May 24, 2013 As we get older our minds and bodies begin to change. Some change may be for the better, we may get taller or our hair may even grow longer. Unfortunately, some people may experience a different kind of change, they may start to be forgetful, have a hard time remembering the names of familiar people and places or they may even forget where they live. There may be a point where their mind may begin to fade to the point where they may not be able to perform basic lifestyle functions such as eating, drinking or even speaking. This unfortunate change is due to Alzheimers disease. AD affects the lives of the elderly population and their families every day. Alzheimers disease is a progressive and debilitating disease that affects cognition and overall brain function and thus requires special care and support. Caring for a loved one with Alzheimers can be difficult, but with patience, compassion and education of the progression of the disease, how to care for a person with Alzheimers and tips on some important safety measures to use, caregivers and family members can be confident in the care that they provide for their loved one. Now that we have covered the basics of what Alzheimers Disease entails, lets enter into the main purpose of this paper which is to discuss how continuity of care is essential in the proper care of patients with Alzheimers/Dementia Disease. Lets first discuss the definition of continuity of care and the role that it plays in the care of the AD patient. Broadly speaking, continuity of care means that there is a smooth transition between different healthcare workers and health providers in various healthcare settings, and it can also be used when discussing staffing issues that occur within various Alzheimers/Dementia units (Servellen 2006). Quality healthcare is especially important when working with the patient and family and for some healthcare facilities, the quality of care outweighs the continuity of care in regards to the AD patient. It is important for the AD patient to have consistency as well as quality care. As stated previously, cognitive function become severely impaired during the disease process and a person may eventually be unable to recognize family members or remember their names. With that being said, continuity of care in regards to staffing is very important. It is important to try and have the same healthcare workers such as nurses and CNAs working on an AD unit. While and AD patient may not remember a persons name, they may be able to recognize or somewhat recognize a familiar face, thus making them feel more comfortable and willing to do more activities. When caring for a patient or family member with Alzheimers it is important to know and understand the disease process. Alzheimers is a progressive disease that affects the brain cells and causes memory loss and overall progressive loss of daily functions and activities. The disease can affect an individual in three different stages. The National Institute on Aging describes the stages of the disease as follows: Stage One (Mild Alzheimers). During this stage a person may begin to experience some memory loss and small changes in their behavior and personality. It may even be hard for them to remember familiar people or places. During this transitional stage it is especially important that the patient and family have consistency and see familiar faces around the clock especially if they are in a health care facility. We move next to the Second stage which the NIA describes as the Moderate stage. During this time, memory loss is now significant and the cognition level of the person is even lower. Not only has memory loss become more pronounced the persons level of continence (ability to know when they have to use the restroom and ability to control it) may also be decreased or beginning to decrease. This can cause further frustration for the patient as well as the family. Seeing a loved one continually decline over a short period of time can be hard. What adds to the stress of the situation is when the patient is being taken care of my numerous healthcare workers some of which may not know the patients history and personal routine. It is less stressful on the patient and the family when they know the cna or nurse that is working with their loved one knows their routine and knows what the patient likes and dislikes. It allows the patient to open up and be comfortable in participating in activities, even though they may not fully understand what is going on, they may feel more comfortable when they see a familiar face. The third stage is known as the Severe stage and at this point the persons brain is completely affected and they may no longer be able to perform basic daily functions such as dressing, bathing and eating. Their level of speech may be jumbled and unable to be understood or they may not speak at all. They also may not be able to recognize friends or family. It is seen by these descriptions alone why Alzheimers disease can be devastating. During this stage the patient is severely declining and may be near the end of life. They may be on palliative or hospice care and in need of support from family members and they may benefit from the patient centered care that can be provided by a healthcare worker that continuously cares for that patient. Now, this is not to say that someone who is not familiar with the patient and the family cannot provide good quality care. The point that is being made here is that when a nurse or cna has continuously worked with a patient, they know things about the patient that other workers may not know that can assist them with things such as transferring or assisting the patient to eat. Some patients that need to be fed may eat better