Disease Processes

Alzheimer’s is a progressive disease that is considered the main cause of dementia in older adults. Alzheimer’s effects a person cognitive abilities, causing a person to be in a state of constant confusion. It starts with difficulty remembering newly learned information, but slowly advances through the brain and leads to severe symptoms including; deepening confusion of events, disorientation, mood and behavior changes, and unfound suspicion of known family and friends(Alzheimer’s Association). This disease can even go as far as effecting speech, swallowing and walking, Alzheimer’s symptoms generally worsen as the patient grows older. The disease causes loss of memory and ability to think critically. The effects of this condition in early stages are mild but in the late stage, the patient loses the ability to either respond to the environment or even successfully carry on a conversation. In late stages of Alzheimer’s patients can become aggressive and extremely hard to care for, losing all activities of daily living.

Alzheimer’s effects the brain and makes microscopic changes in the brain far before the first signs of memory loss. Within the brains 100 billion nerve cells, each nerve cell connects with others to form clear communication. These nerves have special jobs that help us think, learn, remember, hear and smell (Alzheimer’s Association).

 

Scientists believe that Alzheimer’s disease prevents the parts of a cell nerve from functioning with one another. It is not known exactly where the problem starts just that it causes problem in one area and then the damage spreads and cells no longer do their jobs properly, eventually dying and causing irreversible change in the brainAlzheimer’s Association.

Scientists and researches both believe that there is not a single cause for Alzheimer’s disease. It is thought that the disease develops from multiple factors which include:

 

• Age
• Family history
• Genetics
• Lifestyle
• Environment
• Heredity
• Head injury
• Heart head connection

 

 

While the disease process is known as well as signs and symptoms, there is no treatment. There is medication to help with the side effects and medication that is thought to slow the process…but no known cure.

 

Patient Profile

Mr. John is a 65 years old patient suffering from Alzheimer’s disease. He has a health history of dementia, with the onset of this disease beginning when he was only age 55 . Mr. John has faced various challenges with this disease; including gradual memory loss and inability to engage in conversations effectively, disorientation, deepening confusion of events and suspicion and inability to remember family. He has also had the challenge of becoming increasingly incontinent, especially through the night. This leaves Mr. John feeling alone and incompetent, not wanting to share this medical information with anyone.

The patient holds a master’s degree in mechanical engineering, and worked as a engineer his entire life(This is an indication that he is such a hardworking individual). He has had a great career as a mechanical engineer for a Power Plant company for 30 years. He enjoyed his job and was a great employee and made many strives to better the plant facility. He was the leader of a engineering team that led to clean stacks for less environmental pollution. However, he was forced to retireat the age of 50,due to his dementia as he began forgetting simple work related task and, was becoming progressively agitated. Mr. John did this in hopes to become more aware and  concentrate on managing his health condition and medication, hoping to get his dementia under control and understand the disease process better.

The financial state of Mr. John has not been so great since his retirement. He has only been receiving a total amount of $ 500 pension monthly; this has not been enough for his basic daily needs andmedication or healthcare. This forces Mr. John to not be able to properly care for himself or obtain the proper medical equipment for his disease, process. He is becoming increasingly weak and unstable, partially to nutritional intake and partially due to disease process.

Mr. John is a widow and leads a very lonely life losing his wife very early on and his children are grown up with families of their own to care for. This tragic event and lack of social environment led to Mr.John being diagnosed with depression leaving him even more isolated and lonely. Since his wife’s death he has become an extremely isoloated individual and has not been frequently seeking support from his neighbors or even relatives with regard to his health status. Every time Mr. John calls his children, they are all too busy to visit, he would like help understanding his disease process. Furthermore he would like his children to know that he has a disease and would greatly enjoy time with his family before he forgets who they are.Depression and isolation have been viewed by various practitioners as the main cause of Mr. John’s Alzheimer’s condition. Mr. John’s, is clearly facing financial problems in such a way that he cannot manage to access the required medication and support needed to assist with his mental dissability

The Influence of Socioeconomic Factors on Mr. John’s Ability to Access Healthcare Services

The socioeconomic factors highlighted in Mr. John’s profile greatly influences his ability to access medical care (Maresova, Mohelska, Dolejs, & Kuca,  2015). Having retired from his job as an engineer, Mr. John has limited outlets to get finances to support his daily activities as well as access to medications. He has faced many challenges trying to raise funds to get medical attention with regard to his condition. Despite the fact that Mr. John faces financial challenges, cultural influences and the spirit of individualism has prevented him from seeking assistance from friends or even relatives. This has been viewed as a set back in his effort to gain access to healthcare services.

