Book review—Slow Dancing with a Stranger: Lost and Found in the Age of Alzheimer’s”

I just finished reading, “Slow Dancing with a Stranger: Lost and Found in the Age of Alzheimer’s,” by broadcast journalist Meryl Comer.  The words demonstrated the devastating cost—personal and financial—of caring for a loved one with Alzheimer’s disease. Comer’s husband, Dr. Harvey Gralnick, was chief of hematology and oncology at the National Institutes of Health until he received a diagnosis of early onset Alzheimer’s at age 58.  Comer’s mother, who also had Alzheimer’s disease.

I am reading all I have time for regarding Alzheimer’s disease as I have had the unfortunate opportunity to see this disease on an up-close, personal level.  The first thing that struck me when I picked up this book was the title.  I did not see my loved one’s as strangers.  They were still my father, my mother-in-law and my uncle.  They didn’t go anywhere...they were attacked by a progressive disease that often lasts for many years.

Beyond this subjective criticism of the book, I would not criticize the emotions felt or the decision made of anyone who has a loved one subjected to this disease.  We all try to do the best we can within the constraints of our resources.  I did find it interesting that Mr. Gralnick was aggressive and the health system recommended a mental health facility to “adjust his medication”.  There are few resources available for appropriate treatment of the complicated disease process of Alzheimer’s, but her description of options tried gives her audience insight into the road traveled and the hope for a new route in the future.

Despite these observations Comer’s purpose for writing this book seems not to be to inspire false hope, but to show why Alzheimer’s disease needs to receive the same level of attention and research funding as other major diseases—diseases which have seen a decrease in mortality rates while the incidence of Alzheimer’s disease is rising (one in three people now have Alzheimer’s disease when they die). A study by researchers at Rand Corporation and other institutions calculated that the direct cost of care for people with Alzheimer's and other dementia in 2010 was $109 billion. In comparison, healthcare costs for people with heart disease was $102 billion; for people with cancer, it was $77 billion. Yet cancer research was allocated an estimated $5.4 billion (2014) in federal funds, and heart disease will get $1.2 billion — while research on Alzheimer's and other dementias comes in at only a fraction of that, at $666 million.

For more information regarding research funding see

http://report.nih.gov/categorical_spending.aspx

  

 

Alzheimer Training vs. Psychotropic Drugs

Recently there has been much discussion of psychotropic drugs being prescribed to those with Alzheimer’s disease in both hospital and long-term care environments.  Many times these drugs are used to control a dementia patient when appropriate care of the individual is all that is needed.  The example below illustrates how important caregiver approach is to the Alzheimer’s patient.

A nursing assistant walks in a room and advises the patient that it is time for a shower.  He responds negatively stating that he just took a shower and doesn’t need another one.  She advises him that he has not had a shower this week and he must shower now.  She approaches the patient, taking his arm to guide him to the wheelchair.  The patient strikes out hitting her in the face.  The nursing assistant leaves the room and returns with reinforcements. Three people enter the room and advise the patient that he must take a shower.  The patient sees three individuals approaching and unsteadily turns to flee, falls and fractures his ankle...he would receive no shower today.

Utilizing the knowledge of how Alzheimer’s disease affects an individual’s thought process:   

1)      The Alzheimer’s patient does not have short term memory.  Reasoning with a patient with Alzheimer’s is not effective.  Cognitively, they are not able to participate in this high level skill.

2)      All individuals, but especially Alzheimer’s patients become fearful when approached by a group of individuals that he perceives as a threat to his safety.

 

Alternative scenarios: 

A nursing assistant walks into a room and advises the patient that is time for a shower.  He responds negatively stating that he just took a shower and doesn’t need another.  The nursing assistant notes that the patient his acting rather defiant this am and suggests that they take a walk together to look at the beautiful sunshine coming in the windows.  The patient and the nursing assistant take a short stroll which seems to calm the patient.  The nursing assistant then asks the patient if he would like to for another short walk to take a shower.  Having forgotten that he told the nursing assistant no a few minutes ago he willingly goes with her to the shower room.

 A nursing assistant walks into a room and advises the patient that it is time for a shower.  He responds negatively stating that he just took a shower and doesn’t need another.  The nursing assistant states “ok” and advises the patient that he looks tired and suggests that he may enjoy sitting in the recliner in the other room to relax.  He agrees and follows her to sit in his favorite chair.  A short time later the nursing assistant returns to the patient with his shower supplies in hand.  She approaches him and states that he looks like he is more rested and suggests that he get cleaned up for lunch.  The patient is assisted from the chair and makes the short walk to the shower room where he willingly participates in his shower.

There are many other ways to handle this situation keeping in mind that a person with an altered memory does not respond to attempts to convince them to act.  Alzheimer’s patients are programmed to fight or flee when threatened.  These individuals are often influenced by how they feel at the moment.  By changing how they feel, cooperation in daily tasks will follow.

ABC NIGHTLINE Tells America About the Virtual Dementia Tour®

 

This technique for education should be added to all Alzheimer's Care Giver courses.  I did this for my Certified Nursing Students during restraint instruction.  They were quite verbal afterward regarding how they felt vulnerable and frightened when in restraints.

Alzheimer's patients can still feel emotion long after memories have vanished

Date:

September 24, 2014

Source:

University of Iowa Health Care

Summary:

A new study further supports an inescapable message: caregivers have a profound influence -- good or bad -- on the emotional state of individuals with Alzheimer's disease. Patients may not remember a recent visit by a loved one or having been neglected by staff at a nursing home, but those actions can have a lasting impact on how they feel.

http://www.sciencedaily.com/releases/2014/09/140924135018.htm