Alzheimers and Elderly Care

Alzheimer's disease is seen often in elderly care and is the term used to describe a dementing disorder marked by certain brain changes, regardless of the age of onset. It is not a normal part of aging--it is not something that inevitably happens in later life.

Rather, it is one of the dementing disorders, a group of brain diseases that lead to the loss of mental and physical functions. The disorder, whose cause is unknown, affects a small but significant percentage of older Americans. A very small minority of Alzheimers patients are under 50 years of age. Most are over 65.

Alzheimers disease is the exception, rather than the rule, in old age. Only 5 to 6 percent of older people are afflicted by Alzheimer's disease or a related dementia--but this means approximately 3 to 4 million Americans have one of these debilitating disorders.

Research indicates that 1 percent of the population aged 65-74 has severe dementia, increasing to 7 percent of those aged 75-84 and to 25 percent of those 85 or older.

At least half the people in U.S. nursing homes and elderly care facilities have Alzheimers disease or a related disorder; in 1985, the annual cost of caring for individuals with Alzheimers disease and related dementias in institutional and community settings was estimated between $24 billion and $48 billion for direct costs alone and is probably higher today.

As our population ages and the number of Alzheimer patients increases, costs of care will rise as well.

Who Gets Alzheimer's disease?

The main risk factor for Alzheimers disease is increased age. The rates of the disease increase markedly with advancing age, with 25 percent of people over 85 suffering from Alzheimers or other severe dementia.

Some investigators, describing a family pattern of Alzheimers disease, suggest that in some cases heredity may influence its development. A genetic basis has been identified through the discovery of several genetic markers on chromosomes 21 and 14 for a small subgroup of families in which the disease has frequently occurred at relatively early ages (beginning before age 50).

Some evidence points to chromosome 19 as implicated in certain other families that have frequently had the disease develop at later ages.

At the same time, data indicate that the likelihood that a close relative (sibling, child, or parent) of an afflicted individual will develop Alzheimers disease is low. In most cases, such an individual's risk is only slightly higher than that of someone in the general population, where the lifetime risk is below 1 percent.

And, of course, many disorders have a genetic potential that is never expressed--that is, despite being at risk for a certain illness, one might go through life without ever developing any symptom of the disease. What to Look for in Earlier Stages of Alzheimers Disease

• Inability to remember names, birthdays, or details of any sort.
• Sitting on the sidelines during conversations, answering politely but vaguely if spoken to, but never engaging meaningfully.

The onset of Alzheimers disease is usually very slow and gradual, seldom occurring before age 65. Over time, however, it follows a progressively more serious course.

Among the symptoms that typically develop, none is unique to Alzheimers disease at its various stages. It is therefore essential for suspicious changes to be thoroughly evaluated before they become inappropriately or negligently labeled Alzheimer's disease.

Problems of memory, particularly recent or short-term memory, are common early in the course of the disease. For example, the individual may not recall which of the morning's medicines were taken. Mild personality changes, such as less spontaneity or a sense of apathy and a tendency to withdraw from social interactions, may occur early in the illness.

As the disease progresses, problems in abstract thinking or in intellectual functioning develop. The individual may begin to have trouble understanding what s/he is reading. Further disturbances in behavior and appearance often seen in elderly care and skilled nursing facilities are agitation, irritability, quarrelsomeness, and diminishing ability to dress appropriately.

Later in the course of the disorder, the affected individuals may become confused or disoriented about what month or year it is and be unable to describe accurately where they live or to name correctly a place being visited.

Eventually they may wander, be unable to engage in conversation, seem inattentive and erratic in mood, appear uncooperative, lose bladder and bowel control, and, in extreme cases, become totally incapable of caring for themselves if the final stage is reached.

Death then follows, perhaps from pneumonia or some other problem that occurs in severely deteriorated states of health. The average course of the disease from the time it is recognized to death is about 6 to 8 years, but it may range from under 2 to over 20 years.

Those who develop the disorder later in life may die from other illnesses (such as heart disease) before Alzheimers disease reaches its final and most serious stage.

Though the changes just described represent the general range of symptoms for Alzheimers disease, the specific problems, along with the rate and severity of decline, can vary considerably with different individuals.

Indeed, elderly care professionals must remember that most persons with Alzheimers disease can function at a reasonable level far into the course of the disorder.

Moreover, throughout much of the course of the illness residents maintain the capacity for giving and receiving love, for sharing warm interpersonal relationships, and for participating in a variety of meaningful activities with family and friends.

A resident with Alzheimers disease may no longer be able to do math, but still be able to read a magazine with pleasure. Playing the piano might become too stressful in the face of increasing mistakes, but singing along with others may still be satisfying. The chess board may have to be put away, but one may still be able to play tennis.

Thus, despite the many exasperating moments in the lives of Alzheimer residents and their families, many opportunities remain for positive interactions. Challenge, frustration, closeness, anger, warmth, sadness, and satisfaction may all be experienced by those elderly care workers who work to help the resident with Alzheimers disease cope as well as possible with the disease.

The reaction of an individual to the illness--his or her capacity to cope with it--also varies and may depend on such factors as lifelong personality patterns and the nature and severity of stress in the immediate environment.

Depression, severe uneasiness, and paranoia or delusions may accompany or result from the disease, but they can often be alleviated by appropriate treatments.

The elderly care worker must remember that although there is no cure for Alzheimers disease, pharmacological and psychological treatments are available to alleviate many of the symptoms that cause suffering.