Hypothesis statement
There are many ailments that are often associated with old age. Reduced immunity and other factors lead to the susceptibility to diseases at old age because of increased risk factors. One of the most ailments in people of advanced age is Alzheimer’s disease. Alzheimer is the most common form of dementia which is a term that denotes sets of symptoms that causes problems in intellectual abilities coupled with memory loss, language, thinking and disorientation, lack of motivation, mood swings, and problem-solving abilities. In some cases, some behavioral issues can be observed in a person who is reporting symptoms of this disease.
The most common feature that characterized this disease is difficulty in remembering recent events and the lack of ability to perform simple tasks that the person was able to do (Brill 2005). As the condition progresses, the patient tends to withdraw from family, friends, colleagues and the society in general and at this time, the patient may lose control over some bodily function which eventually leads to death. Some patients even forget the important people in their lives like family members and friends and at this time they develop dramatic personality changes.
It is estimated that 60% to 80% of dementia cases are attributed to Alzheimer’s disease. The disease progresses in a gradual manner, and it mostly destroys essential mental functions as well as memory loss. These interferences often affect a person’s daily life and lower the quality of life and the way they perform their duties or the way they relate to their family or colleagues. The disease is not considered the normal part of aging despite the most prevalent and greatest known risk factor is increasing age. The disease also appears in younger people from the age of 40years, and this is known as early onset of Alzheimer.
About 5% of individuals start experiencing the symptoms of this disease when they are 40 or 50 years. But in most people the symptoms start appearing when they are 60 years and older. Estimates may vary, but health professionals estimate that about five million Americans are affected by Alzheimer’s disease. The rate at which the disease progresses varies from one patient to another, but the average life expectancy after diagnosis has typically been made ranges from three to nine years (LaFerla 2010).
Sampling frame
The main question that this study seeks to address is the causative agent of the ailment, the symptoms that are presented by the patients, the best possible methods of intervention or treatment and the management and care of the patients that have this condition. Therefore, this study will provide an in-depth investigation into the risk factors and the general information of the disease. Research patients were selected from clinical and nursing practice. The study incorporated 2000 patients who are mostly 60 years and above to help in observing patterns and history of the disease.
Participants
After selecting the patients who will be under study, they all underwent a screening interview and a cognitive test. Apart from these, they also provided a sample of their blood, and they filled a questionnaire about their health and lifestyle. Alzheimer’s disease has affected individuals, families and the society for quite some time. Obtaining information about this condition is very crucial in providing knowledge how to handle the cases in the event of a family member or loved one developing this condition. The cause of Alzheimer’s disease has not been clearly defined, but it is understood that a group of disorders in the brain causes the brain cells to degenerate and die which in turn causes a steady decline in memory loss and mental decline. In most cases the risk is thought to be genetic, and other factors like depression and hypertension may lead to a person contracting this disease (Ballard, Gauthier et al. 2011).
Measurement techniques
The research was conducted on some cases that have been reported in various health facilities, and close monitoring of the patients was taken into account. Factors that were considered when carrying out the survey included age, sex, medical history and the family setting of the patient. The likely diagnosis of the disease is primarily based on the history of the condition and the blood tests, medical imaging and cognitive testing are usually conducted to rule out other possible underlying diseases or causes (Lu & Bludau 2011).
The symptoms of the disease can sometimes be mistaken for normal aging, but further examination should be considered to ensure the outcome of a definite diagnosis. One of the tests that are particularly recommended is the examination of the brain tissue. Currently, no medication or treatment can stop or reverse the progression of the disease, but some treatments can improve the symptoms albeit temporarily (Bennington 2003). Since there is no medication or supplements to reduce the risk of this disease, avoiding obesity by observing a healthy diet, physical and mental exercise are said to reduce significantly the risks that are associated with this disease. The patients who are affected by this condition normally have to rely on family members or a caregiver to perform essential functions; this can exert so much physical, psychological, social and economic pressure on the caregivers (Mace & Rabins 2011).
Alzheimer’s disease has many stages of which different patients who were experiencing various stages were observed, and the data was used in determining the condition or symptoms at every stage. At the initial or mild stages, memory loss is the common symptom or cognitive impairment that is reported in patients who are starting to develop dementia. Some patients who are experiencing memory loss problems may have a condition called mild cognitive impairment (MCI). When somebody is going through this condition, they exhibit symptoms that do not necessarily interfere with their normal life or daily routine, but the memory problems are not usually typical for their age. Problems with the senses of smell as well as motion or movement difficulties have also been linked to this condition. People with advanced age who have this condition are at a higher risk of developing Alzheimer, but some of them may go back to their cognitive state. The initial symptoms of the patients that were under study varied from person to person. However, most of them reported memory loss, impaired reasoning and judgment are the common signs that characterized their early stage of the disease.
