Appraising the need for care in alzheimer’s disease

Abstract

BackgroundIncreasing incidences of dementia necessitate the improvement of supportive measures for patients suffering from this disease and their proxies. Clinicians without psychiatric backgrounds and others involved in appraising the supportive needs of dementia patients, such as those who allocate nursing insurance, base their appraisals on the ability of patients to perform basic and instrumental activities of daily living (B-ADL, iADL). Our aim was to investigate whether a reduced ability of the patient to perform ADL is sufficient to adequately assess the supportive needs of family caregivers.MethodsCross-sectional baseline data were obtained from dementia patients and their proxies in the context of a nationwide prospective cohort study on non-pharmacological treatment of dementia. To our knowledge, the present study is the first country-wide study to assess patients and proxies in their domestic surroundings (e.g. Mini-Mental State Examination (MMSE) Behave-AD, B-ADL and iADL for patients; Quality of Life (QOL) and depression of the proxy).ResultsLogistic and linear regression analysis show that the allocation of nursing care allowance provided by German mandatory nursing insurance is associated with scores on the B-ADL- and iADL scales, but not with the severity of behavioural symptoms or the supportive time the proxies spend on caring. However, the severity of cognitive and non-cognitive symptoms of dementia patients, correlate with each other and both parameters correlate with the time the proxy spends on caring. The time spent on caring is associated with an increase in depression and a reduction in the quality of life of the proxy.ConclusionsBasic and instrumental activities of daily living do not sufficiently reflect the perceived burden of care experienced by the proxy who has to cope with the imposition of the dementia patients’ behavioural symptoms. When allocating nursing care, patients’ behavioural symptoms should also be taken into consideration, because depressive symptoms of proxies are linked to non-cognitive symptoms in dementia patients. To provide better health care, it is necessary to identify and treat psychiatric symptoms in proxies who care for dementia patients as early as possible.

Family dynamics in face of Alzheimer's in one of its members

“…According to a study, with the disease evolution, the primary caregivers assume greater responsibility and begin to dedicate themselves almost entirely to the person with AD (8) . For the study participants, those who were once seen as pillars of the family, become increasingly dependent on the family members to carry out the activities of everyday life (5) . In this sense, the primary caregiver feels more burdened than the secondary caregivers (8) .…”

“…The family involvement in the care is directly related to their perception of the benefits promoted by the interventions for both the person with AD and their family members. Therefore, it is important to explore emotional and relational aspects, personality factors and the relationship among members before the disease (4)(5) . Therefore, it is increasingly necessary that the family understands how is living with a member who is physically present, but psychologically absent, and also knows about the changes in the family routine, including the psychological and social aspects of those involved.…”

Galantamine treatment in outpatients with mild Alzheimer's disease

“…In the early and moderate stages of dementia, symptoms and disease‐related disturbances are compensated for by caregivers, especially when patients suffer from anosognosia. The general health risk of caregivers is therefore increased in proxies who care for such dementia patients, which is increasingly recognized . The study, however, has not fully assessed care giver burden.…”

Cognitive Performance Deficits and Dysgraphia in Alzheimer’s Disease Patients

“…Expressions of dysgraphia ought to be considered against this background. Finally, it has been observed that both ADL and IADL fail to reflect caregivers' burden and patients' behavioral symptoms, including affective domains, which need to be assessed in conjunction with cognitive analyses [57].…”