The Burden Growing Healthcare Challenge

Introduction

Dealing with the aggravation and agony of burst appendix or broken bones is not easy. However, at least one can be less troubled knowing that the pain will end and they will be normal again. That is not true for long-term conditions such as diabetes, arthritis, osteoporosis, and Alzheimer's disease. With no promise of a cure soon, patients usually suffer for a lifetime. Long-term diseases are on the rise, leading to a huge healthcare burden for most families and those who pay for healthcare. According to Menegazzo (2015), spending in healthcare in the world reached 3.2 trillion dollars in 2015 and is expected to rise at 5.5 percent through 2025., with long-term conditions taking a significant percentage of the total spending. Long-term conditions can disrupt one’s life in many ways. The conditions may affect one’s independence and physical abilities. A patient with a long-term condition may also be unable to work leading to financial strain.

My patient is a 67-year-old man with Alzheimer's disease. The patient has three grown-up children, two daughters, and a son. Alzheimer's disease leads to cognitive dysfunction, and my patient has difficulty expressing himself. Alzheimer's disease develops in stages, and it slowly results in a situation where the patient will be entirely dependent on other people. Therefore, I have learned to be aware of his nonverbal cues that need my intervention. For instance, he is usually calm, but when he becomes agitated, I know that he requires nursing intervention. When there is a subtle change in the behavior of a patient with Alzheimer’s disease, a nurse should ask themselves whether the change in behavior is due to an underlying problem. Perhaps the patient has insufficient voluntary control because they have an infection or he is experiencing a change in temperature. They may also have lost weight because they are not nutritionally sound. Nutrition may play a significant role in the change in the mental status of a patient with Alzheimer's disease (Shahrzad Yektatalab et al., 2014). When I notice these changes, I usually make interventions like giving my patient food high in protein and heavy. Also, intervention with smaller and frequent meals usually improves the mental state of the patient.

2017 memories are still fresh in most minds, but people with Alzheimer’s disease may have nothing to remember. Alzheimer's disease not only affects cognitive function and memory, but it is also one of the leading causes of death in the United Kingdom (Gov.uk, 2017). For instance, Alzheimer’s disease was the second leading cause of death in the UK, and for females, it was the most common cause of death. For males and females over eighty years old, Alzheimer’s disease is the leading cause of death. Estimates indicate that by the year 2025 over 7.1 million people above 65 years old will be diagnosed with Alzheimer’s disease (Gov.uk, 2017). The number of patients with Alzheimer’s disease is expected to pass 2 million in the UK by 2051.

Further, it is estimated that patients with Alzheimer's disease occupy almost 25 percent of hospital beds in the UK, and their stay in hospitals is often more extended than other patients (Alzheimer's Research UK, 2018). According to the World Health Organization, Alzheimer's disease has a psychological, physical, and economic impact on patients, families, and the entire society. As researchers continue to look for ways of treating and preventing Alzheimer’s disease, nurses are learning how they can be successful in providing Alzheimer’s care.

Alzheimer’s disease has a considerable impact not only on the patients but also on the people who are close to them. A patient's family are forced to take on various responsibilities. Daughters and sons of patients often become primary caregivers, and the roles they play in the family change drastically. As time progresses, Alzheimer's disease worsens, and family members may find it hard to accept the changing roles (Karlawish, 2015). When this happens, it may confuse family about what to do or how to act. Sometimes it takes time before family members figure out what their roles will be. Speaking with my patient's children, I learned just how tough it was for them when roles in their family changed as a result of their father’s diagnosis with Alzheimer’s.

