Alzheimer's Disease - Observational Study (psychology)

Observational Study on Alzheimer's Disease in 24-hour Care
Introduction
Discovered in 1906 by German physician Dr. Alois Alzheimer, Alzheimer’s disease is a chronic and progressive illness of the brain. Through our archival research we found that Alzheimer’s disease causes slow but sure decline in cognitive abilities. This disease develops slowly usually over a span of 20 years; eventually it affects all brain functions (including memory, language, behavior, judgment and abstract reasoning). Alzheimer’s disease affects 4.5 million Americans and 25 percent of those affected are in assisted living or long term care facilities. People affected with mid to late stage of Alzheimer’s disease need 24 hour care. A person in the late stages of Alzheimer’s disease loses their ability to care for themselves and requires special attention. The objective of this project was to research the effects of Alzheimer’s disease on the brain, to observe the behaviors of people affected by Alzheimer’s disease living in 24 hour care, and to have better insight on why people are placed in these facilities.
Method
Members of the group participated in activities with the residents of Home Place and recorded what was seen as far as abnormal behavior. Our research included natural observation, taking place at an assisted living facility, and archival research. “The Unforgettables” participated as volunteers at Home Place, a special care facility. To better understand the stages of Alzheimer’s disease, the group researched Alzheimer’s effects on the brain. There are seven stages of Alzheimer’s disease, which are condensed into three levels (early, moderate and severe Alzheimer’s disease); beginning with early onset Alzheimer’s where impairment of the brain goes unnoticed. As the disease progresses the persons ability to complete complex tasks or simply verbalize a need is diminished.


Participants
With permission from Home Place, our group was allowed to participate in activities with the residents. The selection process was on a volunteer basis and varied with each visit. Participants included any residents interested in a particular activity of the day. Participants ranged from three to twenty residents of both genders, but primarily women. The age range of the participants was between 70 and 90 years old.
Apparatus
Materials and equipment used for the natural observation varied from activity to activity. These included cooking materials, art supplies, grooming materials (hair and nails) and music. Research materials included on-line research, DSM-IV, psychology textbook and journals kept from natural observation.
Procedure
“The Unforgettables” first researched the different stages of Alzheimer’s disease and the effects it has on the brain. By researching the stages of Alzheimer’s disease, the group acquired an understanding of the changes in the brain and the effects on behavior. For example, the hippocampus is affected first. In early onset of Alzheimer’s disease, short-term memory is lost. Memories are impossible to make and learning no longer exists. Second, we observed and participated in activities with actual Alzheimer’s patients. The point of our observation was to see the cognitive abilities of the residents as they try to perform simple tasks such as cooking, painting and grooming.


