Caring for Patients with Alzheimer’s Disease

Alzheimer’s disease does not form part of the common ageing process but a higher risk of experiencing this disease is more prevalent in the older population. Alzheimer’s disease emerged as a term when Dr. Alois Alzheimer reported in 1906 the condition of a fifty-five year-old woman suffering from the effects of progressive dementia, a condition that is strongly linked to old age. Edwards et al.

Due to the progressive nature of the disease, the individual with Alzheimer’s disease together with the community within which the individual belongs also becomes affected. In the latter stages of the disease, the individual may suffer dementia manifested in the disorientation of surroundings, inability to recognize family members, and lack of awareness of daily needs and wants.

Mahoney (2003) states that around four million of the American population is already suffering from Alzheimer’s disease with the number expected to multiply three-fold in 2050. The effects of the disease together with the expected increase in the population of people with Alzheimer’s disease has given importance to the enhancement of knowledge and practical experience on the part of caregivers with family members suffering from Alzheimer’s disease stressing on vigilance as a standard of care.

Family Caregivers of Individuals with Alzheimer’s Disease Alzheimer’s disease has been the subject of many studies covering its various areas from the determination of the causes and effects of this disease to the access and availability of healthcare for people with Alzheimer’s disease and then to the focus on caregivers and care giving standards.

Some studies on caregivers are continuing because of the need to collect and collate information on the importance of families caring for members with Alzheimer’s disease together with the concurrent important role of nurses and other healthcare professionals in providing family caregivers with the informative and other forms of support they need to take on the task of dealing with the effects of Alzheimer’s disease. Mahoney (2003) explains that caregiver burden emerged in studies on the caregivers of family members with Alzheimer’s disease to describe the aggregate demands and issues faced by the caregivers.

These cover the financial burden incurred by the family in caring for their family member with Alzheimer’s disease from seeking professional healthcare to continuing care at home as well as the emotional and social burdens of seeing or experiencing the symptoms of dementia such as the inability of the individual with Alzheimer’s to recognize family members or frequent disorientation. The failure of family caregivers to understand and effectively deal with these demands and issues could lead to fatigue and stress or even to psychological problems on the part of family caregivers.

This means that apart from studying the cause, effect and treatment of Alzheimer’s disease, there is also need to focus on providing multi-faceted support to family caregivers based on the underlying principle that family caregivers also need care. This implies the important role of health professionals, especially nurses that constantly deal with family caregivers to extent care to family caregivers. Care Issues of Family Caregivers

With the expected increase in the number of people with Alzheimer’s disease in the succeeding decades, it is then important to make sure of the proper care not only for the patients but for their caregivers as well. As individuals depend on them for optimum care so that keeping abreast with current care giving trends and applications covering patient care and keeping themselves less stressed and fatigued are imperative. This ensures the caregiver’s health and competence in handling Alzheimer’s disease cases and patients.

Sufficient and relevant data exist that prove the increased probability of caregivers of those with Alzheimer’s disease to experience symptoms related to depression. The financial burden, coupled by the physical and emotional turmoil of caring for elderly with Alzheimer’s may be some reasons for the increased risk of depression and health problems of caregivers. Wykle (1996) conducted an earlier study on family caregivers and recognized the extent that the Alzheimer’s disease takes its toll on the families caring for their members suffering from this disease.

While studies on the cause and cure of Alzheimer’s disease are ongoing, there is also need to conduct parallel studies on alleviating the stress and pressure on families caring for their members with Alzheimer’s disease. Based on the recognition of the increases responsibility of families in caring for members with Alzheimer’s disease, these families are calling for appropriate and effective interventions in reducing family stress and supporting caregivers managing the manifestations of dementia. After almost a decade, studies on caring for family caregivers of patients with Alzheimer’s disease continue to advance.

Vitaliano, Katon and Unutzer (2005) studied caregiver health in the context of geriatric psychiatry in the five areas of: 1) caregiver outcomes in relation to the manifestations of the link between caregiver distress and physical indices in order to determine the intervention to caregivers; 2) assessing caregiver status and condition; 3) relationship between the caregiver and the recipient of care; 4) future studies; and 5) important areas to consider in applying interventions to family caregivers.

These constitute important considerations for nurses providing support and care to family caregivers. Nursing Support for Family Caregivers Roper, Logan and Tierney (2001) developed a model for nursing care that incorporates a consideration of five factors, which are:

1) activities of living,

2) lifespan,

3) continuous relationship of dependence and independence,

4) factors affecting activities of living,

5) individuality in living experiences.

This means that throughout a person’s lifetime, a number of biological, psychological and environmental factors experienced by individuals either improve or threaten the physical, mental and emotions well-being of individuals. To prevent the threats, individuals engage in preventive activities such as being in a safe environment, communication, and having a healthy lifestyle. People go through these activities with other people, such as other family members, other families and healthcare professional, creating a continuous relationship of dependence and independence with the dependence

In relation to nursing support for family caregivers, this model suggests that nurses play the important role of supporting family caregivers especially in the stages of dependence. This means that importance of determining when the dependence stages occur, the extent of support needed by family caregivers, and the appropriate intervention to apply. To assist nurses in this task, Mahoney (2003) discuss the model of vigilance that applies to the relationship between the family caregiver and care recipient and the nurse’s relationship with the caregiver and care recipient.