According to Jurczak et al., (2014), families can be tremendously affected by the ripple effects of having to take care of a patient with Alzheimer's. The impact on a family can be so profound that those close to the patient are considered ‘the second victims of Alzheimer’s disease’ or ‘the invisible patients’ (Jurczak et al., 2014). Regardless of having families of their own, personal time, and careers, family members have to take care of an Alzheimer’s patient round the clock. Therefore, one may experience social isolation, physical illness, financial distress, and emotional stress. James, not his real name, opened up one day and revealed that he had no personal life and their father’s condition had placed them in financial hardship. According to Alzheimer's Research UK (2018), the cost of Alzheimer’s has reached 26 billion pounds per year in the UK, and families pay two-thirds of the expenses. Karlawish (2015) asserts that psychological stress levels are substantially higher in Alzheimer’s caregivers than caregivers of patients with other diseases and non-caregivers. This stress level leads to reduced emotional health and severe psychological problems like anxiety and depression.

As mentioned earlier, Alzheimer's disease is a progressive neurodegenerative disease that is commonly distinguished by an initial slow decrease in the ability of a person to remember new events and information, followed by retrogression of other features of memory and cognitive areas such planning, organization, and language (Menegazzo, 2015). Given the functional and cognitive impairments brought by the disease, in the onset of the illness, my patient’s ability to make daily decisions about finances and living arrangements was adversely affected. Additionally, one may ask how they can lead a quality life with dignity in the face of Alzheimer’s disease that gradually leads to disability and, eventually, death. Patients with Alzheimer’s disease decision making and cognitive impairment often render them incapable of answering this question. When family and healthcare professionals fail to acknowledge and adapt to these impairments, patients agonize and suffer. Most people did not recognize the cognitive impairments my patient had at the early stages of the disease leading to immense emotional stress for the patient.

As time passes, patients become unable to carry out daily tasks like taking medication properly. Patients also start developing impairments in figuring out how to manage the problems they have (Jurczak et al., 2014). These impairments reflect a situation where patients often misjudge or fail to acknowledge their disabilities. The failure to adapt to and be cognizant of the complex disabilities brought by Alzheimer’s causes a patient to suffer harms like abuse, exploitation, neglect, loss of dignity, and loss of respect (Jurczak et al., 2014).

Nursing is a diverse and complex profession. Nurses today perform numerous functions that range from the promotion of health, education, preventive care, rehabilitation, diagnosis, and medical treatments (Miller, 2018). Miller (2018) posits that caring for Alzheimer’s disease patients is a difficult task requiring caregivers to be competent. A patient with Alzheimer’s disease needs the help of a nurse at every stage of the disease. Roach & Drummond (2014) add that although nurses are essential in the provision of care for patients with Alzheimer's disease, it is vital that nurses cooperate with all members of the family and the therapeutic team. The therapeutic team includes social workers, doctors, physiotherapists, speech therapists, and nurses whose roles are unique. Nurses help to relieve caregivers of the burden and ensuring that the patient is independent for as long as possible.

The role of a nurse is not only to care for the patient when a patient’s caregiver is incapacitated but also identifying sources of help, ensuring that the patient has access to expert care, educating, and providing social assistance (Shahrzad Yektatalab et al., 2014). Further, the nurse should endeavor to give quality life to the patient and occur caregiver and prevent complications that may arise due to the disease. Shahrzad Yektatalab et al., (2014) posit that the educational role of a nurse is critical, particularly when it regards the care of Alzheimer's disease patients. Nurses educate primary caregivers, usually family members, to ensure that they are well prepared to provide care for a patient.

Moreover, the nurse should find out whether the family of a patient are willing and able to take care of the patient. In order to establish whether the family can provide care, it is necessary to obtain details about the psychological, biological, the social status of the patient, and the functioning of the patient’s family. According to Roach & Drummond (2014), before leaving an Alzheimer’s patient in the care of family, they should establish whether the resources and knowledge of the family are enough. On the contrary, Khon et al., (2016) argue that the role of a nurse in the management of Alzheimer’s disease is not well defined. This lack of definition owes to the tasks depend on a patient’s health and skills and knowledge deficits of the family. The National Institute for Health and Care Excellence (2018) also has a similar opinion. Owing to the constant variation in the course of Alzheimer's disease, it is impossible to establish procedure and rules with a patient with the disease (National Institute for Health and Care Excellence, 2018). Furthermore, when providing care, it is essential to evaluate the needs, ability, capabilities, interests, and determine the number and types of the patient’s impairments, and recognize that the scope of the roles of nurses changes in patients with Alzheimer's.

