40. A patient with advancing Alzheimer's dementia who has lost 40 lb in the last 6 months has been living alone and wants to remain independent. The palliative care nurse notices the patient is no longer able to cook and forgets to take medications. The patient was started on donepezil 2 months ago, but the family does not feel it is helping. Which of the following is the BEST option for the patient that the nurse should discuss with the family?
Answer: C
Arrange for Meals on Wheels and have the family take over the patient's medication administration
This option provides practical support for the patient while respecting their desire to remain independent. By ensuring the patient receives nutritious meals and proper medication administration, the nurse can help maintain their health and safety.
A) Move the patient to a long-term care facility so that the Medicare benefit will pay for care
While this option may provide comprehensive care, it does not align with the patient’s expressed desire to remain independent. Additionally, it does not address the immediate issues of nutrition and medication management that the patient is currently facing.
B) Increase the patient's dose of donepezil
While increasing the dose of donepezil might seem beneficial, there is no evidence to suggest that a higher dose would address the patient's current challenges with daily living activities. Furthermore, the family has already noted that the medication does not appear to be effective, indicating that other strategies may be more appropriate.
C) Arrange for Meals on Wheels and have the family take over the patient's medication administration
This option directly addresses the patient's immediate needs by ensuring they receive adequate nutrition and support for medication adherence. It helps maintain the patient's independence while providing necessary assistance, making it the most suitable choice.
D) Encourage the family to move the patient in with them to manage care needs
Though this option may provide additional support, it may not be feasible for the family or desirable for the patient. It could also lead to a loss of autonomy for the patient, which they are trying to maintain.
Conclusion
Option C is the best choice as it effectively balances the patient's need for independence with the practical support required for their health and safety. Other options either do not adequately meet the patient’s immediate needs or may compromise their desire for independence. Thus, arranging for Meals on Wheels and family support for medication administration is a holistic approach to care for this patient.