?The chosen mental health condition to be discussed in this essay is Alzheimer’s Disease, this is a disease which is highly relevant in society today. This essay will begin with a brief definition of the condition including signs and symptoms sufferers will endure , it will then follow on to identify how this condition can effect caregivers and families of sufferers also. It will also look at key issues concerning the condition such as key policies involved, treatment/ prevention plans and the epidemiology of Alzheimer’s disease.
Alzheimer’s disease is a form of Dementia a term which is used to describe cognitive and intellectual deterioration (Gelder, et al, 2012, pg333-337); it has been chosen for this essay specifically as it is the most common type of Dementia which service users suffer from (Blennow, 2006). Alzheimer’s is a physical disease affecting the brain which over time alters a person’s memory, thinking and behaviour severely causing difficulties with everyday living (NICE) causing them to .
It is a disease which continues to damage different areas of the brain causing symptoms to become more aware and serious to an individual’s everyday living as suffers may begin to develop different behaviour manifestation such as aphasia, sleeping difficulties and wandering. It was first described by the German neurologist Alois Alzheimer in 1950 (Khachaturian, 2007). Alzheimer’s cannot be definitely confirmed in a service user until an autopsy is carried out after their death there are a number of signs and symptoms which may lead to a person being diagnosed with the disease.
Alzheimer not only effects the individual but also their family and care givers. When a service user suffers from Alzheimer’s disease there are several signs and symptom which may begin to present themselves, these include cognitive and functional impairments (Gelder, et al, 2012), neuropsychiatric symptoms and other behavioural manifestations. It is important to remember that rates of which symptoms get worse can differ between different people.
Although the signs can be broken down into 7 stages it also possible to assess the severity of an individual’s Alzheimer’s by categorising symptoms into mild, moderate and severe stages according to The Alzheimer’s Society(2013. Stages can vary from mild, moderate and severe. The three stages of the Alzheimer’s disease model are known as Mild/Early , Moderate/Middle and Severe/Late. The severity of these signs and symptom can differ between individuals and can also develop at different levels as the disease progresses. (Reitz, 2011).
This can make it difficult to notice early on. According to Gelder, et al , (2012) the most common signs and symptoms of Alzheimer’s disease can be categorised into two, cognitive and behavioural. The cognitive symptoms can include impaired thinking and memory, disorientation and confusion, as well as problems with reasoning and thinking. Behavioural signs and symptoms can include difficulties with performing basic everyday tasks, agitation, delusions, depression, hallucinations, changes in sleeping patterns and wandering.
In earlier stages of the condition sufferers may begin to have minor memory loss , at the middle stage, sufferers can begin to have difficulties carrying out everyday tasks and become very forgetful at this stage symptoms become more obvious( Gelder, et al , 2012). . At the severe stage individuals do not have the ability to carry out simple everyday tasks as well as being dependant on others for this. The individual will be unable to speak logically and can begin to suffer from malnutrition and dehydration as a lack of an ability to feed them self or to even remember to eat and drink.
Individuals at this stage can become incontinent and will need help with going to the toilet and general movement(Burns & Lliffe ,2009). . At this stage death can occur as individuals may forget how to swallow and tend to personal hygiene which may lead to infections(Pinel, 2009). They are unable to interact properly with their environment, to speak properly and to move normally as muscles grow rigid and maybe confined to a wheelchair or bed causing them to be vulnerable to infections, malnutrition and dangerous situation( Gelder, et al , 2012).
It is essential that healthcare professionals are able to distinguish the signs and symptoms of Alzheimer’s in order to help individuals get diagnosed as soon as possible in order to start treatment.. Alzheimer’s cannot be definitely confirmed in a service user until an autopsy is carried out after their death, these signs and symptoms can help to diagnose a service user with Alzheimer disease (National Institute of Aging, 2012).
