Alzheimer’s disease (AD) is state of neurological and cognitive deterioration, which is associated with structural and biochemical changes in the frontal and temporal lobes in middle and late life (Markowitz, 2005). Typical symptoms include impairments of recent memory, orientation, comprehension and reasoning, as well as psychological, motoric and neurological difficulties (ibid.). With increasing prevalence rates and over 400,000 new cases a year in the US, AD is the fifth leading cause of death in the elderly and the third most costly disease in the country (Dharmarajan & Guniuru, 2009). This paper summarizes the principal features of AD, as discussed by Dharmarajan & Guniuru (2009), with special emphasis on the fields of nursing and healthcare management.
Nursing and Healthcare Management in AD
The growing prevalence and incidence rates of AD in adult population pose great challenges for the American healthcare system. The relatively slow development of the disease, the special needs of patients with dementia and their dependency on medical staffs and caregivers (typically female relatives) bring about considerable secondary costs, which are often hard to measure (e.g. caregivers’ loss of productivity and sacrifice of personal lives, with the propensity of underpinned psychological difficulties). In addition, healthcare professionals should recognize the different stages of AD, in particular its early signs, as well as means to improve AD patients’ quality of life (QOL).
Motoric impairments, memory loss and other symptoms of dementia are not the sole property of AD. Dharmarajan & Guniuru (2009) suggest a careful diagnostic procedure, which can assist to reject other (and often curable) causes for the symptoms on one hand, but avoid misdiagnosis on the other. It is imperative to remember that AD is currently chronic, but early detection may assist to prolong and improve the lives of the sufferers.
The management algorithm include several pharmaceutics, whose effectiveness increases the earlier AD is diagnosed. Other QOL-improving measurements include cognitive training, psychological/psychiatric treatment and means to prevent falls and minimize injuries (e.g. carpeting). Empathy and compassionate care for patients and caregivers can assist to minimize emotional adverse effects and ease the overall course of AD. General considerations of aged patients, such as deterioration of hear and sight, insomnia and decrease of muscle mass should be also mentioned in this context.
The authors generally oppose measures of coercion, such as restrains, feeding with percutaneous endoscopie gastrostomy (PEG) and life-prolonging treatments without consent. As indicated in prior studies, PEG does not significantly improve nutrition, whereas patients feel comfort from knowing how they will be treated at the late stages of AD. Therefore, patients should give advance directives regarding their future treatments when they are still capable of making decisions. In addition, attorneys should be empowered to give directions on behalf of severely demented patients.
Finally, case managers of AD patients should not neglect the effect on caregivers, who must bear most of the burden of the disease. As most of AD sufferers are not inpatients, the caregivers’ strength is an important factor of the treatment, and thus should be considered as well. Caregivers and families should be also aware of their rights, principally Medicare’s coverage, which is quite extensive in AD.
The prevalence rate of AD among people aged 65 years and above is a serious issue of public health. With the “baby-boomers” approaching the age of retirement, healthcare personnel are expected to get more and more occupied with the disease. By applying a holistic approach to the patients, their needs and their environment, we can drastically improve QOF under AD and decrease the direct and adverse costs of AD.
Dharmarajan, T. S. & Guniuru, S. G. (2009). Alzheimer’s disease: A healthcare burden of epidemic proportion. American Health and Drugs Benefits, 2(1), pp. 39-47.
Marcovitch, H. (2005). Black’s medical dictionary (41st edition). London: A&C Black Publishers.
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