Alzheimer’s Disease and Advanced Nurse Practice, Term Paper Example

Introduction

Alzheimer’s Disease is a challenging and unique condition which involves mild to severe cognitive impairment and gradual loss of function over time. This condition presents many challenges for caregivers, including advanced practice nurses who possess clinical knowledge of this condition and its presentation in older adults. These nurses must continuously develop new ideas and approaches to effectively treat and manage patients with Alzheimer’s Disease to produce effective outcomes and an improved quality of life for these patients. In advanced practice settings, nurses must develop tools and educational frameworks that support effective outcomes for Alzheimer’s patients to expand knowledge of this complex condition and its challenges for patients, caregivers, and family members. The following discussion will address the different characteristics of Alzheimer’s Disease and its impact on patients, as well as the strategies and health promotion activities that caregivers must utilize to achieve effective results in managing this condition. In addition, evidence-based practice will be considered in the context of Alzheimer’s Disease and how this contributes to successful practice methods and approaches over the long term.

The Problem

Alzheimer’s Disease is a complex and multifaceted condition that is characterized by a unique pathophysiology which includes buildup of amyloid plaque and subsequent lesions (Castellani et.al, 2010). In particular, “The most common and distinctive “hallmark” lesions present within the diseased brain are the senile plaques and NFTs…Neuronal and dendritic loss, neuropil threads, dystrophic neurites, granulovacuolar degeneration, Hirano bodies, and cerebrovascular amyloid, are also typical of the AD brain” (Castellani et.al, 2010, p. 3). In this context, it is important to note that many patients who suffer from Alzheimer’s Disease experience similar pathologic concerns to those experiencing normal aging; however, this disease also represents a continuous decline of cognitive functioning over a period of several years (Castellani et.al, 2010).

From a clinical perspective, patients with AD first show signs of the condition with memory loss and cognitive impairment which worsens gradually over time (Castellani et.al, 2010).The condition is progressive and leads to deterioration of functionality, including personal care giving and performance of activities of daily living (Castellani et.al, 2010).At the end of life, AD patients often reside in a state of partial to full vegetation and are unable to function at normal levels (Castellani et.al, 2010). Therefore, patients lose their quality of life, dignity, and general ability to contribute to society (Castellani et.al, 2010). In this context, it is the responsibility of advanced practice nurses to utilize knowledge and experiences learned from caring for AD patients at all stages to facilitate improved management of this debilitating condition for future patients. These efforts will contribute to the overall scope and breadth of knowledge that advanced practice nurses possess in order to preserve the quality of life for these patients for as long as possible.

Clinical Management

The diagnostic tools that are available for Alzheimer’s Disease represent a means of expanding knowledge regarding the condition and how to treat patients more effectively to improve the quality of their lives (McKhann et.al, 2011). For example, advanced practice nurses must recognize the following criteria in this group of patients: “Impaired reasoning and handling of complex tasks, poor judgment—symptoms include: poor understanding of safety risks, inability to manage finances, poor decision-making ability, inability to plan complex or sequential activities. Impaired language functions (speaking, reading, writing)—symptoms include: difficulty thinking of common words while speaking, hesitations; speech, spelling, and writing errors” (McKhann et.al, 2011, p. 4). Therefore, advanced practice nurses must recognize the different warning signs of AD in order to develop methods of caring for these patients in an effective manner (McKhann et.al, 2011). These and other clinical criteria are essential to the discovery of new treatment and management alternatives to promote health and wellbeing for these patients and to preserve the quality of their lives for as long as possible (McKhann et.al, 2011). It is expected that AD patients will face many different challenges throughout the progression of the disease; therefore, it is important for advanced practice nurses to recognize these concerns and to take responsibility for improving health promotion for this patient population.

