Korsakoff Syndrome care plan

Posted by Winnie Melda on January 3rd, 2018

This lady was brought to care home setting as she cannot take care for herself and requires supervision with activities of daily living, advocacy, family contact, and socialization. Theaim of thecasestudy is to create an awareness of the korsakoff syndrome and the impact it has on the individual and her family.

Definition and Manifestation of Korsakoff syndrome

Korsakoff syndrome is characterized by a severe amnestic disorder, and it is caused by the extended malnutrition, and not merely excessive use of alcohol. It is as an abnormal mental state that affects memory and learning. Adoption to the new situation needs the acquisition of new information and its integration with experiences. Failure of Korsakoff Syndrome patient to make new memories makes them capable of performing only the most habitual routines (Van der Stigchel et al., 2012). It's characteristic with the memory loss. The loss takes place in a setting of clear consciousness such that the patient give impressions in a conversation that she or he is entirely in possession of her or his faculties. However, show a severe impairment of current and recent memory. Patients may repeat the same question over and over, read the same page four hours, and be unable to recognize people he or she has ever met (Beaunieux, 2013).

Korsakoff disease patient may also have a multiplicity of different, and often intractable, problems. There is much attention currently paid to the need for multidisciplinary health and social care, and for the application of both medical and social models of care. A whole range of professional disciplines and skills need to be brought to beat at the appropriate juncture. Such multidisciplinary working, across many agencies, requires considerable coordination and the various elements need to be “joined-up.” The multidisciplinary team needs to be a coherent whole focused primarily on the needs of the clients (Latt & Dore, 2014). Unlike other alcohol-related brain damage conditions such as dementia, the structure and extent of the current Krorsakoff syndrome are unknown. The situation is compounded by the fact that Korsakoff syndrome may co-exist alongside other mental health problems and occur among persons below the age of 65 years.

Korsakoff syndrome is often an invisible disability in thatitoftengoesunnoticed until there is a change in activities of daily living. Therefore, it is complex to estimate the prevalence or kind of services Korsakoff syndrome patients is receiving. In addition, there is a general lack of training among staffs who work within specialized care home environments (Maharasingam, Macniven, & Mason, O 2013). Most staffs report lack of adequate assessment tools as an impediment to assessing and rehabilitating individuals with KS. These employees need training on awareness, screening tools, and information about vitamin prescription and referral options. Alcohol specialists working in such facilities are useful in detecting, referring, counseling and managing alcohol use, increasing awareness about alcohol related conditions and providing immediate support for KS patients (Chiang, 2002). The patient memory loss leads psychogenic problems may benefit from talk therapy.

The long care objectives

The holistic management of the lady should ensure she continues to abstain from drinking alcohol, and she maintains a balanced diet that provides ample thiamine. The care team must acknowledge that even when the patient abstain from alcohol and replenish thiamine, symptoms of the disease including problematic behaviors, lack of coordination and learning deficits may continue. These symptoms may be as a result of the irreversible damage caused by the disease to the brain and the nervous system.

The care program should ensure the safety of the patient and those interacting with the patient. Korsokoff patients may be confused or disoriented and as such should not be left alone. There is a great need for close supervision to ensure the patient does not wander away from the facility or home, leave gas burning or water running. Obstacles including throw rugs, toys, and pets can further impeded one’s ability to ambulate safety.

Services requirements

Patients with KS require a well-integrated support in a network of managed care. In addition to guidance on thiamine treatment, there is a great need to consider formal treatment packages which aim at maintaining abstinence in a supported housing environment. Abstinence may lead to and facilitate improvement in the care. Families and caregivers need to be educated and offered assistance. The patient requires regular follow-up, and monitoring of improvement in her cognitive status and functional well-being. The needs of the patient are most likely wide-ranging and variable. Most Korsakoff’s patient are younger than the usual dementia patients, and they are physically more active and may become frustrated, angry or suspicious in residential settings. They can question why they are living in assisted facilitates and often request to go home. The greatest concern is to grant them some “independence” in the care setting while at the same time meeting their need of keeps them safe. Most requires an individually-formulated cognitive behavioral approach to allow him or her to develop coping strategies for coping with day-to-day routines (Thomson & Guerrini, 2012).

