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Abstract
Alzheimer’s disease remains one of the most prevalent forms of dementia among elderly people. One of the principal goals of Healthy People 2020 is to reduce morbidity and the number of costs associated with Alzheimer’s. This paper provides a brief insight into the current situation with Alzheimer’s and its implications for community health. The epidemiology of Alzheimer’s and relevant state data relating to Alzheimer’s in Ohio are discussed. The role of the community nurse in primary, secondary, and tertiary prevention of Alzheimer’s is evaluated.
Keywords: Alzheimer’s disease, AD, community, nurse, health.
Alzheimer’s disease is one of the most prevalent forms of dementia among older people. Age remains the main risk factor for Alzheimer’s. Notwithstanding the rapid advancement of medical science, the rates of Alzheimer’s disease per 1000 person-years constantly increase. One of the principal goals of Healthy People 2020 is “to reduce morbidity and the number of costs associated with various forms of dementia, including Alzheimer’s disease” (Healthy People, 2011). The community nurse’s role is to develop and participate in primary, secondary, and tertiary preventive strategies and to provide a wide range of nursing care services while maintaining the health and wellbeing of individuals with Alzheimer’s disease.
Alzheimer’s disease was first identified about 100 years ago, but it was not until the end of the 1970s that research into its signs, symptoms, causes and treatment gained momentum (Alzheimer’s Association, 2011). The fact that the prevalence of Alzheimer’s among other forms of dementia constantly increases has far-reaching implications for nursing care: one of the Healthy People 2020 goals is “to reduce morbidity and costs associated with and maintain or enhance the quality of life for, persons with dementia, including Alzheimer’s disease” (Healthy People, 2011). In the epidemiology of Alzheimer’s, age is the most serious risk factor: AD occurs in 2.8 per 1,000 person-years in the 65-69 age group (Mariani, 2004). The prevalence of AD in individuals older than 90 is even higher: 57 per 1,000 person-years (Mariani, 2004). A higher educational level is believed to reduce the risks of AD, but the exact relationship between AD and the level of education remains poorly understood (Mariani, 2004). Family history is generally considered a serious risk factor for developing AD (Healthy People, 2011).
Racial and ethnic disparities in the diagnosis and treatment of dementia, including Alzheimer’s, are well documented. The burden of Alzheimer’s falls disproportionately on vulnerable and minority populations (Zuckerman et al, 2008). Statistically, non-Hispanic blacks are more likely to go misdiagnosed or undiagnosed compared with non-Hispanic whites (Zuckerman et al, 2008). In the meantime, the prevalence of dementia and Alzheimer’s disease in minority populations remains increasingly high (Zuckerman et al, 2008). In African American and Hispanic individuals, the onset of AD may occur at an earlier age (Griffith & Lopez, 2009). These health disparities are associated with the risk factors that include but are not limited to diabetes, hypertension, and other metabolic abnormalities that are rarely found in non-Hispanic whites (Griffith & Lopez, 2009). It goes without saying that the disparities in the diagnosis and treatment of AD may have serious consequences for individual health (Griffith & Lopez, 2009). Delayed diagnosis increases the risks of developing cognitive impairment (Griffith & Lopez, 2009). It may limit the capacity of individuals and families to take effective, relevant treatment decisions (Griffith & Lopez, 2009). Individuals and families may fail to utilize the fullest range of available community resources (Griffith & Lopez, 2009). These disparities increase the utilization and costs of health care and the burden of financial difficulties on the health care system (Husaini et al, 2003).
The situation with Alzheimer’s disease in Ohio is no better than in other states. A recent report from the Alzheimer’s Association exposes severe disparities in how Alzheimer’s affects individuals and families in Ohio. Statistical data provided by Alzheimer’s Association (2011) suggests that the disease poses a serious threat to the health and wellbeing of people in Ohio. 230,000 people in Ohio are diagnosed with and live with AD (Alzheimer’s Association, 2011). The number of caregivers supporting individuals with AD dramatically increases: in 2010 alone, caregivers provided more than 660 million hours of unpaid care that could have cost almost $8 billion (Alzheimer’s Association, 2011). Ohio is the seventh among the states with the highest levels of unpaid caregiver contributions (Alzheimer’s Association, 2011). The prevailing majority of caregivers are family members, who have to give up their jobs and assume a responsibility for taking care for a person with AD (Alzheimer’s Association, 2011). Long-term services in individuals with Alzheimer’s are covered by Medicaid (Alzheimer’s Association, 2011). Ohio has already developed a complex plan to assess the current and predict the future impact of Alzheimer’s on the state (Alzheimer’s Association, 2011).
Alzheimer’s remains one of the most popular topics of discussion in empirical and scholarly literature. Williams and Tappen (2008) evaluated the effectiveness of comprehensive exercise training techniques in nursing home residents with Alzheimer’s disease. The researchers found that exercise training was an excellent behavioral approach for treating depression in persons with AD (Williams & Tappen,, 2008). Exercise training could become a valuable alternative to pharmacological treatment of depression in elderly people with AD. The results of Williams and Tappen’s (2008) analysis have little to do with primary prevention, as they address and cover persons who are already demented; however, the proposed exercise training strategy could become a valuable contribution to secondary and tertiary preventive strategies against AD.
