The Royal College of Nursing defines nursing as the use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death (RCN, 2003). This essay will look at the role as a nurse, in supporting an individual, the family or carer living with a person suffering from Alzheimer’s disease. Walker’s, (2002) definition of Alzheimer’s is that of ‘a degenerative brain disease, manifesting itself in premature ageing, with speech disorder’ and was first discovered by a German neurologist, Dr Alois Alzheimer who, in 1906, examined the brain of a patient he cared for who subsequently died of an unusual mental illness (dementia) at age 51. Her symptoms included memory loss, language difficulties, and unpredictable behavioural manner. After her death, Dr Alois Alzheimer examined her brain and found a plague like structure and tangled filament in the nerve (neurons) of the patient brain (Stanton, 2001). The plaques represent a naturally occurring sticky protein and the tangled filament represents collapsed tau proteins. Though Krebs, et al (2012) theory agrees with this that plaque clumps (now called amyloid plaques) and tangled bundles of fibres (now called neurofibrillary tangles) accumulating in the brain triggers this disease, it has been called into question.
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Of today, Alzheimer’s is classified an unquantifiable science condition; which holds within its own right a large area of mental health. The definition of Walker’s, (2002) “degenerative” refers to gradual deterioration; this means that this disease may be broken into gradual stages of ‘early’, ‘middle’ and ‘late’. The early (onset) stage appears with symptoms such as memory loss, confusion, personality and behavioral changes, these normally occur between 2-4 years prior to and during diagnosis. The middle (progressive) stage has similar symptoms as the onset but with more obvious signs such as an increase of confusion, an increase of memory loss, difficulty in completing simple tasks, showing a decrease in communication skills and occasionally can at times appear to be delusional; this stage may be more distinct with language ability being decreased. This stage has a time frame of 2-10 years following diagnosis. The late (end) stage show symptoms that are more prominent than earlier stages, with the inability to care for oneself; with little or no communication ability, continence and inability to recognize loved ones, followed by death usually caused by infections. These symptoms may appear between 1-3 years after the disease has passed through its progressive stage as Gwyther’s (1985) cited by Gogia and Rastogi (2009). Though the cause of this disease is a common subject amongst scientist and physicians, it is believed that excessive intake of aluminium may be a key factor in acquiring this disease. In the 1960s and 1970s, research showed high aluminium levels in the brain tissues of some people who died with Alzheimer’s disease; this discovery spurred public concern that exposure to ‘aluminium in our diet could be the cause of the disease’ (Rao and Rao 1995). Since then several scientific studies have examined the link between aluminium and Alzheimer’s, and none have found a clear association between them, Dean (2009). This contradicts Crapper et al (1976) that Aluminium has been shown to be associated both, with plaques and tangles, in the brain of people with Alzheimer’s disease.
There have been numerous studies among experts to resolve the issue in question, whether aluminium is in fact the cause of Alzheimer’s disease. This has been extremely difficult as this common disease is believed to have multiple causes, but while aluminium is widespread in our environment, there is no method that allows researchers to measure this ‘individual burden’ or lifetime exposure to this element.
Lliffe and Rusted, (2012) states that ‘although no one single factor has been identified to be the cause of Alzheimer’s disease, it is likely that a combination of factors, including age, genetic inheritance, lifestyle and overall general health, are responsible’. Even so, Alzheimer’s disease has a high impact on the aged population affecting around 496,000 people in the UK, with one in every fourteen people over the age of 65 and one in six over the age of 80, this shows that the greatest risk factor of Alzheimer’s is indeed old age. However, this disease is not restricted to the older generation; in the UK alone, there are over 17,000 people under the age of 65 living with the disease. (Ref) The Wife of United States former president Regan quoted: “Alzheimer disease is a cruel disease that steals lives. It’s hard to know what to expect. The years of exchanging memories of old age are gone. It’s a long, long good-bye” (Reagan, N. Cited in Brill, 2005).
Burfoot, (2008) believes there are a minority that do not worry about getting Alzheimer’s disease; these include athletes which are at half the risk compared to that of the sedentary individual, studies have shown that they are showing lower risk for senile dementia and diseases like Alzheimer’s. Indeed, the chances of Alzheimer’s disease increases with each successive year of life after age 65. However, Alexander, (2009) believes that the disease is inevitable and is associated with the ageing population, particularly from the ‘baby boom’ generation that came after the second world war and also due to the difference in medical care given by the National Health service (NHS) compared to health services that were available at this era, because of this people are living longer, and an increase in population means more people are making it to old age, but the reward for making it to old age is a gift of Alzheimer’s for 6 from every 100 people who gets past the age of 65, (Brody 2011). Though scientists have estimated that 496,000 people have Alzheimer’s disease in the United Kingdom alone and 22 million worldwide, the disease only affects about “five percent of people ages 65 to 80 and nearly half the population of those 80 and older”. Disturbingly, the disease is becoming even more common; statistics now show that the number of people with the disease doubles every five years among older people and failing to find a preventative or curative measure will be costly to society.