Detoxification and specialized assessment

The number of organizations or facilities offering out-patient detoxification services is not clear. Although detoxification is not always an option, care providers should not negate the importance of alcohol management, nutrition and on-going needs assessment. The need assessment should regularly be conducted, preferably after every three months of alcohol abstinence. The assessment should involve social workers to ensure joint data is produced to facilitate co-ordination, co-operation, and more accurate information. It should include a multidisciplinary team including rehabilitation experts and those with knowledge of psychiatrists’ information. Regular multi-disciplinary assessment is critical to ascertain the level, rate and areas of recovery. It assists in the implementation of rehabilitation and decrease the chance of inappropriate accommodation placement. It also enhances the provision of individualized care. The care plan needs to integrate psychiatric, cognitive and functional well-being assessment. Assessment procedure has direct implications on subsequent rehabilitation and placement into the most appropriate care.

The care plan should integrate the assessment of the patient ability to perform ADLs efficient and safely on a daily basis with an appropriateassessment tool. The restricted movement of the patient affects the ability to perform most of ADLs. A variety of assessment tools is available depending on the care or clinical setting. Such tools offer objective data for baselines. The assessment of mobility should also evaluate the ability to perform ROM to all joints. The assessment will provide data on the extent of nay physical problems and guides therapists. The patient also needs be assessed for the need for assistive devices. Proper use of assistive devices including wheelchairs, bars, and other assistance can promote ADLs and reduce dangers of falls.

Planning for family involvement

In addition, there is a greatneed to involve the entire family in decisions concerning care and management. It is critical for family members to discuss their feelings and emotions as well as identify their willingness to participate and the response for various aspects of the care and management. Over the past decades, numerous studies have shown that family members remain critical in the lives of their loved ones even after placement in residential long-term care facilities. Family involvement is a multidimensional concept that entails visiting, socioeconomical care, advocacy and provision of personal care. Family members emphasize the potential isolation the patient experience during the long-term care. The long-term care includes intensified isolation and depression by both the caregiver and the family members of the patient (Guagher, 2008). Therefore, family members are involved in all aspects of a frail before, during, and after admission into the long-term care institution (Janzen, 2001).

Theplacement of a familymember into a long-term care facility may precipitate a family crisis. A family’s difficulties discussing placement may lead to a crisis versus planned decision for placement. Discussing options for long-term care may not be communicated among all family members. In addition, placement may lead to family role adjustments (Kopelman, Thomson, Guerrini & Marshall, 2009). The role of shifting occur within the family as they adjust to illness and placement can be difficult, especially for those with ingrained beliefs about those roles (Yih, 2012). On the contrary to the “myth of abandonment,” admission to a long-term facility does not mean the end of family caregiving. Most family caregivers maintain frequent contact with the recipient post-institutionalization. Although physical exertion and demands on caregivers’ leisure time decrease with residential home admission, other types of stress increase resulting in a level of caregiver burden that is essentially unchanged. Instrumental responsibilities, such as financial management, legal assistance, and emotional burden often increase upon admission to assisted living facilities (Pearce, 2008). The family members take on the new role of advocate and monitor, roles that can be ambiguous and emotionally draining. Caregiver exhaustion or decline in caregiver health is frequently the catalyst for institutionalization. The transition involves negotiation of new role expectations with the caregiver receiver, family members, and facility staff. There is evidence that family members tend to focus upon care tasks that preserve the care recipient’s self-worth, personal identity, and dignity post institutionalization. Family caregivers sense a tendency toward uniformity of caregiving within an institution and strive to differentiate their relative as a unique individual, distinct from other facilities. Family members are important, often underutilized resource to assisted living facilities. Family members act as resident advocates, system “watchdogs” decision makers, and often provide at least minimal direct care within long-term care facilities. Family caregivers will bring to the facility, knowledge and resident history and care preferences often inaccessible to staff, especially in situations where a resident has cognitive impairment.

