14.5/15

Gerontology Case Study Week 8
Kalyn Madej
Lakeview College of Nursing
N309 Nursing of the Gerontological Client
March 19, 2012

Case 17.2: Early Dementia
1.	According to the website alz.org there are seven stages of Alzheimer’s.  These stages provide a general idea of how the patients’ abilities change during the course of the disease.   After reviewing all seven of the stages the stage that Claudine is experiencing at this point would be the third stage.  This stage is referred to as mild cognitive decline.  During this stage friends, family or coworkers begin to notice some signs of difficulty in the patient.  According to the Alzheimer’s Foundation common difficulties include, noticeable problems where the patient struggles to come up with the right name or words, the patient has trouble remembering names when it comes to introducing people, there is greater difficulty performing task in social or work settings, materials that have previously been read are forgotten, the patient loses or misplaces a valuable object, and they have increasing trouble planning or organizing events.  ( Alzeimers's Association. 2012).
2.	According to the Hartford Institute for Geriatric Nursing, “Dementia is a clinical syndrome of cognitive deficits that involves both memory impairments and a disturbance in at least on other are of cognition (e.g., aphasia, apraxia, agnosia) and disturbance in executive functioning”(Fletcher,2008).  Not only does dementia cause disruptions in cognition but it also causes disruptions and changes in the patients function and behavior. The prevalence of this condition according to Hartford Institute for Geriatric Nursing is that dementia affects about 5% of people whom are 65 years and older, four to five million Americans are diagnosed with Alzheimer’s disease, 13.2 million people are suspected to be diagnosed with Alzheimer’s disease by 2050, and globally dementia is seen in about 24.3 million people and there are roughly 6 million new cases a year. (Fletcher, 2008)
3.	After conducting an internet search the three reputable websites that Claudine’s family may want to take time to look at to gain a better knowledge on Alzheimer’s disease would be the following: http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp, http://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-fact-sheet, & http://www.nlm.nih.gov/medlineplus/alzheimersdisease.html
4.	After doing some research the family finds some warning signs and behaviors. According to alz.org there are 10 warning signs and symptoms for Alzheimer’s disease. The first sign would be memory loss that disrupts the daily routine of the patient. This is one of the most common signs of Alzheimer’s, the patient normally forgets important dates, the person tends to ask for information multiple times, and they rely on the use of memory aides. (Alzheimer’s Association, 2012). The second sign would be challenges in planning or solving some problems. The patient may find it hard to come up with a plan and there maybe difficulty when working with numbers. When it comes to following recipes or keeping track of things it is not always easy and the patient has trouble concentrating. (Alzheimer’s Association, 2012). The third sign is difficulty completing tasks that are familiar in routine. These patients have trouble with familiar locations, managing budget, and remembering the rules to games. (Alzheimer’s Association, 2012). The fourth sign is considered confusion with the time or place. These patients lose track of dates and the time that has passed. These patients also may forget how they got to a particular location or where that location even is. (Alzheimer’s Association, 2012). The fifth warning sign is the patient tends to have trouble understanding visual images and spatial relationships. These patients have trouble reading, judging the distance of an object, and determining colors. In some patients they may pass a mirror and thing that someone is present in the room and not realize it is them in the mirror. (Alzheimer’s Association, 2012). The sixth sign is the patient has trouble with speaking or writing. As the signs develop these patients have a hard time joining in on conversations or have a hard time carrying on conversations. These patients may also have a hard time coming up with the right word in conversation. (Alzheimer’s Association, 2012). The seventh sign is misplacing objects and not being able to retrace their steps.  These patients may put things in strange places and lose things. When this happens the patients are unable to retrace their steps to find the items and may accuse people of stealing from them. (Alzheimer’s Association, 2012). The eighth sign is there is a decline in judgment and the patient tends to make poor decisions. These patients may make poor decisions when it comes to dealing with finances and give large sums of money away. These patients also may lose interest in grooming and keeping up with their hygiene. (Alzheimer’s Association, 2012). The ninth sign is the patients have a withdrawal from work environments and social atmospheres. These patients tend to stop participating in hobbies, social activities, work, and sports. These patients also have a hard time following sports teams and do not remember how to complete their once favorite hobbies. (Alzheimer’s Association, 2012). The tenth warning sign is a change in mood and personality. These patients tend to be confused, suspicious, depressed, fearful, and anxious. It may be seen by others that these patients may be easily upset at home or where they are out of their comfort zone. (Alzheimer’s Association, 2012). The family must take note in these warning signs because they may pertain to Claudine. 
5.	According to the Alzheimer’s association website Claudine should go visit a physician that will be able to perform numerous test to diagnose the Alzheimer’s. While reviewing the site there were no specific tests to prove that someone has Alzheimer’s. The patient may need to go to a doctor that can perform genetic testing, neurological examinations, mental status testing, and brain imaging. These tasks may most likely been performed by a neurological physician. (Alzheimer’s Association, 2012).
