Case study of a person with alzheimer’s disease

The word old brings to most people in our society an image of homeless, helpless, forlorn derelicts inhabiting park benches, slum hotels, nursing homes and other institutional ghettos. The elderly and aging population is poised to be the center of attention in the coming years since the Baby Boom generation will be retiring. Consequently, these retired individuals shall be experiencing the different problems that come with the concept of aging and that is their quality of life is disturbed as they are hampered by chronic illnesses or chronic physical pain, depression or simply just the inability to perform several activities of daily living.

(Understanding Aging as a Social Process 2005). These particular tasks must be performed well by an individual or else he or she may be classified as disabled. And this disability is the one issue that every aging person in America faces. According to Erik Erikson, each of us passes thru eight psycho-social stages in our life where we are all faced with a crisis. The last two stages in a man’s life, middle adulthood and the aging years will be carefully discussed in this reaction paper, and the life of real-life models will be revealed to verify if Erikson’s theories are right.

The elderly face the crisis of “integrity versus despair. ” This paper is based on an actual interview with an 88-year old male who is showing early signs of Alzheimer’s disease. This paper looks into the plight of the elderly population and presents the different ways they are presently treated and are seen as a kind of abuse of this sector of the population. It also hopes to start a momentum and take a conscious effort for those who are able to act for these individuals and represent them and their varying plights for a better quality of life.

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The Case of Paul, male, 88 years old with Alzheimer’s Disease Paul, who now is 88 years old, has resentments about his accomplishments. He did not finish any degree and just marries with 6 sons and daughters who are also unfulfilled like him. He has grand daughters and grand sons who live in the same neighborhood with him. He still has unfulfilled dreams and desires because of stagnation during his younger days. He would always say: “Life has been hard, that’s why.” By nature, the old man is a jolly and funny person but behind his words, you can feel a trace of sadness and frustration on how life had been hard on him. Instead of dreaming more, he would prefer to look up to younger folks who have been successful so far with their life. He would prefer telling stories about other people, cracking jokes about his friends, unable to talk much about his own accomplishments because inside him, he feels he has not achieved much in life. Alzheimer’s disease is manifesting in Paul now. He fumbles with his hands and is quite mentally incapable of being consistently coherent.

Constantly needing assurance, I help him to understand how his clothes look good on him and he beams radiantly at the compliment, eyes and face crinkling. He is forgetful now, peering into my face and asking who I am even if I am his niece. He appreciates how I talk to him so kindly. I focus on what he needs in the process, how the he seems to be coping with his life, what sort of help he is seeking, what sort of help he may need, and my ability to participate in the helping process with him, given his needs. During the time I spend with him, I managed quite well in relating with him verbally most of the time.

He had lucid moments at times but was quite conversant during other times that kept me on my feet in terms of history and other interesting topics that would often crop up during our conversation. Talking with him involved an interactive process based on certain fundamental principles in counseling and communication. The interactive process with the elderly can be based on a generic model of helping such that of Egan (1975). His model for counseling and communications includes three stages wherein the person is expected to begin with self-exploration, move to deeper levels of self-understanding and finally to develop a plan of action.

While engaging him in an active verbal conversation, he describes his past life. He forgets the name of his eldest child but that is all right. I help him differentiate the conditions of the past from conditions of the present so that a clearer understanding of attitudes and behaviors emerge. I was able to build the trust needed in this kind of session, and at the same time help the client focus on concrete concerns about which he personally must make. Then, I use that trust that has been built to get involved more potently in helping him understand himself.

I now respond not just to what he says but also to what he implies.

Mental and Emotional Condition

The mental and emotional condition of old people is a major issue in designing for the welfare of the elderly. Often, aging is associated with increased depression, loneliness and lower self-esteem as old people begin to be unable to do the usual activities they do while they were still young and strong. The need to move out of one’s home also adds to the emotional issues that the senior may be facing.

It becomes apparent that facilities and environments created specifically for the elderly should promote mental and emotional well-being, aside from addressing the general health and medical needs of these people.

Developmental Theories

According to Erik Erikson, each of us passes thru eight psycho-social stages in our life where we are all faced with a crisis. The last two stages in a man’s life, middle adulthood and the aging years will be carefully discussed in this reaction paper, and the life of real-life models will be revealed to verify if Erikson’s theories are right.

The aging years of any person are a time when he or she either feels fulfilled and satisfied, or becomes in despair: this is the age of 65 and above. Usually, those who have fulfilled their social roles satisfactorily in middle-adulthood are those who become happy and active until their last days on earth. Those who have failed with their dreams and social roles are the ones who have poor health and illnesses in their old age. During this time, an individual asks himself if he has lived well.

If he looks back with regret, it is an indication that his failures overpower his achievements. Meanwhile, Peck (1968) modified Erikson’s last stage, ego integrity, which he elaborated into two broad periods: middle age and old age. Peck subdivided each of these periods again into stages and said that these stages may occur in a different time sequence for different individuals and thus do not imply sequentiality. The theme of transcendence iterated by Peck appears in the thinking of several other life p developmental theorists.

For example, Erikson (1950, 268) says of the individual in Stage 8: “He knows that an individual life is an accidental coincidence of but one life-cycle with but one segment of history. Peck’s ego transcendence versus ego preoccupation puts it as this, ‘The constructive way of living the late years might be defined in this way: To live so generously and unselfishly that the prospect of personal death—the night of the ego, it might be called—looks and feels less important than the secure knowledge that one has built for a broader, longer future than any one ego ever could encompass.”

