Alzheimer Agitation - Prevention - Research Paper Example

? Alzheimer Agitation – Prevention 29-Dec-11 Alzheimer Agitation – Prevention Purpose ment: The purpose of this research paper is to provide an in-depth analysis on the prevention of Alzheimer agitation. The paper provides an outline on the various themes followed in preventing the onset of agitation in patients suffering from Alzheimer disease. The paper also throws light on the various contributing factors which are responsible for mediating the behavioral patterns considered as agitation in patients of AD. Moreover, the paper provides a brief introduction on Alzheimer disease and describes the significance of agitation. Method of Search: The paper has been written after extensive research on literature available on Alzheimer disease and the agitation associated with it. As no treatment is available to fully cure the disease, therefore, following preventive measures is the only effective way to prevent the onset and reduce the severity of agitation. Some of the common up to date preventive measures followed in nursing homes are listed in this paper and have been taken from different books written on Alzheimer disease. Introduction and Significance: The Dementing disease was first discovered by a German neuropathologist, Alois Alzheimer and the disease is named after him. Among individuals of age 65 and older, the most common type of Dementia is Alzheimer’s disease which is known in medical literature as Alzheimer disease. As the age progresses, half of the elderly individuals experience a loss of memory, judgment, and language to an extent that it starts to mediate a huge impact on their daily lives. In the United States, AD is a major health problem because of its huge impact on various departments of the health care system, the lives of the patients and their families. In accordance with the recent statistical data, there are a staggering number of AD cases in the United Sates alone amounting to 4 million individuals. The percentage of individuals with AD doubles for every five year age group beyond the age of 65. Moreover, the highest risk of AD is amongst the individuals over the age of 85. In industrialized countries, the improvement and widespread provision of health care facilities have increased life expectancy which has inevitably led to an increase in the number of cases being reported over the past few years. (National Institutes of Health 2002). Scientists estimate that if curative measures are not discovered then the number of cases in US in 2050 would be around 14 million. Over the years the cost of care of patients with AD has steadily shown an increase. In United States of America, the annual national cost of caring for individuals with AD amounts to approximately around $1 billion. (National Institutes of Health 2002). Alzheimer disease is a progressive brain disease which is irreversible and gradually reduces the thinking skills and memory to such an extent that the person becomes incapable of carrying out normal daily activities. However, the causes and the subsequent progression of the disease has not yet been fully exposed which has significantly slowed the progress in devising ways to prevent the disease. The treatments that are currently available only aim at reducing the severity of the disease symptoms. (National Institutes of Health 2002). Alzheimer agitation refers to the behavioral patterns exhibited by a typical Alzheimer patient. The typical behavioral patterns include screaming, complaining, wandering, cursing, fidgeting, pacing, moaning and shouting. Progression of the disease is characterized by memory loss and degradation of thinking skills in addition to an increase in the severity of Alzheimer agitation. It is worth mentioning that every abnormal behavior is not classified as agitation. If the abnormal behavior poses a risk to the individual with AD or the people around him then it is considered to be agitation. Agitation associated with AD can be due to a single medical problem or a cumulative effect of a variety of different contributing factors such as drastic changes in routine including moving to a new home and switching to a new caregiver coupled with anything that interferes with the patient’s ability to think clearly. (Turkington 2003). Alzheimer agitation is a very significant problem as it is not only difficult to deal with but is equally traumatizing for the patients and their families. Moreover, it is important to control and prevent such behavior in an effort to reduce the chances of the patient hurting themselves or their caregivers. (Turkington 2003). Contributing Factors: The onset of Alzheimer agitation is associated with a wide variety of situations. In most cases, agitation is caused due to drastic changes in daily routine such as moving to a new home or nursing home, switching to a new care giver or any situation that interferes with the thinking process of the patient. The fuzzy thinking of the patient causes them