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What is Alzheimer's Disease?

Alzheimer's disease is a progressive, degenerative disease that attacks the brain and results in impaired memory, thinking, and behavior. It affects an estimated 4 million American adults.

At first, you may have trouble finding words, finishing thoughts, following directions, remembering names or other information. Later you may feel confused and frustrated, and have difficulty accomplishing tasks and making decisions. Other people may notice changes in your personality or behavior.

It is difficult to say how quickly these changes will occur, since they vary from person to person. Sometimes people with AD stay at the same level of functioning for several months or a year before noticeable changes occur. But the disease is progressive and, over time, it will make you less able to function in your usual activities.

When it was first diagnosed by German physician Alios Alzheimer in 1907, Alzheimer's disease was considered a rare disorder. Today, it is recognized as the most common cause of dementia.

Dementia is not a disease itself but a group of symptoms that characterize diseases and conditions. Dementia is commonly defined as a decline in intellectual functioning that is severe enough to interfere with the ability to perform routine activities.

Alzheimer's disease is distinguished from other forms of dementia by characteristic changes in the brain that are visible only upon microscopic examination.


What are the symptoms?

1. Memory Loss, Decreased Attention Span

2. Difficulty Performing Familiar Tasks

3. Problems With Language, Loss of Physical Coordination

4. Disorientation of Time and Place

5. Poor or Decreased Judgment

6. Problems with Abstract Thinking

7. Misplacing Things

8. Changes in Mood or Behavior

9. Changes in Personality

10. Loss of Initiative


Stages of Alzheimer's Disease

Normal Adult - No functional decline.

Normal Older Adult - Personal awareness of some functional decline.

Early Alzheimer's Disease - Noticeable deficits in demanding job situations.

Mild Alzheimer's' Disease - Requires assistance in complicated tasks such

as handling finances, planning parties, etc.

Moderate Alzheimer's Disease - Requires assistance in choosing proper attire.

Moderately Alzheimer's Disease - Requires assistance dressing, bathing, and

toileting. Experiences urinary and fecal

incontinence.

Severe Alzheimer's Disease - Speech ability declines to about half-dozen

intelligible words. Progressive loss of abilities

to walk, sit up, smile, and hold head up.

*Course of the disease usually progresses an average of eight years from the time the symptoms first appear, although Alzheimer's Disease has been known to last as long as 25 years.

Another way to divide the Stages of Alzheimer's Disease:
 

Alzheimer's Disease Statistics

* Approximately 4 million Americans have AD. In a 1993 national survey, 19 million Americans said they had a family member with AD, and 37 million said they knew someone with AD.

* By the year 2040, Alzheimer's disease will afflict 14 million Americans unless a cure or prevention is found.

* One in 10 persons over 65 and nearly half of those over 85 have AD. A small percentage of people as young as their 30's and 40's get the disease.

* A person with AD will live an average of eight years and as many as 20 years or more from the onset of symptoms.

* U.S. society spends at least $100 billion a year on AD. Neither Medicare nor private health insurance covers the long term type of care most patients need.

* Half of all nursing home patients suffer from AD or a related disorder. The average cost for a patient's care in a nursing home 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 $174,000.

* Alzheimer's disease is the third most expensive disease in the United States, after heart disease and cancer.

* From age 65 to 74, about 3% of the American population is affected.

* From age 75 to 84, the figure rises to 19%.

* And for those 85 and older, Alzheimer's afflicts 47%.



 

Is It Alzheimer's?

Ten Warning Signs:

1. Memory Loss That Affects Job Skills

It is normal to occasionally forget assignments, colleagues' names, or a

business associates telephone number and remember them later. Those with dementia, such as Alzheimer's disease, may forget things more often, and not remember them later.

2. Difficulty Performing Familiar Tasks

Busy people can be so distracted from time to time that they may leave the carrots on the stove and only remember to serve them at the end of the meal. People with Alzheimer's disease could prepare a meal and not only forget to serve it, but also forget they made it.

3. Problems With Language

Everyone has trouble finding the right words sometimes, but a person with Alzheimer's disease may forget simple words or substitute inappropriate words, making his or her sentence incomprehensible.

4. Disorientation of Time and Place

It is normal to forget the day of the week or your destination for a moment. But people with Alzheimer's disease can become lost on their own street, not knowing where they are, how they got there, or how to get back home.

5. Poor or Decreased Judgement

People can become so immersed in an activity that they temporarily forget the child they are watching. People with Alzheimer's disease could forget entirely the child under their care. They may also dress inappropriately, wearing several shirts or blouses.