Nuances of the Alzheimer’s Disease

The Alzheimer’s Disease Fact Sheet of the National Institute on Aging explains in detail the Alzheimer’s Disease. It is under the Alzheimer’s Disease Education and Referral Center and defines first the word as a brain disorder that seriously makes a person unable to carry on with his activities. It then clarifies that the most common form of dementia among the elderly is Alzheimer’s disease (AD). This is a disease that involves particular portions of the brain that controls thought, memory and language.

To date, this disease is still incurable and most experts are at a loss as to what causes it. Basically, this site contain valuable information about the disease including contact persons and their telephone numbers and locations so that one can easily consult with those who are equip to handle and give advice. Clarifying further, this disease begins after age 60, increasing with age. Discovered by Dr. Alois Alzheimer, a German doctor who observed that there were changes in the tissues of an old woman who died of an unusual mental illness.

Upon closer inspection, it revealed clumps called amyloid plaques and bundles of fibers called a neurofibrillary tangle that is a sure sign of AD. (Alzheimer’s disease Fact Sheet. National Institute on Aging). The NIH Senior Health website provides links to the disease, its causes and risk factors, symptoms and diagnosis, treatments and a site on Frequently Asked Questions. The elderly and aging population in the United States is increasing ever more and such ill-effects of old age occur more often such as injuries, disabilities, emotional pain and worst-case scenario, suicide.

Without any participatory work done by the ones who are able-bodied, the elderly of America might not be as safe and as well-taken care of as they should be. Bottom line is that the quality of life of elderly people should not be compromised just because they have already finished their foremost contribution to society through hard labor. With one click, one is led to make more discoveries in the process. (NIH Senior Health). There are newer ways of spotting early symptoms of the disease from McCoy’s (2006) research.

When water molecules move throughout the brain when it is damaged, then this processes of cellular damage can cause an increase in the “apparent diffusion coefficient” which measures the amount of water in the brain. (McCoy, 2006). Friedland (2004) stated that estimates show that there will be more aging individuals requiring long-term care than people, whether family members or hired caregivers, who will take care of the senior citizens.

He added that “family caregivers need all the help they can get to provide care, including purchasing modifications to the home, purchasing labor-enhancing and labor-saving technologies, and figuring out how best to integrate caregivers into their homes” (Friedland, 2004, 2). The issue of the effectiveness of the healthcare and housing systems for those with Alzheimer’s disease is also important to consider. According to Lawler (2001), the current challenge is in the integration of housing with the health care strategies for the elderly.

She added that “most of the current inefficiencies in the delivery of aging services occur during the provision of both overcare, providing more housing or health care than required, and undercare, when inadequate service provision compounds problems and increases expense” (p. 1). To address the health needs of the aging population, the American Dietetic Association [ADA] (2000) promoted the provision of “a broad array of culturally appropriate food and nutrition services, physical activities, and health and supportive care customized to accommodate the variations within this expanding population of older adults” (p. 580). The association also asserted that “medical and supportive services, including culturally sensitive food and nutrition services that are appropriate to levels of independence, diseases, conditions, and functional ability, are key components of the continuum of care (p. 580).

Conclusion

The right kind of assessment is the cornerstone of treatment and care for those individuals afflicted with Alzheimer’s disease. Because assessment is so critical, clinicians must be certain that the models or principles that guide the data collection and analysis lead to the richest possible view, of the client as a person.

A person with Alzheimer’s disease who comes to treatment with a history of successes and failures, traumas and satisfying experiences; a person with a culture that influences values, beliefs, and norms; a person with psychological archives that have shaped the individual's personality and patterned his or her interactions; a person who lives in an environment that imposes conditions on the quality of life; a person with an enduring drive to bring order to the world, to reduce the anxiety that accompanies psychological unrest, and to experience competence in valued activities.

These dimensions of a person's life, singularly and in interaction with each other, constitute the "baggage" of the client that must be considered in the assessment process. The attempt to deal with a client's difficulties without taking stock of this larger context will probably result in ineffective treatment strategies because the clinician's understanding of the client's problems will be incomplete and the treatment plan will lack relevance.

Indeed, the aging years of any person are a time when he or she either feels fulfilled and satisfied, or becomes in despair: this is the age of 65 and above. Usually, those who have fulfilled their social roles satisfactorily in middle-adulthood are those who become happy and active until their last days on earth. Those who have failed with their dreams and social roles are the ones who have poor health and illnesses in their old age. During this time, an individual asks himself if he has lived well. If he looks back with regret, it is an indication that his failures overpower his achievements.

Elder care is significant since people over the age of 65 are usually prone to, and may be suffering from diseases, sometimes multiple diseases, and they would need to be accorded assistance somehow, although the assistance is in varying degrees. Frailty, diseases and disability are often correlated with old age.

References

1. Alzheimer’s disease. NIH Senior Health. Retrieved Nov. 7, 2006 at: http://nihseniorhealth. gov/alzheimersdisease/toc. html Erikson, E. (1950). Childhood and society. New York. Norton. Friedland, R. B.
2. Caregivers and long-term care needs in the 21st century: will public policy meet the challenge Georgetown University Long-Term Care Financing Project. McCoy, K. (2006).
3. New Technique Might Help Diagnose Alzheimer’s Disease. Retrieved Nov. 7, 2006 at: http://www. nlm. nih. gov/medlineplus/news/fullstory_39170. html Peck, R. (1968). Psychological developments in the second half of life. In B. L. Neugarten (Ed. ) Middle age and aging. Chicago: University of Chicago Press. Understanding Aging as a Social Process. (2005) Retrieved Nov. 7, 2006 at: http://www. roxbury. net/esgch1. pdf

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