Introduction
Alzheimer’s disease is a neurodegenerative disorder that manifests with irreversible and progressive loss of memory. The disease causes memory destruction and cognitive dysfunction, and finally the ability to perform simple tasks is affected. Recently the disorder is ranked as among the leading cause of deaths in the United States after heart diseases and cancers thus making it the third leading causes of death especially in geriatrics. Alzheimer is the main cause of dementia among the old people. Dementia simply means loss of cognitive functions which involves thinking, remembering as well as reasoning, and change in behavioral abilities to carry out certain tasks hence interfering with an individual's daily life and activities. Memory loss varies in severity from mild just at the beginning of the disease to the severe stage when it has progressed further, and the person has to depend on support either from the family or health institution (Nasreddine, Phillips, Bedirian, Charbonneau, Whitehead, Collin, & Chertkow, 2005).
The causes of dementia are wide depending on different types of brain changes that took place during disease prognosis. Dementia can either be Levy body dementia or frontotemporal disorders or vascular dementia as Hughes (2011) explains. Most patients have mixed dementia, either a combination of Alzheimer’s disease or one of the types of dementia, for example, frontotemporal. Apart from memory loss and language interference, amyloid plaques and tangles in the brain are also signs of Alzheimer's disease. In addition, there is a loss of connection between the neurons in the brain. This rather impairs the transmission of messages between different parts of the brain and to other tissues and organs such as muscles (Nasreddine et al., 2005).
Changes in the brain
There are complex brain changes during the early onset of the disease and as it progresses. According to scientists, the damage to brain starts a decade ago before it proceeds to memory and thinking problems. During the preclinical stage, the person is asymptomatic, but harmful changes occur in different areas of the brain. There is excessive deposition of proteins that causes the formation of amyloid plaques in the entire brain. The deposition of these proteins disrupts the connections of the nerve cells thus neurons stop transmission of information. The damage first appears in the hippocampus, the part that deals with the formation of memories in the brain. As more nerve cells die, the adjacent parts of the brain are also affected. They begin to be atrophic and at the final stage of the Alzheimer’s, the massive damage has taken place with significant shrinkage of brain tissues (Nasreddine et al., 2005).
Signs and symptoms
The symptoms of Alzheimer's first appear in individuals at their mid-60s. Newport (2013) explains that the typical first sign is memory loss with impaired cognitive functions. Some patients have mild cognitive impairment, and these suffers more memory mishaps than their normal age but do not affect their daily life. They also experience movement difficulties and altered sense of smell. People with mild cognitive impairment have a high prevalence of developing Alzheimer’s disease (Nasreddine et al., 2005).
Other symptoms include the inability to speak complete sentences, difficulty in word -finding, visual disturbances, and impaired judgment in the early stage of the disease. In moderate Alzheimer's, the signs include wandering and getting lost, difficulty in handling money, taking longer periods than usual to finish daily work, personality and behavioral changes and repeatability of questions. While in the moderate disease, parts of the brain that control language, conscious thought, thinking and sensory nerve synthesis are damaged as Lu and Bludau (2011) argue. Memory and cognitive problems become worst, and the affected individual starts having difficulty in recognizing family members and people as a whole. He or she is unable to multitask and learn new skills. The person may experience hallucinations, paranoia, and delusions.
In the severe Alzheimer’s disease, the formed plaques and tangles from abnormal protein deposition spread widely throughout the brain. The brain tissues significantly shrink. At this stage, the person cannot communicate and depend on the caregivers who can be family members or in a living facility (Nasreddine et al., 2005).
Causes of Alzheimer’s Disease
According to Turkington and Mitchell (2010), the cause of the disease is not yet fully understood to most people but in those with early onset, genetic mutation is a significant contributor while the late stage results from complicated series of brain changes over time. The causes arise from a combination of environmental factors, lifestyle, and genetics as well as age-related factors. These age-related factors include inflammation, production of free radicals, atrophy of neurons and mitochondrial malfunctions resulting in energy insufficiency.
