Navigating Alzheimer’s Disease: A Guide for Families

QUESTION

M.E. is a 66-year-old woman who has a 2-year history of progressive forgetfulness. After a neurologic evaluation, M.E. was diagnosed as having Alzheimer disease (AD). She is no longer able to care for herself, has become increasingly depressed and paranoid, and recently started a fire in the kitchen. Her husband and children have come to the Alzheimer unit at your extended care facility to seek information about AD and discuss the possibility of placement for M.E. You assure the family that you have experience dealing with the questions and concerns of most people in their situation.

1. How would you explain AD to the family?

1. M.E.’s husband asks, “How did she get Alzheimer’s? We don’t know anyone else who has it.” How would you respond?

1. After asking the family to describe M.E.’s behavior, you determine that she is in stage 2 of Alzheimer’s three stages. Describe common signs and symptoms for each stage of the disease
2. M.E.’s daughter expresses some frustration at the number of tests M.E. had to undergo and the length of time it took someone to diagnose M.E.’s problem. What tests are likely to be performed, and how is AD diagnosed?

M.E.’s husband states, “How are you going to take care of her? She wanders around all night long. She cannot find her way to the bathroom in a house she has lived in for 43 years. She cannot be trusted to be alone anymore; she almost burnt the house down. We’re all exhausted; there are three of us, and we can’t keep up with her.” You acknowledge how exhausted they must be from trying to keep her safe. You tell the family that Alzheimer units have been created to provide a structured, safe environment.

1. Describe specific nursing interventions to place in M.E.’s plan of care that are part of National Patient Safety Goals aimed at minimizing her risk of falling.

1. M.E.’s son asks why you can only access the unit through a door that has a keypad control. He wants to know if there are violent patients on the unit. How will you respond?
2. Describe the Alzheimer-related nursing interventions related to each of the following problems: chronic confusion, inability to perform self-hygiene, disrupted sleep pattern, impaired verbal communication, and agitation.
3. M.E.’s son asks whether medications can help her AD. How would you respond?
4. What other medications might be prescribed for M.E. and why?

You try to comfort the family by telling them that the problems that they are experiencing are common. You explain that family support is a major focus of your program.

1. List four ways in which M.E.’s family might receive the support they need

ANSWER

Navigating Alzheimer’s Disease: A Guide for Families

Introduction

Dealing with Alzheimer’s disease (AD) can be challenging for both the individual affected and their families. In this essay, we will explore how to explain AD to a concerned family, address their questions, describe the stages of the disease, and provide insights into the diagnosis and nursing care for someone like M.E. Additionally, we will discuss the support available to families dealing with AD.

Explaining Alzheimer’s Disease

To explain AD to M.E.’s family, it’s essential to emphasize that AD is a progressive neurodegenerative condition that affects memory, cognition, and behavior. It results from the accumulation of abnormal proteins in the brain, leading to the death of brain cells and the disruption of neural pathways. Genetic and environmental factors play a role in its development. It’s not uncommon for families not to know anyone else with AD, as this disease varies widely in its onset and progression.

Diagnosis and Testing

To diagnose AD, a comprehensive evaluation is necessary. The process often includes neurological assessments, cognitive tests, and imaging studies (such as MRI or CT scans) to rule out other possible causes. A lumbar puncture may be used to analyze cerebrospinal fluid for biomarkers associated with AD. The diagnostic journey can be lengthy and frustrating, but it’s essential to ensure an accurate diagnosis and appropriate care.

Stages of Alzheimer’s Disease

AD is typically categorized into three stages:

Stage 1 (Mild): Common signs include memory loss, difficulty finding words, and challenges with problem-solving. M.E. may repeat herself or misplace items.
Stage 2 (Moderate): In this stage, memory and cognitive decline are more pronounced. Behavioral changes, paranoia, and agitation can occur. M.E. might require assistance with daily activities.
Stage 3 (Severe): This stage is marked by severe memory loss, inability to communicate, and the need for total assistance with personal care. M.E. may become non-verbal, wander, and experience incontinence.

Nursing Interventions

To minimize the risk of falls, M.E.’s care plan should include interventions such as clear path lighting, non-slip flooring, and monitoring devices. AD units are secured for the safety of residents, not due to violent patients, but to prevent wandering and ensure their safety.

Specific nursing interventions for common AD-related problems include using memory cues and visual aids for chronic confusion, providing step-by-step guidance for self-hygiene, establishing a consistent sleep routine, using non-verbal communication techniques, and employing calm and soothing environments to reduce agitation.

Medications for AD

While there is no cure for AD, medications like cholinesterase inhibitors (e.g., donepezil) and NMDA receptor antagonists (e.g., memantine) are often prescribed to manage symptoms and slow disease progression. Additionally, other medications may be used to address specific behavioral symptoms.

Family Support

Support for M.E.’s family is crucial. They can receive help through:

Support Groups: Local and online support groups provide a space for families to share experiences and advice.
Education: Learning more about AD can help families better understand and cope with the disease.
Respite Care: Temporary relief from caregiving responsibilities is essential for family caregivers.
Professional Counseling: Therapists and counselors can help families navigate the emotional challenges of AD.

In conclusion, dealing with AD is a complex journey that requires understanding, patience, and support. M.E.’s family can find solace in the fact that their experiences are not unique and that various resources are available to guide them through this difficult time. Collaborating with healthcare professionals and joining a supportive community can significantly ease the burdens associated with Alzheimer’s disease.