Alzheimer Disease and Methods of Dealing with It - Literature review Example

Literature Review Introduction Alzheimer Disease (AD) is a devastating condition that impacts the family on multiple levels. First, it draws the family members into the patient’s condition because as the disease progresses, the patient becomes more difficult for the family to manage. Patient’s not only lose their ability to recognize their own family members, but often become combatant, suffer loss of ability to maintain their selves hygienically, nutritionally, and emotionally. This can be exhaustive for the family that attempts to care for a loved one going through these stages of deterioration. To further complicate and intimidate the immediate family caregivers is the reality that AD is a hereditary disease, and that as they care for their afflicted loved one, they are ostensibly watching their own future unfold before their very eyes. Understandably, AD is a disease that people are working hard to understand so that more effective treatments and cures can be found that, if the disease cannot be eradicated, at least it can be more effectively managed by the caregivers, and extend the quality in the patient’s life and environment for as long as possible. It is, too, a condition for which there are mechanisms of support for family members who experience the psychological loss of their loved one sometimes years before the physical loss. Discussion The existing bodies of research and literature give rise to the PICO format question that drives this research and literature analysis: Among family members with Alzheimer Disease, is group therapy more effective than individual therapy as a method to cope with the loss of the family member (memory, personality, etc)? The PICO format formula that is used to drive the search for the literary analysis and review is: P-families of patients with Alzheimer I-group therapy C-individual therapy O-effective coping Two data bases were used to search for relevant information using the keywords taken from the PICO formula: Medline, accessed through: Medline/PubMed http://www.pubmed.gov/; and CINAHL, a subscription only data base. Using Medline, and limiting the keyword search to “families of patients with Alzheimer,” the search returned forty-two results directly related to the keyword search. From the search selection, three journal articles selected as appropriate for use in the research, and in this literature review. The first article selected was Improving Caregiver Well Being Delays Nursing Home Placement of Patients with Alzheimer, by researchers Mittleman MS, Haley WE, Clay OJ, and Roth DL, found in the Neurology, 2006, Nov 14: 67(9):1592-9 (PMID 17101889 [PubMed – indexed for MEDLINE]). Mittleman, Haley, Clay, and Roth look at the Alzheimer patient’s caregivers from the perspective of improving the quality of life for the patient, and for the caregiver, and their research supported the conclusions that caring for the caregiver leads to an improved quality of life for the patient. The authors of the research support their conclusions with statistical data yield from the studies they conducted using a clinical methodology described as a randomized controlled trial of an enhanced support and counseling that led to an improved caregiver mental and physical state of improved well being. The first article, using the keyword search from PICO, families of patients with Alzheimer disease, pointed to a second one related to the keyword search (number 43, since it was not included in the direct search article yield). The second article, Preserving Health of Alzheimer Caregivers: Impact of a Spouse Caregiver Intervention, authored by researchers Mittleman MS, Roth DL, Clay OJ, and Haley WE, found in the American Journal of Geriatric Psychiatry, 2007, Sept; 15(9):780-9. This second article describes in detail the research of the group as it focused on the spouse as the Alzheimer patient’s primary caregiver. The study cites data yield derived from a randomized controlled trial over a nine year period time between 1987 and 2006. The volunteer sample participating in the study was referred, and reflective of 406 spousal caregivers of Alzheimer patients. The study examined the functionality and usefulness of an ad-hoc counseling availability on a continuous at need basis of availability. The conclusions of the group based on the study was supportive of the availability of counseling to Alzheimer patient caregivers as a source of support and a means by which to help improve and maintain the quality of life for the patients and their caregivers. Finally, the third article selected was, again, selected as one directly related to the first, by Mittleman MS, Brodaty H, Wallen, AS, and Burns, A, found in the American Journal of Geriatric Psychiatry, 2008, Nov; 16(11):893-904. The article, therefore, as it came up as a recommended related article of one selected from the original 42, and as within which there was a separate and independent link to the article, makes it forty-four using the keyword search “families of patients with Alzheimer disease. The article, A Three Country Randomized Controlled Trial of a Psychosocial Intervention for Caregivers combined with Pharmacological Treatment for Patients with Alzheimer Disease: Effects on Caregiver Depression, was conducted over a period of 24 months examined the relationship