain entry. Next, it releases an enzyme called reverse transcriptase. This enzyme converts HIV RNA into HIV DNA, which allows it to invade the CD4 nucleus. Another HIV enzyme is then released in order to integrate the HIV DNS into the cell’s DNA. The virus uses the CD4 cell to begin replicating itself. The new HIV then expels itself from the host cell and releases protease, another HIV enzyme. The protease engages the immature virus to become an infectious virus (“The HIV Life Cycle,” 2019). Most of the symptomatic changes occur once AIDs has developed and the individual’s immunity is significantly weakened. The organ and systemic changes often occur due to the opportunistic infections that they contract due to this weakened immune system.

Those that are infected with HIV often don’t show any signs or symptoms in the beginning, but they may experience symptoms of an acute viral infection. These symptoms may include fever, fatigue, headache, inflamed lymph nodes, muscle and/or joint pain, and a rash on their skin (McCance & Huether, 2019, p.313). These symptoms occur during stage 0, which is the first 180 days after they become infected. The CD4 cell counts are closely monitored during stages 1 through 3 to follow the progression of the disease (McCance & Huether, 2019, p.313). These initial symptoms will resolve and the individual will become asymptomatic, even though the virus is still causing cell damage. After about three months, antibodies specific to HIV may be detected. The disease usually progresses very slowly, and it may take years for symptoms to develop (Naif, 2013). Once the primary infection develops, the virus is constantly replicating itself in the bloodstream and lymph nodes. However, the infected individual will still look and feel healthy during this time. Although they don’t feel ill yet, the immune system is progressively getting more damaged. Once symptoms begin arising, the person has entered the late stage of HIV, or AIDS. This is the point in time where they are the most vulnerable to opportunistic infections (Naif, 2013).

There are a few diagnostic tests than can be performed to diagnose HIV. Antibody tests may be done to identify antibodies that the person is making against the virus. A more specific test, an antigen/antibody test, is a common diagnostic test that is used to detect for both HIV antibodies and antigens in the body. If the individual positive for HIV, an antigen called p24 will be noted via this test (“HIV Basics,” 2019). A more expensive test that can be conducted is a nucleic acid test, or NATs. This can detect the actual virus in the bloodstream (“HIV Basics,” 2019). One major lab value to monitor closely is the number of CD4+ Th cells. The number of these cells declines dramatically once the disease has progressed to AIDS (McCance & Huether, 2019, p.313).  The number of CD4 cells depends on the age of the infected individual, so the provider must keep this in mind when determining the severity of the disease.

There is currently no cure for AIDS. However, there are preventative therapies that can help prevent or slow the progression from HIV to AIDS. The standard treatment is highly active antiretroviral therapy (HAART). These drugs work together to attack distinctive parts of viral replication. Currently, there are more than 25 drugs that are FDA approved to treat this disease (McCance & Huether, 2019, p.313). The therapeutic regimen may be individualized for the infected individual. The overall goal of these therapies is to lessen the amount of the virus and decrease morbidity associated with the disease. Additionally, these drugs are aimed to extend survival and prevent further transmission of the virus (McCance & Huether, 2019, p.314).

Being diagnosed with HIV or AIDS not only affect a person’s mental and physical well-being but also their financial well being. One study found that a high proportion of people with AIDS lost their jobs due to illness. This in turn decreased the amount of family income. Furthermore, paying for constant medical check-ups, lab work, and medications put a significant financial burden on these individuals (Haldar et al., 2011). Antiviral drugs and continuous monitoring can be extremely expensive. Although insurance helps cover some of the costs, not everyone has insurance to do so. One study found that some people receiving antiviral therapy could pay up to almost $400,000 in total over approximately 25 years (Hutchinson et al., 2006). “75% of the total costs were mortality-related productivity losses (Hutchinson et al., 2006).

Nurse practitioners and other health care providers need to use evidence-based practice to better the care of these patients. Once the disease progresses to AIDS, many of these individuals need palliative care measures to ease their suffering. Clinicians should constantly be assessing these patients for pain and treating them with pharmacologic and non-pharmacologic therapies to lessen the pain. Many of these patients become depressed once being diagnosed. Therefore, health care providers need to consider their mental health status. This disease is very physically exhausting, but it also wears on people’s mental status, emotions, and quality of life. Enhancing their quality of life as much as possible is crucial for these patients.

Human immunodeficiency virus is a preventable disease, but almost 40,000 people were still diagnosed in the United States in 2017 (“HIV Basics,” 2019). Education is crucial in preventing this disease, including regular screenings if high risk, protection during sex, avoiding IV drug use, etc. It takes years for signs and symptoms to occur, but once they do, the disease has progressed to the final stage, AIDS. Although there is no cure, there are treatments available to help these patients and improve their quality of life.