According to WHO, ICD-10(1992) in order for a clinician to diagnose an individual with Alzheimer’s disease there are certain guidelines which must be followed first, for example there must be a “presence of dementia”, in the individual and also an “absence of clinical evidence or special findings” which may suggest other conditions are present which may effects an individuals cognitive functioning. Although there are no specific tests it is essential other conditions are ruled out in order to avoid misdiagnosis(Pinel, 2009)..
Conditions such as depression and thyroid problem can present dementia/Alzheimer’s disease like symptoms too (Wilkinson ,2006) . Service users may be referred to specialist clinicians who may carry out additional tests and physical examinations in order to assess the service users, this will then allow care and treatment plans to be created in order for the service user to seek out the relevant advice and support in order to cater to the change the disorder will cause.
Before any treatment is commenced it essential that in accordance with the NMC code (2008) consent is obtained, as Alzheimer is a cognitive impairment many service users will lack capacity to make decisions and therefore decisions can be made on behalf of the service user by the appropriate person for this the Mental Capacity Act (2005) should be followed. If a service user is not capable of making their own decisions together care giver, families and Doctors can agree on a treatment/ intervention deem more appropriate for the service user.
Although there is no cure for Alzheimer disease (NICE, 2011) there are a number of different treatments available to service users. Service users suffering from Alzheimer disease are usually treated using both pharmacological and non-pharmacological therapies (Voisin and Vellas , 2009) in order to cope with memory loss, behaviour change and changes in sleeping behaviour.
Although there is still no cure a number of medications have been known to help reduce the symptoms as well as slow down the progression of the disease(Voisin and Vellas , 2009), these drugs are administered in accordance to the National Institute for Health and Clinical Excellence standards (NICE,2011). In accordance with the NICE (2011) recommendations , medications such as Donepezil, Galantamine and Rivastigmine can be prescribed for sufferers of Alzheimer’s disease in order to help the symptoms of Alzheimer’s, although these medication can be prescribed Wilkinson (2005).
Argues they do not work for all sufferers of Alzheimer’s disease and can only be prescribed depending on how severe the service users Alzheimer’s is, these medications are usually prescribed for service users who are in the mild to moderate stages of Alzheimer’s whilst medications such as Memantine can be prescribe for service users who are at the moderate and severe stages Rountree, et al, 2013). It is essential that before any medication is prescribed consent is obtained from either the sufferer or their family/carers. Although they can be very effect it is essential suffers are constantly watched and given the appropriate doses.
“Drug treatment should be continued only as long as it is having a worthwhile effect on cognitive, global, functional or behavioural symptoms. ”(Rountree, et al, 2013) There are also many service users who look to alternative treatments such as herbal remedies and dietary supplements, although some of these service users claims success with these treatments they have not be researched enough to be classified by governing bodies. Both effectiveness and safety have been questioned. (National Institute on Aging. 2013).
There are also other treatment plans which do not include medication or drugs but therapies. Although some service users suffering Alzheimer’s choose other treatment sources there are studies to show the effectiveness of service users treated pharmacologically according to Wilkinson, (2005), he suggests that treatments that are completed and continued can help delay the need for 24hr care. Although cognitive impairment cannot be repaired service users who are seeking treatment using medication are benefiting more.
As well as effectiveness according to Rountree ,et al, (2013) treatments used for Alzheimer’s are under much scrutiny this is due to the cost of medications in relation to the effectiveness of the drugs although studies by Wilkinson(2006) refutes this research and clinical trials are still on-going. According to the Alzheimer’s society(2013) there is no one reason for Alzheimer’s disease and life expectancy is not so high although with new treatments life expectancy can reach up to 7-10 years after being diagnosed (Zanetti, et al , 2009).
According to research carried out by Reitz, et al, (2011)there a number of key factors that can may contribute to the progress and development of Alzheimer’s, factors such as blood pressure, cerebrovascular- disease, type 2 diabetes, body weight, smoking and traumatic brain injury have been known to be great risk factors as well as factors such as genetics, environment and age (Burns & Lliffe, 2009).. It has been identified that Alzheimers can progress without signs for years before becoming evident to healthcare professionals or others.
