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Caring for the Alzheimer Patient 20-96434 1 Hour Back to Course Index

Caring for the Alzheimer’s Patients

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Purpose:

To assist the staff to identify the signs and symptoms of Alzheimer’s disease vs. dementia, identify the causes and treatments associated with Alzheimer’s disease; plan. care in the various stages of Alzheimer’s, and to become aware of the costs and the role of various organizations involved in caring for Alzheimer’s patients.

Objectives:

. Define dementia

Identify criteria for the diagnosis of dementia

. Define Alzheimer’s disease

Identify criteria for the diagnosis of Alzheimer’s disease

Identify those likely to be afflicted with Alzheimer’s disease

Discuss the causes of Alzheimer’s disease

. Identify the signs and symptoms of Alzheimer’s disease

. Discuss medications used for the management and prevention of Alzheimer’s

Discuss the costs associated with Alzheimer’s disease

­Abstract

Alzheimer’s disease is a degenerative disease of the brain from which there is no

recovery. The disease attacks nerve cells in all parts of the brain. This disease affects

millions of people around the world. Health care costs for those individuals inflicted

with the disease averages around $100 billion a year. While extensive research has been done in this field there is still much to learn.

Introduction

Alzheimer’s disease is a progressive, degenerative disease of the brain, and the

most common cause of dementia. The causes and incidence of the disease are related to risk factors and genetic mistakes. The symptoms begin with forgetfulness and progress to senility. Although considerable research has been done, Alzheimer’s disease continues to cause significant health complications, has limited treatment modalities, and significant social and economic impact.

Definitions

Dementia is a term used to describe the loss of cognitive or intellectual function.

Many conditions can cause dementia.

Possible causes of dementia include: AIDS, drug intoxication, thyroid disease, severe

nutritional deficiencies, blood clots, syphilis, multiple infarct or vascular disease, brain

tumors, closed head injuries, hydrocephalus, meningitis, multiple sclerosis, and

encephalitis.

Criteria for the diagnosis of dementia include: impairment of attention, orientation,

memory, judgment, language, motor and spatial skills, and functions.

It is the role of the health care professional to rule out other possible causes of dementia before diagnosing Alzheimer’s disease.

First described by Dr. Alois Alzheimer in 1906, Alzheimer’s disease is an

irreversible disorder that worsens with time. Alzheimer’s disease (pronounced Alts’-hi­

merz) is a degenerative brain disease that usually begins gradually, causing a person to forget recent events or familiar tasks. How rapidly it advances varies from person to person. The progression of the disease is categorized into three stages; early, middle, and late. Specific behaviors and how long they last vary greatly, even within each stage of the disease.

Alzheimer’s disease afflicts 1 in 10 people over the age of 65 and nearly half of

all people age 85 and over. Currently four million people have the

disease. That number will jump to 14 million by the year 2050 unless a cure or

prevention is found. In addition to the elderly, people at higher than average risk for developing the disease are those who have a family history of the disease and those afflicted with Down’s syndrome. Women are more likely to develop Alzheimer’s than men. Americans are significantly more likely to be afflicted.

However, those families that have emigrated from other countries are also significantly affected. African-Americans have four times the risk as white Americans and Hispanics have over twice the risk as whites.

Causes

The cause of Alzheimer’s disease is still unknown and can only be definitively

diagnosed by examination of the brain after death. It is known however, that two

significant abnormalities occur in the brain of those afflicted with the disease; twisted

nerve cell fibers, known as neurofibrillary tangles and a sticky protein called beta

amyloidal (WebMD, 2001). The beta amyloids break into fragments, oxidize, and bind to other molecules causing damage to DNA. These abnormalities affect the nerve cells in the part of the brain responsible for memory and other thought processes. There is also a so-called inflammatory response in which the immune system overproduces factors normally intended to fight harmful agents, but in excess, they actually injure the body’s own cells.

Signs and Symptoms

Most people with Alzheimer’s share certain signs and symptoms of the disease.

At its onset, Alzheimer’s disease is marked by periods of forgetfulness, especially of

recent events or simple directions. These individuals have difficulty with abstract

thinking; they may initially have trouble balancing their checkbook, a problem that

progresses to trouble understanding and recognizing numbers. Many have difficulty

finding the right word to express their thoughts or even follow conversations.

Alzheimer’s disease is characterized by greater difficulty in doing things that require

planning, decision-making and judgment. Once routine tasks that require sequential steps, such as cooking, become a struggle for people with Alzheimer’s. People with Alzheimer’s may exhibit mood swings. They may express distrust in others, show increased stubbornness and withdraw socially.

Typically, loved ones notice gradual, not sudden, changes in a person with

Alzheimer’s. As the disease progresses,. symptoms become serious and noticeable

enough to cause people with Alzheimer’s or their family members to seek medical help.

Many people with Alzheimer’s disease realize that something is happening to their

memory, which can be very frightening. For some, the progression from simple

forgetfulness to severe dementia takes 5 years. For others, it can take a decade or longer.

Alzheimer’s generally progresses from mild to moderate to severe. People with

mild Alzheimer’s can usually live alone and function fairly well. Persons with moderate

Alzheimer’s may have greater difficulty coping without supervision. People with severe

or advanced Alzheimer’s generally can no longer care for themselves.