From a knowledge-based perspective, advanced practice nurses must be trained to recognize the various signs and symptoms of dementia in order to improve health promotion activities and other elements that contribute to the effective management of AD within this patient population. This is best achieved through clinical assessments and other evidence-based criteria that support the diagnosis of AD in its different stages (McKhann et.al, 2011). These criteria represent a means of evaluating AD in its different forms and in diagnosing patients according to specific stages of disease evolution, based upon cognitive deficits as well as symptom recognition and awareness (McKhann et.al, 2011). Patients with AD should be evaluated by advanced practice nurses in order to determine how to best move forward with a comprehensive treatment and management plan to alleviate symptoms and to slow down the progression of the disease as best as possible to improve quality of life for these patients (McKhann et.al, 2011). These patients face difficult challenges that must be addressed through active interventions and caregiver strategies that will encourage the development of new concepts to preserve patient wellbeing for as long as possible (McKhann et.al, 2011).

Evaluation of Outcomes

Advanced practice nurses that are responsible for the care of geriatric patients must consider the different issues that arise within this population group, including but not limited to AD. Evidence-based practice methods are likely contributors to the effectiveness of geriatric nursing environments, particularly for patients with AD (Capezuti et.al, 2012). In a general context, it is known that “As the older adult population grows, there will be a significant increase in the demand for health services. The number of older hospitalised patients makes it impractical to consider segregating older adults on specific units; instead, most units in a hospital should adopt ageing-sensitive principles” (Capezuti et.al, 2012, p. 3118). This framework supports the ongoing development and growth of specific geriatric models to provide effective care for patients with AD and other forms of dementia (Capezuti et.al, 2012). Several models exist; however, the model known as Nurses Improving Care for Healthsystem Elders (NICHE) represents a means of exploring different forms of knowledge to implement a model that is evidence-based and that supports the development of new ideas and approaches to geriatric patients, and in particular, AD care (Capezuti et.al, 2012). It is expected that the continued development of new models to provide comprehensive services to Alzheimer’s patients must recognize the demands of this type of care and the level of knowledge that is required to accommodate these patients and their families accordingly (Capezuti et.al, 2012).

Patients with Alzheimer’s Disease are a significant challenge for advanced practice nurses due to the natural progression of the disease and its unpredictable nature with respect to symptoms and other factors. Individual caregivers must demonstrate their understanding of dementia and AD and what steps are required to treat these patients and provide an optimal level of care to meet their needs at different stages. Merrilees and Ketelle (2010) note that “Practitioners who are more familiar with deficits seen in AD (poor memory, getting lost, word-finding deficits) may be reluctant to view the personality and behavioral changes as the result of a neurodegenerative condition. An APN familiar with atypical dementias can be a valuable resource to families in finding the providers and centers more familiar with these conditions” (p. 3). This is an important resource in the development of protocols that will facilitate the recognition of AD and dementia and support patient wellbeing (Merrilees and Ketelle, 2010). At the same time, it is necessary to provide family members with a greater sense of comfort and to be as clear as possible regarding the clinical implications of AD for patients, including what should be expected as the disease progresses to other stages (Merrilees and Ketelle, 2010). The focus should also be on managing behaviors in patients with AD and to provide insight regarding how family members should manage this condition and the behaviors that accompany it when the patient is in a setting where specific behaviors might be questioned by others (Merrilees and Ketelle, 2010).

For advanced practice nurses, their role in shaping AD patient outcomes is realized in the form of effective leadership, guidance, and collaboration in supporting this group (Merrilees and Ketelle, 2010). In this context, nurses provide education to families and patients to assist in minimizing symptoms, taking the appropriate safety precautions, and other factors which often represent a challenge for these patients and their families (Merrilees and Ketelle, 2010). In addition, advanced practice nurses must also work with patients and their families to reduce the impact of stress and the burden of this patient population in daily living (Merrilees and Ketelle, 2010). These efforts demonstrate that advanced practice nurses may have a significant impact on patient care and the care giving that is provided by family members and other levels of support (Merrilees and Ketelle, 2010). It is expected that in this capacity, advanced practice nurses will enable care givers and other individuals to develop a greater level of understanding and provide a comforting hand to patients and their families who face the devastating impact of Alzheimer’s Disease (Merrilees and Ketelle, 2010).

