Alzheimer's Disease

 

Alzheimer's disease, named for the doctor who first described the condition, Dr. Aloios Alzheimer in 1906, has an incidence rate that increases with age and affects thirty-two percent of people ages eighty-five years and older, two-thirds of those being women (Jett, 2020). The higher incidence rate in women of older ages is only because more women survive to eighty-five than men. Alzheimer's disease is a brain disease that affects a person's mental abilities and progresses in stages. According to Jett (2020), there have been advances in genetic science that have provided us with the knowledge that specific genes are related to the development of Alzheimer's disease. Symptoms start with memory loss as the stages advance. Diagnosis is often based on the decline of functioning, slow onset of symptoms, and a slow decline of mental abilities (Jett, 2020). The use of magnetic resonance imaging (MRI) can be used in combination with the changes taking place to diagnose this disease.

Alzheimer's disease is a progressive disease meaning it will continue to get worse over time. There are three phases or stages of the disease, each having various symptoms and therapies as the disease progresses. The first stage of Alzheimer's disease is considered early stage and is mild. During the early stage, the person will still function independently, maintaining the ability to live independently and continue to drive a vehicle (Alzheimer's Association, n.d.). During this early stage, the person will usually notice their memory is not the way it used to be. They may have difficulty remembering names or forgetting material they just read. It becomes more difficult for them to stay organized, and they will often misplace valuable items they usually would not lose.  Family might start noticing something is wrong. It is crucial to start financial and medical planning during this stage while the person can still help in decision-making (Alzheimer's Association, n.d.). The second stage is usually the longest stage and can last for several years. This stage is the middle stage or moderate stage. It is marked by increased confusion, the inability to tell one's history, the inability to dress according to the weather, displays of frustration and anger, loss of bladder control, loss of ability to remember the what day it is, and wandering or becoming lost in familiar places (Alzheimer's Association, n.d.). During the moderate stage, it is crucial to help the person maintain as much independence as possible (U.S. Department of Health and Human Services, n.d.).  Allowing the person simple choices to maintain at least some control in their lives is essential. Offering options like, "Do you want to wear the green shirt or the blue shirt today?" allows the person to make choices without feeling overwhelmed with too many options.  Mental cognition and being able to perform daily living activities are positively correlated (Clemmensen et al., 2020). As the disease advances, the person will start to lose the ability to dress, toilet, and groom themselves. It is important to allow the person to perform as many activities of daily living tasks as possible to help maintain the abilities. During this stage, safety can become a concern if the person wanders and gets lost. They might turn on the stove and forget to turn it off or attempt to drive a vehicle if they have access to one. Caregivers should try and seek respite when feeling fatigued. Caregiver burnout can lead to unintentional abuse or neglect of the person with Alzheimer's disease.  Reminiscence therapy has been shown to decrease the rates of depression during the moderate stage of Alzheimer's disease (Li et al., 2020). Talking about the past and remembering the positive parts of one's life can help reduce the chances of depression during the middle stage of Alzheimer's disease. The third and final stage is the late stage and is severe. During the final stage, the person will need total care for all activities of daily living. This person will need around-the-clock supervision as they will lose the ability to walk, dress, talk and even swallow. During the final stage, the family might want to seek support from hospice services and support groups. Therapeutic touch and relaxing music help the emotional wellbeing of the person with late-stage Alzheimer's disease (Alzheimer's Association, n.d.).

Local resources for families: https://www.alz.org/cnfl

24-hour helpline: 24/7 HELPLINE800.272.3900

References:

Clemmensen, F. K., Hoffmann, K., Siersma, V., Sobol, N., Beyer, N., Andersen, B. B., Vogel, A., Lolk, A., Gottrup, H., Høgh, P., Waldemar, G., Hasselbalch, S. G., & Frederiksen, K. S. (2020). The role of physical and cognitive function in daily living activities in patients with mild-to-moderate Alzheimer's disease - a cross-sectional study. BMC Geriatrics, 20(1), N.PAG. https://doi.org/10.1186/s12877-020-01926-9

Jett, K. F. (2020). Ebersole & Hess' toward healthy aging: human needs & nursing response (Tenth). Elsevier.

Li, M., Lyu, J., Zhang, Y., Gao, M., Li, R., Mao, P., Li, W., & Ma, X. (2020). Efficacy of Group Reminiscence Therapy on Cognition, Depression, Neuropsychiatric Symptoms, and Activities of Daily Living for Patients With Alzheimer Disease. Journal of Geriatric Psychiatry & Neurology, 33(5), 272–281. https://doi.org/10.1177/0891988719882099

U.S. Department of Health and Human Services. (n.d.). Alzheimer's Disease and Related Dementias. National Institute on Aging. https://www.nia.nih.gov/health/alzheimers.

