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Alzheimer’s Disease: A New Perspective Towards Care

Submitted by on April 27, 2017 – 4:46 PM

ad“Every few months, I sense that another piece of me is missing. My life… myself… is falling apart. I can only think half-thoughts now. Someday I may wake up and not think at all.”
From—A Loss of Self

 

Being chronic and disabling ailments, neurodegenerative diseases present a glaring challenge for healthcare professionals [1], wherein the requirement of enduring, sympathetic and vigilant care becomes priority. It has been estimated that in 2030, the neurodegenerative diseases will toll up to 62% [2]. However, among neurodegenerative diseases, Alzheimer’s disease specifically shows a major drift of incidence and prevalence.

 

While current estimated global prevalence of Alzheimer’s disease is 24 million with an average of 360,000 cases being reported per year [3], estimations have also noted that frequencies are predicted to double every 20 years until 2040 [4], so it is evident that its care, management and prevention entail labor. Alzheimer’s disease is characterized by progressive cognitive decline such that foremost strain is on memory, which is termed as ‘dementia’ and ultimately leads to ADL dependence [4].

 

Since progressive decline is concerned, it is quite evident that healthcare professionals play a prominent role in care and management. NIH [5] has previously classified symptoms in AD patients into three categories i.e. changes in communication skills, personality and behavioral alterations, and alterations in sexual and intimate relationships.

 

Alteration in communication skills: Since Alzheimer’s disease is characterized by dementia, these patients typically struggle to acquire words and convey their meanings in terms of communication. Moreover, relentless concentration [6], thought blocking [6], frustration and anger [6], sensitivity to loudness [5], and susceptibility to distraction due to external stimuli are their common inadequacies [5].

 

Nursing considerations that becomes significant include; firstly, that a nurse should be a tolerant and calm listener because these patients have a scarcity of appropriate words to fit in their sentence and are often unable to organize their thoughts. Furthermore, it is imperative that simple, clear and easy-to-grasp instructions should be used so that patients’ self-integrity remains intact, which consequently helps in avoiding the feeling of frustration [6].

 

It is also notable that calling the patient with their name is crucial, as it helps the patient recall their identity persistently. Avoiding long conversations is also important since these patients have a problem with insistent concentration. Besides the nurse’s language, body language is also an integral aspect of communication so genuineness in the nurse’s attitude plays a vital role; it shouldn’t exhibit a sense of the nurse feeling obligated.

 

Nonverbal communication in the form of tactile stimuli, such as hugs and hand pats, are generally inferred as signs of affection and care that promotes the sense of security of the patient. However, this act of care should be exhibited as a professional gesture.

 

Alteration in personality and behavior: Personality and behavioral alternations are a reflection of a person’s identity. Patients with Alzheimer’s disease may express the following behaviors and personality changes: feelings of helplessness, feelings of insecurity, anxiety, loss of interest, anger and aggression, paranoia, wandering, pacing, decreased self-confidence, etc. Coping with these feelings is an essential element in the management of their illness.

 

Few basic attempts are crucial in managing behavior and personality alteration; the environment should be kept familiar and unchanged so that feelings of helplessness and anxiety can be avoided. When caring for these patients, by principle the patient should kept involved throughout i.e. while planning a routine activity for the patient. It becomes decisive that scheduling should include the patient’s opinion and decisions. A prominent clock and calendar should be visible in the room to retain the patient’s orientation of time.

 

Furthermore, their room should include family belongings that increases patient’s orientation towards people. These thorough orientations can help in decreasing the patient’s loneliness, insecurity and paranoia that may otherwise emanate in the form of aggression. To settle the patient’s aggression, distraction techniques can be stimulated though motivating methods.

 

Distraction should be promoted by music, dancing, singing and other such activities; it is suitable that energy-consuming and extensive activities should be planned so as to keep the patient engaged and replace the patient’s isolation with involvement. More importantly, it is essential that argument with the patient should be avoided as it further enhances the patient’s aggression and disagreement.

 

Humor is an additional source of promoting affability. As mentioned above, pacing and wandering are aspects of regular behavior in these patients. Hence, it is important to ensure that a safe place is available for pacing and that the patient has access to comfortable and sturdy shoes to avoid foot issues. More significantly, giving them snacks and plenty of water/drinks is an indispensable factor to refill the energy consumed by pacing and wandering.

 

AD patients also suffer from sleep-related problems, so some sleep-promoting interventions are vital. Endorsing bedtime routine such as reading and dairy writing can provide a calm, quiet and sleep-promoting environment, which is an essential requirement. Hallucinations and delusions are also common behavior observed in these patients, for which interventions are crucial.

 

Apart from this, few other interventions are also necessary to manage hallucinations and delusions. The foremost requirement is to avoid contention with patient, to ensure the patient’s security and safety, and to practice distraction techniques in order to overcome these hallucinations and delusions. Moreover, since paranoia has been linked with memory loss, trust and rapport is central while dealing with this manifestation.

 

In the context of alterations in intimacy and sexual relationships, the wife of an Alzheimer’s patient once stated, “I finally figured out that it’s me who has to change. I can’t expect my husband to change.”

 

It is important to understand that Alzheimer’s patients cannot be expected to bring about a change in themselves; it is the caregivers, intimate partners and family members who must change. Firstly, they must always make the patient realize that they are cared for and loved. Their sense of security and safety has to be solidified. The patient and their partner should be recommended for relationship counseling so as to embolden the positivity of the relationship and incited to enroll in support groups so as to promote encouragement and reinforcement.

 

References:

 

  1. Saba L. 2014. Imaging in neurodegenerative disorders. Oxford University Press.
  2. Lee, A. (2009). Global Burden of Neurological Disorders.
  3. Cummings J, Cole G. 2002. Alzheimer Disease. American Medical Association, VOL 287(No. 18), 2335-37.
  4. Mayeux R, Stern Y. 2012. Epidemiology of Alzheimer Disease. Cold Spring Harbor Perspectives In Medicine, 2(8), a006239-a006239. doi:10.1101/cshperspect.a006239
  5. NIH, N. (2015). Caring for a Person with Alzheimer’s Disease. Nia.nih.gov. Retrieved from: http://www.nia.nih.gov/sites/default/files/caring_for_a_person_with_alzheimers_disease  0.pdf
  6. Brunner, L., Suddarth, D., &Smeltzer, S. (2008). Brunner & Suddarth’s textbook of medical-surgical nursing. Philadelphia: Lippincott Williams & Wilkins.

 

 

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