Another important area to consider with advanced practice nursing as related to Alzheimer’s patients is the psychological impact of care giving for this population group (Elliott et.al, 2010). For many caregivers, patients who suffer from dementia or AD create challenging circumstances and psychological responses that are difficult to manage, as noted in the following: “CGs in good health, which may provide protection from the negative outcomes of caregiving, may better tolerate the resulting burden and bother of caregiving for persons with dementia. Thus, it is necessary for CGs to attend to their own healthcare needs and engage in health-promoting behaviors” (Elliott et.al, 2010, p. 2). Therefore, caregivers often require assistance and support of their own when providing care and treatment to these patients (Elliott et.al, 2010). Advanced practice nurses are likely to play an important role in shaping the direction of healthcare practice for AD patients by supporting the needs of caregivers in important ways that impact the quality of care that is offered (Elliott et.al, 2010). These opportunities are important contributors to the ability of caregivers to balance their own psychological responses to this practice with the needs of these patients in a very difficult state (Elliott et.al, 2010). Therefore, caregivers have a responsibility to their patients to provide the best possible care and treatment and this is best achieved through various health promotion activities that support and strengthen the quality of care that is provided (Elliott et.al, 2010.

Quality of care as it relates to AD patients is of critical importance and requires an effective approach that encourages health promotion activities in different ways (Elliott et.al, 2010). Advanced practice nurses play a role in these practices by establishing different models for improved healthcare outcomes by recognizing how caregiver burden might play a role in supporting effective AD care for this patient population (Elliott et.al, 2010). Since many caregivers are susceptible to psychological and emotional concerns, it is important to address these findings as they relate to successful outcomes for patients with AD at all stages of the disease (Elliott et.al, 2010). It is expected that caregivers who manage their own health concerns in an effective manner will offer their patients improved quality of care to meet their needs throughout all stages of AD (Elliott et.al, 2010).

For advanced practice nurses providing care to AD patients, the appropriate level of health literacy is important in demonstrating the impact of this disease on patients. It is of critical importance to develop an effective approach to patient care for AD patients as facilitated by advanced practice nurses and this is best achieved through the acquisition of knowledge regarding this patient population. Patients with AD at all stages require a specific level of care and treatment for which experienced and knowledge are required at an advanced level. A program known as the Healthy Brain Initiative was developed by the Centers for Disease Control (CDC) as a means of improving the understanding of “brain health” and the prevalence of AD in the United States (CDC, 2011). It is known that “Alzheimer’s disease is now the 6th leading cause of death among American adults aged 18 and older, and the 5th leading cause of death for those aged 65 and older…Current estimates for the prevalence of Alzheimer’s disease range from 2.6 million to 5.2 million Americans, and the risk of developing the disease increases with age…If present trends continue, by 2050, as many as 16 million people may be living in the United States with Alzheimer’s disease” (CDC, 2011, p. 2). Based upon these statistics, it is more important than ever for advanced practice nurses and other caregivers to possess the tools and the knowledge that is necessary to expand awareness of AD and its impact on older adults in the United States and beyond (CDC, 2011). The severity of AD is becoming increasingly relevant and requires a level of attention and detail that does not currently exist to improve care outcomes for this population group (CDC, 2011). These efforts will also demonstrate the potential positive impact on patients who are cared for by advanced practice nurses and caregivers with specific knowledge and information that will promote improved wellbeing for these patients and a greater sense of relief for their family members.

