Alzheimer’s disease & Dementias by Robin Fenley, CSW Director

Alzheimer’s disease & Dementias
by Robin Fenley, CSW
Director
Alzheimer’s and Long-term Care Unit
NYC Department for the Aging
What is Dementia?
The term given to changes experienced
in cognition, behavior and self-care
Reversible
Metabolic
Physiologic
Irreversible
Alzheimer’s disease ~75% of all dementias
Alzheimer’s Disease (AD)
Not a normal part of aging
Progressive decline in executive
functioning
Memory loss
Inability to learn new tasks
Behavioral changes
Deterioration in self-care abilities
Ten Warning Signs
(Alzheimer’s Assoc.)
1.
Recent memory loss that effects job performance
2.
Difficulty performing familiar tasks
3.
Problems with language
4.
Disorientation of time and place
5.
Impaired judgment
6.
Problems with abstract thinking
7.
Misplacing things
8.
Changes in mood or behavior
9.
Personality changes
10.
Loss of initiative
Medical Work-up
Neurological and physical examination
Lab tests, EKG, chest X-ray
Brain scans CT, MRI, PET
EEG
Psychiatric evaluation
Neuropsychological tests for mental
status and cognitive functioning
Disease Course of AD
Prognosis
Insidious onset
Avg 8-10 years after diagnosis
Up to 20 years
Retrogenesis
Barry Reisberg, MD, NYU Silberstein
Dementia Research Center
20 year reversal in abilities
Risk factors
Age
Family history
< 10%
Before age 60
High cholesterol
High blood pressure
Head injury
Speculative:
Exposure to aluminum
Aspartame (artificial sweetner)
Treatments
Medication
Early stage
• Aricept, Exelon, Reminyl
Moderate to late stage
• Namenda
Antipsychotics
Antidepressants
Vaccine
Elan Pharmaceutical, 2002 and 2004
Alternative Treatments
Vitamin E
400 IU 2x day
1200 IU 2x day in 1997 study
Ginkgo biloba
1997 study showed ~improved cognition, ADLs,
social behavior
Current study with 3000 participants
Exercise
NYU’s study
Facts & Figures
4 million persons with AD nationally
Estimated 200,000 in NYC
Projected to grow to 14-16 million by
2050
1 in 10 people 65+
Almost 50% for those 85+
(Source: Alzheimer’s Association)
Facts & Figures cont’d
4th leading cause of death in the elderly
(heart disease, cancer, diabetes)
75% of individuals with AD are cared
for at home
(Source: Alzheimer’s Association; National Institute on Aging)
The Price of AD
Nationally
$100 billion/year
• Direct and indirect care
$61 billion/year to business
• Lost productivity, absenteeism, replacement
(Source: Alz Assoc., Nat’l Institute on Aging)
Average lifetime costs per person
$174,000
(Source: Ernst,RL & Hay,JW. The U.S. economic & social costs of
Alzheimer’s disease revisited. American Journal of Public Health. 1994.
Cited in Nat’l Institute of Health, 2003.)
Challenging Behaviors
Psychosis
50-70% incidence rate
• Theft
• Intruders
• Misidentification
• Infidelity
(Source: J.Cummings, MD, UCLA Alzheimer’s Disease Research Center)
Depression
25% incidence rate
• Decreased appetite
• Decreased interest in life activities
• Lethargy
• Apathy
(Source: J.Cummings, MD, UCLA Alzheimer’s Disease Research Center)
Agitation
60-80% incidence rate
• Resistance to care
• Aggression, striking out
• Shouting
٠Disinhibition
٠Anxiety
٠Irritability
(Source: J.Cummings, MD, UCLA Alzheimer’s Disease Research Center)
Impact of Behavioral
Changes
Distressing to caregivers
Distressing to person with AD
Can precipitate abuse
Can lead to earlier institutionalization
BUT
Can respond to medical intervention
Engaging the Person with
Dementia
Respect the dignity of the individual
Approach the individual in their direct
line of vision
Identify yourself in reassuring tone
If appropriate, use touch to get their
attention
Avoid sudden movements that may
startle
Be Aware of the
Environment
Reduce background noise and
distraction
Sundowning
Simplify Verbal
Communication
Convey ideas one step at a time
Select concrete words when possible
Avoid abstractions or generalizations
Use yes/no questions
Repeat as necessary
Person may ‘mask’ responses
Active Listening
Be patient. Allow time for the individual
to find the words
Do not interrupt or finish the sentence
Understand what the person is saying
before responding
Nonverbal Communication
Communication skills deteriorate from
verbal to nonverbal
Watch body language and facial
expression for signs of agitation,
discomfort or pain
Communicating with the
Caregiver
Allow time to vent
Listen for veiled or overt expressions of
exhaustion, frustration, anger
Be sensitive to caregiver/care receiver
confidentiality
If possible, interview separately
Resistance in Alzheimer’s
If the person becomes agitated, stop the
activity
Schedule enough time
Do not force the issue unless there is an
immediate threat to health and safety
Service Options
Diagnostic centers
Safe Return Program
Clinical trials
NYC Caregiver Program
Community Care Options
Home care
Home delivered meals
Transportation
Adult day service
Social model
Medical model
Taking a Break
Respite
In-home
Congregate
Overnight respite
Residential Continuum
Adult home
Assisted living
Nursing home
Considerations
Available social supports
Awareness of community services
Utilization of services
Financial resources
Involvement of APS where appropriate
The Multidisciplinary Team
Family members
Social workers
Geriatricians, psychiatrists
Elder law attorneys
Law enforcement
Geriatric care managers
Faith-based community
Useful Contacts
311 for all city services in NYC
NYC Dept for the Aging
(212) 442-1000
www.nyc.gov/aging
www.nyccaregiver.org
Alzheimer’s Association, NYC Chapter
(212) 973-0700
www.alznyc.org
Useful Contacts, cont’d
U.S. Administration on Aging
www.aoa.gov
Fisher Foundation
www.alzinfo.org