ADULTS WITH ALZHEIMER’S DISEASE 1
PromotingAging among Elderly Adults with Alzheimer’s disease (AD)
Promoting Aging among Elderly Adults with Alzheimer’s disease (AD)
AD is a globalepidemic affecting nearly 24 million of the world population. Thedominance of AD in U.S is approximated to be around 5 million and isanticipated to triple to 15 million by 2050 (Alzheimer’sAssociation, 2011). AD is a significant public health problem for asmany as 4 million American (Alzheimer’s Association, 2011) withunpredictable clinical course and is characterized by memory loss,behavior and personality changes as well as declined thinkingcapabilities. The risk of Alzheimer’s disease doubles nearly everyfive years between the ages of 65 and 85 years. It is projected thatnearly 50% of adults will have Alzheimer’s disease by ages of 85-90year (Budson and Solomon, 2011). With an aging population, theincidence of Alzheimer’s disease has increased significantly posinga challenge to a primary care provider who are faced with managingthe epidemic burden related to Alzheimer’s disease.
Overviewof the Topic
Recognizing theimpacts on family members and individuals, as well as the growing useof resource, institutes connected to Alzheimer’s disease around theglobe like Alzheimer Scotland and Alzheimer’s New Zealand havecalled for practical guidelines for primary caregivers managingAlzheimer’s diseases. The Canadian Medical Association haspublished many recommendations resulting from the Canadian Consensuson Alzheimer’s disease. All these organizations argue that althoughcases of Alzheimer’s disease should be weighed on merits, it isethically preferable to inform the persons with AD (Budson andSolomon, 2011). The Canadian Alzheimer’s Association have takenthis initiative by amending their ethical guidelines detailingappropriate practices for primary care providers to disclose theinformation. This brochure will document the Alzheimer’s diseasedisclosure practices for the primary care physicians. The brochurewill increase discourse about the legal, ethical and disease relateddimensions that impact the Alzheimer’s disease disclosure practicesof the physicians. The brochure will also examine the difficultconcerns about the value of elderly people with the limited capacityand the commitment to the society to treat them with respect (Budsonand Solomon, 2011).
Alzheimer’sdisease disclosure practices have varying opinion among primaryhealth provider. While some physicians fear that disclosure of anAlzheimer’s disease diagnosis will lead to suicide, other are moreconcern about the more common occurrence of depression as a result ofdisclosure. Other believe that it is the right of the patients toknow their diagnosis (Chao et al. 2008).
Disclosure ofAlzheimer’s disease diagnosis has also been linked to patients’external reasons. Some physicians feel they have little to offer apatient, as there are few treatment and no cure. Likewise, somephysician perceives disclosure as futile where impaired cognitiveability limits understanding of the disease (Chao et al. 2008).Besides, it is challenging to provide an accurate prognosis. Anotherexternal factor is the request by the family member who asks thephysician not to disclose the diagnosis. However, the autonomy of thepatient needs to be considered. This ethical principle is a primaryvalue held by the World Medical Health Association in their Charterof Medical Profession. The Charter highlights the right of patientsto know and to make decisions about their future (Chao et al. 2008).Choices on advance directives, power of attorney and treatment andresearch opportunities can only become available once a diagnosis hasbeen provided. Although disclosure of diagnosis is beneficial, theolder adult will require some assistance with interpretation of theinformation (Chao et al. 2008).
The decision ofprimary care provider to disclose or not appear to be motivated by acommon effort to be ethical and to consider the quality of life ofthe elderly patient with Alzheimer’s disease and their family.Ethical decision making in cases of older adult with Alzheimer’sdisease demands primary health providers to balance three positions:what is most helpful to the patient at that time what is most usefulfor the patient’s wellbeing if each physician adopted the samecourse of practice and what is the most useful for the future andprofessional as a whole (Chao et al 2008 Ashida et al, 2009). Indoing so, the physician conserved the outcomes from each perspective.It is understandable that a physicians could be challenged byAlzheimer’s disease disclosure when the consequence of the decisionis focused on the principle of “do no harm” result in a differentoutcome than a decision based on “patient autonomy” (Ashida etal., 2009).
Policy statementshave been made in many countries such as Canada calling forphysicians and others to disclose diagnoses to patients in anaccurate, consistent, and compassionate manner (Ashida et al., 2009).Guidelines have been developed and adopted by associations andgovernment bodies in recognition of the aging population, and theincreasing incidents of Alzheimer’s disease are identified. In manycases, Alzheimer’s disease strategies have been developed so as toestablish a process for managing the effects on society.
There may be a timewhen administering care for elderly patients with Alzheimer’sdisease can be achieved through partnership with non-medicalpractitioners. Such partnership with individuals such aspsychologists and others can be helpful to older adult receiving adiagnosis of AD because of the multidimensional nature of thedisease. However, the current structure of health care excludespsychologists as publicly funded professionals recognizing counselingas a privately accessed resources (Raicher et al., 2008).
The effective implementation of Alzheimer’s disease strategyrequires information on current practices and needs to guide planningand innovation. Disclosure is an area where concerns are addressingpatient-centered approaches can be workable, sustainable andaffordable in the evolution of health care reforms (Chao et al.2008).
Most Alzheimerassociation in the world have established their position ondisclosure policies. For instance, the Canadian Alzheimer Societyamended their ethical guidelines in April 2003 demanding theprimarily caregivers to disclose Alzheimer’s disease diagnosis topatients (Ashida et al., 2009). Such ethical guidelines are based onprinciples of patient autonomy and an individual centered approach tomedical decision making and care. Most nations have also recognizedthe need to address Alzheimer-related issues beyond disclosure andhave funded initiatives to plan for the care of older adults withAlzheimer’s disease and their families (Ashida et al., 2009).Resources and community infrastructures, as well as physicalactivities, are critical dimensions of an approach to managing thedemands on resources as the population ages and the incidents of ADincreases. AD disclosure practices and the growing issue ofAlzheimer’s disease care is one instance of how a changingpopulation requires an adaptive and efficient health care system.
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Ashida, S., Koehly, L.M, Roberts, S. J., Chen, A. C, Hiraki, S &Green, R., C. (2009). Disclosing the disclosure: Factors associatedwith communicating the results of genetic susceptibility testing forAlzheimer’s disease. Journal of Health Communication: InternationalPerspective, 14(8): 768-784
Budson, A. E., & Solomon, P. R. (2011). Memory loss: Apractical guide for clinicians2011. Elsevier HealthSciences.
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Raicher, I., Shimizu, M. M, Takahashi Y, D., Nitrini, R. &Carameli, P. (2008). Alzheimer’s disease diagnosis in Brazil: ASurvey of specialized physicians’ current practice and attitudes.International Psychogeriatrics, 20(3): 471-481