In genetically related causes, mutation of the apolipoprotein E (APOE) gene is the contributor of late onset of Alzheimer's. Besides, individuals with Down Syndrome are at high risk of developing Alzheimer’s disease since they have an additional copy of chromosomes 21, which has the gene that forms harmful amyloid. The host factors above genetic mutation may contribute significantly to the development of the disease. The presence diseases such as heart disorders, hypertension and metabolic problems such as diabetes and obesity have proved to increase cognitive decline. Lifestyle factors for example diet, social engagement and physical activities and use of mentality stimulating agents have been risks factors to the progression of cognitive dysfunction. Reduction of these risk factors helps to improve brain functioning (Nasreddine et al., 2005).
Treatment
Alzheimer's disease is complex and requires both supportive and pharmacological therapy. Supportive treatment targets managing the behavioral changes such as agitation, wandering and aggression as well as delaying severe symptoms of the disorder. The pharmacological regimen focuses only on maintaining normal mental functions and delaying symptoms by targeting specific genes, biomolecules, and cellular activity to reduce the underlying causes hence aid in prevention. Several drugs have been approved by Food and Drug Association to treat the symptoms of the disease thus reducing the cognitive problems. These medications include donepezil, rivastigmine, and galantamine to treat mild and moderate Alzheimer's. Donepezil has also found activity on severe disease while mematime is used for the treatment of moderate to severe Alzheimer's (Nasreddine et al., 2005).
The drugs above act by regulating neurotransmitters, the chemicals that convey information between neurons. They improve thinking, memory and communication skills and to lesser extent behavioral problems. However, these medications have limited activity as they are not effective for all patients as John (2010) explains.
Living situations of Alzheimer’s patients
Alzheimer's is sometimes called a family disease because of chronic stresses they go through watching their loved ones deteriorating thus effective treatment require a joint effort from everyone. The caregivers need to focus on their own health and get respite from caregiving routinely to sustain their well- being throughout the journey as caring for Alzheimer’s patients have greater physical and emotional challenges as well as huge financial losses. The demands of daily care are high, the shift of family roles of provision and sound decision making to take the patient to a care facility can sometimes be a cross puzzle. The family requires good tolerability skills, strong support network and to be well informed about the disease to enable them deal with difficult behavioral changes and to handle challenges that come with brain malfunctions. Dealing with severe Alzheimer's is more difficult to handle since the persons lack communication skills and lose contact with reality. They are always aggressive making it challenging to cope with other family members. More aggressive patients can cause harm to children and need to be taken to care facilities.
Taking the patient to the care facility help the family to get relieved from depression and grief associated with caring for an Alzheimer's disease person. The caregiver at the facility uses intuitive skills to deal with changes such as restlessness, anger, overreaction and paranoia. It also provides relief to family members by providing assistance care and adequate management.
Care facilities ensured maximum safety to the patient who is capable of running away from home. It creates a safe and conducive environment for both the care receiver and giver. Additionally, it ensures appropriate and effective medical care. In the care institution, patients receive medication for both Alzheimer’s and other ailments that precipitate the progression of the diseases on time as compared to when they at home. Availability of physicians in these places who understand the disease well enhances provision accurate medicines.
Role of various social workers working on management of Alzheimer’s diseases
The diagnosis of the level of dementia requires evidence- based decline in cognitive functions from a prior level of performance of certain tasks. The criteria also need that these cognitive changes are adequate to cause interference in occupational and social functions. Social workers are likely to experience challenges while working with individuals who suffer cognitive impairment. It is very important for social workers to recognize dementia, familiarize with diagnostic criteria and identify suitable work programs for the affected persons. Individuals with late stage disease need are laid off from daily tasks.
The specific roles of the social workers
When dealing with families and Alzheimer’s patients the social worker helps the patient by taking on the roles of advocator, caregiver, administrator and outreach worker as discussed below;
Roles of caregivers as social workers
Caring for individuals who suffer from Alzheimer's poses significant challenges to the caregiver and it is financially, physically and emotionally demanding. The caregiver needs to adjust to her or his new role to sustain these challenges of managing behavioral changes. The caregiver offers supportive listening skills, company, empathy, emotional and psychosocial support reducing the risk of depression (Alliance, 2006). Apart from emotional and psychosocial support, caregiver provides money for medications. In the case where the caregiver employment has been terminated, other social workers can assist in raising funds for medication and food by helping the individual. Social workers can mobilize the community to raise money as well as advocates for better health care services in conjunction with health providers.
