Long term care and Alzheimer’s
term care and the experience of Alzheimer’s disease:
disease is by far the most common type of dementia present in
long-term care facilities. The Diagnostic and Statistical Manual of
Mental Disorders-IV (DSM-IV) lists two different times of Alzheimer’s
disease: early-onset, which starts prior to age 65, and late onset,
which starts after 65 years old. The late onset type is much more
common for residents in long-term care facilities as well as for the
community-based elderly. As an individual gets older they’re more
likely to contract Alzheimer’s disease. While only about 2%
to 4% of
seniors over 65 have Alzheimer’s disease, the rate increases to about
20% for those over 85 years old. A diagnosis of Alzheimer’s disease
is made by establishing that the individual meets the criteria for
dementia and by ruling out all other medical and psychiatric
conditions which may have a causative affect.
The course of
Alzheimer’s disease is relatively consistent with one of the first
signs of the disease being an impairment in recent memory and some
mild impairment in long-term memory. As time goes on, more and more
cognitive abilities are lost in each successive year. Some of the
early stages include the first stage (possible pre-Alzheimer’s stage)
in which there are minor impairments which result in mild to moderate
difficulty in one’s life. This stage may last for up to seven years.
These stages progress on to the most severe stage in which there is
pervasive, severe cognitive impairment which affects every aspect of
an individual’s life, and ability to think and manage their affairs.
There are a
variety of other mental disorders that accompany Alzheimer’s disease
with about 50% of Alzheimer’s disease patients displaying delusions
during the course of their disease. Some experts believe that it is
doubtful that an increased rate of depression accompanies Alzheimer’s
disease. A recent study of community dwelling Alzheimer’s disease
patients found that very few have a diagnosis of major depression.
However, these conclusions are subject to controversy. Alzheimer’s
disease patients often appear depressed because some of their symptoms
such as decreased energy, sleep disturbance, lack of interest, and
poor concentration, seem to overlap with the symptoms of depression.
These symptoms may lead caregivers to believe that relatives are
depressed when in fact they are observing the “pseudo depressive
syndrome” of Alzheimer’s disease. Of course this does not mean that
Alzheimer’s disease patients never get depressed, just that
Alzheimer’s disease does not appear to be a risk factor as a result of
provided by Psychosocial Intervention in Long-Term care by Gary W.
Hartz, Ph.D. and D. Michael Splain, LCSW
information and web page by
Paul Susic M.A. Licensed Psychologist
Ph.D. Candidate (Health Psychology)