Although ageing is a natural physiological process of growing older, which consists of a number of mental and physical changes, it is frequently accompanied by severe and often incurable diseases. Alzheimer’s disease is one of the most crucial issues related to health care of the elderly. Interest in research on Alzheimer’s disease has become one of the major focal points in science and in the many professional areas that serve aging populations.
Accounting for approximately 50 % of all cases, Alzheimer’s disease is one of the most common forms of dementia, which is generally associated with numerous symptoms affecting elderly humans’ brain (Mayo Clinic, 2011; NIA, 2011; AFA, 2012; Turkington & Mitchell, 2010; James et al., 2011; Darby et al., 2012). People aged 65 and older can have Alzheimer’s disease. Advancing age is identified by the Alzheimer’s Association as “the greatest known risk factor” for this illness (2012). However, despite the rise of research on dementia in general and Alzheimer’s disease in particular, efficient medicines, and new techniques of treatment, numerous scholarly studies testify to the growing rates of patients diagnosed with Alzheimer’s disease.
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According to the data provided by the U.S. Congress Office of Technology Assessment, 5.3 million Americans are affected with Alzheimer’s disease. Moreover, it has been estimated that the number of people with this illness is gradually increasing (Mayo Clinic, 2011; NIA, 2011; AFA, 2012), the rates of afflicted population “could rise to 11 to 16 million by 2050” (Turkington & Mitchell, 2010, p. 14). Developing from mild forgetfulness to irreversible brain impairment, manifestations of Alzheimer’s disease frequently result in lethal outcomes. “A constricted life space is associated with increased risk of AD... and cognitive decline among older persons” (James et al., 2011, p. 961). In addition to comorbid illnesses associated with ageing, patients with Alzheimer's disease die from their diminished immunity and vital abilities; they cannot eat, move, and resist to infections. Thus, family members should be provided with appropriate educational programs on recognition of the earliest symptoms of the illness occurring in their elderly relatives in order to reduce rates of mortality associated with Alzheimer’s disease.
Although particular symptoms of patients may vary, the course of Alzheimer’s disease is generally characterized by the death of neurons in several areas of the brain (Pocnet et al., 2011; James et al., 2011; Darby et al., 2012). “These neurons, which produce the brain chemical, or neurotransmitter, acetylcholine, break connections with other nerve cells and ultimately die“ (AFA, 2012). Memory loss, development of multiple cognitive deficiencies, degenerative behavioral and mental changes, and emotional disorders are the basic displays of Alzheimer’s disease. Furthermore, symptoms can include speech dysfunctions (aphasia, echolalia, and anomia), infringements of movement (apraxia), cognitive, sensory, and sensitive abnormalities (agnosia). Patients experience difficulties in performing intellectual operations and independent living skills (Turkington & Mitchell, 2010; James et al., 2011; Darby et al., 2012).
Conducting research on the course, predisposition, causes, and possible outcomes of Alzheimer’s disease, scientists and medical professionals distinguish the following Alzheimer’s symptoms: problems with familiar tasks, language problems, memory loss, disorientation, poor judgment, abstract thinking problems, changes in mood and behavior, misplacing problems, and personality changes. Severity of cognitive and memory losses induces a decrease in social or professional adaptation of patients in comparison with the previous level. Symptoms vary according to the stage of the illness (mild, moderate, or severe). The course of the illness is accompanied by a gradual, steadily progressing decline in cognitive capacities. Lifespan of patients with Alzheimer’s disease can be from 8 to 20 years.