 

Preparing for Role Changes When Caring for Older Adult

Most of us have an idea in our heads about how life will be as we age. We often grow up imagining who we will marry, how many children we will have, and finally, we imagine growing old with our significant other. We think about what our children will be like as they become adults, who they will marry, and how many grandchildren they will provide to us. These visions of how life will be as we age many times do not involve the idea of caring for our aging parents. We have spent our entire lives building a relationship role of being cared for by our parents. When that role becomes reversed as our parents need care for themselves, our lives can change significantly.  These changes will also involve our significant others, and it is best to start thinking about and preparing for the changes early on in our adult lives to help decrease the shock of family role changes when they occur. We want to envision the perfect life when bringing our aging parent into the household, but we should make sure to be prepared for the potential conflicts that may arise with this significant change.

One area of preparation may be the most obvious but still needs a considerable about of thought. Where will my family member's living area be? According to Jett (2020), it is best to have semiprivate living quarters that provide privacy for the older adult (p. 457). We must consider how we will obtain this space. Will someone else in the home need to sacrifice their own living space to accommodate the new member of the house? How will that person feel about the sacrifice? Will resentments arise if the person feels forced to make that change? It is imperative to have those discussions with the family before making changes to the living arrangements. There should be clear expectations about the family members' personal private space and what will be considered shared living space. Everyone's privacy should be respected, and discussions about furnishings and shared spaces should occur before the move (Jett, 2020).

Another consideration to discuss before moving an elderly parent into the home is the financial changes that will take place. There might be changes to your ability to maintain a career while simultaneously providing care to your parent, depending on the level of care needed. According to Ehrilich (2020), women are often impacted the most by workforce changes due to their often assumed role as the primary caregiver in western society (p. 1388). The family will need to consider who will leave the workforce if the need arises to provide full-time care to the elderly parent. There are often extra costs involved in caring for an elderly parent, like medical costs and living expenses. Medication costs can be thousands of dollars per month, and insurance does not always cover the costs at 100%. While many people believe that Medicare will cover their healthcare expenses, the reality is it will only cover a portion of a skilled nursing facility stay and does not cover long-term care facilities or in-home care services for the elderly parent (Ward, 2020). It is essential to discuss your parents' financial responsibilities early to prepare for the possible need for healthcare services. According to Jett (2020), having older adults pay for a share of their living expenses can help decrease financial conflict in the home (p. 457). Preparations should be made for unexpected medical expenses that may occur as aging progresses. There may be a need for outside recourses to assist in covering costs, and The National Council on Aging (n.d.) provides links to helpful resources families can apply for, including food assistance and medical coverage.

Another aspect to consider will be the parents' wishes in regards to healthcare decisions and end-of-life care. There needs to be a clear understanding of who will be responsible for healthcare and financial decisions if the parent becomes unable to make those decisions. A living will is a legal document that allows a person to have their healthcare wishes known to assist with future medical decisions made on the person's behalf. It is a good idea to have a living will, a durable medical power of attorney, and durable financial power of attorney. These powers of attorney can be different people or the same person according to the parent's choosing. A family law attorney can assist with these documents, or the family can pursue obtaining the documents through free online resources. Free Florida Living Will Forms website provides these forms for people residing in Florida. The forms can be filled out online and then printed and signed with witnesses to become legally binding. It is advised that all parties have a copy in a safe place that can be easily accessed when needed. When these forms are in place, it can decrease decision-making stress because the parent's wishes are written down. It can also reduce potential disagreements on who should be making decisions medically and financially because those roles are set in place before the need arises.

Communication and preparation are critical when preparing for significant changes in family roles. Bringing a parent into the home will require adjustments in lifestyles and planning for everyone in the house. Having discussions, making preparations, and knowing the recourses available will help make the transition less stressful for the entire family. It is vital to anticipate potential conflicts and addressing those problems before they occur.

Below are links to the resources listed above:

Click here for free Florida living will and power of attorney online forms.

Click here for caregiver resources.

Click here for older adult resources. 

References:

Ehrlich, U., Möhring, K., & Drobnič, S. (2020). What Comes after Caring? The Impact of Family Care on Women's Employment. Journal of Family Issues, 41(9), 1387–1419. https://doi.org/10.1177/0192513X19880934

Free Florida Living Will Forms: Advance Health Care Directive. Living Will Forms. (n.d.). https://livingwillforms.org/fl/.