Results
In reporting results of this project, each stage of Alzheimer’s will be presented along with examples from our observation. In Home Place, there are four pods. The residents are categorized and placed into pods based on which stage of Alzheimer’s disease they are in. Pod One is designed for end stage Alzheimer’s. These residents require total assistance with all activities of daily living including, toiletry, grooming and eating. Pod Two is for residents with moderate stage Alzheimer’s. The residents in this group need constant cueing with activities of daily living -- they can accomplish tasks but need reminding. Pod Three is where mildly affected residents are placed. They also require cueing, but they can finish tasks, such as dressing, as long as their clothes are set out for them. Pod Four, similar to Pod Three, also called “ the bungalow,” houses residents who are almost independent but are still at risk to wander and to forget to finish tasks such as cooking and leaving the stove on.
Stage one of Alzheimer’s disease is no impairment (normal function). The group did not observe any residents at this stage. Stage two, very mild cognitive decline: did not observe any residents at this stage. Stage three, mild cognitive decline: still no observation of this behavior. Stage four, moderate cognitive decline: in one of the visits while participating in a cooking activity in Pod Four, a gentleman was asked where he was from and he replied that he was from Idaho. When asked why he came to Washington he was baffled by the fact that he was even in Washington. This is a symptom of stage four - reduced memory of personal history. Stage Five, moderately severe cognitive decline: one resident was wearing two hats and oblivious to it. While doing a cooking activity a woman who appeared mildly affected by the disease, needed constant cueing on how to put paper cups in a muffin pan and still doubled the paper cups and was confused. During a painting activity in Pod Two, a resident who was a painter did not remember that she was an artist and did not realize that her art was hanging 5o feet away from her. Stage six, severe cognitive decline, a resident accused a care giver of stealing his wallet. He was so convinced that she did it that he became aggressive and would not let go of her hands. Another resident was convinced that his car was in the parking lot and demanded that they let him go. A care giver stated that a gentleman in Pod Two urinated on the glass door daily, convinced he was peeing outside. Stage seven, very severe cognitive decline, these residents generally napped between meals and did not participate in activities. Many were confined to a wheel chair and the ambulatory residents wandered in Pod One. These individuals required total care with activities of daily living. One individual in Pod One cried and there was no consoling him. He did not know why he was crying, but he was overwhelmed with sadness. We were in that pod for fifteen minutes and he cried the entire time.
Discussion
The group’s observational visits provided insight on 24 hour care for these vulnerable people. Actually seeing the behaviors of these people with different stages of Alzheimer’s Disease proves that this kind of care is necessary not only for their safety but for their well being. The particular setting that we observed specialized in Alzheimer’s disease care. If a patient needs to wander throughout the night or eat meals at unusual times there is always experienced staff available to meet those needs. We have learned that although a person can be cared for at home, it is difficult for the spouse or care giver to provide all the care needed as well as meeting their own needs. Shortcomings of our study include no measurable variables because each person is affected differently by Alzheimer’s disease. Twenty five percent of those affected by Alzheimer’s disease are in assisted and long term care facilities while seventy five percent of the victims of Alzheimer’s disease are cared for at home. Increasing age is the greatest risk factor for developing Alzheimer’s disease. Placement in long term care facilities cost an average of $42,000 per year and can exceed to $70,000. In order to receive help from the state, the person must liquidate all assets including selling their home. The cognitive decline of Alzheimer’s disease is devastating and what is worse is it could affect anyone. Family members of the residents in the particular facility we volunteered at appeared very supportive and very involved with their care. Caregivers at Home Place stated that family members considered the staff family to their loved ones. We have learned that having a good sense of humor about Alzheimer’s disease is positive because these people need genuine care and to be treated as people. The only way to diagnose Alzheimer’s disease is by autopsy and so far there is no definitive way to explain why an individual gets Alzheimer’s disease. There is no cure.

References
Alzheimer’s About, http://www.alzheimer.about.com
Alzheimer’s Association, http://www.alz.org
Alzheimer’s disease; New Alzheimer’s disease findings from the United States detailed. (2007, March). Pain and Central Nervous System Week, 277. Retrieved March 2, 2007, from Research Library database. (Document ID: 1225173601)
A History of Alzheimer’s Disease, www.ahaf.org/alzdis/about/adhistory.html
Alzheimer stages: how the disease progresses. http://www.mayoclinic.com
Anderson R. „Brain study sheds light on anti-Alzheimer drugs” .APA Online, Volume 35, No. 4 April 2004
Dementia; Alzheimer's Dementia Conference Set for March 24. (2007, March). Mental Health Law Weekly,59. Retrieved March 2, 2007, from Research Library database. (Document ID: 1225184591).
Diagnostic and Statistical Manual of Mental Disorder IV. American Psychiatric Association. Washington D.C. 1994.
Recognizing Alzheimer’s, http://www.pbs.org/theforgetting/symptoms/index.html
Shani A Langdon, Andrew Eagle, James Warnen, (2007). Making sense of dementia in the social world: A qualitative study. Social Science and Medicine, 64(4), 989.
Martta Rose, “Living with Azlheimer’s”. Psychology Today. http://www.psychologytoday.com