Caring For Patients With Dementia And Alzheimers
Over 55 million people across the globe live with dementia. According to the World Health Organization, dementia, which includes the diagnosis of Alzheimer’s disease, is one of the leading causes of disability for the world’s elderly population and ranks as the seventh leading cause of death among all diseases. The demand for nurses with the training and sensitivity to care for dementia and Alzheimer’s patients has never been greater.
Whether you have just started your nursing career or have already decided to specialize in gerontological nursing, this guide describes what to expect working with dementia and Alzheimer’s patients. It also offers tips and resources to help you provide high-quality dementia patient care and maintain your own well-being in this stressful field.
Dementia and Alzheimer’s: An Overview
Dementia mainly affects the elderly, but aging does not necessarily lead to a diagnosis. Risk factors such as genetics, lifestyle choices, and underlying health conditions also play a role. However, as life expectancy increases, the prevalence of dementia among the aging population has emerged as a major challenge to caretakers and healthcare providers. One in three seniors dies of some form of dementia. Alzheimer’s disease causes more fatalities than prostate cancer and breast cancer combined.
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“One in three seniors dies of some form of dementia. Alzheimer’s disease causes more fatalities than prostate cancer and breast cancer combined.”
–alz.org
Ann Kriebel-Gasparro, a faculty member in Walden University’s master of science in nursing program, describes dementia as a group of symptoms rather than a particular disease. This term encompasses a variety of conditions that affect memory, problem-solving, and decision-making. The loss of cognitive functions associated with dementia symptoms interferes with the ability to carry out everyday activities such as driving, paying bills, or living alone. Alzheimer’s, the most common type of dementia, affects 60-80% of all patients diagnosed with dementia.
Recognizing the Warning Signs and Symptoms of Dementia and Alzheimer’s
Because the early warning signs can be mistaken for normal age-related behaviors such as forgetfulness or misplacing items, family members and caretakers may not know how to recognize the symptoms.
Kriebel-Gasparro emphasizes that nurses who have training in dementia and Alzheimer’s disease with gerontological patients can provide quality medical care to help track and manage symptoms. Early detection of dementia and treatment of other health issues can help people maintain their independence longer and slow the progression of symptoms.
Dementia and Alzheimer’s share many of the same symptoms in the initial stages. These are among the most common warning signs.
Symptoms of Dementia
* Changes in short-term memory
* Poor judgement and decision-making
* Inappropriate or out-of-character behavior
* Trouble completing basic or familiar tasks
* Mood and personality shifts
Symptoms of Alzheimer’s
* Difficulty planning ahead or solving problems
* Losing track of dates and time
* Confusion getting to and recognizing familiar places
* Difficulty with visual images, spatial relationships, and balance
* Trouble speaking or writing
The Role of Nurses in Providing Care to Patients With Dementia or Alzheimer’s
The population pool of older people has steadily increased across the world. The elderly not only have longer life expectancy than ever before, but many live with chronic conditions that require healthcare services provided by geriatric specialists. Consequently, the demand for Alzheimer’s and dementia nursing care continues to grow. Nurses with gerontological specialties and training in these conditions play a crucial role in helping these patients maintain their quality of life and remain independent as long as possible.
Because there is currently no cure for dementia, patients rely on the care management provided by nurses in both clinical and home-based settings. Nurses provide direct care to patients, helping to relieve the burden placed on family members and other caregivers. An important component of Alzheimer’s and dementia nursing care involves education and communication about treatments, progression of symptoms, interventions, and coordination of services with other specialists.
Nursing Duties and Responsibilities
* Create a care plan and establish daily routines.
* Assist with patient self-care including daily activities such as hygiene, eating, toileting, and exercise.
* Provide care with these daily activities for patients that have significant cognitive impairment or deficits in motor functioning.
* Assess patient safety and avoid risk of injury due to disorientation or confusion.
* Manage behavior problems, anxiety, and anger.
* Encourage time for socialization with family and friends.
Tips for Nurses Providing Care to Patients With Dementia or Alzheimer’s
Among all healthcare providers, nurses caring for patients with dementia and Alzheimer’s face some of the most challenging conditions. They need patience and understanding as the disease progresses while also taking time to care for themselves. These practical tips can help improve the quality of patient care and minimize caregiver stress.
1. Communicate in a way that will not distress patients
As dementia progresses, Kriebel-Gasparro reminds nurses not to make assumptions about a patient’s ability to communicate and comprehend. The symptoms of dementia and Alzheimer’s disease affect each person differently from the early to moderate states. Patients need to be treated with kindness and support, using these communication techniques:
* Maintain eye contact and direct one-on-one interaction.
* Be patient and offer assurance when the patient makes mistakes or feels embarrassment.
* Ask clear and simple questions requiring yes or no answers to minimize confusion.
* Do not interrupt or argue.
* Engage in conversations in quiet spaces without distractions.
2. Establish a routine with a daily care plan
The importance of routines and familiarity for dementia and Alzheimer’s patients cannot be underestimated. Creating a nursing care plan helps to reduce restlessness, anxiety, and other challenging behaviors.
Before making a structured daily plan, nurses need to get to know their patients, taking into account their abilities, likes, and dislikes. They should consider what times of day the patient functions best and when they need breaks or distractions.
While most care plans include regular times for waking up and going to bed, meals, and bathing, they should be flexible enough to allow nurses to adjust and experiment with activities that provide enjoyment and meaning. The best care plans include activities that help patients stay connected to their pre-dementia lives, such as watching a favorite TV show or movie. As the disease progresses, nurses should make sure the activities fit their patients’ ability levels.
Nurses should also include their own self-care needs when creating a daily plan, by incorporating activities that reduce their patients’ stress and their own, such as listening to music or taking a walk.
