BY CASSANDRA STURRUP (MSN,RN,RRT)
Alzheimer’s is a kind of dementia that is characterized with difficulties with memory, thinking and behavior. The symptoms usually progress and gets worse over time and becomes severe that it affects the individual activities of daily living. Activities of daily living include bathing, dressing, toileting, meal preparation etc. Alzheimer’s can affect people younger than sixty-five years of age. In the United States, approximately 200,000 people have early onset of Alzheimer’s. This disease can affect any person regardless of their race, nationality, and gender. Currently, treatment or medication for Alzheimer’s cannot cure or stop the progression of disease but it can slow down the progression of the disease and improve the quality of life for the individual.
Alzheimer’s disease is characterized clinically by early memory impairment followed by language and perceptual problems. This disease can affect anyone – it has no economic, social, racial or national barriers. Alzheimer’s disease is currently ranked as the sixth leading cause of death in the United States, but recent estimates indicate that the disorder may rank third, just behind heart disease and cancer, as a cause of death for older people. Alzheimer’s is the most common cause of dementia among older adults. Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities to such an extent that it interferes with a person’s daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living.
Alzheimer’s disease (AD) was first discovered in 1906 by a German doctor named Alois Alzheimer. It is a disorder of the brain, causing damage to brain tissue over a period of time. The disease can linger from 2 to 25 years before death results. Alzheimer’s disease is a progressive, debilitating and eventually fatal neurological illness affecting an estimated 4-5 million Americans. It is the most common form of dementing illness.
Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear in their mid-60s. Estimates vary, but experts suggest that more than 5 million Americans may have Alzheimer’s. Alzheimer’s disease is currently ranked as the sixth leading cause of death in the United States, but recent estimates indicate that the disorder may rank third, just behind heart disease and cancer, as a cause of death for older people.
Alzheimer’s is the most common cause of dementia among older adults. Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities to such an extent that it interferes with a person’s daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living.
There is no one cause for Alzheimer’s disease. AD may be sporadic or passed through the genetic make-up. The disease causes gradual death of brain tissue due to biochemical problems inside individual brain cells. The symptoms are progressive, but there is great variation in the rate of change from one person to another. Although in the early stages of Alzheimer’s the victim may appear completely healthy, the damage is slowly destroying the brain cells. The hidden process damages the brain in several ways:
- Patches of brain cells degenerate (neuritic plaques)
- Nerve endings that transmit messages become tangled (neurofibrillary tangles)
- There is a reduction in acetylcholine, an important brain chemical (neurotransmitter)
- Spaces in the brain (ventricles become larger and filled with granular fluid)
- The size and shape of the brain alters – the cortex appears to shrink and decay
Understandably, as the brain continues to degenerate, there is a comparable loss in mental functioning. Since the brain controls all of our bodily functions, an Alzheimer victim in the later stages will have difficulty walking, talking, swallowing and controlling bladder and bowel functions. They become quite frail and prone to infections such as pneumonia.
Dementia vs. Normal Aging
As a person grows older, he/she worries that forgetting the phone number of a best friend must mean he/she is becoming demented or getting Alzheimer’s disease. Forgetfulness due to aging or increased stress is not normal aging and is not dementia.
“Dementia” is an encompassing term for numerous forms of memory loss. There are many types of dementia such as Alzheimer’s disease, Multi-Infarct dementia or Parkinson’s disease. When a person has dementia, he/she will lose the ability to think, reason and remember and will inevitable need assistance with everyday activities such as dressing and bathing. Changes in personality, mood are also symptoms of dementia. Many dementias are treatable and reversible. Alzheimer’s disease is the most common form of untreatable, irreversible dementia.
Alzheimer’s Disease – Stages of Progression
Alzheimer’s Disease can be characterized as having early, middle, and late stages through which the patient gradually overlap. Everyone progresses through these stages differently. Alzheimer’s is the most common cause of dementia in the elderly.
First Stage: This is a very subtle stage usually not identified by either the impaired person or the family as the beginning signs of the disease. Subtle changes in memory and language along with some confusion occur at this time. The family usually denies or excuses the performance deficiencies at this stage.
- Forgetfulness/memory loss
- Impaired judgment
- Trouble with routines
- Lessening of initiative
- Disorientation of time and places
- Personality change
- Apraxia (forgetting how to use tools and equipment)
- Anomia (forgetting the right word or name of a person)
Second Stage: As Stage 1 moves onto Stage 2, there is usually a significant event which forces the family (and impaired person) to consider that something is wrong. At this time, they usually go to a doctor to diagnose the problem.
- Poor short-term memory
- Wandering (searching for home)
- Language difficulties
- Increased disorientation
- Social withdrawal
- More spontaneity, fewer inhibitions
- Agitation and restlessness, fidgeting, pacing
- Developing inability to attach meaning to sensory perceptions: (taste, touch, smell, sight, hearing)
- Inability to think abstractly
- Severe sleep disturbances and/or sleepiness
- Convulsive seizures may develop
- Repetitive actions and speech
Third (Final Stage): This stage is the terminal stage and may last for months or years. The individual will eventually need total personal care. They may no longer be able to speak or recognize their closest relatives.
