It is a common degenerative brain disease that impairs mental and emotional functions in older adults from which there is no recovery, causing loss of memory and ability to care for themselves. Although there is extensive ongoing research, no cure has yet been found for Alzheimer’s.
Slowly, the disease attacks nerve cells in all parts of the cortex of the brain impairing a person’s abilities to recognize emotions, errors and patterns, coordinate movement, and remember. Eventually, an afflicted person loses all memory and mental functioning.
Causes Of Alzheimer’s Disease
Biological Factors In The Brain
- There is block in the activity of the flow of nutrients causing twisted nerve fibers in the neurons in the brain.
- There is a high concentration of plaques (sticky patches) of a protein known as beta amyloid, which forms patches called neuritic plaques. These plaques are found outside the nerve cells. High levels of beta amyloid are associated with reduced levels of the neurotransmitter acetylcholine. Neurotransmitters are chemical messengers in the brain. Acetylcholine is part of the cholinergic system, which is essential for memory and learning, and which is progressively destroyed in Alzheimer’s patients.
The inflammatory response, is a situation in which the immune system overproduces factors normally intended to fight harmful agents. There is an excessive production of prostaglandins, substances which can actually injure the body's own cells which may in turn cause increased levels of glutamate, an amino acid that is a powerful nerve–cell killer.
Environmental And Other Factors
- There has been one study that has indicated that Chlamydia pneumonia, a bacterium causes respiratory infections in parts of the brain affected by the late–onset Alzheimer’s. The presence of the bacterium may have been the result of Alzheimer’s disease rather than its cause.
- Some people exposed to intense electromagnetic fields have reported a higher incidence of Alzheimer’s. Some researchers believe that magnetic fields may interfere with the concentration of calcium inside cells, and others believe that they may increase production of beta amyloid.
- Injury to the head can accelerate the development of Alzheimer’s in people who are already susceptible to it. Poor nutrition in childhood may render the brain more susceptible to mental impairments later in life, including Alzheimer’s disease. Other recent studies suggest an elevated homocysteine level may be a risk factor for Alzheimer’s. Homocysteine is a substance in the blood that increases with deficiencies of vitamins B12 and folate. No evidence exists that supplements of these vitamins offer any protection against Alzheimer’s disease.
- Forgetfulness.
- Loss of concentration.
- Unexplained weight loss.
- Mild difficulties in walking.
- Fatigue.
- Grief.
- Depression.
- Illness.
- Vision or hearing loss.
Treatment In Early Stages
Telling the patient
If an Alzheimer’s patient expresses a need to know the truth, it should be disclosed to him/her. Both the caregiver and the patient can then begin to control the disabling disease through support groups and drug research.
Mood and emotional behavior
Alzheimer’s patients show abrupt mood swings, and can become aggressive and angry. This behavior is caused by chemical changes in the brain. It is important for the caregiver to control the environment by keeping distractions and noise at a minimum and to speak clearly. It has been suggested that Alzheimer’s patients respond well to clear, quickly spoken sentences. Certain factors that feel threatening (people talking outside the room) can cause agitation and aggression. Offering a distraction, such as an eatable or car ride, in response to shouting or other disruptive behavior may be helpful. Although much attention is given to the negative emotions of Alzheimer’s patients, some become extremely gentle, retaining an ability to laugh at themselves.
Appearance and cleanliness
Alzheimer’s patients resist bathing or taking a shower. Often the Alzheimer’s patient loses the sense of color and combination, and puts on odd or mismatched clothing. This may be very frustrating and embarrassing to a loved one.
Driving
As soon as Alzheimer’s is diagnosed, the patient should be prevented from driving as they tend to wander. For those who remain at home, locks should be installed outside the door, which the patients cannot open, but the others can.
Sexuality
Alzheimer’s patient may lose interest in sex. If sexual issues are a problem, they should be discussed openly with the physician.
Disturbed sleep
Treatment During Later Stages
Incontinence
Urinary incontinence (inability to control urination) may be controlled for some time by trying to monitor times of liquid intake, feeding, and urinating. Once a schedule has been established, the caregiver may be able to anticipate incontinent episodes and get the patient to the toilet before they occur.