The community nurse’s role is to provide a wide range of nursing care services while maintaining health and wellbeing of individuals with Alzheimer’s. Prevention is the most important and challenging aspect of community nursing care. Primary prevention usually aims to “reduce the incidence of the disease by eliminating or treating specific risk factors which may decrease or delay the development” of Alzheimer’s (Fratiglioni, Winbald & Strauss, 2007, p.99). In case of AD, primary risk factors include age and educational level (Mariani, 2004). Anderson and McFarlane (2011) write that many health practitioners neglect preventive services for the elderly, on the premise that there is no use in prevention at the end of the age continuum. At this stage of prevention, the nurse is expected to monitor changes in individuals’ cognitive development and functioning and pay particular attention to possible signs and symptoms of dementia. The community nurse must ensure that elderly populations participate in physically and mentally/ socially stimulating activities, which can postpone the onset of AD (Fratiglioni et al, 2007). Here, community nurses could develop education courses for the elderly, to ensure that old community residents are aware of the risks, symptoms, and possible outcomes of AD. Community nurses could also visit nursing home residents, to monitor their health and educate them about the risks and symptoms of Alzheimer’s.
Secondary prevention is essentially about addressing the disease and reducing its complexity. Secondary preventative strategies must help to reduce the prevalence of AD and reduce its duration (Fratiglioni et al, 2007). Secondary prevention is possible, if community nurses identify biological and clinical markets of AD in elderly patients (Fratiglioni et al, 2007). At this stage of community care, nurses are expected to detect those who are not yet diagnosed of dementia but may develop the disease in the coming years (Fratiglioni et al, 2007). This is possible, if nurses regularly perform a detailed analysis of the elderly population’s health, especially those with the family history of and genetic predisposition for developing AD.
Finally, tertiary prevention covers those who are already demented but want to improve or at least preserve the current state of wellbeing. The goal of tertiary prevention is to reduce the negative effects of long-term disease (Fratiglioni et al, 2007). The community nurse must evaluate the quality of care provided to patients with AD. Various strategies need to be compared in terms of their individual, family, and social outcomes (Fratiglioni et al, 2007). In tertiary prevention, community nurses work to minimize patient suffering (Fratiglioni et al, 2007). Community nurses must engage individuals with AD in activities and strategies that maximize potential years of useful life (Fratiglioni et al, 2007). For example, and based on Williams and Tappen (2008), community nurses could engage demented individuals in exercise training sessions, to reduce the risks of depression and improve their wellbeing. Counseling individuals and families is the major responsibility of the community nurse (Hitchcock, Schubert & Thomas, 2003). The community nurse must be able to expand his (her) thinking from individuals with AD to their families and communities in which they live (Hitchcock et al, 2003). This is the best way to fulfill the role and potential of the community nurse in promoting the health of the entire community.
Alzheimer’s disease remains the most prevalent type of dementia in elderly people. Age is the most important risk factor of AD. The situation with Alzheimer’s in Ohio is no better than in the rest of the U.S.: 230,000 people in Ohio currently live with AD. The costs of medical care for people with AD pose a serious economic challenge to Medicaid budgets in Ohio. This is one of the reasons why medical practitioners try to evaluate the current and predict the future impacts of Alzheimer’s on the state budget. The community nurse’s role is to develop and participate in primary, secondary, and tertiary preventive strategies and to provide a wide range of nursing care services while maintaining health and wellbeing of the individuals with Alzheimer’s disease. The community nurse must be able to expand his (her) thinking from individuals with AD to their families and communities in which they live.
References
Alzheimer’s Association. (2011). 2011 Alzheimer’s disease: Facts and figures. Alzheimer’s Association. Web.
Anderson, E.T. & McFarlane, J.M. (2011). Community as partner: Theory and practice in nursing. New York: Lippincott Williams & Wilkins.
Fratiglioni, L., Winblad, B. & Strauss, E. (2007). Prevention of Alzheimer’s disease and dementia. Major findings from the Kungsholmen Project. Physiology and Behavior, 92, 98-104.
Griffith, P.A. & Lopez, O.L. (2009). Disparities in the diagnosis and treatment of Alzheimer’s disease in African American and Hispanic patients: A call for action. Generations, 33(1), 37-46.
Healthy People. (2011). Dementias, including Alzheimer’s disease: Goal. Healthy People.
Hitchcock, J.E., Schubert, P.E. & Thomas, S.A. (2003). Community health nursing: Caring in action. Boston: Cengage Learning.
Husaini, B.A., Sherkat, D.E., Moonis, M., Levine, R., Holzer, C. & Cain, V.A. (2003).
Racial differences in the diagnosis of dementia and in its effects on the use and costs of health care services. Psychiatric Services, 54, 92-96.
Mariani, S.M. (2004). Unraveling the origin of Alzheimer’s disease. Medscape News.
Williams, C.L. & Tappen, R.M. (2008). Exercise training for depressed older adults with Alzheimer’s disease. Aging & Mental Health, 12(1), 72-80.
Zuckerman, I.H., Ryder, P.T., Simoni-Wastila, L., Shaffer, T., Sato, M., Zhao, L. Stuart, B. (2008). Racial and ethnic disparities in the treatment of dementia among Medicare beneficiaries. Journal of Gerontology, 63(5), S328-S333.
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