to perceive the changes as a threat. The perceived threats are responsible for the behavioral patterns associated with agitation such as screaming, shouting and wandering. A patient suffering from Alzheimer agitation becomes incapable of handling normal daily activities and often threatens and frightens the caregivers. (Whitehouse 2000). Common Themes: Some of the common themes available for the prevention of Agitation in patients of Alzheimer disease are listed below: i. Medication ii. Using behavioral improvement techniques iii. Maintaining a calm, quiet and a stress free environment iv. Exercise v. Promoting the adoption of healthy diet habits vi. Normalizing the patient’s sleep patterns vii. Socialization viii. Music therapy ix. Healthy activities (Poirrier 1999). Medication: A successful AD therapy is almost always associated with recognizing the preceding symptoms of agitation and eliminating them before the condition exacerbates. Depression is a common preceding symptom of agitation. Therefore, using anti depressants coupled with the elimination of stress factors is commonly used in nursing homes to prevent the development of agitation. Commonly used Anti depressants include Prozac, Celexa, Zoloft, Paxil and Pamelor. In 2008, a study conducted by The University of Pennsylvania revealed the significance of aripiprazole in the treatment and prevention of agitation. Anti anxiety drugs are also used in the treatment of low mood and restlessness and verbally disruptive behavior. The most common types of anti anxiety drugs prescribed are Buspar or oxazepam (Serax). In certain cases, mood stabilizers or anticonvulsants are used such as carbamazepine (Tegretol) or divalproex (Depakote) in order to reduce and prevent hostility and aggression. (Weiner et al 2009). Behavioral Improvement Techniques: The use of behavioral improvement therapies is one of the most common ways used in the prevention of Alzheimer agitation. In a nursing home, various behavioral improvement techniques are employed in the management of patients with Alzheimer disease. Commonly the reward and punishment strategy is utilized for the improvement of behavior. The relatively basic interventions combined with medication have shown drastic improvement in agitated patients. In order to measure the level of depression in patients, a Geriatric Depression Scale (GDS) is used. The scale provides a useful measure of the levels of depression which are then used by the physician to estimate the efficacy of the treatment regimes and behavioral improvement therapies used. (Wisocki 1991). Maintenance of a Stress Free Environment: The maintenance of a stress free environment is very important in preventing the onset of disruptive behavior in individuals with Alzheimer disease. An essential factor responsible for stress in patients is change of environment. Therefore, in order to minimize stress levels it is essential to maintain a routine. (Perry 2001). On the other hand, it has been observed that different patients have different needs. Therefore, situations that are perceived as a threat by one individual might be perceived as non-threatening by another. Recognizing the factors that boost stress levels are important in the prevention of agitation. Thus, in a nursing home it is important to realize the needs of different individuals only then the prevention of agitation can be carried out effectively. (Weiner et al 2009). Exercise: Exercise is essential in preventing agitation in patients suffering from AD. In accordance with the report of a study funded by the National Institute of Aging, it was revealed that exercising thrice a week helps the prevention of disruptive behavioral patterns in patients of Alzheimer disease. (Weiner et al 2009). Physical exercise is beneficial in the management of stress levels which inevitably reduces the incidence of agitation. In accordance with the study conducted by Saint Louis University School of Medicine in Missouri, it was revealed that 30 minutes of aerobic exercise significantly reduced stress levels and was tremendously effective in preventing agitation in patients with agitation. Patients with severe Alzheimer disease who have broken limbs can perform less severe exercises such as chair exercises. (Ratey 2008). Development of Healthy Eating Habits: Healthy diet is an essential component in the management of agitation. In accordance with a recent research, low consumption of caffeine significantly reduced the development of agitation. On the other hand, consumption of healthy diet is effective in slowing down the progression of the disease. A Meta analysis of 23 studies published in 2008 in Age and Ageing revealed that consuming small amounts of alcohol is effective in the progression of AD and other forms of dementia and is also effective in significantly reducing the incidence of disruptive behavioral problems. (Turkington 2003). Healthy Sleep Patterns: Hallucination, paranoia, wandering and other behavioral patterns associated