with a person they know, than they will with a person they dont know. Again we are back to the person centered care and the continuity of care. Knowing the history, preferences, needs, interests and particularities of the person receiving the care is fundamental in the provision of person-centered care (Edvardsson 2010). Being familiar with the small things that a patient enjoys such as a certain way they take their coffee or that they like to sit by the window at lunch can often make the person feel more comfortable and it is often helpful when starting conversations and getting the person to participate in daily activities. While there is not yet a surefire and approved way to slow the progression of Alzheimers, once the stages and progression of the disease and how it affects a person are understood, it opens the door to understanding the best way to care for them. The AD patient needs continuous care and support. Consistency is ideal for the AD patient because this helps with the memory loss, according to the National Institute on Aging. They should have a normal morning routine for getting ready for the day and a normal routine for getting ready for bed in the evening. Showering or bathing may be difficult because they may be afraid of the water or they may not feel comfortable having someone else shower them even if it is a family member or friend. Allow them to do as much as possible for themselves because its helps to maintain a state of privacy and dignity. The Alzheimers Foundation of America states on their website to Allow the individual to have some sense of control. Being able to save face is important to someone who is confusedkeep things simple to avoid frustration. Routines and daily activities must be kept simple enough and directions must be given in short simple phrases, almost as if one is speaking with a small child. Have them use familiar soaps and lotions during the bathing process as the familiar scents may help them to relax and may even trigger their memory a little in regards to bathing and dressing. It may also make them feel more comfortable and having their own clothing items for them to dress in afterward may give them a since of autonomy and individuality. Seeing their own clothes may also give them a sense of familiarity and make them feel a little more comfortable. One of the most difficult aspects of AD is communicating with the person. Because of the decline in normal brain function and their area of memory and speech being affected by the disease, it can be difficult to communicate with the AD patient. According to the Family Caregiver Alliance website, a few important tips on communication with the AD patient are to first, set a positive mood for interaction, approach them with a smile, a positive attitude and a calm speaking voice. Next you want to get the persons attention, limit the distractions in the area and address them by name to get their attention, use hand signals and soft touch to keep their attention on what you are trying to tell them. If they are sitting on the couch or in a chair, sit down next to them and direct their attention your way. Always use a calm speaking voice and use small words. Finally you want to state what you are trying to say clearly and to the point so you do not lose their attention. Be sure to us small simple words and make instructions as simple as possible, guiding them if needed. The Family Cargiver Alliance website also states to Use the names of people and places instead of pronouns or abbreviations. For example, say place your sweater on the chair instead of put this over there. You must be specific so as to limit confusion and keep their attention.
With cognition and motor skills declining, it is very important to have safety measures in place when caring for the AD patient. Keep the area where they will be staying clear of clutter. The National Institute on Aging states that People with AD are able to read until the last stage of the disease. Use signs with simple written instructions to remind them of danger or to show them where to go. Small changes can be made to their living area that will greatly improve their safety status. Remove shallow rugs or mats that can be tripped over, off of the floor and make sure that rooms are always well lit. Always make sure that they have good walking shoes on while moving around throughout the day. They should have shoes that have a secure non-slip grip on the bottom or they should be wearing non-slip footies. The vision state of the AD patient can also be affected so it is important to make sure that areas are brightly lit in order to avoid and accidents. If they wear glasses, be sure that their glasses are cleaned and that they fit properly. Access to stoves and cabinets where dangerous chemicals are kept should be restricted and alarmed if possible. If possible, door stop openers should be place on cabinets where dangerous items are placed. Also access to stairwells and doors leading to any unsupervised or dangerous areas should be gated and if possible, alarmed. Caring for a patient or loved one with Alzheimers can be difficult, with a decline in cognition and overall brain function, it can be hard to see a loved one go through such a trying time. With patience and proper education on daily care, understanding the different stages of AD and some education on safety measure one can confidently and properly care for the AD patient. Alzheimers disease debilitates the brain and cause life altering changes that require special care and continuous support. While there is no cure for AD yet, with all of the technological advancements and new medications being released so often, family members and care givers alike only hope that one day there will be.