Alzheimer's Disease - Term Paper Example

Impact of Culture, Gender and Age in Disability Introduction The population of the elderly is constantly rising all over the world because of advances in health care, education, nutrition and better standards of living (Pittman, 2007). However, the elderly people do not receive the same attention, respect, dignity and importance as the younger generation. This is known as ageism. Added to this, individuals who suffer from mental illness are treated in a different manner and are neglected frequently due to increased vulnerability. There also exists gender and culture bias while instituting treatment for elderly people with mental illness. In this assignment, discussion of the role of factors like age, culture and gender on the treatment of those with mental disabilities will be discussed through discussion of a case scenario. The disability discussed is Alzheimer's disease. This disability was selected for two reasons. The primary reason being the fact that many health professionals ignore patients with dementia because of "sense of impotence" pertaining to the treatment of their health problems and perception of increased cost of treatment (Advisory Panel on Alzheimer's Disease, 1996). The second reason being that dementia is very common in elderly patients and they undergo a great deal of stress because of that condition. Case Scenario 75 year old Maria was admitted to a nursing home for long term care in view of severe dementia due to Alzheimer's disease. The elderly lady had only one son who passed away and her grand daughter Susan was taking care of her until admission to the nursing home. Susan told the treating physician that she felt uncomfortable leaving Maria alone in her home with the caregiver and hence admitted her for institutional care. Susan raised several concerns over certain biases for which her grandmother may be subjected to because of her age, gender and Black race. Her grandmother was upset over Susan for having 'thrown' her in the institution without even asking her for what she felt. She looked at Susan and said “I always thought that I would die in my house, amidst my people.” Alzheimer's disease Alzheimer's disease is a condition in which there is progressive degeneration of the brain. It is "the most common cause of dementia, is an acquired cognitive and behavioral impairment of sufficient severity that markedly interferes with social and occupational functioning" (Anderson, 2010). The condition is common especially in those above 65 years of age and it contributes significantly to health care costs. The lifetime risk for any individual is about 1:4-1:2. Infact, more than 14 percent of individuals above 65 years of age develop Alzheimer's disease and the incidence raises to 40 percent in those above 80 years of age (Anderson, 2010). Warning signs which hint at the development of the disease are memory loss that affects day-to-day tasks, difficulty in performing certain tasks which are actually familiar, development of language problems like finding the right word, disorientation in time and space, poor or decreased judgment in certain situations, problems with abstract thinking, misplacing things, changes in mood, behavior and personality and loss of initiative. The condition is neither curable nor preventable. It is always progressive. The condition is one of the leading causes of death in the elderly because of high chances of intercurrent illness like pneumonia secondary to feeding problems and aspiration (Anderson, 2010). Other than the medical problems associated with dementia, the patients suffer other problems too. Maria was economically dependent because she had to use up all her saved money on her illness. She was frustrated and irritated and hence lost all social connections. In the late stages of the condition, the patient develops severe cognitive impairment leading to severe memory loss, inability to process information, lacks orientation of place and time, inability to recognize speech, needs help for toileting and eating, needs help for walking and has difficulty in swallowing. In this stage, the patient cannot live at home alone and involvement of caregiver and family becomes a must (Alzheimer Society Totonto). After admission to the nursing home, the nurses complained that her behavior was rude and aggressive. Patients with dementia have difficulty in adaptation to new situations and may find it difficult to adjust to the unfamiliar environment and thus respond adversely (McCloskey,2004). Admission to hospital also changes the normal routine of the the daily life and this can cause significant distress to the patient (McCloskey, 2004). Gerdner, Buckwalter, and Reed (2002, p363) proposed that there are basically six types of stressors which have detrimental effects on patients with dementia and contribute to development of aggressive behaviours even in those with initial stages of dementia. These factors are environmental factors, excessive fatigue, caregiver factors, demands above and beyond functional capacity, variety of stimuli, physical stressors and perception of losses. Despite the dislike Maria had towards institutional care, she had to live there because she was dependent, disabled and without money, job and housing. Impact of culture, age and gender Maria often complained to Susan that she was not given the respect she deserved by the staff of the nursing home because she was an 'old Maori'. She was not allowed to eat what she liked and was always given shabby clothes to wear. Older people are neglected or treated in an inferior manner or not given the best options for heath care due to their 'age factor'. This prejudice is known as 'ageism.' The term ageism was coined by Dr. Robert N. Butler in the 1960s and he defined it as “a deep and profound prejudice against the elderly which is found to some degree in all of us...ageism allows the younger generations to see older people as different from themselves; thus they subtly cease to identify with their elders as human beings” (Alliance for Aging Research, 2003). All forms of medical care including mental health involve interaction between two or more people and hence an understanding of how social factors influence treatment will assist the nurse in developing skills. In mental illness, social factors play an important role in a person's decision