However, similar health statuses are typical of other disease-related conditions such as vascular disorders, senile dementia, hydrocephaly, diverse forms of mental disorders, hypo/hyperthyroidism, specific infectious diseases, heart problems, etc. Thus, it is obligatory to perform a thorough comprehensive examination of a patient in order to determine an accurate diagnosis as early as possible. Diagnostics of Alzheimer’s disease is based on physical and neurologic examination, assessment of medical history, physical and neuropsychological testing, and brain scans such as a computerized tomography (CT) scan, a positron emission tomography (PET) scan, or a magnetic resonance imaging (MRI) scan. There is no unique diagnostic method, which can precisely identify whether Alzheimer's disease progresses. Medical examination evaluates a patient’s health condition in general and reveals comorbid diseases, which influence thinking abilities. In accordance with recent research conducted by Pocnet et al. (2011), such a patient’ personal characteristics as extraversion, openness to experience, neurotieism, agreeableness, and conscientiousness should be accurately assessed.
According to Darby et al. (2012), “intraindividual decline in cognitive performance can be detected in otherwise healthy, community-dwelling, older persons, and this may deserve further study as a potential indicator of early Alzheimer’s disease pathology” (p. 95). Family members are those who can be the first to recognize the earliest manifestations of the illness. Thus, they should be aware of possible Alzheimer’s-related pathological changes in their elderly relatives. In order to provide patients with Alzheimer’s disease with efficient treatment and care, it is essential to diagnose them at the earliest stage of the illness. Despite prevalence of the disease, it is difficult to differentiate it from other similar conditions and make a correct diagnosis (James et al., 2011; Pocnet et al., 2011; Darby et al., 2012). Family members, caregivers, and even physicians wrongly perceive early symptoms of Alzheimer's disease as displays of an inevitable process of ageing. An early diagnosis provides patients and their families with opportunities to prolong life expectancy, cope with problems, and maximize patients’ quality of life. Family members and patients can discuss variants of care provision and try to slow down regressive processes. Hence, family members should be educated to recognize early symptoms of Alzheimer’s disease.
The more relatives know about Alzheimer’s disease, the better care they can be able to provide. “The information given by a close relative about a patient's previous personality may be biased to some extent” (Pocnet et al., 2011, p. 409). Thus, educational patient- and caregiver-oriented programs should be thoroughly designed and developed in order to promote effective treatment of the illness. Today, educational programs are developed by the Alzheimer’s Association, the Alzheimer’s Disease Education and Referral Center, the National Institute of Neurological Disorders and Stroke, the American Geriatrics Society (AGS), the National Institute of Mental Health (NIMH), the National Institute on Aging, the Association for Frontotemporal Dementias, the Family Caregiver Alliance, and many other empowered healthcare organisations. Therapies and methods cannot be effective without appropriate theoretical grounding. Conceptual and theoretical frameworks for educational programs involve Bandura’s self-efficacy concept of social learning (Bandura, 1997), a concept of schemas, and cognitive theory.
Social learning of humans is substantially defined by processes of modelling, supervision, and imitation. According to social learning theory, a person is system of social skills, developed reflexes, self-efficacy, and subjective significance. A person’s behavior is regulated by complex interactions of these external and internal factors. Supporting patients and enabling them to perform their activities of daily living, family members positively influence their perception of self-efficacy and, thus, make a positive impact on their cognitive abilities (NIA, 2011; “2012 Alzheimer's disease facts and figures”, 2012).
Although reduced cognitive abilities could not be improved or reversed due to inconvertible brain changes, family members can make a set of instructions or stimuli to promote patients’ executive functions and influence their behaviour. “Stimuli or situations become linked to actions, routines, or processing schemes and then groups of these routines become linked to one another. In this manner, a single stimulus may result in a relatively automatic string of actions, referred to as a schema” (Banich & Compton, 2011, p. 338). Schemas are specifically organised knowledge structures, which influence ways of acquiring and keeping information. Memory and cognitive processes are interconnected. Thus, it is essential to design and develop specific programs and techniques to train memory of patients with Alzheimer’s disease.
In order to preserve and expand the cognitive abilities of patients with Alzheimer’s disease, the Centers for Disease Control and Prevention (CDC) and the Alzheimer’s Association have devised and implemented the Road Map. These guidelines include 44 recommendations and determine an approach to promotion of the public’s awareness and comprehensive knowledge of brain health.