6.	Claudine’s family knows that there are no current medications to cure Alzheimer’s or to stop it from getting worse. They do think however the use of medications can help lessen the symptoms that Claudine is already experiencing for a limited time. Claudine’s family may choose medication to slow the loss of memory, confusion, and problems related to thinking and reasoning. According to the website www.alz.org the FDA has approved two medications, cholinesterase inhibitors and memantine, which are used to treat the cognitive symptoms of these patients with Alzheimer’s disease.  (Alzheimer’s Association, 2012).  Cholinesterase inhibitors treats early to moderate stages and is used to prevent the breakdown of acetylcholine which is a key importance in learning and memory. This medication delays the worsening of symptoms for 6 to 12 months in patients. This medication is usually well tolerated with minimum side effects such as nausea, vomiting, loss of appetite and increased frequency of bowel movements. (Alzheimer’s Association, 2012).  Memantine is used to treat for moderate to severe stages and is prescribed to improve memory, attention, reason, language and the ability to perform simple tasks. This medication can be taken alone or with other treatment methods for Alzheimer’s disease.  Memantine is a medication that delays worsening of symptoms temporarily and has some side effects such as headache, constipation, confusion, dizziness. (Alzheimer’s Association, 2012).  Vitamin E is sometimes prescribed to treat Alzheimer’s disease and should not be taken for this unless the physician has suggested it since it is not approved. At high doses vitamin E can delay loss of ability to carry out daily activities. (Alzheimer’s Association, 2012).  Claudine’s family can suspect that the doctor may prescribe both of those prescriptions and possibly high doses of vitamin E for the cognitive changes. 
7.	Respite care is used to provide the family a temporary break from the daily care giving responsibilities. Families tend to use this service so they can support and strengthen the ability to continue taking care of their loved one with Alzheimer’s in their home. There is a variety of respite care services offered to families but the most common are in-home care and adult day centers. Since the Everett family is having a dilemma deciding whether or not they should bring Claudine to the out of state wedding they may want to look into these services. The family also knows Mr. Everett has been caring for Claudine around the clock for months now it would be nice for him to have a break. The in-home care services offer a variety of services. People will come in to assist with personal care such as bathing, dressing, toileting, and exercise. They may also help with laundry, shopping, and preparing meals. There are also skilled care services to help the patients with medications and other types of medical services that may be needed. (Alzheimer’s Association, 2012).  The other service commonly used is the adult day center which the patient with Alzheimer’s is placed with others in a safe environment. The staffing at these facilities has planned activities for the patients throughout the day and these centers help the patient by supporting their strengths, abilities, and independence.  Meals and transportation to these adult day care facilities are often provided.  At this point in time the best option so that Mr. Everett can have a break would be to use the adult day care so he has time to rest. Since he is always caring for Claudine he may not have time to do anything for himself and may reach the point of total exhaustion. (Alzheimer’s Association, 2012).  
8.	Since Mr. Everett does not want to move Claudine out of their home into a facility it has caused increasing signs of stress. He is also showing that he doesn’t have any time for himself when he stated he didn’t even have time to get a haircut. The nurse may recommend an adult day care facility for Claudine. The nurse would suggest this because Mr. Everett needs to give himself a break from care giving. According to alz.org, “While your loved one is at a center, you’ll have time to rest, run errands or finish other tasks” (Alzheimer’s Association, 2012). By using this type of facility Mr. Everett will be refreshed and renewed because if he keeps going without tending to himself he will soon reach the point of exhaustion. If he reaches the point of exhaustion it will not be good for him or Claudine. 
9.	I would advise the family to consider a few questions as they are handling this issue. There are many concerns that the family is going to have when it comes to safety for a loved one with Alzheimer’s. The family will need to decide if it is safe to leave their loved one alone or if they need to have around the clock supervision. According to the National Institute of Aging, families have some questions they should ask themselves before deciding if they can leave their loved one at home for any period a time alone. There are three questions that Claudine’s family should ask themselves and they are does Claudine become confused or unpredictable when under stress? Does Claudine recognize a dangerous situation? Does Claudine know how to use the telephone in an emergency? ( National Institute of Health, 2011). There are a variety of questions that the family will want to ask themselves but those are some of the main concerns. 
10.	When considering Claudine’s safety the family may want to promote safety in their home and entryways. According to the National Institute of Health, there are a few things that the family can do.  Some of the main changes would be to prevent falls from happening. The elimination of throw rugs and mats should be done in entryways. Also applying strips or wax on hardwood and tile floors can be done to prevent falls. (National Institute of Health, 2011). Making sure that the doorways are lit will be another measure the family should look into. 
11.	When discussing the ending of his daughter’s marriage it should probably be best to avoid telling her mother Claudine. According to Lauren Batalka, a writer for the home helpers senior care service blog, “Therapeutic Fibbing is a technique often used when caring for patients who have Alzheimer’s or dementia.  Its purpose is to avoid further harm or upset and it involves telling a patient a white lie in order to prevent anxiety, emotional damage or hurt” (Batalka, 2010).  Since the divorce can potentially cause an upset and a bigger problem for Claudine, as Mary’s suggestion seems to be best. 