References

• McCance, K. L., & Huether, S. E. (2019).
  
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More must be done to address the growing impact of dementia

Dementia, which is recognized as a syndrome of multiple-domain cognitive impairment and a brain dysfunction caused by impaired brain, causes the ability of memory, understanding, judgment, self-control to undergo sexual degradation and persistent intelligence impairment, thus affecting daily life and social skills. (Quinn, 2014). According to the World Health Organization (2019), there are about 50 million people suffering from dementia worldwide, with the trend of nearly 10 million new patients each year. Moreover, the total number of patients is expected to reach 82 million by 2030 and 152 million by 2050. Whether more measures are needed to deal with the growing impact of dementia has been the subject of debate. This essay will discuss the effects of dementia, proposing that it is necessary to take more measures to deal with the growing problem of dementia. Although dementia seems to be only a common disease for the elderly, its impact is tremendous. The negative effects are mainly reflected in three aspects — dementia causes a serious decline in patients’ quality of life, aggravates the financial burden of patients’ families, and affects the physical and mental health of other family members.

One of the effects of dementia is reducing patients’ quality of life. Firstly, dementia usually affects the part of a person’s brain that controls language, thus reducing the patient’s ability to communicate with others, so patients cannot clearly and accurately express their specific thoughts. According to the summary of Wick (2016), people with dementia will gradually forget the meaning of words and phrases, and as the disease progresses, they begin to use body movements instead of language to express, such as pointing objects and clapping hands. Secondly, dementia often affects the patient’s concentration and emotional control. They may become more prone to anger and frustration because they cannot recognize what is happening around them clearly. Therefore, they are easily influenced by others’ emotions. Patients no longer have different emotions towards different circumstances as before. Besides, with the aggravation of the illness, their deficiencies in emotional processing and expression become more and more obvious (Rodríguez et al. 2016). Thirdly, the early symptom of dementia is the decline of memory, which makes many patients mistakenly think that this is just a normal aging phenomenon, thus missing the best treatment opportunity, speeding up the development of the disease and reducing the life expectancy of dementia patients. The United States has conducted a study on people with dementia (1300 people). The results show that the life expectancy of people with dementia varies from 1 to 26 years (the time begins when the patient first becomes sick) (Corr, 2015). Dementia causes significant changes in all body functions, including blurring of language, slowness of movement, and confusion of thought. These phenomena have a serious impact on patients’ life, reducing their life happiness, and making their life less colorful. Therefore, people should take measures to control the growing trend of dementia, so that more and more people can live a high-quality life.

One of the most significant effects from dementia is the severe economic burden on families. First of all, with the increasing severity of dementia, its impact is also growing. According to some incomplete investigations, it was concluded that the average annual cost of health care for people with dementia increased from $3150 billion to $4220 billion during the period of 2005 to 2009, an increase of around 34% in just 4 years (Wimo, 2013). In addition, a large part of the financial expenditure of dementia families is the cost of patients’ medicines and expensive drugs cost increase household financial expenses. Sköldunger (2016) did a survey and the result shows that the average number of drugs for dementia patients was 5.4 (a cardinal number, the larger the number, the greater the representation), compared with 3.5 for those without dementia, and the average drug cost in the study population was nearly 4,000 Swedish kronor a year, and costs for dementia patients were about 60 percent higher than the elderly without dementia. In general, most family members of dementia go to work as they need to make money to bear the family expenses, but people with dementia need someone to accompany them to prevent them from being lost or injured, which means they need professional nursing staff, but the cost of hiring caregivers is also very high. According to research, about 80 percent of people with dementia have at least one caregiver in their homes, and half of non-hospitalized patients have more than one caregiver (Castro et al. 2010). Moreover, dementia patients are not able to continue their normal work as the condition worsens. In other words, the reduced income of dementia patients represents the overall economic loss of their families. The cost of dementia patients is divided into direct costs and indirect costs, the loss of patients’ income is one of the factors of indirect costs. The survey shows that among the treatment costs of patients, direct costs account for 40% and indirect costs account for 60% (ibid). It is clear to note that indirect costs also greatly affect the overall economic situation of families with dementia. The capital expenditure of dementia patients is very large, which is reflected in many aspects, including medical expenses and non-medical expenses, which are increasing year by year. To reverse this trend, more measures must be taken to control the development of dementia.