Finally, there are some policies in the UK that aim at enhancing Alzheimer's care, research, and support. For instance, The Prime Minister's Challenge on Dementia 2020 was published in 2015 to improve care, boost research, and raise public awareness about this long-term condition. The objectives’ key policy is to ensure the UK is the best country for dementia care and support for dementia patients, their caregivers and families to live and to lead in research into dementia and all neurodegenerative illnesses. Additionally, over 300 million pounds was committed to medical innovation and research to support research and the medical sector.

Both non-drug and drug approaches are used to manage the patient’s condition. The challenge is to find out the needs of the patient that underlie his distress, and then look for ways of addressing the needs. In order to do so, a patient has to be viewed as an individual and checking their personality, likes and dislikes, and history (Khon et al., 2016). Therefore, when the patient develops any psychological and behavioral symptoms, they are assessed immediately by a specialist.

Further, some of the non-drug approaches that are used to manage the patient include considering their environment and communicating with him. It is critical to consider the surroundings of the patient to make sure that the surroundings have no excess noise, cluttered, or too bright. Noise, litter, and excess brightness can cause a patient with Alzheimer’s to become agitated and over stimulated. Further, drugs are not always the first option for the patient because most of his psychological and behavioral symptoms can be improved within a few weeks of making changes in his surroundings.

Social interaction and communicating with the patient can also eliminate the need for drugs. When the non-drug approaches fail to work, the patient may be given an antipsychotic drug, an anxiolytic, an antidementia drug, or an antidepressant. There have been positive changes in the rates of diagnosis of Alzheimer's and the quality of care and drug treatment over the last few years, and promising approaches that help patients and their caregivers are in the following key areas. Positive relationships, active lives, and personal wellbeing. However, more research is needed to establish effective ways of managing Alzheimer's disease (Khon et al., 2016). The available evidence is not sufficient to enable objective evaluation of the effectiveness of the available approaches. Hopefully, the Prime Minister’s Challenge on Dementia 2020 will result in more approaches to managing Alzheimer’s Disease.

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References

• Alzheimer's Research UK, 2018. Hospitals. [Online] Available at: [Accessed 6 November 2018].
• Gov.uk, 2017. Health profile for England: 2017. [Online] Available at: [Accessed 6 November 2018].
• Jurczak, W., Parzych, K. & Polak-Szabela, A., 2014. Nurse's Role of Taking Care of Patient with Alzheimer's Disease: Journal of Biological Sciences, XXVIII(2), pp. 5-10.
• Karlawish, J., 2015. How Are We Going To Live With Alzheimer’s Disease?. US National Library of Medicine, XXXIII(4), pp. 541-546.
• Khon, M., Belza, B. & Petrescu-Prahova, M., 2016. Beyond strength: Participant perspectives of the benefits of an older adult exercise program. Health Education & Behavior, LXXIV(3), pp. 305-312.
• Menegazzo, F., 2015. Socio-economic and health impact of chronic diseases on families: patients opinion in Italy. European Journal of Public Health, XXV(3), pp. 112-125.
• Miller, C. A., 2018. Nursing for Wellness in Older Adults. 3rd ed. London: Wolters Kluwer Health.
• National Institute for Health and Care Excellence, 2018. Dementia: assessment, management, and support for people living with dementia and their carers. [Online] Available at: [Accessed 6 November 2018].
• Roach, P. & Drummond, N., 2014. ‘It’s nice to have something to do’: Early-onset dementia and maintaining purposeful activity. Psychiatric and Mental Health Nursing, XXI(10), pp. 889-895.
• Shahrzad Yektatalab, 1. F. S., Kaveh, M. H., Khoshknab, M. F. & Petramfar, P., 2014. Living with and Caring for Patients with Alzheimer’s Disease in Nursing Homes. Journal of Caring Sciences, II(3), pp. 187-195.
• World Health Organization, 2017. Dementia. [Online] Available at: [Accessed 6 November 2018].