Educational programs are designed to promote and expand family caregivers’ knowledge about medical aspects of Alzheimer’s disease, applicable methods of diagnostics, treatment procedures and options, patient care, caregivers’ needs, support groups, long-term care, etc. Family members obtain necessary information concerning effective ways to communicate with their relatives diagnosed with Alzheimer’s disease, techniques to reduce stress and anxieties, methods to observe mood and psychological status, and tools to assess changes in health. Family members’ awareness of symptoms specific for each stage of the illness allows them to assess the course, estimate degrees of disability and progression of the disease. Educational programs and training courses involve “assisting and improving the caregiver’s ability to give care (for example, instruction, behavioural intervention strategies, community integration, and stress management)” (Shannon, 2010, p. 198). Thus, this intervention helps family caregivers understand how cognitive skills and strategies influence Alzheimer’s disease treatment. Increased knowledge and cognitive abilities of family members provide them with opportunities to utilize the most effective methods of care and treatment. Family members should be aware of future manifestations their sick relatives will display in order to avoid physical exhaustion and emotional burnout. Such frequent symptoms of Alzheimer’s disease as agitation, enormous sexual activity, combativeness, unreasoned anxieties, increased irritability, hostility, sleep disturbances, or hallucinations can trigger mental or emotional stress in family caregivers, which “places them at a 63 percent higher risk of dying than people the same age who are not caregivers” (Turkington & Mitchell, 2010, p. 53). Family members often suffer from depression, neurological disorders, and hypertension (NIA, 2011; “2012 Alzheimer's disease facts and figures”, 2012). The above-mentioned factors testify to necessity and effectiveness of educational programs.
Taking into consideration destroyed abilities of patients with Alzheimer’s disease to perform their everyday living activities, family members should be prepared to support them in dressing, washing, toileting, cooking, eating, and communicating with others. They should constantly take precautions and supervise their sick relatives to prevent injuries and accidents. Growing patients’ needs, complicated home care, demands for treatment and medications, as well as personal tiredness and anxieties lead to aggravated health conditions of family members. They often experience feelings of despair, loss, grief, bitterness, anger, and other negative emotions (NIA, 2011; Mayo Clinic, 2011; AFA, 2012). State, federal, public, and diverse scientific organizations offer family members psychological support, contact information about support groups and communities (“2012 Alzheimer's disease facts and figures”, 2012). Sharing their experiences, discussing problems, and exchanging information, family caregivers expand their dimensions of awareness.
Efficacy of educational intervention has been justified by findings of recent research conducted by Kurz et al. (2010). This study has estimated that educational interventions should be more comprehensive and individualized and “include problem solving and behavioural management strategies”. However, researchers have revealed that “the intervention achieved minor effects on the participants' psychological quality of life and did not reduce caregivers depression” (Kurz et al., 2010, p. 861).
According to Turkington & Mitchell (2010), the cost of Alzheimer’s disease is approximately “$100 billion per year in health care expenses and lost wages of both patients and their caregivers” (p. 88). Needs and possibilities of family caregivers should be thoroughly assessed and estimated. Information, education, and comprehensive training regarding this illness and its consequences should be accessible to all family caregivers. Thus, patients with Alzheimer’s disease and their relatives should be provided with adequate financial support and state funding. “Future studies should attempt to detect early personality changes using long-term prospective designs. A better understanding of such links may ultimately suggest novel strategies for delaying the occurrence of symptoms of Alzheimer disease and help patients and their proxies more efficiently” (Pocnet et al., 2011, p. 416).
To conclude, brain disorders are a serious and frequently encountered clinical issue. They interfere with most aspects of humans’ well-being, affect the way people think, function, and behave; they can disable an individual and impair health. Hence, the most appropriate assessment tools, educational toolkit, and deliberate interventions should be selected to provide patients suffering from Alzheimer disease with efficient medical aid.