Evidently age plays a huge factor in terms of Alzheimer’s disease although it generally affects people over the ages of 65 ( Rountree, et al, 2013) some sufferers can be much younger than this whilst people who are over 80 years of age are thought to have a one in six chance of developing the condition (National Institute on Aging. 2013). Genetics also play a role as research shows Alzheimer’s can be inherited by a single gene.
Alzheimer’s can be prevented by keeping the mind and body healthy, by socialising, reading books, writing and involving self in activities etc. As well as affecting service users Alzheimer’s can also affect their families and care givers too. As Alzheimer’s develops in a service user their lifestyle and daily living will change dramatically causing resulting in more dependence on family and care givers. It is common for family and relatives to become care givers as well as healthcare professional to offer support and care.
Service users have to make changes in order to suit their disorder such as driving, simple daily tasks, accommodation, social activities, social relationships and medication as symptoms of Alzheimer’s can seriously alter their ability. Service users’ ability to carry out simple daily tasks such as cooking, eating and ability to care for them self begin to decrease as well as possibly developing additional problems such as incontinence and wandering as the disease progresses.
Due to this service users suffering from Alzheimer’s disease can begin to suffer from weight loss, malnutrition and dehydration if not looked after properly due to their cognitive impairments such as memory loss they can forget to eat and drink. Depending on where they are accommodated service user can begin to suffer from problems such as pressure ulcers from being kept in bed all day as well as immobility, becoming mute and infections .
Families and care givers of service users suffering from Alzheimer may have much difficulty when caring for a service user and therefore will require a lot of support for themselves, whether this may be physical, emotional and financial support as it can prove to be quite difficult but still essential their needs are also met too in order to provide better service. It is vital that care givers still treat service users suffering from Alzheimer with respect, dignity and kindness. The Social Care Institute for Excellence, (2006) provides an e-learning module in order to educate people on dementia.
Although some families and service users opt for respite care, some people still choose to stay in their homes or be looked after by family members and this is why it is necessary to have relevant understanding in order to keep the individual safe. As a care giver of an individual suffering from Alzheimer’s disease it is vital that their dignity is respected at all times by still treating them with respect and allowing them to make choices . Looking after an individual who is suffering from Alzheimer’s can cause great stress as it not only can emotionally and physically draining but also financially draining too.
When communicating an individual suffering from Alzheimer’s it is essential to remember that as Alzheimer’s is a cognitive impairment their communication will become significantly reduced (Burns & Lliffe ,2009). According to (Gelder, et al, 2012)some individuals may be able to make certain noises and sounds but at severe stages will have a lack of effective communication, whilst individuals in the earlier stage will have better communication but may have loss of understanding or talking languages other than their first language.
It is essential that people who are in contact with sufferers are not only patient but understanding too . As Alzheimer’s begins to develop in an individual communication significantly reduces, how significantly can depend on the individual sufferer themselves. Individuals suffering Alzheimer’s can often become very repetitive and forget conversation had within minutes as well as symptoms noted above.
When communicating with an individual who suffers from Alzheimer’s disease it is vital not only be supportive but to also be empowering (Alzheimer’s Society). At different stages of Alzheimer’s disease different types of communication is necessary nurses and other professionals of the multi-disciplinary team must consider their volume, pitch, rate of speech, tone of voice conversational cues and choices of word (McCabe and Timmins ,2006) in order to effectively communicate with service users as well as keeping a therapeutic relationship.
It is essential nurses as well as other professionals of the multi-disciplinary team are able to communicate as Morris and Morris (2010) argues the quality of patients and nurses relationship is influenced by the way each which both the service user and nurse communicates with each other as well as being at the core of professional practice (Jootun and McGhee, 2011).