A Holistic Approach To Alzheimer’s Disease Care

Ginny FullerFebruary 28, 2008

Dr. Hadley

Objectives

• Provide an overview of Alzheimer’s disease• Discuss standard treatment options• Discuss complementary treatment options• Address religion and spirituality in the

patient, caregiver, and from a provider’s prospective

Epidemiology

• AD is the most common form of dementia worldwide

• AD affects over 4.5 million Americans• Prevalence increases dramatically as age

increases after 60• Nearly 50% of individuals >80 have

diagnosable AD

Diagnosis of AD

• Diagnosis must include memory impairment plus at least one of the following:– Apraxia– Agnosia– Aphasia– Impaired executive functioning

Pathophysiology

• Decreased acetylcholine• Increased glutamate• Diffuse brain atrophy• Inflammation• B-amyloid plaques• Tau protein tangles

Standard Treatment

• Acetylcholinesterase Inhibitors• NMDA Receptor Antagonists• Behavioral Treatments

Complementary and Alternative Treatments

• Ginkgo biloba• Phosphatidylserine• Huperzine A• Curcumin• Music therapy• Touch therapy and massage

Spirituality and the AD Patient• AD patients’ religion and spirituality must be taken into

consider during treatment• Involvement with religious activities and practices may

improve health and longevity and may slow cognitive impairment

• Sermons, singing, scripture study, prayer, and socializing improve and stimulate cognitive functioning

• Even highly progressive AD patients can be reached on a spiritual level

• Patients may use religiosity to accept, make sense of, and be at peace with their diagnosis

• It is estimated that nearly 90% of AD patients pray

Spirituality and the AD Caregiver• Spirituality plays a major role in the day to day lives

of many AD caregivers• Caregivers find support through a local church or

religious organization• Caregivers use their spirituality and faith as a type of

coping mechanism to deal with grief, loss, and depression

• They may use AD as an opportunity for spiritual growth

• Religiosity may lead to lower levels of depression, a higher perception of stress, and higher levels of self acceptance

Spirituality from a Provider’s Standpoint

• 82% of Americans over 65 state that they are actively a part of a faith community, but there is very little training given to health professionals dealing with spirituality and religion

• Providers must listen to family and patient concerns and wishes and must acknowledge various faith traditions and practices

• Especially with end of life care, spiritual needs may be just as important as physical, social, and psychological needs

Spirituality from a Provider’s Standpoint

• Forms like the “Sacred Center Assessment” are available to health care providers to help address patients’ spiritual wants and wishes

• Professionals must provide support and develop individualized plans for each AD patient

• Providers must cooperate with clergy and other individuals in faith communities

• Encourage caregivers and AD patients to join care and support groups

– “We are not obliged to reorient them into our reality, but we are obliged to be an attentive presence in theirs.” ~ S. Post

Conclusions• The number of individuals affected with AD is expected to

continue to grow in the future decades, tripling by 2050• Research regarding spirituality and the patient, caregiver, and

practical tips for providers must be continued and increased• More in depth studies regarding complementary and alternative

therapies in AD patients need to be performed• A holistic approach needs to be adopted by physicians and other

healthcare providers caring for patients with dementia• Provider’s must treat every patient as an individual, with specific

customs, beliefs, and practices, which are unique• Patients, providers, caregivers, and other members of society

need to work together to provide the most thorough and encompassing care possible

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