Immobility and pain
As the disease progresses, Alzheimer’s patients become immobile, literally forgetting how to move, finally becoming wheelchair–bound or bedridden. Bedsores can be a major problem. Sheets must be kept clean, dry, and free of food. The patient’s skin should be washed frequently, kept dry and moisturizers be applied. The patient should be moved every two hours, and the feet kept raised with pillows or pads. Exercises should be administered to the legs and arms to keep them flexible.
Eating problems
Weight loss and the gradual inability to swallow are the two major related problems. The patient can be fed through a feeding syringe, or the caregiver can encourage chewing action by pushing gently on the bottom of the patient’s chin and on the lips. Dehydration can also become a problem, it is necessary to drink eight glasses of water daily. It should be noted that coffee and tea are diuretics and will deplete fluid, therefore should be avoided.
Temperature Troubles in Seniors
Withstanding hot and cold weather and regulating body temperature becomes more challenging as people grow older. Medications, chronic ailments and entrenched habits contribute to increased risk of heat disorder (hyperthermia) and cold disorder (hypothermia). In addition to physical changes, lifelong habits and finances add to the problem. For example, many seniors don’t feel safe opening windows and hesitate to use the air conditioner or heater due to the cost of electricity. Seniors also tend to wear long–sleeve, dark, synthetic clothes, which hold in heat and don’t breathe.
Body temperature regulation
The body primarily cools through perspiration. As moisture on the skin evaporates, the body cools. Core temperature remains stable as long as fluid and salt are replenished. But if dehydration occurs, the body tries to conserve fluid loss by ceasing sweating. In order to perspire we have to have fluid on board. But older people begin to lose their sense of thirst. By the time an older person is feeling thirsty, he is already quite dehydrated.
Another contributing factor for temperature–related disorders in many older people is a change in the sensation of temperature. This may be due to changes in the skin, a thinner layer of fat just below the surface of the skin, or to changes in the actual sensation of heat or cold. In cold temperatures, the body attempts to keep warm by shivering. Thyroid conditions, circulatory ailments, strokes dementia, decreased mobility, medications and alcohol all impede an older person’s ability to keep warm.
Several other factors can make controlling body temperature difficult
- Humidity hinders the cooling process, because perspiration doesn’t evaporate as quickly.
- Conditions that alter blood circulation, such as high blood pressure, and inefficient sweat glands have an impact on temperature control, as does lack of conditioning.
- Sedatives and tranquilizers may also decrease the body’s ability to cool down.
- Diuretics or water pills increase the risk of dehydration.
A body that stops cooling creates a medical emergency.
Heat fatigue
The feeling of weakness after exposure to high temperatures. People may feel faint with cool, moist skin and a weak pulse.
Heat syncope
Usually occurs after exercising in the heat. The person suddenly feels dizzy. The skin becomes pale, moist and cool, the pulse weak and rapid.
Heat cramps
Painful muscle spasms after strenuous activity; can also be a sign of heat exhaustion.
Heat exhaustion
Occurs when the body becomes too hot. Thirst, weakness, fatigue, nausea and profuse sweating serve as warnings. If treatment is delayed, heat exhaustion can advance to deadly heat stroke.
Heat stroke
Can occur within 10 or 15 minutes. Symptoms of this potentially lethal rise in body temperature include confusion, bizarre behaviors, a strong, rapid pulse, dry, flushed skin with no sweat, headache or nausea. First aid for heat–related illnesses includes moving to a cool, shady place, offering cool liquids, if able to swallow, packing in ice, if possible, and calling for medical assistance.
Preventing heat illnesses
Several seemingly effortless actions can prevent these heat emergencies.
Beverages
Older persons should drink water or a fruit juice on a regular schedule rather than waiting until they feel thirsty. Avoid beverages containing alcohol and caffeine, which act as diuretics and deplete needed fluid. Do not take salt tablets unless directed by your doctor.