Alzheimer’s disease not only affects the patient, but the society and family around them. Alzheimer’s disease slowly attacks the cognitive function, which is the higher thought processes. These individuals degenerate in such a way that they return to the stages of infantile dependents (Ref). While the lives of family members, especially those directly involved in the individual’s care, are significantly impacted in many ways, ‘caring for adults with a degenerative disease can be an extremely physically demanding task,’ Clark, (2001). For the primary caregiver involved in the day-to-day care, the disease can take its toll emotionally, physically, mentally and financially. The carer responsibility may even be extended for many years; of course this depends on what stage of Alzheimer’s the sufferer has been progressed to.
The diagnosis of a parent or spouse with Alzheimer’s disease may also conjure up a number of mixed emotions; such as frustration, helplessness, or even guilt. ‘The fact that it is a progressive and ultimately terminal illness can be difficult to grasp’, Lu and Bludau (2011). To have a family member suffering from Alzheimer’s disease alters your life unavoidably, as the reversal of roles from being the child to the nurturing care provider can be unsettling and even overwhelming. The impact on the family can be quite difficult to witness, of watching a previously vibrant and independent parent decline over time to a former shadow of themselves and having to adjust to the increasing responsibilities as a caregiver can be psychologically demanding, as this role reversal usually occurs for spouses. For example a husband whose wife who has always managed the household may find himself having to take over this role, or vice versa. Children and grandchildren, nieces and nephew may find themselves in this role. Whatever the make-up of the family, there is usually a role reversal, where someone to steps into the shoes of the caregiver, Lu and Bludau (2011).
This is where a therapeutic relationship between the nurse, the family and patient has to be formed; this is a key component in the nursing profession that enables the best care possible is provided to an Alzheimer’s sufferer. However, before any treatment is given ‘consent’ must be obtained (NMC, 2008) whether it may be from family members or clinicians caring for the patient on a day-to-day basis if the patient is unable. Making decisions for such person as long as it’s within their best interest and lacking the mental capacity to do so for themselves is acceptable, as the Mental Capacity Act (the Act) 2005 states “any act done or decision made on behalf of an adult lacking capacity must be in their best interests”. In the case of an Alzheimer’s sufferer, as their cognitive memory deteriorates, neglection and decision making for themselves becomes apparent, these patients becomes highly vulnerable, helpless and in a dependent position and looks to the nurse to uphold their dignity and respect for their confidentiality, as stated by the Nursing and Midwifery Council (NMC), a person must be treated with respect, dignity and has the right to confidentiality, NMC (2008). As “quality of care not only depends on good healthcare but also on respect for the person as an individual” DH, (2001).
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Teamwork in this sense also has a vital role, without this, communication between different agencies such as social services, and the multidisciplinary team which may involve psysiotherapy, psychologist and nutritionist. These skills together will identify the support needed to make sure treatment is patient-centered and also promotes a collaborative partnership between the patient and health professionals (Silverman et al, 2005), only then effective treatment can be achieved that is needed for an Alzheimer’s sufferer. As a nurse, one should have excellent communication skills, whether through speaking, writing, observing or listening (Egan, 2002), this will enable them to be the ultimate patients’ advocate. To expand on this, nurses form the primary system of support; this could range from logistical issues, such as treatment in the accident and emergency department through to being admitted to the ward within the hospital. In the case of an Alzheimer’s patient where the patient may be within his or her own home for some time, regularly visiting the patient to assess the patient’s health condition, to provide emotional support to both frightened patient and family member.
The nurse must be able to facilitate and identify any health promotions needed for his or her patient so that they are able to implement any strategy to best support the patient, family and carer neccessary. In an Alzheimer’s patient, onset of many chronic diseases, infection or illnesses will become inevitable and a reduction in a once bubbly individual will be a thing of the past, as their brain deteriorates. Alzheimer’s sufferer may forget simple task such as washing of themselves or eating the required amount of meals necessary for intake of nutritions needed, thus health promotions has to be tailored specifically for an Alzheimer’s patient unigue lifespan (Hubley and Copeman, 2008). Addressing issues such as smoking or cooking as well as living alone will enable any health concerns will allow you to make any changes before they become a danger to themselves or others.
Alzheimer sufferer also needs to be protected from abuse; this is one of many important aspects of being a nurse. Abuse may come in many forms, being physical, psychological, financial, sexual, neglect or discriminated upon because of their culture or ethnicity and as the United Kingdom becomes a multicultural society, there are implications on how healthcare is delivered by nurses. Furthermore, a nurses action is guided by principles of moral and legal rights, this compliments excellent nursing care. Awareness of the legal codes helps them to control complicated situation that they may encounter and helps to direct the nurse as well as their multidisciplinary team in the best possible action answerable by law (Dimond, 2011). It is important that nurses are aware of this and that they are sensitive when treatment is being administered. Nurses need to familiarise themselves with what is acceptable behaviour and respond accordingly (Timby, 2005). An example being that in some cultures it may be unacceptable to make eye contact while in others it is not or it may also be unacceptable to touch certain parts of one body.
In conclusion, whether or not aluminium or old age is infact the cause of Alzheimer’s disease, the nurse has to be the the patients representative in order to address underlying issues that exist between, the family, carer and society. Also, to amalgamate the multidisciplinary team and relevant agencies so that health promotions may be implemented by means of controling infections, which is the predisposing factor of an Alzheimer’s patient death. This relationship is complex and the nurses job has to be the forefront of it all, whether it may be to educate family and carer on how best to include hygiene and infection control as the disease worsen or to inform the multidisciplinary team about the patients health and wellbeing.
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