Alzheimer's Disease: Its Effect On The Family (or) Society

Definition and Incidence 

Alzheimer’s disease is a progressive brain disorder which implies that worsens with time and irreversible (has no cure). It progression destroys the memory, ability to learn, affects the thinking skills and in the long run incapacitates the ability to carry out simple tasks as well as decision-making ability. This disease affects the elderly population as many people with the disease are in their mid-60. Alzheimer disease was first discovered in 1906 by Dr. Alzheimer’s who studied the brain of a dead woman who succumbed from a mental disorder that indicated symptoms like memory loss, thinking inabilities and revealed a change in brain tissue on observation. 

Alzheimer's is the most common cause of dementia; it is a general term used to illustrate memory loss and other cognitive abilities that are adverse enough to interfere with the persons daily life. Being diagnosed with this disorder requires lifetime care as it is a terminal disorder. Interventions to delay the onset of the disease are essential in the reduction of the disease prevalence in the state (Brookmeyer, Gray, & Kawas, 2011) . 

Alzheimer disease relationship to Dementia 

According to the National Institute on Aging (NIA), Dementia is defined as a brain disorder that negatively affects communication and performance of daily activities while Alzheimer’s disease is defined as a form of dementia that specifically affects parts of the brain that control thought, memory and language. Alzheimer's disease is associated with 60 percent to 80 percent of dementia cases according to the Center for Disease Control, Alzheimer’s disease. Thou it is a condition that is profound in the elderly it is not a part of an aging process. Dementia is not a specific disease but a descriptive term used for memory decline and thinking skills inabilities which in the long run renders the persons unable to perform their daily activities. 

Progression and Risk Factor 

Alzheimer occurs in three major stages, mild, moderate and severe. They are progressive stages where the impacts intensify as time goes by. As the disease progress, the symptoms manifestation in the patient increases too. The severity of the symptoms indicated the approaching of the death in the individual, and thus the risk factors and the stage of progression can be used to determine the time the person is left with. 

Inadequacies in the progression intervention are the key factor for the increase in the cases that are increasing on an alarming rate. Many Alzheimer disease requires a high level of care that is equivalent to nursing home care (Brookmeyera, Johnson, Ziegler-Grahamb, & Arrighic, 2007) . This is costly to the family, and the patient is at risk of quick deterioration if they do not get the required care and support. 

Diagnosis of Alzheimer disease 

The diagnosis of Alzheimer disease is done by doctors who assess memory impaired observing the available symptoms such as thinking skills, behavior change, functional abilities. This is vital in ensuring that a patient acquires the right treatment, care, and the family gets the education that is essential for coping with the situation (Khachaturian, 1985) . The diagnosis is done either by a brain trained doctor or a specialist for aging adults. This will be done through the evaluation for impaired memory, change in personality, and degree of thinking impairment, how the inability to think right affects the normal functioning and the cause for the manifesting symptoms. This is supported by brain imaging tests or memory testing. 

The diagnosis occurs in differing categories to reveal different aspects; blood tests, Physical and neurological exam, brain imaging and Mental status and neuropsychological testing. The results from this tests enable the doctor to make a decisive decision on what will be most helpful for the patient and what stage of the disorder they are currently in (Guy McKhann, Folstein, Katzman, Price, & Stadlan, 1984) . 

Treatment of Alzheimer’s 

Even though Alzheimer's disease is not curable, there are management interventions that are used to manage the signs (Thies & Bleiler, 2012) . This includes behavioral changes medication such as antipsychotic, medication to address memory loss such as cholinesterase. This antipsychotic drug is used for the treatment of mild and moderate Alzheimer which is an inhibitor of some symptoms and help in behavior regulations. Healthy living is a key factor which recommends feeding on foods that supports and boosts brain health. Alzheimer's is a mental disorder, and thus the patient struggles with symptoms such as depression and insomnia. To address this, the patient is administered with medication to change the sleep pertain and alleviate the depression disorder. 

Impacts of Alzheimer’s to the Family 

Emotional 

Diagnosis of a family member with Alzheimer’s affects the emotional functioning of the family. They may be stressed, fell a sense of sadness and anger due to the inability of the person to perform their daily duties as before (Biegel, Sales, & Schulz, 1991) . The family members need to meet regularly to discuss how the patient will be taken care of. This can be both draining and a bonding aspect for the family as they have a sense of responsibility to support one of them. 