with agitation disrupt the sleep pattern of the individual which inevitably exacerbates the problem. Therefore, normalizing the sleep patterns is an effective way to prevent agitation in patients with AD. Agitated individuals in a nursing home not only pose a danger to themselves but also to other patients and caregivers. Thus, it is important to treat agitation as soon as it surfaces. (Check 1989). Socialization: Socialization is an important component in managing patients of Alzheimer disease. Large groups are often perceived as a threat, therefore, in most cases introducing a high school friend or someone who has played a significant role in the patient’s life, plays an important in preventing the development of disruptive behaviors. In most nursing homes, the patients and their friends are encouraged to perform activities such as communicating verbally and exercising together. (Hepburn 1989). Music Therapy: Some recent studies funded by the National Institute of Ageing have revealed a correlation between music and lower incidence of Agitation. Many nursing homes practice music therapies with patients of AD and play soft calming music in an effort to reduce stress levels which inevitably reduces the onset of agitation. Moreover, it has observed that playing the patient’s favorite music helps to calm them as it reminds them of their past and enables them to reconnect with their earlier life. (Mittelman 2003). Healthy Activities: Human studies have revealed the significance of safe activities such as gardening and other simple tasks in reducing stress levels thus preventing the development agitation in patients. In nursing homes, patients are encouraged to perform safe activities in an effort to enable them to be in touch with their former life. Reconnection with the patient’s former life coupled with the maintenance of a stress free environment and proper medication not only slows the progression of the disease but also prevents the development of life threatening disruptive behaviors. (Rader et al 1995). Conclusion: Alzheimer is an irreversible disease and in most cases it has a huge impact not only on the lives of the patients but also the individuals around them. The development of disruptive behavioral patterns such as screaming, wandering, fidgeting and cursing is very traumatizing for the patient’s family members which is the reason why admitting the patient to a nursing home is the best option. Furthermore, the disruptive behavior poses a significant risk not only to the patient themselves but also their loved ones. The prevention of agitation is, therefore, an essential component in the management of patients in a nursing home and various techniques are employed in combination in an effort to increase the efficacy of the treatment regime. The cost of caring for patients has significantly increased over the years which inevitably increases the financial strain of the disease on the patient’s families. (Maddox 1995). Alzheimer’s disease continues to plague the roots of modern health care systems because as yet, no cure has been discovered. References: National Institute on Aging., & National Institutes of Health (U.S.). (2002). Alzheimer's disease: Unraveling the mystery. Bethesda, Md.: National Institutes of Health. Turkington, C. (2003). The encyclopedia of Alzheimer's disease. New York: Facts On File. Wisocki, P. A. (1991). Handbook of clinical behavior therapy with the elderly client. New York: Plenum Press. Ratey, J. J., & Hagerman, E. (2008). Spark: The revolutionary new science of exercise and the brain. New York: Little, Brown. Poirrier, G. P., & Oberleitner, M. G. (1999). Clinical pathways in nursing: A guide to managing care from hospital to home. Springhouse, Pa: Springhouse Corp. Perry, A., & American Medical Association. (2001). The American Medical Association guide to home caregiving. New York: J. Wiley & Sons. Maddox, G. L., & Springer Publishing Company. (1995). The encyclopedia of aging: A comprehensive resource in gerontology and geriatrics. New York: Springer Pub. Co. Rader, J., & Tornquist, E. M. (1995). Individualized dementia care: Creative, compassionate approaches. New York: Springer Pub. Co. Mittelman, M. S., Epstein, C., & Pierzchala, A. (2003). Counseling the Alzheimer's caregiver: A resource for health care professionals. Chicago, Ill.: AMA Press. Hepburn, K., & United States. (1989). Alzheimer's. Washington, D.C.?: Dept. of Veterans Affairs, Veterans Health Services and Research Administration, Office of Geriatrics and Extended Care. Check, W. A. (1989). Alzheimer's disease. New York: Chelsea House Publishers. Whitehouse, P. J., Maurer, K., & Ballenger, J. F. (2000). Concepts of Alzheimer disease: Biological, clinical, and cultural perspectives. Baltimore: Johns Hopkins University Press. Weiner, M. F., Lipton, A. M., & American Psychiatric Publishing. (2009). The American Psychiatric Publishing textbook of Alzheimer disease and other dementias. Washington, DC: American Psychiatric Pub. Read More