between Alzheimer patient caregivers with pharmacological interventions for depression combined with counseling services for the spousal caregivers of Alzheimer patients. The goal was to measure the levels of depression suffered by patient caregivers, and to determine if the pharmacological intervention in combination with counseling yielded improved results in measuring caregiver levels of depression. Each of the three articles selected using PubMed are relevant to the study, and provide qualitative and quantitative analysis that furthers the understanding of the objectives of the study and research being proposed. The first article selection from the CINAHL database chosen as relevant to the study and research being proposed, Mannion E, from the journal Nursing Older People 14720795, May 1, 2008, Vol. 20, Issue 4, titled: Alzheimers Disease: The Psychological and Physical Effects of the Caregivers Role. The goal of this study was to determine the impact of caring for Alzheimer patients on “informal,” caregivers. The study was conducted in Ireland, and used a sample group of caregivers over a three county range. The study established the need for interventions to be designed for caregivers, because the study yielded data to show that the onset of poor health could be directly related to the caregiver’s role in caring for the Alzheimer patient. The methodology employed included forty-four questionnaires designed to ensure the most complete and comprehensive study data possible. It meant that the questionnaires had to be gone over and analyzed in detail, and where there was no answer given by the participant, missing variables had to be identified and then the relevance of those variances to the study had to be determined. The sampling was random, which was organized using two voluntary organizations. A list of appropriate caregivers was compiled, and the final participants were selected from the list. The second article selected from CINAHL, Counseling provides benefits to Alzheimer caregivers, Tufts University Health & Nutrition Letter, 15260143, March 1, 2004, Vol. 22, Issue 1. The goal of this study was to examine to the ways in which stress suffered by Alzheimer caregivers might be reduced. The goal was to provide the caregivers with ways as a result of their improved nutrition to reduce the stress even during those times when the patients’ behaviors accelerated in ways that would be normally be very stressful. The study was conducted over a four year period of time, involving 200 spousal caregivers to Alzheimer patients. The study was conducted in three parts: individual and family counseling for the first 4 months; required attendance at a weekly support group; and continuous access to counseling by telephone. The focus was to determine if over the course of the study the caregivers, who were provided with improved nutritional diets for their selves and for their loved ones, would themselves experience an improved health and perspective. The nutritional values included controlling calories and sugar, and other designed nutritional approaches that would help improve the participants’ strength, stamina, and well being. The hypothesis that improved nutrition would improve the overall health of caregivers was supported when caregivers reported experiencing reduced stress levels in caring for their loved ones. This, even despite the fact that over the period of the study the caregivers experienced problems involving the deterioration of their loved ones’ conditions in areas such as depression, agitation, wandering, and incontinence. All these conditions would be dealt with by the participants demonstrating less stress as a result of adherence to nutritional guidelines in their own lives. It was noted by the researchers that the individuals who practiced improved nutritional behaviors, experienced higher levels of ability to deal with their stress and stressful situations in their roles as caregivers than did the population who had access to just counseling without the nutritional component. The findings are useful independently and in conjunction with therapeutic interventions such as counseling and pharmacological supports. The third selection, by Belle PhD., Burgio PhD, Burns MD, Coon PhD, Czaja PhD, Gallagher-Thompson PhD, Gitlin PhD, Klinger MA, Koepke PhD, Lee MS, Matindale-Adams EdD, Nichols PhD, Schultz PhD, Stahl PhD, Winter PhD, and Zhang MS, found in the Annals of Internal Medicine, 2006, Nov 10, 145:727-38, Enhancing the Quality of Life of Dementia Caregivers from Different Ethnic or Racial Groups: A Randomized Controlled Trial. The study provides extensive data yields on pertinent study areas that provide valuable insight and data into the differences in cultural and ethnic needs of caregivers. That there are these kinds of differences and needs has been largely overlooked, yet they remain real needs that can adversely impact the health and well being of the patient and the caregiver. This study identifies the specific needs of caregivers by ethnicity, which involves their cultural traditions and environments. All of these things need to be understood by support sources and especially by the counseling community and physicians in order to maximize the effectiveness of their support services, and in the care delivered to patients of varying races and from different cultural backgrounds. This study