Treating Alzheimer’s in the nursing home

More than 50 percent of residents in assisted-living and nursing homes have some form of dementia or cognitive impairment, and that number is increasing every day. The Alzheimer’s Association’s Campaign for Quality Residential Care offers strategies aimed at helping skilled nursing homes better respond to this growing healthcare demand.

The campaign incorporates four strategies:

• It encourages adoption of recommended practices in assisted living residences and nursing homes by advocating with direct care providers.

• It ensures incorporation of the practice recommendations into quality assurance systems for nursing homes and assisted-living residences by working with federal and state policymakers.

• It encourages quality care among providers by offering training and education programs to care staff in assisted-living residences and nursing homes.

• It empowers people with dementia and their caregivers to make informed decisions through the Alzheimer’s Association CareFinder™, an interactive online guide that educates consumers on how to recognize quality care, choose the best care options, and advocate for quality within a residence.

These recommendations are the foundation of the campaign:

Management goals. Because there is no cure for Alzheimer's disease, the chief goals of treatment are to:

• maintain quality of life

• maximize function in daily activities

• enhance cognition, mood and behavior

• foster a safe environment

• promote social engagement.

Elements of a strategy to maximize dementia outcomes include regular monitoring of patients’ health and cognition, education and support to patients and their families, initiation of pharmacologic and nonpharmacologic treatments as appropriate, and evaluation of patient/family motivation to volunteer for a clinical trial.

Treating cognitive symptoms

Alzheimer's medications cannot alter disease progression, but the FDA-approved drugs that treat the symptoms of Alzheimer's disease can temporarily slow the worsening of symptoms and improve quality of life for those with Alzheimer's and their caregivers.

Managing behavioral and psychological symptoms

Behavioral and psychological symptoms of dementia (BPSD), especially agitation, aggression, depression and psychosis, are the leading causes for assisted-living or nursing facility placement. Early recognition and treatment can reduce the costs of caring for these patients and improve the quality of life of the patient and caregiver.

Monitoring Alzheimer's disease

After a diagnosis of Alzheimer's disease is made and a treatment plan implemented, patients should return for evaluation on a regular basis in order to allow adaptation of treatment strategies to changing needs. Patients may not be a reliable resource for history-taking, so it’s wise to encourage a family member, friend or caregiver to accompany the patient.

Consider these nonmedical needs for patients with Alzheimer’s:

• ongoing information and support

• a living will

• a durable power of attorney for health care

• review of finances

• planning for changing care needs over the course of the disease

• preferences for end-of-life care

Alternative treatments

There are legitimate concerns about using alternative treatments, "prevention" food and vitamins, or "memory/brain booster" supplements as an alternative or in addition to physician-prescribed therapy. Effectiveness and safety are unknown, purity is unknown, adverse reactions are not routinely monitored, and dietary supplements can have serious interactions with prescribed medications.

Prevention

Risk factors identified in studies and clinical trials show that cardiovascular risk factors, such as hypertension, hypercholesterolemia and smoking, increase the risk for cognitive decline. Remaining physically active and socially and intellectually engaged can have a positive impact on cognition.

The caregiver, your partner in care

Most patients with Alzheimer's disease have a primary caregiver, often a family member, who helps to ensure appropriate care. In striving to meet the needs of the patient, the caregiver often neglects or her own needs. Many report high levels of stress; nearly 40 percent suffer from depression. Health care professionals can help by looking for signs of caregiver burnout, treating medical problems and referring them to support services, such as the Alzheimer's Association's 24/7 Helpline (800.272.3900). The Association’s Caregiver Center offers guidance on how to maintain physical and mental health in the midst of caregiving, as well as advice on how to manage their loved one's daily care, enhance their daily life, and respond to negative behaviors.

More resources:

For providers:

http://www.alz.org/health-care-professionals/medical-management-patient-care.asp

Alzheimer's Association Position Statement on Therapeutic Goals (pdf)

Alzheimer's Association Position Statement on Right to Treatment (pdf)

For patients and caregivers:

Alzheimer's Disease: The Basics – Symptoms, diagnosis, treatments and more.

Find a Support Group – Patients with Alzheimer's or another dementia and caregivers can find support and get advice at their local Alzheimer's Association support group, and can also join message boards.

Alzheimer's Navigator – Free online tool designed specifically for individuals with Alzheimer's disease and their caregivers, helping them create customized action plans and providing access to information, support and local resources.