Roles of Advocator as a social worker
Advocator intercedes for the needs, sound decisions and the rights of the Alzheimer's patient especially the older ones. The advocator engages in both political and social activities that aim at the family of the affected patients to have equal access to resources needed to meet the standard treatment and biopsychosocial requirements. An effective advocacy enables the individual and his or her family to determine their strength, objectives, and needs and to communicate these goals and preferences effectively to the decision-maker and healthcare provider. Social Advocator ensures adaptation of association policy and resources to make it easier for the provision of multicultural clients. Social Advocator works hand in hand with other services providers to facilitate the provision of high-quality medical services (Gitlin & Schulz, 2012). In addition, the advocator clearly articulates and makes sure the missions and functions of the organization that has employed the patients before complete memory loss are fulfilled.
Roles of a teacher as a social worker
Among the scopes of rehabilitation for an Alzheimer’s patients is to provide adequate knowledge and various skills to provide a safe and friendly environment for both the caregiver and the recipient. The teacher gives new learning skills and information pertaining to the behavior changes as individual with Alzheimer’s suffers massive memory loss thus have inabilities in learning and performing various duties. The teacher provides learning skills through procedural memory training, which act as a store. The procedural memory preserves the cognitive abilities and ensures learning and supports the goals of rehabilitation which include maintenance of normal function of the brain. The teacher tolerates the patient by allowing him or her to repeat a concept severally. Through repetition and daily practice, the concepts are involved in memories that can be processed automatically hence improve cognitive functions. The procedural memory training generates potential positive impacts on both functional and behavioral changes (Gitlin & Earland, 2010).
As these individuals interact with their environment more regularly but with minimum ability to remember, provision of effective surrounding cues by their teachers prompt their thinking and memory systems. The rehabilitation teacher must ensure that the environmental cues match the level of the individual's dementia to maximize the new learning skills. The knowledge provider should identify the memory capabilities systemically and standardize sets of assessments based on the performance of a particular work. The assessments achieve a score that reflects the functionality of the brain. Despite the level of cognitive impairment, understanding the capability of the person optimizes learning. Once the occupational teacher has evaluated and established functional capabilities, duties can be executed depending on his or her abilities. The following teaching techniques can also be employed to reconstitute the memory, simplification of tasks, modification of environment and repetitive practice of a skill improves ability to think and remember.
The teacher also educates other workers on effective communication skills. Use of commanding and rude voice or speaking too faster may not give the Alzheimer's patient time to internalize the information can result in agitated behaviors and increased feelings of anxiety and confusion. The most powerful technique to minimize the behavioral problems while working with an individual with Alzheimer's is employing an effective communication skill such as talking slowly and calmly and assurance. Demonstration serves as visual and tactile cues. A teacher helps the person to imitate an action and provide gentle physical assistant to the individual with dementia. This hand to hand help may relay information to the nerves enabling the person to complete the task successfully. (Gitlin & Earland, 2010).
The Roles of Social Outreach Workers
The outreach social workers are those employees who perform their duties in the field. They provide services directly to clients by going to them. The main function of mentally challenged outreach workers is to give support to these individuals. The mental health outreach workers run a wide range of services including provision of psychoeducation to those suffering from mental illnesses or for children at risk of involving in unhealthy behaviors (Skogan, 2008). The mental health social outreach workers conduct groups for individual with behavioral problems. These groups focus on the safe and sound decision- making activities or refusal skills. Good communication, determination and expression of emotions in an appropriate manner are also included in the discussion.
Apart from supportive services, outreach workers provide therapeutic care to the patients. They may pay a visit to clients with severe mental deterioration especially those in rural areas to check on their progress. During these visit, they can discuss the client's feelings and outline the improved quality of life (Skogan, 2008). Additionally, outreach workers create community awareness on mental health concerns. They can come up and implement community events to impart knowledge on Alzheimer’s disease to the public.
Roles of Administrators as social workers
The administrator is concerned with the rights and obligations of patients being given medical services in a healthcare setting. The patient rights are considered paramount. They ensure the patients’ rights are not violated. Administrators protect the rights of the Alzheimer’s patients against oppression by either the government or community as well as unfair treatment and unaccepted invasion of privacy. They also provide caring to the vulnerable groups of people such as mentally challenged patients. They ensure good relationship exist between the patients and caregiving agencies (Aroskar, 1998).
Conclusion
References
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