6. Problems with Abstract Thinking

Balancing a checkbook may be disconcerting when the task is more complicated than usual. Someone with Alzheimer's disease could forget simply what the numbers are and what needs to be done with them.

7. Misplacing Things

Anyone can temporarily misplace a wallet or keys. A person with Alzheimer's disease may put things in inappropriate places: an iron in the freezer, or a watch in the cookie jar.

8. Changes in Mood or Behavior

Everyone becomes sad or moody from time to time. Someone with Alzheimer's disease can exhibit rapid mood swings-from calm to tears to anger- for no apparent reason.

9. Changes in Personality

People's personalities ordinarily change somewhat with age. But a person with Alzheimer's disease can change drastically, becoming extremely confused, suspicious, or fearful.

10. Loss of Initiative

It is normal to tire of housework, business activities, or social obligations, but most people regain their initiative. The person with Alzheimer's disease may become very passive and requires cues and prompting to become involved.


Caring for Alzheimer's Patients

  1. Making the Choice
  1. Considerations
  1. Making the Home Safe
  1. Basic Concepts
    1. Make changes as they are needed
    2. Make changes that make life easier for you.
  1. Safety Inside the House
    1. Lighting
    2. Furniture
    3. Cleaning supplies
    4. Sharp objects
  1. Safety Outside the House
    1. The yard
    2. Emergencies
  1. Day to Day
  1. Helping, Not Doing
    1. Personal hygiene
    2. Eating
    3. Communication
  1. Support
  1. Who Can Help?
    1. Family and ffriends
    2. Professional services
    3. Nursing homes
  1. Finances
  1. Paying for Care
    1. Medicare
    2. Medicaid

I. A. The decision to provide home care for a dementia patient often may not seem like a choice. For instance, the cost of long-term care may be too expensive to consider. But this is not to say that a dementia patient cannot be cared for at home. According to the U.S. Dept. of health and human service task force on Alz. Disease more that 70% of all Alzheimer's suffiers live at home.

But before deciding on a care plan, you must consider the following.

  1. Will you have to give up a job or reduce your work hours to care for the patient?
  2. How much will it cost to use a day care program, paid companion, visiting nurse or other outside help?
  3. Will insurance cover medical expenses, nurses aides or paid companions.
  4. How do home care costs compare with nursing costs.
  5. Dementia patients may develop Beh problems. Some problems that are common in Alzheimer's patients are:
In any case you have to ask yourself if you are prepared to handle these situations.

If you make the decision to care for the patient at home, careful planning will be necessary. And this is what I attend to address in my next main point, which is, "making the home safe"

II. A. You'll want to make sure the patient is safe in and around the house. But you don't need to completely redo the entire house. Complete change isn't necessary, and it might even be harmful. Because drastic changes may very well confuse or agitate the patient. Some of the basic concepts to keep in mind are:

B. When you actually start the task of safe proofing your home probably the easiest way of doing this is item by item or room by room. One of the first stops would be:

Lighting-Make sure there is adequate lighting throughout the house. Especially for nighttime trips from the bed to the bathroom, and at the top and bottom of stairs.

Furniture- arrange furniture with clear pathways. Install safety bars in bathrooms, hallways, and other places where one there may be the danger of losing one's balance.

Cleaning Supplies- as the patient loses the ability to read, there is increased danger of poisoning from eating or drinking cleaning supplies. Lock away poisonous supplies or keep them away where they cannot be reached.

Sharp objects- as the ability to remember the function of tools or control their use diminishes, patients need to be protected from sharp objects- razor blades, knives, scissors, breakable items, and other things that may pose a harm.

C. The key to safety outside the home is to let your neighbors and local authorities know the situation. But there are also other protective measures that you can take.

The yard- always supervise the patient when they go outside. Also you may want to put up a fence or a gate around the perimeter of your house.

Emergencies- Carry a list of all medicines taken by the patient. Include phone numbers of pharmacists, Physician, and the poison control center. Patient should carry a duplicate list and wear an identification bracelet with his or her name on it. Good Idea-

A medic-alert bracelet linked to 24-hour hot line.

III. A. Now that we have discuss some of the safety measures you can take in and outside the house, now I want to talk about some of the day to day activities that you will be faced with when caring for an Alzheimer's patient.

Bathing-Keep it simple. Have bathing be a regular routine, done at the same time, same steps.

Tioleting- Most people with AD are able to use the toilet on their own through the early stages. As time goes on more help is needed. (Removing clothes, sitting, cleaning properly). Always ask permission to help-Maintains patient privacy and sense of control. Prevent accidents by making it easy to find the bathroom and easy to remove clothing.