Most people with Alzheimer’s don’t die from the disease itself but from a

secondary illness, such as pneumonia or an infection. They may have difficulty chewing or swallowing, become incontinent or be unable to walk and find their way back home.

Eating difficulties may cause pneumonia due to aspiration of food or liquids. Infections

are another serious problems that may be caused from urinary incontinence or bedsores from prolonged immobilization. As these people become disoriented they have an increased risk for falls, which could lead to head injuries or broken bones.

Treatments

Currently there is no cure for Alzheimer’s disease. Current medications for

Alzheimer’s can’t stop or reverse the underlying disease process. But they may slow it

down, lessening symptoms.

Medications commonly recommended for people afflicted with the disease includeTacrine (Cognex), which can improve mental abilities in about 30 percent of people with mild to moderate Alzheimer’s disease and Donepezil (Aricept) and Rivastigamine (Exelon) which are used to decrease mild to moderate symptoms by improving levels of neurotransmitters in the brain (Mayo Clinic Health Information, 2001).

Some alternative medicines may benefit a person with Alzheimer’s disease. The

herb gingko biloba continues to be studied for its brain-enhancing effects in both healthy people and people with Alzheimer’s. But it is not proven to improve memory or prevent Alzheimer’s. Some limited studies suggest that aromatherapy; using fragrant plant oils to relax and affect the body, and massage can play a supportive role in Alzheimer’s treatment.  According to a research study, Estrogen may eventually play a role in treatment of brain diseases like Alzheimer’s.

Doctors also sometimes prescribe drugs to improve behavior symptoms that often

accompany Alzheimer’s, including sleeplessness, wandering, anxiety, agitation and

depression. Today, treatment of Alzheimer’s disease is still in its infancy. But

researchers are confident that in the not-too-distant future, new medications should be available that do more than treat the symptoms.

Currently there is no way to prevent the onset of Alzheimer’s disease. According

to a study in 1996, such things as Non-steroidal anti-inflammatory drugs (NSAIDs), like Advil, Motrin, and Nuprin, reduce the risk of Alzheimer’s by 30 percent to 60 percent (Mayo Clinic Health Infonnation, 2001). Vitamin E and selegiline (Eldepryl) are

antioxidants and may help prevent brain cell damage by destroying toxic free radicals.

Estrogen helps keep the brain healthy by boosting production of a key neurotransmitter; helping prevent plaque deposits and improving blood flow to the brain. Studies show that hormone replacement therapy after menopause can reduce a woman’s risk of developing Alzheimer’s disease by 30 percent to 40 percent (Mayo Clinic Health Information, 2001).

Costs

Alzheimer’s disease costs the United States at least $100 billion a year. The cost

to American businesses is more than $33 billion annually, $26 billion to lost productivity of caregivers plus $7 billion related to costs for health and long-term care.

Approximately 7 out of 10 people with Alzheimer’s live at home, almost 75 percent of

home care is provided by family and friends. The remainder is “paid” care costing an

average of $12,500 per year, most of which is covered by families. Half of all nursing

home patients suffer from Alzheimer’s or related disorders (Alzheimer’s Association,

2001). The average per patient cost for nursing home care is $42,000 per year but can exceed $70,000 per year in some areas of the country. The average lifetime cost per patient is estimated to be $174,000.

Associated Organizations

The Alzheimer’s Association is the largest national voluntary health organization

dedicated both to research for the causes, cures, treatment, and prevention of Alzheimer’s disease and to providing education and support services to affected individuals and those who provide their care. Genetic testing for Alzheimer’s is in its infancy stage as is hormone therapy and alternative medicine therapy. The Alzheimer’s Association has granted more than $100 million in research grants since 1980. The federal government estimates spending approximately $466 million for Alzheimer’s disease research in 2000 (Alzheimer’s Association, 2001).

Mayo Clinic researchers have recently identified a state of memory loss that could

potentially be known as pre-Alzheimer’s. Identification of this category of memory loss

could help physicians more accurately diagnose and alert patients who are at risk of

developing Alzheimer’s disease. This disease can occur in people in their 30s, 40s, and

50s. The early onset for of the disease that strikes younger people accounts for less than 10 percent of all reported cases (Alzheimer’s Association, 2001). Therefore, this is the population that is currently being targeted for education and health promotion. The Alzheimer’s Association sponsors the Memory Walk. The Memory Walk occurs every fall, over 400 communities band together to participate to raise money and support for the disease. Since its inception in 1989, Memory Walk has raised $90 million for local programs and services.

Many people with Alzheimer’s and their families can benefit from counseling or

local support groups. Each person with Alzheimer’s disease experiences its symptoms

and progression differently. Caregiving can be a challenge. The key to caregiving is to

focus on things that the person can still do and enjoy. You can help a person cope with the disease by being there to listen, reassuring the person that life can still be enjoyed, providing unconditional love and doing your best to help the person retain dignity and self-respect.

Conclusion

Since society, as a whole, has always put so much importance on intellect and

Sociability, a disease like Alzheimer’s can be absolutely devastating. The symptoms of

Alzheimer’s begin gradually and progress in severity. Those afflicted with Alzheimer’s

disease end their lives the same way that they began, in isolation and diapers. This

disease causes significant financial and emotional suffering to the victim and their

families. Care revolves around prevention and treatment of symptoms. With no definite cause or cure, the devastation seems endless.

 

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