Activity Worksheet#6

F: Alzheimer’s Disease in Elder Care – Martha Smith

Student Name: ______________________

Date: ___________________________

Case Study: Martha Smith – Alzheimer’s Disease in Elder Care

Concept:

 Cognitive Impairment and Functional Decline in Alzheimer’s

Disease (AD)
 Topic Focus: Late-stage Alzheimer’s disease, care transitions, safety,
nutrition, hygiene, and dementia-related behaviors.

3 Key Considerations

1. Safety and Wandering:

o Martha’s nocturnal wandering increases her risk for falls and
injury.
2. Nutrition and Hydration:
o Agitation during mealtimes and poor intake pose a risk for
malnutrition and weight loss.
3. Hygiene and ADLs:
o Decline in personal hygiene signals worsening cognitive and
functional capacity.

3 Learning Objectives
By the end of this case, learners will be able to:

1. Identify care priorities in managing dementia-related

behaviors in long-term care.
2. Develop a person-centered care plan for a resident with
advanced Alzheimer’s disease.
3. Explore ethical considerations in respecting autonomy while
ensuring safety.
3 Key Topics

1. Behavioral and Psychological Symptoms of Dementia (BPSD)

o Understanding how agitation, aggression, and paranoia manifest
in dementia patients and how to manage them.
2. Environmental Modification in Dementia Care
o Adjusting the environment to reduce agitation, improve safety,
and enhance the quality of life for patients with Alzheimer’s.
3. Promoting Dignity and Quality of Life in Alzheimer’s Care
o Approaches to providing care that respect the patient’s dignity
while promoting their well-being.

Discussion Questions

1. How can staff address Martha’s nighttime wandering in a way

that ensures safety but maintains dignity?
2. What might be contributing to her agitation and refusal to eat
in the dining room?
3. How can healthcare providers build trust with a resident who
is increasingly suspicious or fearful?

Experience – Analyzing the Case

Case Summary:

 Martha, a 79-year-old widow with progressive Alzheimer’s, was recently

admitted to a nursing home due to safety concerns at home. She
presents with severe memory loss, wandering behavior, agitation, poor
appetite, and neglect of hygiene. The care team must develop a plan
that ensures safety, promotes nutrition and hygiene, and addresses
behavioral symptoms.

Analysis Questions

1. What are the top three nursing diagnoses for Martha based on
this scenario?
o Possible diagnoses may include:
1. Risk for Injury related to wandering and disorientation.
2. Imbalanced Nutrition: Less Than Body
Requirements related to agitation and poor appetite.
3. Self-Care Deficit related to neglect of personal hygiene
and ADLs.
 2. Which environmental modifications might reduce agitation
and wandering?
o Modifying the environment to include:

 A secure and comfortable area with clear, consistent

routines.
 Nighttime lighting that reduces confusion and
disorientation.
 Safety measures such as locked doors or motion sensors
to monitor wandering.

3. How can the nursing staff support Martha’s dignity while

assisting with hygiene and ADLs?
o Staff can use a respectful, non-confrontational approach,
maintaining Martha’s dignity by:

 Providing private assistance with hygiene.

 Allowing Martha to participate as much as possible in
ADLs, even if only partially.
 Using gentle communication, involving Martha in the
process and offering choices when appropriate.

Reflection – Exploring Personal, Professional & Ethical Perspectives

Guided Reflection Questions:

1. What feelings or biases might you have when caring for a

person with advanced dementia?
o Reflect on possible biases or assumptions about patients with
advanced dementia. Consider how these feelings might impact
care, and think about strategies to remain patient,
compassionate, and non-judgmental.
2. How do you balance autonomy and safety when a resident is
cognitively impaired?
o Consider how to empower Martha to make choices while
ensuring her safety. For example, offering choices about what to
wear or when to take meals while also addressing any safety
risks (e.g., wandering).
3. How can you maintain compassion and patience with
residents showing aggressive or paranoid behavior?
o Think about strategies for maintaining empathy and calm when
faced with challenging behaviors, such as using de-escalation
techniques or offering reassurance in a quiet environment.
Action – Developing a Care Plan
Intervention Strategies:

 Structured Routine and Calming Nighttime Activities:

o Create a consistent bedtime routine to reduce wandering at
night. Use calming activities, such as reading, soothing music, or
hand massage, to help Martha settle.
 Offer Finger Foods or Meals in a Quiet Space:
o Provide meals in a calm, distraction-free environment to reduce
agitation and encourage Martha to eat. Finger foods can be
easier for her to handle and may be more appealing.
 Assist with Hygiene Using a Respectful, Non-Confrontational
Approach:
o Provide daily assistance with hygiene tasks, allowing Martha to
maintain as much independence as possible while offering help
as needed.
 Monitor Weight and Intake; Consult Dietitian if Necessary:
o Regularly monitor Martha’s weight and food intake. If necessary,
involve a dietitian to provide nutritional support and ensure she
is receiving adequate nutrition.
 Engage Family (if Available) in Personalized Memory Activities
or Visits:
o Include family members in memory-triggering activities, such as
looking at old photographs, listening to familiar music, or
encouraging visits to maintain a sense of familiarity and
connection.

Activity: Create a Care Plan

Simple Care Plan:

 Short-Term Goals (1–3 Days):

1. Martha will eat 50–75% of meals with assistance or
environmental modification.
2. Staff will redirect Martha safely back to her room if wandering
occurs.
 Long-Term Goals (2–4 Weeks):
1. Martha will maintain weight or show no further weight loss.
2. Martha will participate in at least one ADL daily with staff
support.
 Support System Involvement:

o Involve family in care planning and memory-trigger activities

(photos, familiar music).
o Coordinate with social worker, dietitian, and occupational
therapist.
 o Ensure consistent assignment of caregivers to build trust and
rapport.

Evaluation – Assessing Learning & Application

Self-Assessment & Group Discussion Questions:

1. What interventions would you prioritize for a resident with

dementia who is refusing care?
o Reflect on interventions that prioritize respecting the resident's
dignity while ensuring essential care needs are met. This could
involve gentle redirection, offering choices, or adapting the
environment to make care less intrusive.
2. What techniques help reduce paranoia and build rapport with
dementia patients?
o Techniques may include using calm, clear communication,
providing reassurance, minimizing distractions, and offering a
consistent routine. Validation therapy and maintaining eye
contact can also help reduce feelings of paranoia.
3. How can you ensure continuity of care and consistency among
staff?
o Promote consistency by assigning the same caregivers to Martha
as much as possible. Hold regular care meetings to ensure all
staff members are up to date on Martha’s needs and progress.

References / Resources

1. Alzheimer’s Association. (2023). Dementia Care Practice

Recommendations – www.alz.org
2. American Psychiatric Association. (2022). Practice Guideline for the
Treatment of Patients with Alzheimer’s Disease.
3. Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2021). Clinical Nursing
Skills and Techniques (9th ed.).
4. World Health Organization. (2021). Dementia Fact Sheet –
www.who.int
5. Gaugler, J. E. (2020). Evidence-based practices in dementia care:
A systematic review of research. The Gerontologist.