Air Conditioning
For those who do not like the blast of cold air generated by an air conditioner, set the unit to a more moderate temperature or cooling just one room for periodic respites from the simmering heat.
Other preventative measures.
- Wear white, short–sleeve, loose–fitting, natural–fiber clothing.
- Wear a wide–brim hat outside to provide shade.
- Take a cool shower.
- Cook with the microwave rather than a hot oven or stove.
- If you do not have air conditioning, cover windows to block sunlight and visit an air–conditioned library or mall.
- Do not go out during the hottest part of the day.
- Pace your activities.
- Ask a friend or relative to check on you twice daily.
Inactive older adults generate less body heat and can easily lose body temperature. There is more publicity about people dying from hyperthermia. A hypothermic death can look like heart failure or an accident. Older people can be in their own home at 60 degrees and yet be in trouble.
In the house, wear multiple layers and use extra blankets. And when going out, bundle up. Wear gloves, a hat and several layers. Stay indoors on cold, windy days. Winds hasten cooling. A drop in core body temperature can kill. Symptoms include confusion, sleepiness, slow slurred speech, a weak slow pulse, extremity stiffness, and slow reactions. Shivering may or may not be present. Check your body temperature with a thermometer. If it’s below 96 degrees, if it’s unreadable or if in doubt, call for medical help. To help someone with hypothermia until emergency medical help arrives, keep him or her warm with additional blankets or your own body. If he or she can swallow, offer warm liquids, but no alcohol, which expands blood vessels near the surface and thereby lets the much needed body heat to escape. Do not rub the person’s skin.
Raynaud’s Phenomenon
Some older adults with rheumatic, nervous or circulatory conditions, such as arthritis or hardening of the arteries, suffer from Raynaud’s Phenomenon. Smoking and some medications used to treat heart conditions or migranes can also cause this condition, which is unrelated to hypothermia. When exposed to cold, the small blood vessels in the hands and feet contract, blocking blood flow. The skin turns white, it then turns blue and then red as circulation returns. The area feels numb or prickly. Doctors recommend that people with Raynaud’s stay warm both indoors and out, with socks, multiple layers of gloves and mittens, and scarves. Wear mittens when taking food from the refrigerator. Sufferers also must protect against injury to the skin and stop smoking.
Urinary Incontinence in Seniors
Urinary incontinence is the leaking of urine from the bladder. It’s especially common in women, especially those who have had children. Urinary incontinence (UI) is a common but poorly understood problem in the elderly population.
Causes of Urinary Incontinence
Temporary incontinence
A number of conditions can cause temporary incontinence, including urinary tract infections, excess fluid intake, constipation, severe depression, and restricted mobility, drugs like alpha–adrenergic, caffeine, sedatives, anti–depressants, anti–psychotics, and anti–histamines.
Stress incontinence
Stress incontinence is caused by poor functioning of the urethra and sphincter muscles. The weakening and stretching of the pelvic floor muscles allows the bladder to sag down within the abdomen. This sagging pulls the bladder neck and changes its angle in relation to the urethra which prevents the internal sphincter from closing completely. In severe cases the sphincter itself may tear. This occurs when urine leaks during exercise, coughing, sneezing, laughing, lifting heavy objects or other body movements that put pressure on the bladder. Women who have had several children through vaginal deliveries are particularly at risk for stress incontinence, because pregnancy and childbirth strain the muscles of the pelvic floor. Hysterectomy, which may damage the pelvic floor muscles, the sphincter itself, or the nerves which make the sphincter muscles to contract, is a common cause of stress incontinence in women. After menopause, the loss of estrogen causes the urethra to thin out so that it may not close properly, thus causing incontinence. Prostate surgery is a leading cause of stress incontinence in men. Both surgery and radiation treatment for prostate cancer commonly cause incontinence.
Urge incontinence
In urge incontinence, the bladder contracts more frequently than normal which can be due to infections, anxiety, the normal aging process, damage to the central nervous system caused by stroke, multiple sclerosis, and Parkinson’s disease causing the bladder to become over–active. An outer layer of muscle fiber, called detrusor muscles, becomes unstable and contracts inappropriately. It can also be a warning signal of early bladder cancer. In men, it is often a sign of an enlarged prostate.