Having to put up with a lonely lifestyle after the death of his wife, has also affected the ability of Mr. John to seek medications for Alzheimer’s disease. He has suffered from depression due to this and it is presumed that this is the main cause of his dementia condition. Because of this, the patient has had problems with memory management, reasoning and even making crucial decisions in his life. According to Cadar et. Al. (2018), “Lower educational attainment is associated with a higher risk of dementia. However, less clear is the extent to which other socioeconomic markers contribute to dementia risk.” Therefore, among the highlighted factors, the educational level does not seem to play a bigger role in influencing Mr. John’s ability to access the medications.

Self-care Practices for Mr. John

Considering Mr. John’s condition and age, the main self-care practices that he needs to put to action is self-acceptance and awareness. It is good to accept that he has had a rough past which includes the agony of losing his wife and distancing his kids. While it may be confusing to Mr. John it is important that he know and remember, what happened to his wife. The best way for him to cope with the past is to accept and move on positively with life, however this proves to be very challenging in a dementia patient. It may be time for the patient to consider long term care or assisted living, if Mr. John chooses not to do so, he needs to frequently visit the restorative care units for the elderly to be able to get more guidance on how to manage his condition. Since Alzheimer’s is a progressive disease, the patient also needs to frequently engage with people who can help him in decision making alongside of encouraging him to practice preserved thinking skills. In addition to this, Mr. John must engage in frequent physiotherapeutic activities that will assist in creating the body balance and proper functioning of the mind. Furthermore, the patient is required to eat fresh produce, low saturated fat foods, and healthy oils. He also requires to pay more attention to medication guidelines that can manage depression and blood pressure. If Mr. Jones chooses not to go to an assisted living home, it is urgent that he reach out to family or even health personal for proper care.

No matter how old a person affected by dementia, it is extremely important to keep a healthcare plan that meets their care needs. A person may have Medicare, retiree health coverage or private insurance. Not all private pay insurances cover long term care, in fact once an individual is diagnosed with Alzheimer’s he or she will not be able to apply for long term insurance coverage. While most insurances say that they cover Alzheimer’s, it is very important to take a closer look; most insurances require that it be preexisting. Meaning an insured person was insured for a long amount of time and developed dementia while insured, most insurances will not take an Alzheimer’s patient for insurance coverage. With that being said; there are a few that will cover and do allow for a level of benefits to be collected (AARP, 2019).

One excellent private pay insurance is AARP, they are responsible for investing $60 billion into the Dementia Discovery Fund. AARP has a commitment to help people and family caregivers effected by dementia. At this very moment 47 million people have dementia and someone is diagnosed every three seconds. AARP are well aware of the broad impact that Alzheimer’s and dementia has, they offer AARP by New York Life for long term care options (AARP, 2019).

The statistics for long term care are overwhelming and indicate that approximately 70% of people over the age of 65 should expect to use some form of long – term care. This is offered through companies that won’t sell long term care insurance after you have been diagnosed. Rather you have to buy the plan before being diagnosed with Alzheimer’s, generally by a company that you work for. Planning ahead for long term care insurance can help an individual, if cognitive impairment arises and force one into an assisted living or skilled nursing home. Right now Mr. John has no insurance only $500 pension monthly, it may be wise for Mr. John to reach out to a Medicare program.

The Healthcare Services that Mr. John has Access to

Mr. John has been able to gain access to various healthcare services since being diagnosed with Alzheimer’s disease. He has been taking medications such as cholinesterase inhibitors which are helping him in memory management and enhancing critical thinking as well as decision-making abilities (Alzheimer’s Association, 2019). Despite his financial problems, Mr. John is also trying to engage in physiotherapy programs which are crucial in managing the overall functionalities of the body.  However, he refuses to go to any longterm inpataient therapy, this is against nurse and doctors orders. Mr. John really needs assistance from family to keep him out of a long- term care facility. He has been seen by the visiting nurses association and by his family Doctor, in which he was referred to a specialist. Mr. John refuses to see the specialist as he belives he can manage this on his own. He feels as if there are