Patients with Alzheimer's disease manifest behavioral change symptoms which may include agitation, restlessness, aggression, and sleeplessness. These behaviors are troublesome to the caregivers due to the inability to predict what will happen to them in the company of the patient the fear increases stress levels of a person and generally affects the relationship of the entire family which can escalate to family breakages. 

Financial 

The insurance policies are available and carters for the settling part of the medication bills thou they need to be topped up by family members where they cannot handle all the costs. The costs incurred in the management of the Alzheimer’s case goes beyond medication management but inclusive of travel cost, caregiver charges as well as nutritional budgets (Alzheimer’s Association, 2015) . Being a lifelong disorder that is terminal and thus expensive to maintain, the financial investments are high. The insurance covers need to be paid, but still, there is a need for out of pocket costs to the needs that pop out from time to time. The financial constraints are not only tied to medication costs but inclusive of family travels and accommodation costs for the patient, as well as hiring the skilled nurse. The family incurs an indirect cost which is not monetary valued as they spend time with the patient. 

Role of caregivers 

Handling Alzheimer’s disease entails the combined efforts of different people. Caregivers can be friends, family, health care providers, home care workers, and social workers. These people work to ensure that the individual suffering from Alzheimer's disease can have all the needs met and assisted with the essential decision-making process. Caregivers are integral to the initiation, administration, and monitoring of treatment in the entire process of treatment (Brodaty & Green, 2002) . This extends to research and reporting of noted side effects caused by the medication thus the need for the doctors to work in partnership with the caregivers for the administration of medication. 

Having the inability to think adequately and support their daily activities, the caregivers ensure that the bills of the elderly people are paid on time, medical insurance is taken care off so that they have a cover for their medical expenses. The caregivers are also responsible for supporting the patients emotionally so that they are not worn out with the sickness and enhance the rate of health deterioration arising from increased levels of stress and depression. 

The assurance of the ability to live a normal life even with the presence of the disease is a positive mechanism that is achieved through being with loved ones. The caregiver can spend time with the patient which will make them feel still needs which prolong their lives. 

Advantages and Challenges 

Alzheimer disease is a challenge to deal with and being a prominent disease in the elderly age. It is advantageous to them as it helps their family to stick by their sides. When a person is struggling with memory loss, they need to be watched as they are at a danger of hurting themselves. As bad as it sounds, it makes the family stay in close contact due to the sense of responsibility attached to it. In other cases, the elderly parents are abandoned by their family or taken to the elderly homes where they are rarely visited. 

Challenges to the elderly 

When an elderly is diagnosed with this disorder, the family feels it's a burden as they need to be watched in all aspects of their lives. They may, therefore, resolve to send them to the elderly homes to be watched by the professionals there. This is a challenge to the elderly as they are disconnected from their family and increase in the financial constraints. 

Memory loss affects the functioning of a person, Alzheimer’s disease levels of care progresses from outpatient to intensive inpatient care of a patient. This is because, as the brain health deteriorates, they need to be confined in a health care facility or have a home nurse to look after them as they cannot support themselves even to go to washrooms (Montgomery, Kahle-Wrobleski, Nakamora, & Vada, 2016) . This is challenging for the elderly due to the need for high financial costs to sustain them. 

Medicare, Medicaid, the Affordable Care Act, Social Security, out-of-pocket, and/or other forms of reimbursement 

Medicare  is a federal health insurance program that benefits the elderly from the age of 65 or the people who have earned social security benefits for a minimum of 24 years due to disability and are below the age of 65 years. This covers not the entire medication cost but part of it, Medicare can be used for the payment of the inpatient hospital care, and doctor’s fee (consultation), medical items purchase as well as some drugs prescribed in the outpatient care services. 

An adult with a Medicare cover, they are entailed to access of skilled nursing care, home care benefits. Despite the financial relief, it can cause for the family, Alzheimer disease is a long term and progressive illness that needs long term care in nursing homes which is not covered in the insurance cover. A person diagnosed with severe Alzheimer disease requires personalized aides to be used to enable performance of daily activities which is not offered by the Medicare cover and thus the need to have an out of pocket financial support. 

Medicaid, on the other hand, is a state medical insurance program which differs from one state to the other. The eligibility for the benefits is depended to whether the patient is eligible for supplemental security income. The extent of eligibility and benefits are dependent on the state and the determined by the assets and income of the beneficiaries living in the nursing homes which protects the spouse from exposures that can lead to impoverishment. 

