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Tiffany Feliciano

Research Paper part 3


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.