- Little or no memory
- Inability to recognize themselves in a mirror
- No recognition of family or friends
- Great difficulty communicating
- Difficulty with coordinated movements
- Becoming emaciated in spite of adequate diet
- Complete loss of control of all body functions
- Increased frailty
- Complete dependence
COMMON PROBLEMS WITH DEMENTIA
Suspiciousness: accusing others of stealing their belongings
People are “out to get them”
Fear that caregiver is going to abandon (results in AD person never leaving caregiver’s side)
Current living space is not “home”
Seeing or hearing people who are not present
Repetitive actions or questions
They forget they asked the question
Will ask the same question repeatedly
Repetitive action such as wringing a towel
Repetitive looking for keys
Repetitive looking for purse or wallet
Pacing (walking back and forth)
Sundowning: at night patient appears confused, disoriented maybe trying to get “home” or look for a love one.
Generally feeling uncomfortable or restless increased agitation at night
Losing thing/Hiding things
Simply do not remember where items are
Might hide things so that people don’t “steal” them
Inappropriate sexual behavior
Person with Alzheimer’s loses social graces and is only doing what feels good
Agnosia: inability to recognize common people or objects
A wife of forty years will become a stranger to the person with AD, he might even think she is the hired help might not recognize a spatula or the purpose of the spatula and/or cannot verbalize the name or purpose of the object
Apraxia: loss of ability to perform purposeful motor movements
Cannot tie a shoe or manipulate buttons on a shirt
(Causes) AD person often becomes excessively upset and can experience rapidly changing moods. The person becomes overwhelmed due to factors such as too much noise, too many people around, unfamiliar environment, routine change, being asked too many questions, being approached from behind.
(Reactions) AD person may become angry, agitated, weepy, stubborn or physically violent. It is best to attempt to avoid catastrophic reactions rather than dwell on how to handle them.
Alzheimer’s disease is referred to as a family disease, because the chronic stress of watching a friend or family member slowly decline affects everyone. Effective treatment for Alzheimer’s will address the needs of the entire family. Caregivers must focus on the needs of the patient and on their own needs.
The goal of a caregiver caring for a patient diagnosed with Alzheimer’s is to keep the patient safe. Through training, caregivers can learn how to manage challenging and disruptive behaviors, improve communication skills and keep the person with Alzheimer’s safe. Research shows that caregivers experience lower stress and better health when they learn skills through caregiver training and participate in a support group(s) (online or in person). Participation in these groups can allow caregivers to care for their loved one or patient at home longer. When you’re starting out as a caregiver, it’s hard to know where to begin. Perhaps you’ve only recently realized that the patient needs assistance and is no longer as self-sufficient as the patient was previously. Perhaps there has been a sudden change in the patient’s health.
HANDLING DISTURBING BEHAVIORS
One of the most difficult challenges for caregivers is how to handle some of the disturbing behaviors that Alzheimer’s can cause. Symptoms such as delusion, hallucinations, angry outbursts, suspiciousness, failure to recognize familiar people and places are often the most upsetting behaviors for families. The following points may help in responding to disturbing symptoms.
First, try to understand if there is a precipitating factor causing the behavior. Were there household changes, too much noise or activity, was the daily routine upset? Time of day can also affect behavior (Sundowning). Being aware of these factors can help to better plan activities or anticipate
- Keep tasks, directions and routine simple without being condescending
- Reorient patient to name, time and place.
- Remain calm and speak in a calm, soft tone of voice
- Ask the person if they need assistance
- Always give the person plenty of time to respond and to complete a task
- Attempt to remain calm and remind yourself that the behavior is due to the disease
- Do not argue with the client
- Write down the answers to frequently asked questions, then remind them to look at the message
- Reduce environmental noise if the patient appears anxious or aggressive: television, radio, too many people talking
- Keep client in a calm environment
- Use distraction when unacceptable behavior starts: bring them into a different room, start talking about childhood or another favorite topic, show them magazines, ask them to help you do something like dusting or sweeping
- Provide relaxation techniques (radio, television, playing cards, card games, coloring etc.)
- Do not overreact or scold for problem behavior: redirect or distract in a soft tone
- Be reassuring with a soft tone of voice, soft touch, and eye contact
- Find the familiar items: favorite purse, favorite book, old pipe, favorite chair, family pictures
- Avoid denying hallucinations: try non-committal comments like, “You spoke with your mother, I miss my mother too”
- Be sure to inform physician of hallucinations, no matter how tame
- Restless behavior or pacing is usually unavoidable; however you can make the environment safe, remove unnecessary obstacles that may cause a fall, and keep an eye on the client
- Make sure the person is wearing identification on them
- Reassure the client you are there if they need assistance
- If they need to get up and move around or pace, don’t try to hold them back. Just stay close by to keep an eye on them
Resources for the caregiver and family members
For an Emergency Call 911
Please call Arch Creek Senior Care Services supervisor if you need assistance with the client at 305-944-0663
Florida Elder Abuse Hotline 1-800-96-Abuse (1-800-962-2873)
The TDD, Florida Reporting Adult Abuse (Device for the Deaf) 1-800-955-8770.
Miami Dade Elder Abuse Hotline 8a.m. to 5p.m. 305-418-7200
Alzheimer’s Association support groups 1-800-272-3900
Alzheimer’s Helpline 24/7 at 1-800-272-3900.
Alzheimer’s Foundation of America Website: http://www.alzfdn.org
Florida Law requires that any person who knows, or has reasonable cause to suspect, that a vulnerable adult has been or is being abused, neglected, or exploited shall immediately report such knowledge or suspicion to the Florida Abuse Hotline on the toll-free telephone number,
1-800-96-ABUSE (1-800-962-2873). The TDD (Telephone Device for the Deaf) number for reporting adult abuse is 1-800-955-8770.
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