assesses the levels of stress, depression, the social support structures available to the caregivers, their social support systems, and identifies problems and behaviors across five domains which yield measurements that are valuable to making decisions as to approaches and services by ethnicity. While the study limits its focus to blacks or African Americans, Hispanics, whites or Caucasians, the yield in information is significant enough as to suggest that studies in other ethnic and cultures would be valuable to society not just in America, but globally too. Alzheimer is not a disease that segregates itself, and it is found in the aging populations around the world. The better informed caregivers and others are, the more productive they can be in facing the very serious nature of the responsibilities in caring for their loved ones. It means, too, that the breadth of improved quality of life for patients and their caregivers can begin to take on new dimensions as the information and practices learned are migrated beyond the borders of the first world nations. The Google search using PICO keyword search “family Alzheimer caregiver support,” yielded 607,000 keyword related items. The keywords were revised to include “pdf,” to reduce the search, and hopefully limit the keyword yield to professional papers on the subject. This new search yielded not fewer keyword returns, but 742,000, significantly increasing the return on the keyword. The selection from this was merely taking those links that looked professional in nature. The first article was a professional white paper, Developing a Support System for Family Caregivers of the Elderly with Alzheimer’s (2007), by Sunja Kim (listed as ‘in charge’), and Jae-Min Shin. The report date is 2007, and it is a three page pdf document found online at http://www.sdi.re.kr/nfile/zcom_eng_bbs/a2007-R-33.pdf. This brief article is an examination of the policies that govern the family caregivers and their support needs. To create structural services to assist them in providing care for their loved ones, it must first be understood what policies govern providing those mechanisms. This particular team interviewed fourteen family caregivers of Alzheimer’s patients to better understand their needs as caregivers. Conclusion Mittleman, Brodaty, and Wallen say that it is possible that enough can be gained by research on Alzheimer patient caregivers in the areas of counseling as to significantly improve the mental and physical well being of both the patient and the caregiver. With the other contributors cited here, we can include to counseling, pharmacological interventions and nutritional interventions. Using these combined interventions in conjunction with what can be gained as insight from studies into the special and unique needs of patient caregivers brings full circle a proactive approach to the individual caregiver, the patient, and the environmental improvement achieved through these interventions. This does not mean that the investigation into the ways that individual caregiver support systems cannot be improved upon with further research. The more that is learned about the disease, the more we have to apply that knowledge to the ways in which the caregiver can pursue the patient’s care, and maintain and improve their health care in conjunction with that service. As we move forward in this millennium, we are going to experience levels of need unlike ever before in the history of Alzheimer care. As the global community begins to blend across cultural and ethnic lines and borders, we will need to be able to deliver care and service from those unique traditions and family values, and we must prepare ourselves to become familiar with them. References A Three Country Randomized Controlled Trial of a Psychosocial Intervention for Caregivers combined with Pharmacological Treatment for Patients with Alzheimer Disease: Effects on Caregiver Depression. (2008, November). American Journal of Geriatric Psychiatry, 2008, Nov; 16(11):893-904. Retrieved February 10, 2009, from http://www.pubmed.gov/Medline/PubMed. Alzheimers Disease: The Psychological and Physical Effects of the Caregivers Role. (2008, May). Nursing Older People 14720795, May 1, 2008, 20:4:1+. Retrieved February 11, 2009, from CINAHL.com. Counseling provides benefits to Alzheimer caregivers. (2004, March). Tufts University Health & Nutrition Letter, 15260143, March 1, 2004, Vol. 22, Issue 1. Retrieved February 11, 2009, from CINAHL.com. Enhancing the Quality of Life of Dementia Caregivers from Different Ethnic or Racial Groups: A Randomized Controlled Trial. (2006, November). Annals of Internal Medicine, 2006, Nov 10, 145:727-38. Retrieved February 10, 2009, from CINAHL.com. Improving Caregiver Well Being Delays Nursing Home Placement of Patients with Alzheimer. (2006, November). Neurology, 14:67(9):1592-9. Retrieved February 10, 2009, from http://www.pubmed.gov/Medline/PubMed. Kim, K., and Jae-Min, S. (2007). Developing a Support System for Family Caregivers of the Elderly with Alzheimer’s. Retrieved February 14, 2009, from http://www.sdi.re.kr/nfile/zcom_eng_bbs/a2007-R-33.pdf. Preserving Health of Alzheimer Caregivers: Impact of a Spouse Caregiver Intervention. (2007, September). American Journal of Geriatric Psychiatry, September 15(9):780-9. Retrieved February 10, 2009, from http://www.pubmed.gov/Medline/PubMed. Read More