Furthermore, there is support for families caring for loved (Wyoming Department Of Health) ones with Alzheimer’s, it is known as National Caregiver Support program. While there are little  for Alzheimer’s patients, there are some facilities listed that can care for a person with the disease, however there are not so many providers. Listed below are the two providers in which Mr. John can visit:

Sage View Care Center

1325 Sage Street

Rock Springs, Wy 82901

 

 

Deer Trail Assisted Living

2360 Reagan Avenue

Rock Springs Wy,82901

 

Disease Processes

Alzheimer’s disease mostly affects middle age people and old individuals in society. However, it develops as people continue aging. The illness is spread throughout the brain, and it can cause the shrinking of the brain tissues. Research shows that individuals suffering from this condition cannot communicate efficiently. Also, the people suffering from this disease rely on others for their care. Most of them are impaired and cannot perform their duties well.

Additionally, most of these patients spend most of their time in bed. As a result, their movement is restricted as they might not go far. Besides, most of the individuals suffering from the illness lose their memory and cannot remember many things. In extreme cases, patients suffering from the condition might become confused. Furthermore, they tend to be suspicious about their close associates and even their immediate family members. It is also evident that the person cannot engage in a conversation.

Patient’s Profile

Mr. Mark is a 60-year patient who has Alzheimer disease. His health history indicates that he developed the disorder at the age of 55 years. During that time, he had not retired from his formal employment and was still serving as a public servant. The illness showed some symptoms as Mark’s condition became chronic. For instance, he was unable to engage in conversations because of memory loss. Mark also lost confidence in some of the family members and his close associates. Therefore, he always became suspicious of them because of the fear that was created by the disease. Mark also experiences sleeping problems at night, and he is still depressed. Currently, his health condition has prohibited him from engaging in any economic activity. This is as a result of his weak body that cannot allow him to work.

Consequently, this has forced Mark to spend most of his time at home under the care of other family members. His wife also passed away five years ago, and he has been staying alone. Finally, He feels isolated and is not willing to share information regarding the illness with anyone.

Besides, he is a highly qualified individual who holds a bachelor’s degree in law. It demonstrates that John is a diligent person. He worked in the banking sector for 25 years. However, he decided to take early retirement at the age of 55 years. This was after realizing that he was suffering from Alzheimer disorder. As a result, it could affect his ability to work thus, decreasing his productivity. He decided to make such a decision to manage his health condition and focus on medication. Besides, he wanted to have enough rest since his situation was becoming chronic.

Mr. Mark has been enjoying good financial status since he retired from formal employment. He had been receiving a total of $450 pension, and the amount is reasonable for the retiree. Though, the amount has not been enough to cater for his medication and his daily needs. His wife also died four years ago (Mata, Frank & Gigerenzer, 2012). This made Mark’s life more horrible since he never had someone to console him. Therefore, Mark lived a stressful experience, and at a certain point, he was diagnosed with depression. Mark preferred living a secretive life and had not made any attempts to seek advice from neighbors regarding his health situation. Many health practitioners believe that this was one of the leading causes of his heart attack. From Mark’s case, it is evident that he is facing financial challenges and might not access the needed medication.

Healthcare Delivery system

Role of Caregivers

In the absence of a spouse who can handle the full-time job of the caregiver, the children should fill that gap immediately. The person trusted with role does several things apart from attending the individual needs of Mark (Wood, 2012). Therefore, he must care for the businesses of the patient to ensure that they go on smoothly. The caretaker might also talk to the doctors on behalf of the patient.

Moreover, he can also pay hospital bills and handle his insurance claims. The caregiver should always act in the best interest of the patient at all times. Finally, he should ensure that the patient has the best health insurance to cater for his health needs.

Guidance and counseling

Since Mark is in a pathetic condition, he needs to be given hope by professional counselors. He has many misfortunes such as the death of his wife. Moreover, Mark lives a life of isolation since he lives alone. Therefore, he might be suffering from depression despite having Alzheimer disorder. Thus, the counselor will guide the patient to accept his condition and live a positive life. The step might be helpful during the healing process. Some of the medicines that the doctor can prescribe to Mark that can help in the breakdown of chemicals in the brain.