Overflow incontinence
Overflow incontinence is the result of an impediment to the normal flow of urine out of the bladder. It can be caused by tumors, medications, benign prostatic hyperplasia, or scar tissues. Overflow incontinence may also be caused by spinal cord injuries or diseases such as diabetes, and multiple sclerosis which can desensitize the nerves so much so that they fail to sense fullness and don’t trigger off the contraction of the bladder.
Functional incontinence
In functional incontinence, the urinary system is itself normal, but the patient cannot use it properly because of severe physical disorders, such as in Parkinson’s disease, or mental diseases, including Alzheimer’s disease and other forms of dementia, as there is failure in recognition of the need to void and locating a bathroom.
Diagnosis of Urinary Incontinence
The first and most important step in treating bladder control problems is to see a doctor for a complete medical examination. The doctor will ask for a detailed history of your health and put you through a physical examination. The doctor may want to check your urine samples. You may be referred to a urologist, a doctor who specializes in diseases of the urinary tract, or to a gynecologist, a specialist in the female reproductive system.
Treatment of Incontinence
- Behavioral techniques such as pelvic muscle exercises, biofeedback and bladder training can help control urination. These techniques can help you sense your bladder filling and help delay voiding until you can reach a toilet.
- Anticholinergic agents inhibit the involuntary contractions of the bladder, increase its capacity. They are useful in treating urge incontinence.
- Antispasmodic drugs help relax the bladder muscle and are used for urge incontinence.
- Alpha–adrenergic agonists are used to strengthen the smooth muscle that opens and closes the internal sphincter and are most effective in patients with stress incontinence not caused by nerve damage.
- Retropubic suspension is used in stress incontinence to correct the position of the bladder and urethra by sewing the bladder neck and urethra directly to the surrounding pelvic bone or nearby structures.
- For severe stress incontinence, a sling procedure is preferred. The procedure is performed through the vagina and also through a small incision in the abdomen. A piece of body tissue or synthetic material is attached under the urethra and bladder neck, and then secured like a sling to the abdominal wall and pelvic bone. This sling then compresses the urethra back to its original position.
- You can get special absorbent underclothing that is no more bulky than normal underwear and can be worn easily under everyday clothing.
Delirium is an acute reversible state of confusion which is characterized by changes in consciousness and cognition over a period of time.
Signs and Symptoms of Delirium
- Reduced level of consciousness and alertness.
- Inability to focus, maintain, or shift attention.
- Disorientation.
- Language difficulties.
- Impairments in learning and memory.
- Perceptual disturbances in the form of illusions, delusions, and hallucinations.
- Emotional disturbances in the form of anxiety, fear, irritability, anger, depression.
- Behaviors such as drowsiness, normal wakefulness and agitation may occur within minutes to hours of each other.
There is increasing evidence that the symptoms of delirium are not transient, but often persist, even with appropriate treatment.
Hormone Replacement Therapy
Hormone replacement therapy is currently prescribed to millions of women. This includes the indications, contraindications, risks and benefits of estrogen replacement therapy.
Indications
- Postmenopausal women for prevention and treatment of osteoporosis.
- To improve cardiovascular health by lowering the risk of myocardial infarctions (heart attacks) and strokes.
- Estrogen replacement therapy can improve the elasticity, moisture and thickness of vaginal, perennial tissues, thus decreasing symptoms of vaginal dryness, dyspareunia (pain during sexual intercourse) and urinary urgency.
- Vaginal bleeding.
- Deep venous thrombosis or pulmonary embolism. (a clot in a blood vessel)
- Breast and uterine cancer.
Side Effects of Hormone Replacement Therapy
- Nausea within the first two months of therapy. This side–effect may be diminished by taking the medication with food, and at bedtime.
- Breast tenderness due to the estrogen component. Lowering the dose may be helpful.
- Migraine headaches.
- Mood swings.
- Abdominal bloating is another common side–effect related to progestins.