At 78 years, James Maxwell, referred to as Max is a bona fide hero. He started a small business in his teenage years and gradually built it into an influential company. He has also taken all of his six children through college and has been a doting grandfather to his grandchildren. However, for the last five years, Max has struggled with Alzheimer’s disease. It started with forgetting a few appointments, then a few names, and rapidly and definitively generated into full-blown dementia. His families only saving grace has been the local mission hospital that been handling Max’s case from the beginning. Alzheimer's disease (AD) is a neurodegenerative disease that affects older people like Max, causing them to gradually but prematurely develop dementia (Kalaria et al., 2008) . In most cases, AD patients will have a late diagnosis because at its advent, the disease mirrors the symptoms of normal aging and may thus be ignored. With time, however, patients and their loved ones will realize that they have an advanced rate of dementia hence seeking medical assistance (Lage, 2006) .
Common signs include memory lapses, language and executive function difficulties, apraxia, which is executive motion problems, and agnosia meaning perceptional problems. Normally, AD is diagnosed by first establishing that the patient is undergoing dementia, then using psychological and physiological tests to rule out other possible causes of dementia. The ruling out of probable causes leads to a confirmation of the existence of AD. The general physical and psychological vagaries of old age can be a problem for a person and loved ones (Han et al., 2011) . When dementia is added to the matrix, the problem degenerates into a crisis that needs a lot of assistance, more so from healthcare officers. The nature and extent of the relationship between the patient and his or her loved ones on the one hand and healthcare officials the other, including how they communicate, make a great difference on how the patient handles dementia (Schultz & Martire, 2004) . It is on this basis that it becomes important to evaluate the effects of patient-provider communication on the well-being of Alzheimer’s patients. The gradual evolution of health care from an amenity-based approach to a holistic and relationship-based approach has exponentially improved the coping abilities of AD patients and their loved ones through their journey with dementia.
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Definition of Terms
The problem being canvassed herein relates to how the well-being of a patient is impacted by patient-provider communication. The basis for this problem is the modern concept of holistic care, which has expanded the scope of the obligation of healthcare officers such as doctors and nurses as and when they care for a patient (Kogan, Wilber & Mosqueda, 2016; Egnew, 2018). Traditionally, doctors and nurses focused on the patient’s problem such as a sickness or injury, as they sought to eliminate it. Under the current approach, the officers focus above all on the patient, through an interpersonal relationship (Ross, 2016). Communication is an integral and inalienable aspect of any interpersonal relationship, hence it's being the focus on the instant research and analysis.
Travaline, Ruchinskas, and D'Alonzo Jr, (2005) defined patient-provider communication as an integral part of clinical practice that entails both the exchange of information and a human to human interpersonal relations between a clinician as a patient. Patient-provider communication thus rises above just what is said between a clinician and a patient to include how it is said and in what context. Examples of patient-provider communication include a clinician carefully collecting information from an AD patient and the patient's loved ones about the progress of dementia (Kogan, Wilber, & Mosqueda, 2016). Another example would be a nurse explaining to an AD patient how to deal with the debilitating symptoms of dementia, or how a nurse assisting the loved ones of the AD patient deal with the gradual dementia of the patient and teaching them how to behave around the patient (Reihard et al., 2008) . Based on the examples above, the holistic nature of patient-provider communication can be perceived.
Dementia patients often fall under the care of different professionals including physicians, psychologists, and nurses. Each of these professional affiliations, after their own respective versions, believe that patient-provider communication is a critical bearing factor to the wellbeing of AD patients (Kogan, Wilber, & Mosqueda, 2016). Physicians hold the position that due to the nature of AD patients, including their age and condition, close interaction and proper communication can assist them to cope with the condition (Ross, 2016). Similarly, psychologists acknowledge that communication and relationship are critical to the well-being of dementia patients. Nurses, on the other hand, have developed the holistic approach to care based inter alia on international relationships, a contention that supports consensus with the doctors and psychologists notion.
The Effects of Patient-provider Communication on AD Patients
Emotional Effects
Most AD patients find themselves handling arguably the greatest crisis for their lives just when they are at their weakest, a fact that exponentially affects their emotional wellbeing. The ordinary AD patient will thus be emotionally weak and susceptible (Mega et al., 1996) . Normal communication with a clinician, more so when it is instructional in nature will exacerbate the emotional state of the patient (D'onofrio et al., 2015). Patient-provider communication will thus be an important bearing factor to the wellbeing of the AD patient as it can exacerbate or mitigate the emotional situation of the patient. A modern holistic clinician who uses a relational approach in communicating with the patient will have a positive effect on the patent. Conversely, the traditional approach where clinicians took a commanding and demanding stance of patients will lead to a poor emotional outcome for the patient (Mega et al., 1996) .