Treatment

The doctor will assist the patient to choose his medication based on the patient’s medical history. The physician will also consider the stage of Mark’s condition before commencing treatment. Additionally, the physician should also evaluate if the treatment will work in favor of Mark. Some drugs curb the breakdown of a chemical in the brain (Velayos-Baeza & Danek, 2017). One of the available medicines that can be used in treatment comprises of acetylcholine. It helps to boost the memory of the victim to ensure that he does not forget things quickly. The medicine will also assist the patient to improve his communication abilities. Lastly, the drugs will help in decreasing the symptoms of the disease.

Cost of treatment

The fee of treatment will be paid at various stages. The first point is where he will pay for the cost of drugs such Cholinesterase inhibitors which can help to reduce agitation and depression among the patient. In this case, the doctor can advise Mark to use donepezil and galantamine to treat the illness. He used approximately $200 in these medications (Wilde, 2006).

Additionally, Mark also spent a lot of resources on guidance and counseling. In this case, he used $1000 for this treatment. Besides, he paid a total amount of $300 for emotional medication that could assist in relieving stress. Lastly, he paid $100 for the gym and regular exercises.

The healthcare delivery system experiences many issues. First, the demand for healthcare services outweighs the number of health workers. Also, the cost of treatment for chronic illness is high, and it is not affordable for many individuals. The number of people who have Alzheimer’s disease is gradually increasing (Roche, MacCann & Croot, 2016). Additionally, the cost of pharmaceuticals is growing progressively, and it is beyond the reach of many patients. The level of awareness on how to prevent this disease is still lower among the patients. Many people realize their conditions when it’s too late. Finally, many health centers especially public institutions lack enough resources and equipment to carry out their activities efficiently. Some individuals might find it difficult to pay for medical treatment (Mata, Frank & Gigerenzer, 2012). This is a common phenomenon among low-income earners and individuals living in developing nations. There are also several areas where the treatment of Alzheimer is rare and not affordable.

Conclusion

Mark’s case indicates that Alzheimer is a chronic illness that adversely affects a person’s health. The disease is associated with memory loss and communication problems. Mark was supposed to retire at the age of 60 years but opted for early retirement because of his illness. Even though he earned a good salary as a lawyer, it is evident that the disease consumed a substantial amount of his resources. Therefore, his pension was not enough to cater for his medication and daily needs. His lonely life also increased his problems since he could not get help from friends. Mark should first begin the process of illness by accepting his situation. These significantly decrease the levels of depression that he is currently experiencing. Mark should also seek various types of medications such as painkillers and stress relievers. Mark’s cost of treatment will comprise the cost of drugs, expenses of cardiac rehabilitation, and emotional therapy. The remaining amount will go to the value of physical exercises. Moreover, I noticed several problems in these sectors. Some of them include the high cost of treatment, lack of adequate staff in the medical industry, shortage of resources, and lack of affordable healthcare to the low-income earners.

 

References

Roche, L., MacCann, C., & Croot, K. (2016). Predictive Factors for the Uptake of Coping Strategies by Spousal Dementia Caregivers. Alzheimer Disease & Associated Disorders, 30(1), 80-91. doi: 10.1097/wad.0000000000000105

Velayos-Baeza, A., & Danek, A. (2017). Chorein Deficiency and Alzheimer Disease. Alzheimer Disease & Associated Disorders, 31(1), 80-81. doi: 10.1097/wad.0000000000000186

Wood, H. (2012). Prostaglandin E2 signalling is implicated in inflammation early in the Alzheimer disease course. Nature Reviews Neurology, 8(8), 411-411. doi: 10.1038/nrneurol.2012.145

 

Alzheimers Association. (2019). Medication for memory. Retrieved from https://www.alz.org/alzheimers-dementia/treatments/medications-for-memory

Cadar et. al. (2018). Individual and Area-Based Socioeconomic Factors Associated With Dementia Incidence in England. JAMA Psychiatry, 75(7): 723–732. doi: 10.1001/jamapsychiatry.2018.1012

Maresova, P, Mohelska, H, Dolejs, J, & Kuca, K. (2015). Socio-economic Aspects of Alzheimer’s Disease. Curr Alzheimer Res, 12(9):903-11. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26510983

Wyoming Department of Health (2019), https://health.wyo.gov/

 

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