By applying the concepts of watchful supervision, protective intervening, anticipating, being on duty, and being there, patients with Alzheimer’s disease will be effectively cared for by family caregivers in the same way that family caregivers will be supported by nurses and other healthcare professionals. Salient Learning on Family Caregivers of Person’s with Alzheimer’s Disease Proper orientation prior to taking on the job of caring for family members with Alzheimer’s disease is important, so is periodic evaluation and assessment of the patient’s condition and the degree of influence it has over the caregiver.

Caregivers must also allow sufficient time for leisure activities, rest and relaxation. It is also important for caregivers to be aware of the symptoms which may lead to their stress and fatigue. The symptoms they must look out for include denial, short and hot temper, anger (which may be prolonged or manifested in spurts), withdrawal from family members, friends and activities which were enjoyed previously, anxiety and agitation, sleeplessness, irritability, and exhaustion.

These symptoms, if undetected, may give rise to serious health problems or even depression later on. Nurses play an important role in facilitating understanding and stress alleviation. Important Topics for Continuous Learning Although many studies have directed focus on diagnosing and treating family caregivers of patients with Alzheimer’s disease, there are still areas that need further investigations and learning.

On the part of nurses providing support to family caregivers, the existence of healthcare infrastructures to support the recognition of the importance of supporting family caregivers through the sharing of knowledge and experience to family caregivers constitutes one important topic for learning. This is because it is common for hospitals and nursing homes not to have their own Alzheimer’s disease care unit. Nurses and other healthcare providers may be commonly assigned from one station or area to the next which may limit the expertise gained if the said people concentrate only on a particular area.

The lack of an Alzheimer’s disease unit may be due to lack of funds, hospital space, facilities, and different priorities. A possible area of learning could be the viability of establishing Alzheimer’s disease units in hospitals or nursing homes or stationing nurses in the care of Alzheimer’s patients to allow nurses to develop learning and best practices not only in treating patient’s with Alzheimer’s disease that they can use in understanding the issues of family caregivers and they can share as practical lessons to family caregivers.

Another possible area of learning could be the differences in the experiences of family caregivers, caring for family members with varying manifestations of dementia, in terms of the degree of stress and fatigue and ways they apply in care giving. Concurrently, effective practical means that caregivers apply to alleviate care giving burden such as relaxation and leisure or group support become equally important. These areas of learning constitute important consideration in the orientation, evaluation, training and development of nursing care to family caregivers to assure the best care possible given to and extended to care recipients.

Pertinent Actual and Potential Nursing Diagnoses of Family Caregivers Enough relevant and significant data are available that discusses the high risk of clinical depression and anxiety in family caregivers. The said depression and anxiety may be a result of the demanding physical and emotional work that caregivers who take care of patients with Alzheimer’s disease experience daily as part of their care routine. This may give rise to certain conditions that afflict the caregiver him/herself.

“Hidden” patient is the term used to describe nurses or caregivers who suffer from anxiety and clinical depression, coupled with health problems (Parks and Novielli, 2003). Hidden in a sense that their despair and symptoms are commonly denied, not given attention to, or altogether ignored, which may give rise to graver threats later on. Caregiver depression is a condition that family caregivers may experience. These include persistent and untreatable pains and aches, irritability, weight loss and loss of appetite, exhaustion and lack of energy, insomnia and feelings of guilt and anxiety (Vitaliano, Katon, & Unutzer, 2005).

Thus, nurses supporting caregivers should be well aware of the symptoms that may lead caregiver depression. Conclusion Due to the extent of the impact of Alzheimer’s disease to the various people, including the family of the individual suffering from the disease, other people comprising the social network of the patient, and healthcare professionals, there is need to apply collaborative learning and information sharing in order to derive optimum and comprehensive understanding of best practices on the alleviation of the care giving burden of family caregivers.

This is important since family caregivers able to handle and adjust to the care giving burden would lead to effective care outcomes for patients with Alzheimer’s disease.

References

Edwards, J. , Handy, R. , Lancaster, M. , & Turnbull, J. (Eds. ) (1998).

Alzheimer’s Disease: A Handbook for Caregivers. St. Louis, M. O. : Mosby. Mahoney, D. F. (2003).

Vigilance: Evolution and Definition for Caregivers of Family Members with Alzheimer’s Disease. Journal of Gerontological Nursing, 29, 24-30 Parks, S. M. , & Novielli, K. D. (2003).

Alzheimer’s Disease Caregivers: Hidden Patients. Clinical Geriatrics, 11(5), 14-16. Roper, N. , Logan, W. , & Tierney, A. (2001).

Roper-Logan-Tierney Model of Nursing: Based on Activities of the Living. London: Churchill Livingston. Vitaliano, P. P. , Katon, W. , & Unutzer, J. (2005).

Making the Case for Caregiver Research in Geriatric Psychiatry. American Journal of Geriatric Psychiatry, 13, 834-843. Wykle, M. L. (1996).

Interventions for Family Management of Patients with Alzheimer’s Disease. International Psychogeriatrics, 8, 109-111.