Alzheimer's Disease Health Article

Outside help, nursing homes, and governmental assistance

Most families eventually need outside help to relieve some of the burden of around-the-clock care for an AD patient. Personal care assistants, either volunteer or paid, may be available through local social service agencies. Adult daycare facilities are becoming increasingly common. Meal delivery, shopping assistance, or respite care may be available as well.

Providing the total care required by a person with late-stage AD can become an overwhelming burden for a family, even with outside help. At this stage, many families consider nursing home care. This decision is often one of the most difficult for the family, since it is often considered an abandonment of the loved one and a failure of the family. Counseling with a physician, clergy, or other trusted adviser may ease the difficulties of this transition. Selecting a nursing home may require a difficult balancing of cost, services, location, and availability. Keeping the entire family involved in the decision may help prevent further stress from developing later on.

Several federal government programs may ease the cost of caring for a person with AD, including Social Security Disability, Medicare, and Supplemental Security Income. Each of these programs provides some assistance for care, medication, or other costs, but none of them will pay for nursing home care indefinitely. Medicaid is a state-funded program that may provide for some or all of the cost of nursing home care, although there are important restrictions. Details of the benefits and eligibility requirements of these programs are available through the local Social Security or Medicaid office, or from local social service agencies. Long-term care insurance can also be another option, if taken out prior to the diagnosis.

Prognosis

Alzheimer's disease can weaken the aging body, making it more susceptible to life-threatening infections such as pneumonia. In the late stages of the disease, autonomic body functions may be impaired, the patient falling into a coma, and death following. In addition, other diseases common in old age—cancer, stroke, and heart disease—may lead to more severe consequences in a person with AD. On average, people with AD live eight years past their diagnosis, with a range from one to 20 years.

Health care team roles

Treatment of AD is a team effort, involving primary care physicians, nurses, imaging and laboratory technicians, gerontology specialists, psychiatrists, psychologists, nursing staff, and caregivers. Physicians order tests that aid in the diagnosis and treatment of AD. These experts must educate the patient and the caregivers in the nature of the disease and its progression, although this burden usually falls on the nursing staff. Nurses are also the first line of access to medical care and support groups. Social workers, counselors, and support group facilitators may also provide emotional support, practical advice, and information about community resources. Special Alzheimer's disease facilities may be used for either respite day care or as permanent long-term care placements.

Prevention

There is currently no proven way to prevent Alzheimer's disease, though some of the drug treatments may delay the development of the disease. The most likely current candidate is estrogen. However, staying active mentally and physically throughout life may be key to prevention.

KEY TERMS

Acetylcholine—One of the substances in the body that helps transmit nerve impulses.

Dementia—Impaired intellectual function that interferes with normal social and work activities.

Donepezil hydrochloride (Aricept)—A drug that increases the brain level of the neurotransmitter acetylcholine, which is given once a day to treat AD.

Ginko—An herb from the Ginko biloba tree that some alternative practitioners recommend for the treatment of AD.

Neurofibrillary tangle—Twisted masses of protein inside nerve cells that develop in the brains of people with AD.

Senile plaque—Structures composed of parts of neurons surrounding brain proteins called beta-amyloid deposits and found in the brains of people with AD.

Sunsetting—Confusion or agitation in the evening.

Tacrine (Cognex)—A drug that may help improve memory in people with mild to moderate cases of AD.

BOOKS

Castleman, Michael, Dolores Gallagher-Thompson, and Matthew Naythons. There's Still a Person in There: The Complete Guide to Treating and Coping with Alzheimer's. New York: G. P. Putnam's Sons, 1999.

Gray-Davidson, Frena. The Alzheimer's Sourcebook for Caregivers: A Practical Guide for Getting through the Day. Los Angeles: Lowell House, 1999.

Khatchaturian, Zaven S., and M. Marcel Mesulam, eds. Alzheimer's Disease: A Compendium of Current Theories. New York: New York Academy of Sciences, 2000.

Mace, Nancy L., and Peter V. Rabins. The 36-Hour Day. Baltimore: The John Hopkins University Press, 1999.

Tanzi, Rudolph E. Decoding Darkness: The Search for the Genetic Causes of Alzheimer's Disease. Cambridge, MA: Perseus Publishing, 2000.