Eating- Appetite of the Ad patient will vary from extremely hungry to not hungry at all. Serve favorite foods. Cook the food the way patient likes it. Use contrasting colors of dishware. This helps the patient to identify plates, cups, and silverware. Add extra nutrients to the diet of a patient who eats too little. Include the patient in preparing the meals such as setting the table, this keeps the Ad patient more sociable and less likely to withdraw.

Communications- Person with AD passes through different stage of communication loss,

IV. A. Family/friends-First line of defense against loneliness, isolation, and too much caregiving. Ask for the help you need. Accept whatever is offered.

Support Groups- they provide a range of help, from education to escorting patients to out -of- home appointments.

Professional services-

Reg. Nurses- provides nursing care. Available on an as-needed basis.

Social workers- evaluates the caregivers and the patients needs, then make referrals and provide counseling.

Home health aides- Provide personal care for patients, helping with med., exercises, and monitoring vital signs. Available either on daily basis or agreed-upon hours.

Adult homes- provides short-term care. And give caregivers a break. Available as needed.

V. A. Just because the patient has insurance doesn't mean everything will be covered (nursing-aides, hospital style beds, wheelchair). Most common sources of payments are Medicare and Medicaid.

Medicare- U.S. govt. med.-insurance program. Covers people over age 65. Covers some nursing home and home care costs. But the amount of benefits and the time period in which it can be used are limited and related to the patient's needs. (Only pays for about 4% of all nursing home care costs).

Medicaid- Joint federal and state govt. insurance program. Assistance is furnished on the basis of needs. Must qualify for it. Qualifications: patients income, assets, medical and personal needs. If eligible Medicaid will cover nursing and home care costs.


Case Study

Jewell Johnson had once been quite active in her neighborhood. She also had attended church regularly. Several months ago her closest neighbors began to notice changes. First, she dropped out of church. They discovered her feelings had been hurt. Apparently, she had made some mistakes as the treasurer of her Sunday School class, losing several hundred dollars. That was not her story though; Mrs. Johnson insisted that someone had stolen the money. It had all been cash and for some reason she had never deposited it in the bank. She began to stay home more and more often. Neighbors and other church members tried to visit, but Jewel was uncharacteristically rude to them.

Several times a week her morning newspapers remained in the yard, and this gave neighbors an excuse to check on her. She always came to the door in her robe and slippers. She thanked them for the paper, making an excuse that she had a cold and was resting more. She refused their offers to help her. Finally her next-door neighbor called Jewell's daughter who lived several hundred miles away. It was strange that Jewell never told her daughter of any problems. The neighbor was asked to watch after Jewell, and the daughter called her mother.

This was not a pleasant conversation, nor was it very long. Jewell denied any problems and told her daughter that she thought that the neighbor was trying to get her house. As the paranoia became more vivid, Jewell became more upset and hung up on the daughter.

Late that night, the neighbors were awakened by screaming outside Jewell's house. It was nearly freezing, and she was outside her home in a gown. She was afraid of the noeghbors who tried to help calm her. She kept talking about her dead husband who was roaming around in the attic. She was afraid of him. The police arrived and found no one in the attic. Mrs. Johnson was hospitalizd since she had become a danger to herself.

Police found that there was not any food in the house. She probably had not eaten for several days. The kitchen was a mess, and the gas burners were still turned on. Clothes were lying around. The toilet had not been fluhed for days, and Mrs. Johnson had had some accidents in her bedroom. Newspapers lay on the living room floor rolled up and unread. Bills and other mail were heaped in piles near the newspapers.

After being stabilized in a psychiatric hospital, a thorough examination was conducted. The diagnosis was inescapable - Alzheimer's Disease. Due to Mrs. Johnson's recent emotional outbursts and recent history of hysteria, the doctors comtemplate whether or not to tell Mrs. Johnson of her diagnosis for fear of further self-harm to herself. So, the doctors inform Mrs. Johnson's daughter of her mother's condition, and she decides not to tell her mother of her condition. You are the doctor, what would you do? As the daughter, what would you do?



 

Ethical Issues of Alzheimer's

Genetic Testing

To Tell or Not to Tell

What kind of care to provide

- Autonomy

- Beneficence

When to limit activities

- Society vs. Individual

Assisted Suicide

End of Life?

Legal Considerations of Alzheimer's

Durable Power of Attorney (DPA)

Living Trust

Living Will

Will

Conservatorship of Property

Guardianship of Person

Consent