Physiological Outcome
AD may be a mental issue but with the brain having active control over the rest of the body, an AD patient is bound to have active or passive physiological outcomes (Han et al., 2011) . Although several versions of pharmacological interventions are available for AD, none of them have been confirmed to reverse or even slow down its impact (Butterfield, Perluigi, & Sultana, 2006) . The fate of the patient is thus mainly predicated on psychosocial intervention at the center of which lies patient-provider communication. What the clinician tells the patient, combined with how the patient is communicated with will thus have a monumental impact on patient outcomes. Proper patient-provider communication may result in reduced stress for the patient, which will mitigate the physical impact on an AD on the patient (Butterfield, Perluigi, & Sultana, 2006) .
Effect on Family Dynamics
Under the modern holistic approach to health care, the definition of the patient is expanded to include loved ones, more so when the patient is psychologically impaired. The families of AD patients are usually in a crisis, as they have to observe a person they earlier looked up to, even relied upon, undergoing neurodegeneration (Schultz & Martire, 2004) . The family needs encouragement, hope and most importantly, education on how to care for the patient all of which rely on patient-provider communication (Kalaria et al., 2008; Reihard et al., 2008) . When patient-provider communication is done properly and effectively, it will enable a better relationship between the patient and loved ones, thus improving the well-being of the patient. Poor communication will result in a negative outcome.
Effect on Ability to Cope
The absence of a viable cure or means to reverse the effects of AD makes it a woeful prospect for any patient and to some extent, can be considered as a near-terminal diagnosis. This is coupled with the fact that AD patients are elderly, hence their deaths and legacies will constantly be on their minds (Lage, 2006) . In this regard, patient-provider communication is a determinant on the quality of life that the patient and loved ones will have post-diagnosis. What clinicians will say to the patient, how they will say it and the level of interpersonal relationship is critical to whether the patient will be able to cope with the prospect of loss of mental capacity then life, or if the patient will be unable to cope (Pomorska & Ockene, 2017).
Patient’s Well-being after Patient-provider Communication
Patient-provider communication is a two-way street that combines what the patient communicates to the clinician on the one hand and what the clinician communicates to the patient on the other. The modern concept of healthcare information technology (HIT) has severely affected the concept of proper patient-provider communication, a fact that can severely affect the outcomes of AD patients (Alkureishi et al., 2016). For example, AD manifests in different ways for different patients. Proper management of AD is thus incumbent of the clinician getting enough time to listen to the patient on a person to person basis, as opposed to reading from a computer (Ross, 2016). Conversely, whatever the clinician tells the patient is subject to how the patient receives it, based inter alia on how the patient perceives the clinician (Coleman et al., 2004) . Therefore, for the patient-provider communication to result in the comfort of the AD patient, and for this effect to last, the two parties must have enough face time with one another. If possible, the clinician handling the patient should forget about whatever information is available on the computer and taken time to listen to the patient. Instead of just keying in information to the computer, the clinician should take time to explain to the patient and, where possible the patient’s loved ones about what is going on, the right intervention, and how the intervention will affect the patient (Alkureishi et al., 2016). When the patient and clinician are in a cordial interpersonal relationship, the patient comfort derived from their patient-provider communication will both be elevated and enduring.
Summary of the Reviewed Literature
AD is a neurodegeneration disease that affects old people, leading to dementia. The advent of AD may be mistaken for aging until dementia rapidly manifests. Patient-provider communication is the combination of the interpersonal relationship between patient and clinician on the one hand and the communication between clinician and patient on the other. The importance of patient-provider communication or AD patients is predicated on the modern concept of holistic clinical care (Kogan, Wilber, & Mosqueda, 2016). The outcomes of patient-provider communication include those pertaining to the emotional status of the AD patient. As available research revealed, AD patients are usually emotionally affected even before they seek medical attention, thus patient-provider communication can either exacerbate or mitigate the emotional crisis. The impact on the physiological condition, the entire family, and the patients’ ability to cope was equally canvassed.
With the effect of patient-provider communication on the well-being of AD patients having been confirmed as exponential as per the above research and analysis, further research is necessary for expanding the role of patient-provider communication as a solution for AD and dementia. With the absence of a pharmacological solution for AD and its mental effects, the need for a substantive solution for AD still remains. The positive role that patient-provider communication plays in AD mitigation might be expanded into an actual solution for AD patients, instead of it playing the role of a mitigating factor.
References
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