Progress in Dementia Care as Treatments and Prevention Lag Behind

Chair exercise class at the Louis and Anne Green Memory and Wellness Center at Florida Atlantic University, Boca Raton. Photo courtesy of the Louis and Anne Green Memory and Wellness Center.

Dementia has long been a diagnosis dreaded by patients and families, as there is no cure. Despite decades of effort, scientists have had little success in developing effective treatments or methods to prevent or slow down the characteristic brain deterioration.

Nearly 6 million people in the United States, including about 14% of the population ages 71 years and older, are afflicted. Dementias, including Alzheimer disease, are among the most common causes of disability and dependency in older adults and projections of the actual number of Americans with dementia—as much as 13.8 million by 2060—suggest rapid growth as the population ages.

Some progress, however, has been made in understanding symptoms and progression of dementias. Recent studies have also shed light on potentially modifiable risk factors, identified new methods of diagnosis, and explored ways to slow disease progression and improve patients’ quality of life. Among […]

2022-06-15T10:13:05-04:00June 15th, 2022|family caregiving, Nursing|0 Comments

How Should a Nurse Support Patients in Choosing a Time to Die?

Two of my six aunts died from Alzheimer disease (AD). They didn’t live nearby, so when I saw them every few months, the deterioration from the illness was evident. Both showed the same behavioral trends: some mild forgetfulness and repetitive questioning at first, then what seemed a prolonged period of incessant questions and bewilderment and anxiety over not understanding where they were or why they were there, who others were. Wandering outside at all hours, agitation and resistance to hygiene, eventually disappearing into a nonverbal, nonresponsive state.

It was painful to watch these formerly active, smart, and vibrant women decline in such a way. The most painful part was when they still understood that they were becoming confused and how frightened that made them.

Now there are alternatives available for those who don’t want to go down that road—but they are hard to come by, especially if you live in the United States.

People with dementia face particularly high hurdles.

A special feature in the March issue, “Medical Aid in Dying: What Every Nurse Needs to Know,” covers medical aid in dying and the nurse’s appropriate role in many end-of-life circumstances, including the ethically and logistically challenging situations of those with dementia who seek some agency over how […]

If Nurses Aged in Reverse

“No—no!” shrieked my 95-year-old patient with dementia as I turned her to her side with the help of my nursing assistant (now called a patient care tech, 30 years later).

The three daughters sitting at her bedside inhaled deeply, their eyes wide. I looked over at them, calmly explaining that their mom was just frightened, and then in a soft voice said to my patient, “Don’t worry, Mrs. Smith, we won’t let you fall,” as she continued to scream. We positioned pillows against her back, and another between her knees. As we saw the family relax, and the patient’s screams turn to a barely audible whimper, I caressed her back and felt satisfied that all was well.

Fast-forward to my retirement. Having inherited my parents’ degenerative joint disease, at age 72 I have certain specific ways to sleep so that my left shoulder doesn’t hurt, my left hip bursitis doesn’t flare, and my right arm doesn’t get numb and tingly from a pillow that’s too puffy, causing hyperflexion of my cervical vertebrae.

Never assume what the patient’s feeling.

I have flashbacks from the days I thought I was an efficient nurse—I dread having someone, someday, assume that I am just frightened in their attempts to keep me on a turning schedule to prevent pressure ulcers. While […]

2021-08-30T14:19:59-04:00August 30th, 2021|patient experience, Patients|1 Comment

April Issue: Career Choice Regret Among Nurses, Acute Care for Dementia Patients, More

“Nursing goes beyond measurable outcomes; it extends to the relationships between nursing staff and patients and their families that help them to adjust to their new normal.”Andrew Dwight Reed, author of the April Reflections column, “A New Normal

In case you’d like a break from 24/7 news of COVID-19 and want to keep up with some other nursing and health care topics, the April issue of AJN is now live. Here are the highlights:

Original Research: An Investigation of Career Choice Regret Among American Nurses

The authors surveyed a random sample of American Nurses Association members to find out the extent of career choice regret among U.S. nurses and whether burnout is an independent predictor.

CE: Acute Care for Patients with Dementia

This article describes the unique care needs of hospitalized patients
with dementia, highlighting evidence-based strategies and person-centered care principles nurses can incorporate into practice.
[…]

2020-04-01T08:36:54-04:00April 1st, 2020|Nursing|0 Comments

Polypharmacy in the Elderly: The Risks Often Outweigh the Benefits

“…the single greatest adverse drug event risk factor is the number of medications a patient takes.”

Lessons from speaking to elders about their medications.

Early in my career, I taught groups of seniors about common medications as part of a hospital-based community health program. I traveled around the Chicago area, speaking to groups at senior centers, apartment buildings, and places of worship about their health and medications.

As part of our program’s mandate to educate physicians and nurses as well, we interviewed many elders on film, asking them to tell us about their medications. I will always remember one lady, relating a friend’s problems with adverse drug effects. “He’s dead now,” she stated with finality. She made it clear that she blamed his demise on the drugs his doctor had prescribed.

My experience in the Chicago medication education program influenced my pharmacology lectures to nursing students. Students may remember me most for the many times I repeated this statement: “The first sign of an adverse drug reaction in an older person is often a change in mental function.” This is a central reality of drug effects on the elderly.

Paying attention to unexplained cognitive changes.

Yet even today, the default response of many […]

2020-02-03T08:54:32-05:00February 3rd, 2020|Nursing|0 Comments
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