A document published by the Geriatric Mental Health Foundation addresses some of the most important requirements of caregiving for AD patients. Advanced practice nurses provide knowledge and expertise regarding a number of areas associated with AD and serve as a positive support system in achieving effective care and treatment outcomes (GMHF, 2013). At all levels of care and treatment for AD patients, it is necessary to achieve the following, particularly during the end of life stage: “Excellent communication among the person with dementia (when appropriate), family caregiver, health care decision-maker and the broader care team is critical to end-of-life care that respects a person’s choices. Communication differences can present problems for the person, family, and provider…Decisions about end-of-life care are best made when those involved in decision-making understand dementia and what happens when people die of it, as well as the benefits and burdens of different types of care” (Alzheimer’s Association, 2009, p. 46). Under this framework, it is important and necessary to develop strategies in the advanced practice nursing role that will provide effective care and treatment for this population so that the end-of-life care decision-making process is both effective and influential in preserving the integrity of the lives of these patients (Alzheimer’s Association, 2009). It is expected that this patient population will face a continual and devastating decline throughout their lives; therefore, caregivers must demonstrate the capacity to manage these activities and make decisions in a professional manner at all times that enables these patients to die with dignity (Alzheimer’s Association, 2009). Advanced practice nurses play a role in shaping the lives of these patients and their families by providing clinical knowledge and support that will be effective in supporting these patients as best as possible (Alzheimer’s Association, 2009).

The standards of care for Alzheimer’s patients are unique because there are many different types of symptoms and presentations of the condition across the affected patient population. Therefore, although a number of universal principles apply, each patient possesses highly unique circumstances and levels of cognition. In a general context, “Dementia is strikingly underdiagnosed…Earlier diagnosis enables patients and families to prepare for coping with the illness, including making time for long desired trips and reunions and participating in legal and financial planning. People with early Alzheimer’s are usually still competent to specify their wishes concerning medical treatment and to complete an advance directive, which can make future decisions regarding health care easier and less emotionally charged for physicians and families” (Okie, 2011, p. 1071). This perspective demonstrates that it is necessary to develop strategies that will encourage family members and patients who remain competent to create advanced care directives and plans to prepare for the future as the illness becomes more serious in nature (Okie, 2011). These efforts are critical to the overall success of patient care and treatment for AD patients while recognizing their wishes and the family’s needs as the patient declines over time (Okie, 2011). In addition, advanced practice nurses must contribute to discussions and directives regarding the quality of care for AD patients because this is an area of critical importance and value to caregivers who wish to make their patients as comfortable as possible at all stages of the disease (Okie, 2011). These conditions represent a means of supporting AD patients as they experience changes in cognitive and physical functioning over time (Okie, 2011).
Advanced practice nurses demonstrate their knowledge and awareness of different types of AD treatments, including pharmacologic drugs; however, it should be noted that these treatments do not cure the condition or eliminate the eventual decline that will take place in these patients. This is difficult for many family members, patients, and caregivers to accept but this process must be understood because the process is inevitable. However, there are methods that exist which are helpful in alleviating some symptoms and prolonging the eventual devastating effects that will occur. It is important for advanced practice nurses to recognize these limitations and to consider other alternatives that could serve as positive factors in shaping the lives of these patients over time. Patients with AD require a unique level of caregiving and regular evaluation so that the quality of their lives is preserved as best as possible and the development of new approaches to managing the disease are identified.

Alzheimer’s Disease represents a complex set of circumstances for advanced practice nurses as they attempt to provide successful care and treatment to these patients to preserve the quality of their lives. This process is challenging and requires open collaboration and discussion regarding the different impacts of knowledge and evidence-based practice in caring for AD patients. The ever-changing scope of this practice mandates a definitive understanding of the different elements that contribute to the effective management of symptoms and the ability to enhance quality of life by using strategic approaches to accomplish these objectives in a successful manner. Advanced practice nurses contribute to this level of knowledge and understanding in a unique manner because they introduce new concepts for caregiving that are unique to Alzheimer’s patients. These contributions are of critical importance because they support the ability of family members to understand the practices that are taking place to support their loved ones through each stage of AD. These tasks are critical to the success and achievement of new forms of therapeutic intervention for AD patients, even as they possess a variety of different symptoms at various stages of the disease.

