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Alzheimer’s
The
Stranger in the
Mirror
by Brenda Fountain, BSN,
RN
As a nurse, I have always found it difficult and frustrating to
understand the needs of a person with Alzheimer’s disease.
Alzheimer’s is the most common type of dementia. It is a
progressive degenerative brain disease first discovered in 1906
by Dr. Alois Alzheimer, a German physician. His autopsy of a
patient’s brain indicated abnormal amyloid plaques
and neurofibrillary tangles on the brain. His patient was
a woman in her late 50’s
who had regressed in her memory and abilities to childhood. The
plaques and tangles are now the indications of Alzheimer’s
disease, though study is ongoing regarding the cause of the
plaques and tangles. As a nurse, using the medical model of
disease and progression should be sufficient to begin to care
for people with Alzheimer’s disease.
But it was as a daughter that I really began to understand
Alzheimer’s. My mother became a stranger to herself. She didn’t
recognize pictures of herself nor her reflection. It doesn’t
seem possible, but I watched my mother slowly regress into
infancy. I could do nothing to prevent it, so I threw myself
into studying everything possible, hoping to understand, hoping
to somehow ease my sorrow. The knowledge that I gained did
nothing to ease that sorrow but it did help me in caring for
and understanding my mother.
In this article, I hope to provide information on caring for a
person with this disease through personal experiences and
education. According to the Alzheimer’s Association, a 1993
national survey indicated that Alzheimer’s disease could be
found in one in ten persons over 65, five of ten persons over
85 and that four million Americans had AD, 19 million Americans
had a family member with AD, and 37 million Americans knew
someone with Alzheimer’s disease. With the aging of our baby
boomers, those numbers are going to escalate at a rate that
will be draining the emotions and finances of the people of
this country. Becoming more aware of Alzheimer’s and its
treatment is a necessity not only for the medical world, but
also for every person.
The article “A Trip Back in Time” by Christopher Johnson, PhD
is an excellent guide to understanding the process of
regression. Dr. Johnson is a professor at the Institute of
Gerontology at the University of Louisiana at Monroe. His
article provided the first step for me in defining the disease
process. It helped me to understand the decline and the moments
of clarity that sometimes occur. At age 74, my mother still
knew who I was but when asked her age, she responded that she
was 43 years old. She did not recognize her grandchildren. How
could she, they were only infants or had not been born. But
yet, further along in her regression, she suddenly asked if my
son was out of the military yet. Dr. Johnson uses spiraling
loops to indicate how there can be fluctuations in regression
with AD. His model would be very helpful professionally and
personally for any Alzheimer’s caregiver.
As with most diseases, there are stages to Alzheimer’s.
Reisberg’s Seven Stages of Alzheimer’s Disease (also known as
FAST-Functional Assessment Staging) is a very helpful tool that
breaks down each stage into specific activities of daily living
(ADLs). ADLs can still be accomplished by a person with
Alzheimer’s disease dependent on their stage and dependent on
our understanding of their stage. Understanding the person’s
stage of illness is important to every aspect of their care.
Early Stages 1-4 still allows decision-making. The person
should be included in decisions that will eventually affect the
end of their life. Excluding them isolates them and certainly
contributes to early feelings of paranoia. It should be noted
that Stage 1 is asymtomatic, which means everyone could have
stage 1 Alzheimer’s disease.
While our mother was still cognizant of her reality (Stage 4),
my sister and I talked with her about her choices. The move was
easier for her and us because we were following her
instructions. My mother lived alone until she was unable to
perform daily activities (Stage 6c). My sister and I checked on
her often and hired someone to help. We did eventually place
her in the nursing home of her choice. What we did not fully
understand at the time was that the placement should have been
more thoroughly researched with her future needs in mind, as
well as her present needs. My mother’s choice was a nursing
home that was familiar to her and was located close to my
sister. The home was pleasant and secure with a kind staff. My
sister could see her everyday. I came on the weekends and
called my mother every night as long as she could recognize the
concept of the telephone. The problem occurred as my mother’s
disease progressed. She began to wander into other residents’
rooms thinking that it was her room. She forcefully insisted
that the person leave her room by grasping the lady’s already
broken arm. Because the staff had not been trained for a true
Alzheimer’s unit, they did not know how to handle this problem,
nor did they have a dedicated Alzheimer’s unit. She was
promptly admitted to a geriatric psychiatric
facility.
Cont'd Part
2
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