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Alzheimers Disease Heidi Czaplewski NURS 4326- Spring 2001

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Introduction Alzheimers disease (AD) is a progressive, neurodegenerative disease which currently has no cure. It is estimated to cost the United States $100 billion per year and is considered to be the third most costly disease to treat. Alzheimers attacks people in late life and if the leading cause of dementia in the elderly. It is estimated to be responsible for 60%-70% of all dementia cases (Rice, Fillit, Max, Knopman, & Lloyd, 2001). There is no known cure to the disease but it is believed to be caused by the formation of plaques and tangles in the brain. These two abnormal structures are the prime suspects in damaging and killing nerve cells. Plaques build up between nerve cells. They contain deposits of a protein called beta-amyloid. Tangles are twisted fibers of another protein called tau and they form inside dying cells. Although most people develop plaques and tangles as they get older, people with Alzheimers disease develop a lot more. The plaques and tangles develop in a predictable pattern, beginning in areas associated with learning and memory and then spread to other parts of the brain Scientists are still not positive what part the plaques and tangles play in the disease. However, most researchers believe that they somehow block communication among nerve cells and disrupt activities that are crucial to cell survival (Alzheimers Association, 2009). In the mild stage of the disease, patients exhibit symptoms of memory loss and impaired judgment. As the disease progresses, the patients lose the ability to perform activities of daily living like grooming, eating and bathing until they require constant care. Other symptoms of the disease include depression, sleep disorders and emotional disturbances. After being diagnosed with the disease, the life expectancy is nine to ten years (Rice, Fillit, Max, Knopman, & Lloyd, 2001). It is estimated that 5.3 million Americans are diagnosed with Alzheimers disease and one in eight people ages 65 and older have Alzheimers disease (13%) (Alzheimers Association,

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2009). The prevalence of AD is expected to increase 3-to 4-fold during the next 50 years as the general population and the baby boomers age, resulting in upwards of 10 million cases by the year 2050. Aging is the main factor is developing Alzheimers and the prevalence of the disease doubles every five years after age 65. Women are more likely to develop AD because they typically live longer than men. (Rice, et al., 2001). Prevalence of AD in Different Settings According to Evans, Funkenstein, Albert, Scherr, and Cook, prevalence rates of Alzheimer's disease were calculated for the community population from a sample undergoing clinical evaluation. Of those over the age of 65 years, an estimated 10.3% had probable Alzheimer's disease. This prevalence rate was strongly associated with age. Of those 65 to 74 years old, 3.0% had probable Alzheimer's disease, compared with 18.7% of those 75 to 84 years old and 47.2% of those over 85 years. Recent studies indicate that at least half of assisted living residents over age 65 have Alzheimers disease, another disease or condition that causes dementia or cognitive impairment that is probably caused by these diseases and conditions. Figures from different studies vary because of differences in the way residents with Alzheimers disease and other dementias are identified. Many assisted living residents with these conditions do not have a formal diagnosis, and assisted living staff members do not always recognize the conditions in their residents. Thus, studies that rely on diagnosis and staff reports will miss some residents with the conditions. Differences in the size of assisted living facilities included in each study also affect study findings (Alzheimers Association, 2004). After searching through Google Scholar, OVID Medline, and CINAHL, for rehabilitation care of patients with Alzheimers, I was unable to find statistics of patients in this setting. There

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were some studies done about memory rehabilitation but did not provide statistics. The evidence shows that alternative and innovative ways of memory rehabilitation for Alzheimer's patients can indeed be clinically effective or pragmatically useful with a great potential for use within the new culture of a more graded and proactive type of Alzheimer's disease care (DeVrees, Neri, Fioravanti, Belloi, & Zanetti, 2001) According to the Center for Disease Control and Prevention, the number of residents in a long term nursing home setting in the United States with Alzheimers in 2004 was 231,900. Residents diagnosed with Alzheimers comprise 15.5% of the total nursing home population (Centers for Disease Control and Prevention, 2010). After searching on Google Scholar, OVID Medline, and CINAHL for statistics about Alzheimers disease in a hospital setting, it was difficult to find specific statistics about this topic. Patients spend some time in the hospital to get a diagnosis of AD and for medication consultations. Although AD patients are often hospitalized, the hospitalization is not directly because of the AD. It is because of secondary factors such as falls, dehydration, and malnutrition so there were not statistics directly describing Alzheimers in the hospital. Alzheimers disease in the Community As stated earlier, Alzheimers disease is more prevalent than previously estimated in the community setting and the number of cases will just continue to rise as the baby boomers become older and life expectancy continues to rise if there is not a cure found. A reason that Alzheimers is a problem in community dwelling setting is because AD increase the risk for falls and is twice as common in those with AD than those without. There is some evidence that deficits in vision, peripheral sensation, strength, reaction time, and balance

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may be partly responsible for the increased risk (Lorbach, Webster, Menz, Wittwer, & Merory, 2007). The increased fall risk for these patients poses a safety threat. Since these patients are living in their homes, they are not always with someone who can help them. If they were to fall when alone, they may not be able to call for help which can lead to more serious injuries or death. In 2007, over 18,000 older adults died from unintentional fall injuries (Centers for Disease Control and Prevention, 2010). The high cost of care for patients with AD is another problem that occurs when in the community setting. Informal caregivers provide the majority of care for patients with AD that live in the community. As the patients become progressively less capable of self care over time and rely on others to manage and supervise basic mental and physical tasks, informal care becomes more and more time consuming. Eventually, these patients will reach a level of disability that requires constant supervision and care. Estimates of informal care giving hours that patients receive range from 13 to 107 hours per week, with associated costs of between $2,019 and $19,699 per year. This can vary depending on the stage of the AD and the level of care required (Zhu, Scarmeas, Torgan, Albert, & Brandt, 2006). This increased demand usually falls on family members or spouses of the person with AD. This can cause the care giver to become overwhelmed because many of these people are untrained in what to expect and how to take care of someone with AD as the disease progresses. A 63% greater risk for mortality was found among unpaid caregivers who characterized themselves as being emotionally or mentally strained by their role verses non caregivers (Mauk, 2010). Care giver burden is a problem also because it can lead to abuse or neglect of the patient with AD when the care giver becomes too overwhelmed.