Most people with Alzheimer's disease or other dementias will eventually need long-term care services, and many will require nursing home care. For people who meet eligibility requirements, Medicaid covers all or a portion of nursing home costs. Notably, not all nursing homes accept Medicaid. Most states have home- and community-care options for people who qualify, which allow individuals to live in their homes in the community and receive long-term care services. 

Recommendations 

Memory loss and inability to think properly affects not only the patient but the entire family and society. If a family key decision maker is struck by this disorder, the repercussions can be adverse as they might be manipulated to make decisions they would otherwise not consent like selling of family assets. To avoid endangering the wellbeing of the entire family, recommendations need to be made that will protect the family from such dangers. Policies should be put in place to restrict the engagement of Alzheimer patient in legal agreements. By so doing, the family and the person's assets will be conserved for the benefit of the future generation. These policies should be expanded to quote the extent to which the assets can be used for conversion to cater for the costs. This will help the patient to have a relaxed mind and peace to slow down the progression of the disorder due to the tension and fear of the unknown incidents. 

The family should be exposed to psychotherapy from time to time. This counseling session should be able to enable the family to understand the disorder facts and be able to support the patient. Counseling will enable the family to stay positive and know how their attitude affects the health of the patient with regard to response to the medication offered to manage the disorder. The therapy will enable the family to share responsibilities that are in agreement with the caregiver's abilities, resources, and emotional capabilities. This is important because overwhelming of a family member with responsibilities leads to the deterioration of their health. 

Disclosure of the diagnosis to the patient is not done by health care providers at the time the diagnosis is made. Timely disclosure is beneficial if it is done promptly, accurately and clearly by the medical professional. With this in mind, improvements with regard to disclosure need to be done as well as the development of a strong support system for the family and the patient to be able to walk through the illness till the end ( (Alzheimer’s Association, 2015) . 

Conclusion 

Alzheimer’s disease affects most of the elderly population, being diagnosed with this disorder call for the increased need for attention and support from the caregivers. Being a terminal disease, it implies that it progress as time goes and its progression calls for the need for intense interventions. The stage of the disorder determines the nature of treatment that can be offered as well as the level of care need. When a family member is diagnosed with the disorder, counting on the federal or state insurance alone cannot cater to the treatment costs which increase the financial need that is to be provided. Disclosure of the Alzheimer disease diagnosis to patients is reported to be minimal especially by the health care providers, this should not be the case as the patient's need to know from the beginning to enable them to put in place measures they might not be able to once the disease progress to advanced stages. 

References 

Alzheimer’s Association. (2015). 2015 Alzheimer's disease facts and figures. Alzheimer’s Association , 332-384. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25984581 

Biegel, D., Sales, E., & Schulz, R. (1991). Family caregiver applications series: Family caregiving in chronic illness: Alzheimer's disease, cancer, heart disease, mental illness, and stroke (Vol. 1). Thousand Oaks, CA, US: Sage Publications, Inc. 

Brodaty, H., & Green, A. (2002). Defining the Role of the Caregiver in Alzheimer’s Disease Treatment. Drug & Aging, 19 (12), 891–898. 

Brookmeyer, R., Gray, S., & Kawas, C. (2011, October). Projections of Alzheimer's disease in the United States and the public health impact of delaying disease onset. American Journal of Public Health (AJPH), 88 (9), 1337. 

Brookmeyera, R., Johnson, E., Ziegler-Grahamb, K., & Arrighic, H. (2007). Forecasting the global burden of Alzheimer’s disease. Science Direct: Alzheimer's & Dementia, 3 (3), 186-191. Retrieved from https://doi.org/10.1016/j.jalz.2007.04.381 

Guy McKhann, D. D., Folstein, M., Katzman, R., Price, D., & Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: Report of the NINCDS‐ADRDA Work Group* under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34 (7), 939. 

Khachaturian, Z. S. (1985). Diagnosis of Alzheimer's Disease. Arch Neurol, 42 (11), 1097-1105. 

Montgomery, G. A., Kahle-Wrobleski, W., Nakamora, K. T., & Vada, K. (2016). Impacts of Caring for the person with Alzheimer's disease or Dementia on Care Givers Health Outcomes: Finding from the community-based in Japan. BMC Geriatrics, 16 (1), 122. 

Thies, W., & Bleiler, L. (2012). 2012 Alzheimer’s disease facts and figures. Alzheimer's & Dementia: The Journal of the Alzheimer's Association, 8 (2), 131-168.