The third point to discuss is that dementia can greatly affect the lives as well as physical and mental health of patients’ family members. Firstly, through interviews with family members of dementia patients, dementia patients have restricted their lives and changed their living conditions and habits. For example, the female star Emma’s mother suffers from dementia. She said that since her mother became demented and became more and more like a child, she often makes strange noises and repeats the same piece for her. Even if sometimes felt depressed, Emma cannot go out because leaving her mother alone at home is dangerous (AlzheimersResearch UK, 2015). Family members of dementia patients will live in single boring environment for a long time and they cannot communicate with patients normally, which seriously affects their emotions. However, the influence of dementia on patients’ families is not only these. As dementia becomes more and more serious, many middle-aged people will suffer from the disease, and their children are still in school, which has a great impact on their children. When parents suffer from dementia, teenagers have the obligation to take care of them. This will put pressure on them to make them unable to concentrate on their studies and parents with dementia are unable to participate in some of the important activities of the children. In a survey, British student Alexandra said that although she had made great achievements in her studies, her mother could no longer share the joy and could not attend her graduation ceremony (Sikes and Hall, 2018). Dementia has a serious impact on the family members of patients, both spouses and children, and the best way to improve this phenomenon is to take some actions to prevent the occurrence of dementia.

In conclusion, with the increasing severity of dementia, the number of people with dementia is increasing at a high increasing rate, and its impact on people is increasing. This essay demonstrates the effects of dementia in three perspectives — the impact on the quality of life of patients, the increasing financial burden, the physical and mental health of family members. Practical actions should be taken to curb the development of dementia fundamentally, so as to control these adverse effects. For instance, the government should build more public sports venues and equipment for people to exercise, because dementia is a common symptom of reduced executive cognitive function in the brain, and adequate daily physical activity can improve executive function (Guitar, 2018).

References

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Introduction

The rise in opioid prescriptions in America proves abuse and mortality rates connected to overdose deaths. This drives physicians, nurses, and policy makers to change their professional perspective in opioid prescription in post-operation surgery framework. The misuse of opioids also results in using painkillers as a recreational drug, which is highly advertised on the black market. The epidemic of opioid use required nurses to receive an appropriate training on identifying risks and symptoms of the medication. It was significant to determine an opioid sedation scale to remove overdoses and prevent fatal outcomes. With the popularity of illicit painkillers including heroin and fentanyl, the target population still could access opioids. In this research paper, I will visualize the statistical overview of opioid epidemics, effects of opioid resistance, misuse including substance disorder and addiction. The relevant solutions are offered from the scholarly literature necessary to determine the causes and effects of painkillers. The recommendations include reducing opioid prescription and prescription of more alternative painkiller medications. Opioid addiction risks and limitations show the devastating effects of opioid on physical and psychological health, and related economic and end-of-life costs.

Significance of Issue

The overuse of opioids resulted in the rise of death rates in response to overdose, which was highly covered by media. Opioids generally can be considered as effective drugs used to decrease the pain after surgery, lessen cancer pain, and symptoms after dental procedures. Prescription for analgesics in the 2000s confirmed the epidemic of fatal overdoses and addictive patterns among the public. It is argued that death rates from opioids were higher than casualties from heroin and cocaine overdoses (Sites, Beach & Davis, 2014). Therefore, the magnitude of the opioid crisis was recognized by the Centers for Disease Control and Prevention (CDC), which promoted alertness and increased awareness about the scope of the issue. The illicit dissemination of analgesics was more controlled by the Drug Enforcement Agency (DEA) and the public became more concerned with risks of opioids.

The media promoted stigma and stereotypes about opioids as dangerous drugs because of CDC refusal to present the justification and proofs about its impact on physical human health. CDC soon began publishing exaggerating data about the danger of opioids for treating pain and its sensationalized depiction in the media. Though, the patient still sought for the treatment of acute pain and asked physicians to get a necessary prescription. On the contrary, they were denied to receive opioids and face sociomedical difficulties to relieve pain. For example, in Indiana, Florida, Montana, Texas, and some other states, doctors avoided prescribing these drugs. In the media, a number of mortality rates as an outcome of opioid use still was on the peak. The patients on their terminal stages of illness and cancer died because of the inability to access opioids and its stigmatization.

The commonality of different opioids affected the rise of its different types at the illicit market, which exacerbated opioid epidemics and brought large economic costs. Therefore, at the nursing practice, patients could not receive a proper prescription for opioids, so the rise of synthetic, semisynthetic, methadone, and nonmethadone drugs was highly marketed online. This brought the large economic and socials costs for the target population that thought the illicit market as the perfect opportunity to reduce the acute pain. Fentanyl became the most common drug in 2014 that present nonmethadone analgesics along with the use of heroin. “In 2013, heroin was detected in 1,342 (10%) of opioid analgesic fatalities, increasing to 26% in 2014” (Rose, 2017). The other types of opioids included such drugs as morphine oxycodone, codeine, hydrocodone, and tramadol. The opioid supply correspondingly brought about the large costs that resulted in expenditures of 53,4  billion dollars per year (Demsey, Carr, Clarke & Vipler, 2018). American population became the primary users of the opioid production covering two-thirds of total opioid supply.