Acceptance of temporary or permanent limitations can vary widely among individuals. Each has his or her definition of acceptable quality of life. The family should particiapte in discussing the financial aspects of the care plan. Expectations of the family members and the care team should be made explicit, and negotiations should honest and direct (Race & Verfaellie, 2012). It will ensure there is no misunderstanding between the involved team. It is obvious that the responsibilities and task of the caregiver will change over time. Consequently, there is a need to discuss the future plan for the care.

Planning for family involvement and settling on responsibilities and caretakers task performance may necessitate the assistance of a professional. The professional not only to assist the family determine what services are available, but also to help the family deal with emotional and interpersonal issues. The lady should also be involved in the planning process depending on not only her cognitive and mental abilities, but also on her personality factors and interpersonal issues in the family system.

Nutritional plan

Proper nutrition provides the needed energy for ambulation, transfer techniques, and participating in exercises or rehabilitative program. The care plan integrates nutrition screening and a thorough assessment to offer optimal nutrition care. The assessment need to address the current nutritional status including thiamine deficiency. In addition, the assessment needs to address other resident characteristics including poor dental health and distractibility during meals.

The nutritional assessment is a necessity in the care plan due to the nutritional vulnerability of individuals with KS. In addition to the thiamine deficiency and related metabolism, the patient may have insufficient consumption or inappropriate food choices (Oudman & Zwart, 2012). Adequate assistance in terms of optimal nutritional will help the resident recover faster and prevent unnecessary complications. The goal of the nutrition care plan is to have an appropriate screening and preventive system for nutritional care to prevent malnutrition, weight loss, infections and peptic ulcers. The plan also seeks to assure proper nutrition and hydration to maintain the health status of the resident

Impaired memory plan

Assess the quality of sleep. Normal sleep plays a critical role in the consolidation of memories. Inadequate sleep can limit cognitive functions such as the formation of memories and new learning. Therefore, the patient should be referred for diagnostic testing. Nuerological and laboratory testing are indicated to rule out problems that may account for memory loss (Janzen, 2001). Blood tests offer provide information on electrolyte imbalance or anemia. Hemodynamic assessments offer information in oxygen saturation and cardiac output. Diagnostic testing may include computed tomography scan, magnetic resonance imaging, lumbar puncture, and electroencephalogram. Psychoneurological evaluation by a trained specialist is important to arrive at a diagnostic of conditions such as Korsakoff.

Therapeutic plan

Provide reality orientation for the patient at eye contact. Patients with impaired memory have difficulty maintaining orientation to the immediate environment. Reality orientation helps the patient remain mentally integrated with the immediate environment. The care provider should provide a low stimulation environment. Excessive auditory and visual stimulation can lead to disorientation and confusion. The patients need a setting with limited distractions to enhance information retrieval from remote memory. The care plan should encourage the patient to reminisce about past experiences. The patient then records the information or data in a memory aid including as a notebook or a computer. When errors occur in the new information, it derails memory development of correct information.

Monitoring and rehabilitation

Monitoring and rehabilitation are two aspects of a continuum of care essential in the care plan. They encompass a number of elements in the continuum of care. They include the provision of flexible care packages that offer support to an individual to maintain independence. Among patients that may require a more supported environment, the option of supported accommodation is vital (MacRae & Cox S, 2008). However, social and cultural stimulation to help individuals with continuing with individual daily activities is a vitalelement in maximizing the recovery and well-being of the patient. Factors that will facilitate the rate of success of the care plan include the level of alcohol abstinence, a rehabilitation method to activities of dailyactivities and family involvement. Hospital-based specialized units that offer structured rehabilitation and support on discharge improve the social functioning, health and recovery outcome of KS patients. Patients accommodated in long-term care have a greater degree of social deterioration than those who are supported to live independently. They principles in the care plan include:

• Thepromotion of andparticipation in alcohol-free socializing activities. Theseactivitiesincludecardandboard, golf, gardening, bingo andvarioussocialoutings to shoppingcenters, theater, andswimmingareas. Games such as crossword puzzles, jigsaw puzzles, or chess havebeenshown to aid in stimulatingimportant neural centers that enhancememoryfunctions.
• There should b a structured hygiene routines, continuous memory work, and interventions that capitalize activities of daily living. The care program ought to provide a standard assessment, medical management, alcohol management, memory impairment and legal issues
• Alcoholspecialists should offeradvice on theday to dayaspects of care. They should participate in theassessment of risk of relapse into drinking andthesubsequentmanagement of alcohol-related issues. Therehabilitationaspect should aim at a structured alcohol-free life.
• Thepresence of a socialand a familynetwork is critical in theprocess of rehabilitatingthepatientsespeciallythoselivingindependently.

The key elements in ensuring the success among caregivers include the presence of a multi-disciplinary assessment, staff leadership and management, staff training, good care practices and good building design of the care facility. These elements facilitate the quality of on-going care for the patient in long-term care facilities. The care plan needs to consider options available to return to independent but supported living. Independent but supported living is unlikely to be a viable option for some individuals. In such situations, there should be attempts to place the lady in dedicated units within care homes or in facilities that specialize in caring for those with KS. The lady may have high dependency or palliative care needs as the condition deteriorate and if there is no proper alcohol rehabilitation programs. While planning the care plan, it is critical to ensure care choices reflect patient’s choices (advanced care directive). Decisions aremade for the patient who is longer able to communicate, and there is sufficient consideration for financial and estate decisions to pay for the services.

Selecting the type of care

Three main residential care option considered include assisted living, specialized Korsakoff’s syndrome care facilities and nursing home. Different agencies and scholars have defined assisted living in different ways. According to Assisted Living Workgroup (2003), assisted living is a residential facility that offer and coordinate oversight and services that met resident’s individual scheduled needs, depending on the resident’s assessments and service plan. The Assisted Living Federation of America definesassistedliving as acombination of housing, individualized supportive servicesandhealthcarethose are designed to meettheneeds (scheduledand unscheduled) of personwhoneedssupport with ADLs. According to the Department of Health and Human Services, assisted livingservicesinclude 24hours servicesandoversight, provision of at least two meals in a day, andpersonalassistance with a least bathing, dressing, ormedications.

Comparison

“Assisted living” is a method of residential long-term care facility that offers various levels and combinations of services, care and privacy. Assisted living facilities offer several levels and combination of services and care. The united States Senate Special Committee on Ageing (2003) stated that assisted livings offer or coordinate services that meet the scheduled individualized needs, based on professional assessment. The Assisted Living Association view assisted living as a combination of housing and individualized supportive services designed to meet scheduled and unscheduled needs of individualswhoneedassistance with activities of dailyliving. The National Center for Assisted Living (NACL) describes an assisted living on a care continuum of long care as a go-between total independent living and skilled nursing home care. In dissimilarity, to a nursing home that is based largely on medical model, assisted living is a socialmodel that combinespersonalservices with healthcare in a home-like setting.

Characteristics of resident in assisted living

Most residents of assisted living facilities are less impaired than those of nursing home facilities, which require more assistance with ADLs, daily nursing care or monitoring. Assisted living residents often have better-perceived health and lower prevalence of chronic and acute care than those in the nursing home. Residents in assisted living have moderate to severe cognitive impairment.

