A Preliminary Care Coordination Plan: Alzheimers Disease

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Introduction

Care coordination (CC) is an indispensable healthcare strategy providing the elaborated organization of patient care activities and information exchange among all stakeholders in inpatient treatment to deliver safe and productive care. Due to such plans, medical providers can ensure that the right people are familiar with the patients needs and preferences beforehand, allowing for reducing healthcare costs and staff errors. Therefore, this paper aims to develop a preliminary care coordination plan analyzing a health care problem, namely, Alzheimers disease, and related best practices to improve patients conditions. The plan will also establish goals addressing the chosen healthcare problem and identify available community resources for quality medical care.

Problem Examination

Problem Overview

Alzheimers disease (AD) is an irreversible, neurodegenerative disorder, the most prevalent form of dementia. Substantial deterioration in memory, especially short-term, and other cognitive skills, behavioral issues, and the conclusive impotence to conduct the simplest activities are the primary AD symptoms, mainly becoming noticeable at over 65 (Alzheimers Association, 2020). Specifically, as the disease progresses, symptoms can comprise language problems, disorientation in space and time, motivation loss, self-neglect, mood swings, and sudden fits of aggression, agitation, and anxiety. Currently, nearly 50 million people worldwide suffer from AD, and the number is expected to achieve over 130 million by 2050 (Liang et al., 2018). The overall estimated global cost of dementia accounts for above $800 billion (Liang et al., 2018). It is also worth noting that most incidents take place in low- and middle-income countries. Furthermore, some studies find that African Americans and Hispanics are at higher risk for AD (Alzheimers Association, 2020). A recent study indicated that the disease is more predominant in women than in men (Liang et al., 2018). Altogether, AD places a significant physical, psychological, and social burden on both people with AD and their families and caregivers.

Causes and Pathophysiology

Scientists presently have a poor understanding of the causes and development of Alzheimers disease. The disorder is assumed to occur when excessive amounts of proteins, particularly beta-amyloid and tau proteins, congest the brain and penetrate the cells (Alzheimers Association, 2020). Plaques of beta-amyloid, known as oligomers, can cause neurons damage and death by disrupting communication between neurons at synapses. Simultaneously, tau tangles obstruct nutrient transportation, especially glucose, and other vital substances inside neurons. Such processes are always accompanied by inflammation and atrophy, principally produced by the activated immune system that clears the brain from dead and dying cells (Alzheimers Association, 2020). The prime root of these protein dysfunctions is obscure and requires further in-depth research. Therefore, to explain ADs possible causes, the main proposed hypotheses include the amyloid hypothesis, tau hypothesis, genetic, and infectious hypothesis.

Best Interventions

Many methods have been offered to prevent and treat AD, but their impact on the diseases course and its severity is not considerable or poorly determined. Concerning disease prevention, physicians can recommend a balanced diet that contains fruits and vegetables, bread, wheat, and other cereals, olive oil, red wine, and healthy seafood. Physical activity (PA), primarily aerobic exercise, is also related to a decreased risk of AD and its severity. Additionally, intellectual activities such as board games, reading, learning a new language, playing musical instruments, doing crosswords, and active, stimulating communication may postpone the onset of the disease or slow its progression.

Furthermore, doctors can propose pharmacologic and non-pharmacologic therapies to improve patients physical and mental status. The US Food and Drug Administration (FDA) approved five medicines for curing AD, including donepezil, rivastigmine, memantine, galantamine, and memantine with donepezil (Alzheimers Association, 2020). Except for memantine, these medications can temporarily enhance cognitive signs by increasing the brains neurotransmitters. The drugs effectiveness considerably depends on patients organism and is limited in duration.

Beneficial psychosocial intervention can comprise the combination of aerobic and non-aerobic exercises, music therapy, and computerized cognitive training (CCT). For example, the meta-analysis by Liang et al. (2018) concluded that PA and CCT demonstrated noticeable improvement in conditions of individuals with AD. Additionally, transcranial magnetic stimulation (TMS) displays notable effectiveness concerning AD. Specifically, a recent systematic review by Limori et al. (2019) confirms the favorable cognitive impact of TMS on patients. The studies also assume that nonpharmacological treatments may be more useful than pharmacological therapies.