The cultural and social considerations of opioid use constituted excessive marketing pharmaceutical campaigns and policies on the regulation of opioid liberation. During the period from 2000 to 2010, Purdue Pharma L.P. was the most famous advertising campaign, which highly promoted the opioid known as Oxycontin From the regulatory framework, the U.S. Veterans Health Administration enforced the rule that pain was deemed to be a natural process and had to be measured at a scale from 0 to 10 to provide specific prescription (Sites, Beach & Davis, 2014). Other organization known as the Joint Commission on Accreditation of Health Care Organizations published the models of pain management applicable to care enterprises.

Review of the Literature/Discussion

The rise of opioid misuse marked the associated deaths from analgesics, which despite their restriction, were still common on the black market. Rose (2017) in his research underlines the facts, origins, outcomes of the opioid ban, and dissemination of synthetic opioids at the black market. He identifies that the basic cause of the opioid crisis was the excessive prescription of opioid analgesics in 2014, which resulted in related deaths. The research highlights the effect of uncontrolled chronic pain on human psychological and physical health including related suicides, premature deaths, low quality of life, and self-medication. Concerning the last approach, it is highlighted that self-medication promoted the dissemination of illicit analgesics such as heroin and fentanyl. As a result, CDC enforced new guidelines and models for chronic pain measurement that affected misconceptions about opioids. The consequence of the model was marked by the restriction of opioid, though, the illicit use of the drugs was on the peak.

Prescription of opioid analgesics in the surgical settings is characterized by the inappropriate use, postoperative analgesics prescription, and refills, which can be modified by prescription of safer alternative painkillers. Waljee, Zhong, Hou, Sears, Brummet & Chung (2016) in their study studies the effect of opioid medication among 296, 452 adults, who underwent arthroplasty and other arthritis problems. It was identified that 59 % had to receive a postoperative analgesics prescription, especially hydrocodone and 8,8 % received them inappropriately (Waljee et al., 2016). One of the solutions was to indicate opioid medication as the risk factor and foreseen the possible prolonged courses of medications before the surgery. It was offered to prescribe more alternative analgesics, though, the scope of this issue was limited in the research.

The usage of opioid analgesics marked the high rates of drug prescription that was not related to improvements of health status within the U.S. population. Sites, Beach & Davis (2014) highlighted that the use of opioids in 2000 rose from 43,8 million to 89,2 million in 2010. Though, the effects of excessive prescription of painkillers did not bring any positive outcomes on the health of  the people with disabilities. The pain measurement plans and pharmaceutical plans were enforced to keep sage opioid use ; however, advertising played the crucial rôle in promoting opioids as beneficial medications. Though, the decision to reduce opioids was not successful among the target population as the levels of morbidity, addiction, and overdose were still the same. The research by Voon, Karamouzian & Kerr (2017) proved the same picture and confirmed the prevalence of misuse, substance use, and addiction among opioid users. The scholars offered that clinical screening could be the alternative approach in testing a drug, checking the blood level, choosing the right opioid, dose, and the proper treatment. Although, the research and evidence on its feasibility were limited and should be more consistent and clear on related strategies.

Conclusion

The scholarly literature used for research confirms the prevalence of opioid crisis in the 2000s and public health necessity of reducing prescription rates of analgesics in clinical practice. The possible solutions to the problem were concerned with controlling the risk management of medication prescription. The pain measurement models offer more consistent monitoring of the patient’s treatment and alternative analgesics, which can substitute the dangerous opioid effects. The research is still limited to potential painkillers, which can be prescribed instead of opioids. The patients undergoing surgery often require the repetitive opioid prescription to manage postoperative rehabilitation. Patients often stay dependent or addicted to the medications, which puts prescription of opioids at risk. While opioid analgesic overdoses have reduced over the years, patients still face restriction on receiving the appropriate opioid therapy. I think that opioids should be prescribed only in case of chronic acute pain to limit the negative symptoms and outcomes of the drug. Nurses and physicians should monitor the history of the disease, blood level, and possible complications, which may arise during the course of treatment. This would help a positive effect on pain management, rehabilitation from surgery, and better health status. Though, avoidance to prescribe analgesics sometimes might induce undesirable outcomes on both physical and psychological health including severity of addiction and possible deaths from the abundance of pain.

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