Jett, K. F. (2020). Ebersole & Hess' toward healthy aging: human needs & nursing response (Tenth). Elsevier.

The National Council on Aging. (n.d.). https://www.ncoa.org/caregivers/money.

Ward, C. (2020). Reflections on Caring for an Aging Parent. MEDSURG Nursing, 29(1), 7–55.

Age Related Skin Changes

We can probably all remember a time when growing up was an exciting experience. I remember the excitement of finally becoming a teenager. Then it was the long-anticipated sixteenth birthday when I finally was old enough to get my driver's license. Not too much longer, and I was finally an adult and was free to do as I wanted. After the age of twenty-one, the excitement seemed to slow down a bit, and getting older felt like less of an accomplishment and more like the harassment of a ticking time clock. Now, growing older meant I needed to make sure I was meeting societal expectations of finding a career, getting married, having children. Suddenly, I am married with three children, and I have grey hairs sprouting from my head, wrinkles around my mouth, and "batwings" hanging off my arms. Looking in the mirror, sometimes I do not recognize the face I see before me. It seems like these changes happened overnight. Even though aging happens to the luckiest of us, the changes we see in our bodies can be challenging to accept. While our entire body changes as we age, we do not see the regular age-related changes to our insides when we look in the mirror. Age-related changes in the skin include losing 20% of the skin's thickness, decreased blood vessels in the skin, loss of skin elasticity, decrease in oil production, and loss of fat tissue under the skin (Jett, 2020). These regular age-related changes result in changes to the color of the skin, fragile skin that is easier to tear, slower healing wounds, dry skin, wrinkles, and more difficulty with keeping warm. The skin function is not usually the first age-related change that we notice. It is typically the change in appearance we see first. The search for skincare products that slow, stop or reverse signs of aging now begins.

The skincare company, Imadeen, has a Derma One product that claims to repair and protect the skin minimizing signs of aging (Derma One, n.d.). The product website provides links to two different retailers for product purchase, including Walgreens and Amazon. The instructions on the product website state to take two tablets daily with younger-looking skin resulting after about twelve weeks (Derma One, n.d.). This claim almost seems too good to be true. So, is it? There were only positive testimonials on the product website because they are looking to sell products. It is essential to look for other sources with a scientific backing of the claims.

According to a sixteen-week study completed on one hundred fifty-two women, there was a significant change in women's facial appearance taking the Derma One medication compared to those taking a placebo or a pill containing no medication (Stephens et al., 2016). Even though this seems like a promising study for those seeking an easy treatment for our aging skin, we need to consider the ingredients in this product and if it interferes with any dietary preferences, allergies, or other current medications. The product label states that the claims have not been evaluated by the Food and Drug Administration (Derma One, n.d.). Not having FDA approval is not uncommon for dietary supplements, sometimes confusing what is safe to take. Many people often do not mention dietary supplements when reviewing medications with their doctors, which could potentially lead to drug interactions. The product website also states fish as an ingredient, and anyone with a fish allergy or dietary preferences that exclude fish should avoid taking this product. Any nutritional supplements added to your daily routine should be discussed with your primary care doctor. According to Butcher (2018), it should not be assumed that changes to the skin are only due to the normal aging process (p.395). Your doctor can look at the skin changes and know if you need other forms of treatment. In conclusion, it is imperative to look at sources other than a product's website to determine if the product works or if it is safe to take. It is always important to seek medical advice before changing your medication routine to prevent drug to drug interactions with medications you are already taking and make sure there is not something more going on with your health that may be more than just age-related changes.

 

References:

Butcher, L. (2018). Eczematous conditions in the older person. British Journal of Community Nursing, 23(8), 395–398. https://doi.org/10.12968/bjcn.2018.23.8.395

Derma One. Imedeen. (n.d.). https://www.imedeen.us/products/derma-one/.

Jett, K. F. (2020). Ebersole & Hess' toward healthy aging: human needs & nursing response (Tenth). Elsevier.

Stephens, T. J., Sigler, M. L., Hino, P. D., Moigne, A. L., & Dispnsa, L. (2016). A Randomized, Double-blind, Placebo-controlled Clinical Trial Evaluating an Oral Anti-aging Skin Care Supplement for Treating Photodamaged Skin. Journal of Clinical & Aesthetic Dermatology, 9(4), 25–32.