Most patients who were observed reported an interruption in their daily activities and the way they interacted with the people who are closer to them. Many of the patients found it hard to remember even the recently learned things and showed signs of difficulty in acquiring new information. The symptoms are normally mild but get worse with the progression of the condition and leads to significant interference of life. The person starts to lose essential items like keys in the house, misplacing their cell phones, forgetting about recent conversations, getting lost even in familiar places and also struggling to find the right words in a conversation (Bäckman, Jones et al. 2004). Increasing impairment of memory calls for a diagnosis to determine which memory capacities have been affected the most because the disease does not affect the all the memory functions equally (Förstl & Kurz 1999). In this case recently learned things are more affected than the older memories of the patient. Shrinking vocabulary can also characterize language problems which often lead to a decline in the oral and written ability of the language.
Administration methods of the study
The patients who were under study were also observed during the moderate stages of the disease, and it was found out that the progressive deterioration hindered self-dependence, and most of them required help from family members or caregivers in performing basic tasks. There was also evident speech retardation which included the use of the wrong choice of words or struggling to find correct phrases to use. The patient starts to lose their writing and reading ability as the condition progresses to the moderate level. The coordination of complex motor movement was also observed in the patients who were under study, and this increased their chances of falling.
Patients who reached the moderate stage of the disease also showed signs of aggression and outbursts which were unpremeditated. Patients may also start to show signs of resistance to caregiving, and they often don’t want to be helped or assisted in doing basic tasks. In the case of the patients that were observed by this study, most of them did not notice the progression of their disease, and they may not realize that they have a problem and need help which presented the main reason for resisting care.
Because the disease is a progressive one, the multiple patients who presented various symptoms in many health facilities needed to be monitored over a long period to ensure the study yield maximum and desired outcome. The medical history of some patients and specifically related to this disease was examined over more than five years to determine the pattern and progress of the disease over that particular period. As the condition progresses, behavioral changes become noticeable, and the patient starts to exhibit common manifestation which includes wandering, getting irritated quickly, aggression and complete loss of memory of difficulty in recognizing people who are close to them.
Control of bias
However, the study did not conclusively conduct a full observation and examination of all the research patients who were initially selected because of various reasons. Some of the patients relocated and the development and progression of their disease were difficult to monitor. Some family members of the research patients could not continue to offer information on their patients because of privacy reasons. Despite the fact that all the information provided by the patient and their families or caregivers would be kept private and confidential, some were reluctant to provide any further information which leads to discrepancies in interpretation of data. The study also does not provide the data on the awareness and interventions that are dome by health facilities and other government agencies that are involved in the study of this subject. The specific cost implications of the disease are also not included in this study. It was concluded that Alzheimer’s disease is one of the costly diseases in the societies today. With a more aging population, the costs are set to rise even higher and therefore it has become a very crucial society problem which should be addressed with urgency.
The patients begin to forget their addresses, their phone numbers, remembering to take a bath or even can forget where they went to school. Patients also experience difficulty in dressing at this point and laying out their clothing in the morning normally helps in encouraging dependence and performs the tasks on their own. The patients who were under observation also exhibited a common event whereby they repeatedly asked the same question. Most clinicians encourage such events to be treated by answering the patient in more reassuring voices.
Getting delusional is common among some patients whose condition has reached later stages. Among the research conducted among the patients under observation, most of the patients who had reached an advanced stage of the disease showed sign of believing things that are not true and reportedly saw or heard things that are not there. The condition can be termed as experiencing hallucinations and patients at this time start calling out or getting restless. The sleep patterns of the patients under study was also a standard feature, and many reported disturbed sleep patterns and sometimes had difficulty falling asleep on regular times or had insomnia.
Such behaviors can pose a challenge to the family members, or the caregivers who are attending the patient and a significant degree of understanding is required at this point. As the condition reaches its later or decline stages, symptoms increase and become more severe hence exerting pressures on the caregivers and the loved ones of the patients. In many cases, these behaviors may require separate treatment or management to minimize them and their effects.