Philosophical framework

Regardless of the differences in definition and terminologies, assisted living institutions adhere to the universal philosophy that emphasizes choice, dignity, autonomy, privacy and other “normal” life characteristics. In theory, assisted living hold the notion of a consumer-focused philosophy that distinguish assisted living from other types of residential long-term care setting. The basic tenet of offering home-like environment with individuality and anonymity is to provide care that follows the social model rather than a medical model. Assisted livings are synonymous with aging in place. According to Zimmerman and Eckert (2001), aging in place defines the phenomenon of growing older in a specific environmental setting. Assisted living is an optimal setting for Korsakoff and Alzheimer care. Approximately 24% of assisted living institutions have designated units for Alzheimer and other cognitive related disorders. These facilities offer a medical model and a residential model of care. The residential model is appropriate for korsakoff patients who are in good physical health and need low to moderate assistance with ADLs. The medical model is appropriate for patients with advanced Alzheimer condition, but in this case, advanced Korsaffok syndrome.

Findings

Early diagnosis and management of Korsakoff is vital in the success of themanagementplan. Failure of Korsakoff Syndrome patient to make new memories makes them capable of performing only the most habitual routines. It is characterizedwiththememorylosstakingplace in a setting of clearconsciousnesssuchthat a patient give impressions in a conversationthatsheorhe is entirely in possession of her or his facultiesbutshow a severe impairment of currentandrecentmemory. A whole range of professional disciplines and skills need to be brought to beat at the appropriate juncture. Such multidisciplinary working, across many agencies, requires considerable coordination and the various elements need to be “joined-up” into a coherent whole, focused primarily on the needs of the clients. Therefore, it is complex to estimate the prevalence or kind of services Korsakoff syndrome patients is receiving. In addition, there is a general lack of training among staffs who work within specialized care home environments on the management of Korsakoff syndrome. Unlike other alcohol-related brain damage conditions such as dementia, the structure and extent of the current Korsakoff syndrome are unknown

The long-term management of the syndrome requires multi-discipline holistic care that focuses not only at rehabilitating the patient, but also assisting in ADLs and medications. The case has informed about the various critical principles that underscores the management of the syndrome. With abstinence, the development of the syndrome can be arrested. Therefore, a fundamental component of the care program is providing and alcohol-free environment that integrates some components of social interactions. The caregiver should link the client with rehabilitation practitioners who are knowledgeable in the rehabilitation of substance abuse. The second core component of the care plan is nutritional care. Korsakoff syndrome and nutritional intake are interrelated. A thorough nutritional assessment should provide a rationale for the nutritional plan. The nutritional play may also include monitoring the daily intake of thiamine supplements and other medications. The third core component is social support. Alcohol rehabilitation coupled by the social isolation requires a social network supported by social worker personnel to ensure the resident retain her social element.

The core role of families in ensuring the success of the plan is critical. In addition to financing the plan, family members are an essential source of foundation information that is critical for the management of the syndrome. They offer information the patient cannot provide due to her lapse in memory. Institutionalization introduces elements of isolation, and the resident may feel abandoned. The family should play their role in ensuring the resident doesn’t feel abandoned. The feeling of abandonment leads to the fact Korsakoff patient may feel out of place due to their age. Most assisted of nursing home harbor individuals with advanced age and with chronic conditions. Therefore, Korsakoff patient may have a feeling of quitting the facility.


References

Beaunieux, H, Pitel, A, Witkowski, T, Vabret, F, Viader, F, & Eustache, F 2013, 'Dynamics of the Cognitive Procedural Learning in Alcoholics with Korsakoff's Syndrome', Alcoholism: Clinical & Experimental Research, 37, 6, pp. 1025-1032, Academic Search Premier, EBSCOhost, viewed 29 November 2014.

Family involvement in residential long-term care: A synthesis and critical review. Aging mental helath. Vol. 95 (2): 105-118

Janzen W, 2001. “Long-term for older adults.  The role of the family.”  Journal of gerontology nursing. Vol. 27 (2): 36-43.

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