Summary

Alzheimer’s Disease is a complex and debilitating condition that is most often characterized by a gradual loss of cognitive function and a decline in the ability to perform routine activities of daily living. This disease is very challenging because there is no known cure, and as time passes its symptoms become progressively worse and have a devastating impact on patients but to also recognize that this process requires expanded knowledge and understanding to achieve the desired outcomes. Advanced practice nurses play an important role in shaping the development of evidence-based practice strategies and initiatives to improve the care of Alzheimer’s patients in a variety of settings that are important contributors to the quality of life that is experienced by these individuals. These individuals must also share their knowledge and expertise with others in the caregiver role so that their needs in this capacity are met in an effective manner. Advanced practice nurses must provide formal and informal education and training to caregivers so that their roles are not only more effective in improving the quality of life for these patients, but also in preserving their own self-awareness and wellbeing to prevent severe psychological deficits or other factors such as depression and anxiety. Since AD is a highly complex condition that is observed in many forms, it is necessary to develop strategies that will encourage caregivers to promote positive outcomes for patients to preserve their lives for as long as possible before severe deterioration and cognitive disruption begins to take hold within this patient population. Advanced practice nurses hold the key to successful care and treatment initiatives to better manage and potentially improve the health status of these patients over a period of time. As a result, it is essential that advanced practice nurses utilize their knowledge, skills, and experience in a variety of ways to advance caregiving practice for these patients and to recognize the limitations that exist in treating this patient population at different stages of the disease.

Advanced practice nurses must provide an effective framework for treating patients with AD, while also recognizing that the disease contributes to an eventual decline in cognitive and physical functioning. This is a difficult balance that advanced practice nurses must achieve because the stages of AD vary widely in patients, along with the symptoms that they experience. Therefore, it is important to recognize these limitations and how they contribute to variable treatment outcomes for patients who require advanced care for this disease and its future outcomes for these patients. Alzheimer’s Disease is such a complex condition that there is no single method of managing the disease, its stages, and its differing symptoms; rather, there are many factors that must be considered when treating these patients, such as their level of cognition and level of independence that remains that the time that the advanced intervention takes place. These efforts are critical to the success of advanced practice nursing for AD patients and support the ability to preserve the integrity and the quality of their lives for as long as possible.

References

Alzheimer’s Association (2009). Dementia care practice recommendations for professionals working in a home setting. Retrieved from http://www.alz.org/national/documents/phase_4_home_care_recs.pdf

Capezuti, E., Boltz, M., Cline, D., Vaughn Dickson, V., Rosenberg, M.C., Wagner, L., Shuluk,

J., Nigolian, C. (2012). Nurses improving care for healthsystem elders – a model for optimizing the geriatric nursing practice environment. Journal of Clinical Nursing, 21(21-22), 3117-3125.

Castellani, R.J., Rolston, R.K., Smith, M.A. (2010). Disease-A-Month, 56(9), 484-546.

Centers for Disease Control (2011). Executive summary progress report on the CDC Healthy Brain Initiative. Retrieved from http://www.cdc.gov/aging/pdf/HBISummary_508.pdf

Elliott, A.F., Burgio, L.D., DeCoster, J. (2010). Enhancing caregiver health: findings from the resources for enhancing Alzheimer’s caregiver health II intervention. Journal of the American Geriatric Society, 58(1), 1-17.

Geriatric Mental Health Foundation (2013). Caring for the Alzheimer’s Disease patient. Retrieved from http://www.gmhfonline.org/gmhf/consumer/factsheets/CaringFINAL.pdf

McKhann, G.M., Knopman, D.S., Chertkow, H., Hyman, B.T., Jack, Jr., C.R., Kawas, C.H.,

Klunk, W.E., Koroshetz, W.J., Manly, J.J., Mayeux, R., Mohs, R.C., Morris, J.C., Rossor, M.N., Scheltens, P., Carrillo, M.C., Thies, B., Weintraub, B., Phelps, C.H., (2011). Alzheimer’s Dementia, 7(3), 263-269.

Merrilees, J., and Ketelle, R. (2010). Advanced practice nursing: meeting the caregiving

challenges for families of persons with frontotemporal dementia. Clinical Nurse Specialist, 24(5), 245-251.

Okie, S. (2011). Confronting Alzheimer’s Disease. The New England Journal of Medicine, 365(12), 1069-1072.