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Alzheimers disease in Long Term Care Many people with AD will end up a long term care facility such as a nursing home when their disease progresses into the later stages or when the burden becomes too much for the family to bear. In the long term care setting, patients receive around the clock with licensed nursing staff. As stated earlier, residents with AD comprise 15.5% of nursing home populations and as this number rises in the future as is projected, this will lead to increases in needed resources. There will be an increased demand for long term care facilities, increased number of staff, and also specific dementia-care training of physicians, nurses, social workers, and other health care providers working in these settings (Alzheimers Association, 2009). In the long term care setting there has been a movement to provide special care units for Alzheimers patients from the early to the late stages of the disease. These units provide benefits such as consistent and educated caregivers with whom the residents and their families will be familiar, a safe and controlled environment, modified surroundings to accommodate wandering behaviors, and nursing care 24 hours a day (Mauk, 2010). Treatment of Alzheimers Disease . Because the exact cause of AD is unknown, it is difficult to treat this disease. There is

currently no known cure but research continues in pharmacology, nonpharmacology, and the use of stem cells to manage symptoms to eradicate this disease. There are several medications such as Aricept, Namenda, Razadyne, and Exelon that may help symptoms such as memory, but they do not slow the course of the disease (Mauk, 2010). Nursing care of AD focuses on symptom management, particularly in the areas of behavior, safety, nutrition, and hygiene. Behavioral issues such as wandering and outburst pose a

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constant challenge in both the community and long term setting. Patients with AD can easily become agitated and respond violently towards others around them. In the long term setting this is a problem because the patient with AD could harm another resident that cannot protect themselves or a staff member. In the community this is a problem because family member could get hurt and if they are not educated on how to handle this behavior, they may get physical with the AD patient so managing these symptoms is an important nursing function. Behavior management can be done with medications, supervision, redirection, or relaxation methods. This is also an area where the specialized care units are helpful. Another important aspect of care of AD is caring for the caregivers. Support from care givers is a key factor in the community care of people with AD, but the role of the caregiver can be detrimental to the physical, mental, and financial health of a person giving care. Caregivers of persons with AD would benefit from training in how to cope with behaviors that arise in the patients and how to cope with practical and legal issues that may also occur. Research has shown that ongoing skills are needed by family caregivers to deal the progressive decline caused by AD. These included skills like time management, maximizing resources, and managing changing behavior to successfully manage the home care of their loved one. Research suggests that nurses should focus a good deal of time on educating caregivers of persons with AD to help them cope with the long and progressive course of the disease (Mauk, 2010). Conclusion Alzheimers disease is a serious and growing problem in health care practice. In the next 50 years as the baby boomers grow older, the prevalence is projected to double or even triple

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which will cause a huge strain on health care resources. Research needs to continue to be done to find the cause and cure of this disease.

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References Alzheimer's Association, Initials. (2004, October). People with alzheimer's disease and dementia in assisted living. Retrieved from http://www.alz.org/national/documents/prevalence_Alz_assist.pdf Alzheimer's Association (2009, July 30). Daily care. Retrieved on October 26, 2009, from http://www.alz.org/living_with_alzheimers_daily_care.asp Centers for Disease Control adn Prevention, Initials. (2010, December 8). Falls among older adults: an overview. Retrieved from http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html

Centers for Disease Control and Prevention, Initials. (2010, April 15). Alzheimer's disease. Retrieved from http://www.cdc.gov/nchs/fastats/alzheimr.htm DeVrees, L., Neri, M., Fioravanti, M., Belloi, L., & Zanetti, O. (2001). Memory rehabilitation in alzheimer's disease: A review of progress. International Journal of Geriatric Psychiatry, 16(8), 794-809.review of progress.

Evans, D.A., Funkenstein, H.H., Albert, M.S., Scherr, P.A., & Cook, N.R. (2011). Prevalence of alzheimer's disease in a community population of older people. The Journal of the American Medical Association, 262(18), 2551-2556. Lorbach, E.R., Webster, K.E., Menz, H.B., Wittwer, J.E., & Merory, J.R. (2007). Physiological fall risks in older people with alzheimer's disease . Dementia and Geriatric Cognitive Disorders, 24(4), 260-265. Mauk, K.L. (2010). Gerotological nursing: competencies for care. St. Louis, MI: Jones and Bartlett Publishers. Rice, D.P., Fillit, H.M., Max, W., Knopman, D.S., & Lloyd, J.R. (2001). Prevalence, costs, and treatment of Alzheimer's disease and related dementia: A managed care perspective. The American Journal of Managed Care, 7(8), 809-818. Zhu, C.W., Scarmeas, N., Torgan, R., Albert, M., & Brandt, J. (2006). Clinical characteristics and longitudinal changes of informal cost of alzheimer's disease in the community. Journal of the American Geriatrics Society, 54(10), 1596-1602.

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