References
Alzheimer’s Association. (2012a). Respite care. Retrieved from 
	http://www.alz.org/living_with_alzheimers_respite_care.asp

Alzheimer’s Association. (2012b). Stages of Alzheimer’s. Retrieved from 
	http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp

Alzheimer’s Association. (2012c). Standard treatments. Retrieved from 
	http://www.alz.org/alzheimers_disease_standard_prescriptions.asp

Alzheimer’s Association (2012d). What is Alzheimer’s? Retrieved from
 http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp

Alzheimer’s Association. (2012). 10 signs of Alzheimer’s.. Retrieved from 
http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp

Alzheimer’s disease: Medline Plus. (2012). National Library of Medicine- National Institutes of 
	Health. Retrieved from http://www.nlm.nih.gov/medlineplus/alzheimersdisease.html

Batalka, L. (2010). Honesty- Not Always the Best policy When Caring for
Alzheimer’s Patients. Home helpers ensures that each caregiver is qualifies, professional and compassionate. Retrieved from 
http://www.homehelpersphilly.com/blog/bid/40822/Honesty-Not-Always-the-Best-Policy-When-Caring-for-Alzheimer-s-Patients

Fletcher, K. (2008). Nursing standard of practice protocol: Recognition and management of 
	dementia. Hartford Institue of Geriatric Nursing. Retrieved from http:// 
	consultgerirn.org/topics/dementia/want_to_know_more.asp

Home safety for people with Alzheimer’s disease National Institute on Aging. (2011). 
 Retrieved from http://www.nia.nih.gov/alzheimers/publication/home-safety-people-alzheimers-disease/general-safety-concerns

Stage, T.F., Plaques., Brain, T.H., & Communicate, B.T. (2011). Alzheimer’s fact sheet| 
National Insitute on Aging. Retrieved from http://nia.nih.gove/alzheimers/publication/alzheimers-disease-fact-sheet