Understanding Alzheimer's
An aging population brings Alzheimer's care to forefront of future nursing

By Karen J. Coates
May 13, 2002

If you're lucky enough to reach age 85, you face a 50 percent chance of developing Alzheimer's. As the American population ages, dementia will play an increasing role in health care-which means nurses have some studying to do.

More patients will enter hospitals with Alzheimer's and other forms of dementia on top of other health problems, so all health care workers must watch for signs, said Susan Scanland, MSN, GNP, RN, president of Geriscan Geriatric Consulting in Clarks Summit, Pa. "We need to have better rates of detection of dementia in the early stages," Scanland said.

Nursing home staffs also need more training on behavioral problems, she said. "We could do much better."

Experts agree: Nurses should be well-versed in Alzheimer's. "I think they need to understand what this disease is all about," said Susan Gilster, RN, executive director of the Alois Alzheimer Center in Cincinnati. That takes "a tremendous amount of education," she said, because Alzheimer's patients aren't like other patients. "This is a population of people who can't communicate."

Mary Anne Filo, MS, RN, a nurse educator at the Milwaukee County Department on Aging, said Alzheimer's nurses should be trained to understand nonverbal cues, patient discomfort and pain, nutrition when patients can't regulate their intake, signs of infection, increased confusion, constipation, dehydration and other situations that, if unchecked, could lead to an ER visit. All nurses should have such skills, she said, but with Alzheimer's patients, "you really have to heighten the importance."

Long-term care nurses naturally encounter Alzheimer's patients, said Shirley Travis, Ph.D., RN, professor of nursing and president of the National Gerontological Nursing Association. "Caring for individuals with severe cognitive deficits is part of the curriculum in most graduate programs," Travis said. Continuing education and on-the-job training also are common preparation for nurses. "These neurodegenerative disorders can be devastating to the individuals and their families," she said. "If you understand that they have a brain disease, most nurses are driven to understand the disease and the proper care to be provided, just as they would for any other disease in their client population,"

Like all else, that costs money. A UCLA study published in the February issue of the Journal of the American Geriatrics Society noted that Alzheimer's care could cost more than $30,000 per patient for a period of six months. "The number of families who could tackle the day-to-day care of a cognitively impaired older adult is very, very low," said Carol Baird, DNS, RN, an assistant professor at Purdue University. "The long-term costs of Alzheimer's will be the responsibility of the state with federal reimbursement, as the number of older adults or families who could handle the financial burden is minuscule."

But the rewards of working with Alzheimer's patients can be great. "People sometimes ask me why I work in this area," Gilster said. But she makes a difference for people. When nursing students spend time in her facility, they are amazed. "First, they say, 'I had no idea what this disease did to people as human beings.' " Second, they say they didn't know what could be done to improve patients' lives. Her facility took a group to the NCAA basketball tournament and they had a great time.

"Who would've thought?" she said. "Just because a person has dementia doesn't mean they have to spend the rest of their lives in a room somewhere."