3. Maintain a support system and practice self-care
Nurses providing dementia and Alzheimer’s care often work for the same patients over long periods of time, becoming personally attached to them and their families. As their patients progress through the disease, nurses may experience a range of emotions—anxiety, sadness, guilt, anger, and depression.
Nurses need to manage their self-care by recognizing and managing these feelings. If left untreated, stress can lead to physical problems such as headaches and high blood pressure, or emotional and behavioral changes such as irritability and inability to sleep. If these kinds of symptoms emerge, nurses should consult with their doctor or a mental health specialist. Nurses can be proactive in managing their stress by routinely engaging in relaxation techniques and arranging with the patient’s family to provide temporary respite care when time off is needed.
Many caretakers manage their stress by connecting with other caretakers and joining professional organizations. The Alzheimer’s Association offers networking opportunities and caregiving resources. ALZConnected, an online community that provides access to resources, programs, and community services, also provides support and encouragement to caregivers.
Nurses who take time for themselves are more likely to provide their patients with consistent and quality care. Nurses also need to recognize that patient needs change through the stages of dementia and Alzheimer’s. Nurses should prepare for these transitions by accepting that their patients will require other kinds of healthcare options that they may not be able to provide, including more assistance with home care to placement in a residential facility.
4. Complete continuing education courses in Alzheimer’s Disease and gerontology
As the population ages and the number of patients with all types of dementia increases, healthcare providers will need to become familiar with new techniques and treatments. Kriebel-Gasparro suggests that nurses can provide the best possible care to their patients through professional development and continuing education that focus on dementia and Alzheimer’s. She also recommends that nurses pursue advanced practice nursing graduate degrees that offer adult-gerontology specialties in acute care and primary care.
Several professional organizations offer continuing education credits and certification that help nurses keep current with changes in treatment and care options:
* The Gerontological Advanced Practice Nurses Association (GAPNA) administers a gerontological specialist certification. Nurses may also choose from several continuing education options that focus on the signs and symptoms of cognitive degeneration and impairment, behavior changes, diagnosis, treatment, and management of dementia.
* Portal of Geriatrics Online provides a free collection of toolkits, competency-based case modules, continuing education courses, and geriatric nursing education materials.
* Engage-IL, administered by the University of Illinois at Chicago, provides evidence-based training and geriatric continuing education modules. The site offers free mobile apps to help identify behavioral symptoms of dementia and links to activity tool kits and national support services.
5. If necessary, provide adequate preparation for the final stages of Alzheimer’s Disease
Nursing care for dementia and Alzheimer’s patients becomes especially critical during the final stages when patients experience memory loss, depression, hallucinations, and psychosis. Kriebel-Gasparro emphasizes the importance of skilled nurses with extensive dementia and Alzheimer’s knowledge at these severe stages. Nurses not only provide treatment to patients but also help families prepare for end-of-life decisions.
While families may find it difficult to face these issues, nurses with gerontological training can help them make important end-of-life decisions. These nurses can facilitate conversations with family members about hiring elder-law attorneys and preparing necessary documents such as living wills, medical power of attorney, and end-of-life directives. They also provide emotional support to family members and suggestions for preparing emotionally for the final stages.
Dementia and Alzheimer’s Resources for Nurses
Many organizations offer educational materials, helplines, and diagnostic and treatment guides that focus on dementia and Alzheimer’s. The resources provided by these websites are representative of the types of services available to nurses and caregivers.
This interactive tool, part of the HIGN website sponsored by the New York University Rory Meyers College of Nursing, enables nurses to search for evidence-based nursing protocols for best practice by type of condition and by symptom. HIGN also offers healthcare providers continuing education courses, case study lessons, and webinars.This 24-hour hotline staffed by specialists and master’s level clinicians offers decision-making support, crisis assistance, and education on legal, financial, and treatment issues. Serving people living with dementia, caregivers, families, and the public, the hotline accommodates speakers of over 200 languages.The CDC’s Alzheimer’s Disease and Healthy Aging Program (AD+HAP) has developed several resources to educate and inform caretakers for older adults. Its REACH OUT community-based action guide offers tips, websites, and additional references.The FCA assists caregivers of adults with dementia through direct care assistance, assessment and care planning, legal and financial consultation, respite services, and other resources. The FCA provides support services in several languages, including Spanish, Chinese, and Vietnamese.The Fall TIPS tool improves dementia patient safety in hospitals. Nurses use this tool to engage patients and families in preventing and reducing falls and remediating the cause when falls occur. This website helps nurses to implement Fall TIPS training, assess safety results, and provide feedback to clinical staff.Meet Our Contributor
Ann Kriebel-Gasparro, DNP, FNP-BC, GNP-BC
Ann Kriebel-Gasparro, a faculty member in Walden University’s master of science in nursing program, holds more than 26 years of nursing experience. She is dual-credentialed as a family and gerontological nurse practitioner. In her clinical practice, Dr. Kriebel-Gasparro provides in-home healthcare for elderly patients. Dr. Kriebel-Gasparro is a current member of the Gerontological Advanced Practice Nurses Association and previously served on the Rare Disease Advisory Council for the Commonwealth of Pennsylvania’s Department of Health.
Reviewed by:
Shrilekha Deshaies, MSN, CCRN, RN
Shri Deshaies is a nurse educator with over 20 years of experience teaching in hospital, nursing school, and community settings. Deshaies’ clinical area of expertise is critical care nursing and she is a certified critical care nurse. She has worked in various surgical ICUs throughout her career, including cardiovascular, trauma, and neurosurgery.
Shri Deshaies is a paid member of the Red Ventures Education freelance review network. Learn more about our review partners.