to seek treatment (Goldman, 2000). Major mental disorders like schizophrenia, bipolar disorder, depression, and panic disorder are found world wide with no racial, ethnic or traditional barriers. According to the Surgeon General Report (1999), the overall incidence of mental disorders in the United States has been estimated to be about 21 percent in adults and children. Amongst individuals living in communities, no difference has been noted between the prevalence of mental disorders amongst whites and mental disorders in minority groups. However, the report states that there is difference in prevalence rates amongst individuals in vulnerable, high-need subgroups such as persons who are homeless, incarcerated, or institutionalized. In vulnerable societies where minorities are over-represented, according to the same report, individuals faced with these circumstances especially the minority do suffer from more mental illnesses like in Maoris in New Zealand. Factors implicated in the development of mental disorders in these ethnic minorities are decreased availability of mental health services, decreased access to mental health services, poorer quality of mental health care, under-representation in mental health research and barriers deterring minorities from reaching treatment (Surgeon General Report, 1999). Some of the barriers include, cost involved in the treatment, fragmentation of services, societal stigma toward mental illness, mistrust and fear of treatment, racism and discrimination and differences in language and communication (Surgeon General Report, 1999). Minorities do not trust mental health services. They suspect clinician bias and stereotyping (Surgeon General Report , 1999). There are two cultural types of people existent in New Zealand. They are Pakeha and Maori. New Zealanders descended from British or Irish settlers of the 19th and 20th centuries are known as Pakehas. Those from Anglosphere nations like United Staes, Australia, Ireland and Canada are referred to as Maori. Research has shown that during any rehabilitation process, Maoris, who are ethnic minorities in New Zealand have poorer rehabilitation outcomes than Pakeha. This set of people have practices and cultural concepts which are undermined by the dominant Pakeha group. Thus, Maoris perceive treatment from Pakeha in a suspicious manner. They are reluctant to engage with Pakeha health professionals. Such a behavior has been referred to as culturally appropriate shyness or shame (Cram et al, 2003). As such Maoris have poorer health than Pakehas because of indulgence in bad habits like drugs and overeating, increase in social problems like stress and poverty, indulgence in corporates like tobacco company advertising and several other health-related behaviors like smoking and alcohol consumption (Cram et al, 2003). It is important for the nurse to know these aspects so that these individuals can be seriously addressed and any disparities encountered in the treatment can be remedied. Communication is an important aspect of health care because mental disorders affect thoughts, moods, and the highest integrative aspects of behavior, and diagnosis and treatment of these mental disorders is largely dependent on communication and trust between the patient and the health professional (Surgeon General Report, 1999). Culture, race, ethnicity and society have wide-ranging roles in mental health, mental illness, and mental health services. Culture influences the way the patients elaborate their symptoms and which symptoms they consider as important reporting. It is important to understand these aspects so that services that are specific to the needs of the racial and ethnic minorities can be provided. Culture influences the way the patients elaborate their symptoms and which symptoms they consider as important reporting. Culture also influences help seeking behavior of the affected individual, what types of help they seek, their coping styles, the social support they get and the social stigma attached to the mental disorder (Gregory, 1994). A person diagnosed with mental illness may be distanced socially. Each culture has its own style of coping with disorders which buffers some people from developing certain disorders. Cultural norms not only affect the way patients present with symptoms, they also affect the way a health professional views the symptoms of the patient. There can be difference in the views of the patient and the health professional which may affect the delivery of care, diagnosis of the condition, treatment instituted and organization and reimbursement of services. It is obvious that health professionals who are much influenced by these cultural norms and who are not aware of the patient's cultural requirements and variations can not do a good job of health care provision (Surgeon General Report, 1999). Gender also influences the treatment one receives in mental health. It is important to understand the gender related demographics of mental health disorders so as to arrive at a correct diagnosis, assist appropriate treatment and take help of other organizations like medical and legal if necessary. In the demographic study on Community Alliance (Community Alliance, Mental disabilities), it has been estimated that the overall incidence of mental health disorders is similar among men and women, however, there does exist a difference in different diagnoses. Women are often at greater risk of mental ailments because of the multiple roles they fulfill in society and the stress they are prone to because of their roles. Women also are at the receiving end of not only gender discrimination and the associated factors of poverty, hunger, malnutrition and overwork, but also of sexual and domestic violence (WHO Media Center, 2000). These differences between men and women are attributed to the biological and hormonal differences in the sexes, social causes, different ways in which women and men cope with distress, and different help-seeking behaviors of the sexes (WHO Media Center 2000). To provide appropriate service to women's mental health needs, it is important to understand the different factors which influence women's mental health. Women are at higher risk for common mental disorders because of single status in child rearing, multiple roles, unequal power relations with men, and sense of powerlessness (Kuruvilla & Jacob, 2007). They suffer more from hopelessness, lack of education, insufficient employment and non-cooperation from family members. They are targets of social stigmas and beliefs (Kuruvilla & Jacob, 2007). Services for Alzheimer's disease Certain attitude is essential when dealing with elderly people suffering from dementia. In advanced stages, even care-givers go through a great deal of stress and admission to long-term care centers in inevitable. Two factors which need to be considered when deciding upon long-term care in a dementia patient are: physical and mental state of the caregiver and the physical and mental state of the patient. Severe mental and physical stress and deterioration on the part of current caregiver and symptoms of social withdrawal and inability to concentrate are indicators of shifting the patient to a 24-hour care place. Also, if the patient is physically abusive and does things which jeopardize his and other's safety, then he must be shifted to long term care (Helpguide.org). Preparing the family member to move to a long-term care place is a very sensitive issue and must be handled with care. the patient must be informed about the benefits and the kind of care that will be delivered in the long-term care. The decisions must be based on the lifelong values and desires of the person and on what the person is expected to want (Alzheimer Society Totonto). On admission to long-term care, the main factors which need to be addressed are difficulty in swallowing solids and liquids, care of body and skin, maintenance of bladder and bowel function, monitoring of pain, and decreasing risk of infection. Other factors include safety of the patient and recreation (Alzheimer Society Totonto). The patient can be helped to adjust to the new situation by structuring the day, by providing consistent cues of environment about the time, helping person look forward to various activities of the day like bathing, meal eating, going outdoors and getting ready for bed, by asking the patient to perform certain small tasks around the house, by being near the person as much as possible and by keeping the environment as familiar as possible (Helpguide.org). The main factors which need to be addressed are difficulty in swallowing solids and liquids, care of body and skin, maintenance of bladder and bowel function, monitoring of pain, and decreasing risk of infection. Other factors include safety of the patient and recreation (Alzheimer Society Totonto). The patient can be helped to adjust to the new situation by structuring the day, by providing consistent cues of environment about the time, helping person look forward to various activities of the day like bathing, meal eating, going outdoors and getting ready for bed, by asking the patient to perform certain small tasks around the house, by being near the person as much as possible and by keeping the environment as familiar as possible (Helpguide.org). Ageism and gender and culture biases can be prevented by increased education and training of the health care providers, more research into various aspects of health of the elderly and education of both the physician and patient population about various screening procedures, etc (Cosgrove-Mather, 2003). Through proper education, health professionals can address many factors that impact health outcomes in the older adults like simultaneous illness, multiple drug regimens, values of the patients, preferences, impact of isolation, lack of independence in oldage, lack of adaptation to oldage and financial and economic issues (AAR, 2003). In the Europe and Japan, there are established geriatric departments in the hospital which is the otherwise around in the US and other parts of the world. Also, in France, gerontology is a compulsory subject in the medischools. In Italy, Spain and Germany, geriatrics is integrated with other medical courses. In the UK and Switzerland, there are courses in postgraduation for geriatrics and the undergraduates have 'problem-based geriatric problem solving' in their curriculum. Since finances also are a problem in ageing, the government in collaboration with non-profit organizations must provide insurance and economically sound health services. Conclusion Like any other health care system, even mental health system is bugged with biases of age, gender and culture. These biases contribute to poor treatment, increased recovery time and inappropriate rehabilitation. These differences in attitudes can be taken care of by appropriate education, training, policies and rigid laws which prevent health professionals from exploiting the vulnerable. References Alliance for Aging Research or AAR. (2003). Ageism: How Healthcare Fails the Elderly. Retrieved on March 30th, 2010 from http://www.agingresearch.org/content/article/detail/694/ Alzheimer Society Totonto. Information Sheets and brochures. Retrieved on March 30th 2010 from http://www.alzheimertoronto.org/lib_brochures.htm Advisory Panel on Alzheimer’s Disease. (1996). Alzheimer’s Disease and Related Dementias:Acute and Long-Term Care Services. NIH Pub. No. 96-4136. Washington, DC: Supt. Of Docs. U.S. Govt. Print. Off. Anderson, H.S. (2010). Alzheimer Disease. Emedicine from WebMD. Retrieved on 30th March, 2010 from http://emedicine.medscape.com/article/1134817-overview Community Alliance. Mental disabilities. Retrieved on March 30th 2010 from http://medicine.creighton.edu/IDC242/2005/Group7/links.htm Cosgrove-Mather, B. (2003). Ageism Is Pervasive In Health Care? Retrieved on 30th March, 2010 from http://www.cbsnews.com/stories/2003/05/20/health/main554845.shtml Cram, F., Smith, L., and Johnstone, W. (2003). Mapping the themes of Maori talk about health. Journal of the new Zealand Medical Association, 116(1170). Helpguide.org. Alzheimer's Caregivers Guide. Retrived on 30th March, 2010 from http://helpguide.org/elder/alzheimers_disease_dementias_caring_caregivers.htm Kuruvilla, A., & Jacob, K.S., 2007. Poverty, Social stress & Mental Health. Indian J Med Res., 126, p.273-278. Gregory, R.J. (1994). Disability and rehabilitation in cross-cultural perspective: a view from New Zealand. International Journal of Rehabilitation Research, 17(3), 189- 200. WHO Media Center, 2000. Women and mental health. World Health Organization. Retrieved on 30th March, 2010 from http://www.who.int/mediacentre/factsheets/fs248/en/index.htm. Read More