Goals to Address the Problem

Although the ultimate treatment of AD is absent, healthcare providers should strive for specific objectives that can deliver relief from the disorders course. Firstly, all persons, irrespective of their social, racial, or gender status, should have access to quality healthcare services and be cared for equally. The second goal primarily concerns nurses who should comply with hygiene rules, including washing and disinfecting exposed parts of the body and wearing gloves and masks. The third objective is to help patients with AD perform their daily tasks and doctors recommendations and prescriptions, especially taking pills, walking outside, dressing up, or going to the toilet. The final goal is that nurses should provide relevant and accurate information and long-term, broad cooperation with family members or caregivers, which better patient wellbeing.

Community Resources of Minnesota

The state of Minnesota possesses a sufficient amount of community resources to deliver safe and adequate care for people with AD. As of 2020, about 99000 patients suffering from Alzheimers disease in Minnesota, and, by 2025, this number will increase to 120000, that is, 21 percent, according to Alzheimers Association (2020). Total Medicaid payments for older Americans with AD or other dementias account for $905 million (Alzheimers Association, 2020). In addition, the numbers of caregivers of individuals with AD in Minnesota comprise 257000. Mayo Clinic is a non-profit organization, one of the largest private medical and research centers globally, specializing in holistic healthcare, research, and education. Currently, the entity serves 1.2 million people and employs almost 7000 medical consultants, about 4200 research personnel, and over 63000 administrative and allied health staff (Mayo Clinic Facts, 2019). Furthermore, Mayo Clinic offers high-quality digital healthcare service that provides video appointments, access to personal healthcare records and medical information, remote patient monitoring, and around-the-clock communication with doctors and care staff.

It is worth noting that the clinic provides comprehensive and up-to-date medical approaches that enhance the conditions of patients with AD and conducts research in the Neurology and Psychiatry and Psychology departments. Mayo Clinic in Rochester has nine available doctors, including Bradley Boeve, M.D., Ulas Camsari, M.D., Daniel Drubach, MD, and others (Mayo Clinic Staff, 2020). There are other organizations in Rochester, including Alzheimers Association Caregiver Support Groups (Location: 435 E. Henrietta Road Rochester, NY 14620) or Support Group for Individuals with Dementia (Location: Alzheimers Association Office, 435 E. Henrietta Road, Rochester). Overall, the resources provide financial and moral support, training, and communication with persons with AD, which favorably impact a safe and effective continuum of care.

In conclusion, the paper had provided a preliminary care coordination plan analyzing AD and related best practices to improve patients conditions. In particular, Alzheimers disease is an irreversible, neurodegenerative disorder characterized by a significant deterioration in memory, mainly short-term, and other cognitive abilities in people aged over 65. Although treatment for this disease is not available, doctors can recommend different useful health improvement methods, such as aerobic exercises, music therapy, CCT, TMS, and drugs, namely, donepezil, rivastigmine, memantine, and galantamine. The principle goals to address this problem include broad access of the population to healthcare services, early diagnosis, ascertaining and treating complementary physical or psychological illnesses, and selecting comprehensive treatment.

References

Alzheimers Association. (2020). 2020 Alzheimers disease facts and figures. Alzheimers & Dementia, 16(3), 391460.

Liang, J.-H., Xu, Y., Lin, L., Jia, R.-X., Zhang, H.-B., & Hang, L. (2018). Comparison of multiple interventions for older adults with Alzheimers disease or mild cognitive impairment: A PRISMA-compliant network meta-analysis. Medicine (Baltimore), 97(20), e10744.

Limori, T., Nakajima, S., Miyazaki, T., Tarumi, R., Ogyu, K., Wada, M., Tsugawa, S., Masuda, F., Daskalakis, Z. J., Blumberger, D. M., Mimura, M. & Noda, Y. (2019). Effectiveness of the prefrontal repetitive transcranial magnetic stimulation on cognitive profiles in depression, schizophrenia, and Alzheimers disease: A systematic review. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 88, 3140.

Mayo Clinic facts. (2019). Mayo Clinic.

Mayo Clinic Staff. (2020). Departments and specialties. Mayo Clinic.

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