Control for confounding
It was also observed that at the later stages of the disease, almost 95% of the patients became less aware of what is happening around them. They also experienced difficulty in movement and also had difficulty in eating. Constant attention was the most common form of intervention offered to such patients. The progression of the condition and life expectancy of the patient was also noted to vary significantly from one patient to another, and this was partly due to many underlying factors. On average, most of the patients who were observed had a life expectancy of 8 to 10 years after the first instance of diagnosis. However, this may vary depending on the age of the patient when the disease was first diagnosed and other underlying conditions. Despite the loss of comprehensible verbal communication from the patient, they can still communicate emotional signs; however, signs of hostility and aggressiveness can be seen as well as exhaustion and fatigue.
Plans for analysis
Currently, there is no known treatment or cure for the Alzheimer’s disease but the research found out that there are available treatments that offer relatively small symptomatic benefits but remain palliative in nature. The treatments and interventions that are mostly considered include caregiving, psychosocial and pharmaceutical therapies. The cognitive problems of the Alzheimer’s disease are treated by using five medications. The four main treatments that are used include galantamine, rivastigmine, tacrine and donepezil which are acetylcholinesterase inhibitors, and the other one is memantine which is a receptor antagonist (Pohanka 2013).
However, the benefits that are derived from these treatments are relatively small, and no definite cure has been successfully formulated to stop the progression or to delay the development of the disease. Acetylcholinesterase inhibitors are used to reduce or slow down the rate at which acetylcholine (Ach) is broken down, as a result, the concentration of ACh is increased in the brain leading to the reduction of ACh that comes about through the death of the cholinergic neurons. It has been determined that these medications that are offered have efficacy in conditions that are mild or moderate and some relevant evidence in their use in stages that have been advanced. Only donepezil is recommended for treatment at the most advanced stages of the disease.
The use of these forms of medication in cases of mild cognitive impairment has not yielded any effects in inhibiting or delaying the progression or onset of Alzheimer’s disease. Some of the patients who were advised to consider these forms of medication reported side effects such as vomiting, nausea, and fatigue. The users who reported these side effects consisted 10% – 20% of the patients who were under study. The side effects that arise in users can be mild or severe, and adjusting the doses gradually is used to manage the side effects (Alldredge 2013). Expected outcomes
Psychosocial interventions are also important treatment channel that was considered in most of the population which were examined. These kinds of responses are typically used as an addition to pharmaceutical treatments and can be classified as cognition-, motion-, behavior-, or stimulation-oriented approaches. Behavioral interventions are applied to reduce the precursors and concerns of problem behaviors. However, the approach has not yielded any successful outcomes in improving the general functioning of the patient. Reminiscence therapy alongside validation therapy and sensory integration are also important interventions that were used in some of the patients. These forms of treatment have not been scientifically examined, but health professionals use them in helping the patients that are mildly impaired to adjust to their illness. The use of music, sound recording, and using photographs are helpful when administering these forms of therapy.
Statement
Further studies are proposed in this area to ensure that a probable cure or treatment is formulated to alter or delay the progression of the disease. The burden of providing care to the patients was also found to be very high with extreme pressure to the families and those providing care because of the unpredictable nature of the condition. Behavioral changes were cited as the most common burden that caregivers and families experienced. Some of the most notable cases of the disease include former United States President Ronald Reagan and Nobel laureate Charles Kao. The efficacy and safety of numerous pharmaceutical treatments are being investigated today which includes a clinical trial. The study proposes that early diagnosis before the symptoms begin critical in identifying any underlying problems. Early detection of the disease may be done by the newly developed biomedical tests.
References
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Ballard, C., Gauthier, S., Corbett, A. et al. (2011). Alzheimer's disease. Lancet 377(9770), 1019–31.
Bäckman, L., Jones, S., Berger, A., Laukka, E., Small, B. (2004). Multiple Cognitive Deficits during the Transition to Alzheimer's Disease. Journal of Internal Medicine 256(3), 195– 204.
Förstl, H. & Kurz, A. (1999). Clinical Features of Alzheimer's Disease. European Archives of Psychiatry and Clinical Neuroscience 249(6), 288–290.
Alldredge, B. (2013). Applied therapeutics: The Clinical Use of Drugs (10th Ed.). Baltimore: Williams & Wilkins.
Lu, L. & Bludau, J. (2011). Alzheimer’s Disease. Santa Barbra: Greenwood.
Mace, N. & Rabins, V. (2011). The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss. Baltimore: John Hopkins University Press.
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Bennington, T. (2003). Alzheimer's disease: Overview and Bibliography. New York: Nova Science Publication.
Pohanka M. (2013). Alzheimer´s Disease and Oxidative Stress: A Review. Current Medicinal Chemistry 21(3), 356–64.
