Treatment of Patients Suffering from Alzheimer’s Disease
“I used to be a high functioning person. I had a high IQ, I went to law school at night while running a real estate company and I still graduated in the top 25% of my class. A few years ago it started taking me longer to get my work done, I was less organized and had piles of paper on my desk. I got fired from 2 companies within 3 years” (“My Story: Alzheimer’s”).
This is an excerpt of a story from an anonymous patient who was suffering from Alzheimer’s Disease. This is only a small example of the heartache that patients and their families go through as a result of this degenerative disease. Personally, the topic of Alzheimer’s Disease is very important to me because my grandpa is suffering from the disease and is currently in a care facility. During his time there, he has been physically abused and isolated from our family. For the sake of my grandpa, I would like to raise awareness for this disease and the change that is necessary for the improvement of future generations’patient care. The quality of care for Alzheimer’s disease patients regarding facilities and caregiver-patient contact, vary throughout the world due to a lack of knowledge, diagnostic skills, and governmental policy. If a global policy regarding the treatment of Alzheimer’s patients is implemented, then the quality of life for those affected could be greatly improved and the world will be able to combat a significant increase in the prevalence of the disease.
Alzheimer’s Disease is a degenerative and progressive disease that destroys memory and other vital mental functions. The disease was first introduced by the German neuropsychiatrist, Aloïs Alzheimer in 1906 as a “chronic disease of the cerebral cortex”; the disease has held his name ever since (Nicaise). Alzheimer’s disease is classified as a form of dementia (is a general term for loss of memory and other mental functions that are severe enough to interfere with daily life). Patients are typically diagnosed specifically with Alzheimer’s disease after being diagnosed with dementia. Alzheimer’s disease is the most prevalent form of dementia, as it represents approximately 70% of all cases. According to the World Health Organization, dementia is a,
syndrome – usually of a chronic or progressive nature, in which there is deterioration in cognitive function (the ability to process thought), beyond what might be expected from normal ageing. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. Consciousness is not affected. The impairment in cognitive function is commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour, or motivation (“Dementia”).
On a scientific level, Alzheimer’s disease causes brain cell connections and the cells themselves to degenerate and die; they eventually destroy memory and other important mental functions. It is important to note that hereditary cases of late-onset Alzheimer’s disease with a genetic casue are extremely rare (1% of cases), meaning that anyone can develop Alzheimer’s without having a family history (which is a common misconception). Researchers have not found a specific gene that directly causes the late-onset form of the disease. However, one genetic risk factor—having one form of the apolipoprotein E (APOE) gene on chromosome 19—does increase a person’s risk. APOE comes in several different forms, or alleles: However, early-onset Alzheimers, Early-onset Alzheimer’s disease occurs between a person’s 30s to mid-60s and represents less than 10 percent of all people with Alzheimer’s. Some cases are caused by an inherited change in one of three genes, resulting in a type known as early-onset familial Alzheimer’s disease, or FAD. For other cases of early-onset Alzheimer’s, research suggests there may be a genetic component related to factors other than these three genes. However, research conducted by the National Institute on Aging suggests that a myriad of risk factors beyond genetics and heredity may play a role in the development of Alzheimer’s disease in a person. There is a large amount of emphasis of research, in the relationship between mental function decline and vascular conditions such as heart disease, stroke, and high blood pressure, as well as other conditions such as diabetes and obesity.
The average age of onset (when a patient starts experiencing symptoms) is sixty-five years old. However, the age of onset could range to forty-five if they fall under an early-onset category. (“Facts & Statistics”) Currently, no cure for the disease exists but medications and management strategies may temporarily improve symptoms. Additionally, non-pharmacological therapies (also called psychosocial interventions) can improve the quality of life of people with Alzheimer’s disease as well as the life of their caretakers. (“What Causes Alzheimer’s Disease?”)
In 2015, there were an estimated 46.8 million people living with Alzheimer's worldwide. (“Alzheimer’s Disease International”) In our world today, we are experiencing a major increase in population aging. Simply put, because of all of the medical advancements and technology that the world has today, people are living longer. With this major increase in population aging comes with an increased amount of Alzheimer’s patients than ever before because the diseases is prevalent in aging populations.
An increase in Alzheimer’s patients requires a major emphasis on an increase of patient care methods, treatment facilities, and knowledge of the disease. According to the Alzheimer’s Disease International Foundation, even though Alzheimer’s patients are not able to function properly and are not mentally stable, they still deserve basic human rights.
“They are entitled to: the right to life, access to justice, liberty and security, freedom from torture or cruel, inhuman or degrading treatment or punishment, freedom from exploitation, violence and abuse, and adequate standard of living and social protection.” (“Brief for Alzheimer’s Associations”)
Not all countries worldwide currently possess what will be needed to combat the increasing population of Alzheimer’s patients, especially in developing countries. Consequently, if developed countries do possess these requirements, some have major flaws in their treatment of the patients that desperately need to be addressed. Two problems will be addressed: how countries are preparing for the global increase in Alzheimer’s patients and how countries are enforcing guidelines regarding patient care methods.
First, the United States of America has a major regarding Alzheimer’s disease. An estimated 5.5 million Americans lived with Alzheimer’s dementia in 2017. 1 in 10 people aged 65 or older has Alzheimer’s Disease in the United States. (Alzheimer’s Association)Alzheimer’s Disease is the 6th leading cause of death in the US. (“Latest Facts & Figures) However, statictics alone cannot express the great impact that Alzheimer’s leaves on the country. The US has varying care methods for patients with Alzheimer’s Disease, ranging between informal in-home care, assisted living facilities, hospitalization, or day-care programs.
However, numerous cases have occurred across the United States of abuse of patients in care-facilities. For example, a Human Rights Watch study found that about 179,000 nursing home residents with Alzheimer’s are being given antipsychotic drugs. (“How They Went Docile”) The patients do not have schizophrenia or other serious mental illnesses that those drugs are designed to treat. The FDA stated that antipsychotic drugs increase the risk of death in older people with dementia. Death rates from Alzheimer’s disease increased fifty-five percent between 1999 and 2014, according to data released by the Center for Disease Control’s “Morbidity and Mortality Weekly Report”. The number of Alzheimer’s deaths at home also increased during the same period, from fourteen percent to twenty-five percent, suggesting an increase in the number of caregivers that would benefit from support, including education and case management services.
Clearly, Alzheimer’s disease is a major problem in the United States and it is unfortunately projected to get worse due to the future aging population. The United States 2010 census found that between 2012 and 2050, the United States will experience considerable growth in its older population. In 2050, the population aged 65 and over is projected to be 83.7 million. The “baby boomer” generation (people born in 1946-1964) is largely responsible for this increase in the older population, as they began turning sixty-five in 2011. By 2050, the surviving baby boomers will be over the age of 85.
Progress to solve this problem of a rapidly-increasing population that will introduce an increase in Alzheimer’s disease has varied between government involvement, more infrastructure being built to prepare for the massive increase in patients, and a greater emphasis on researching a cure. For example, in 2012, the federal government began a program to reduce the use of antipsychotic drugs in nursing homes in coalition with the nursing home industry and advocacy organizations. (“How They Went Docile”) Since then, the use of drugs have dropped 8% by the beginning of 2017. The Center for Medicare and Medicaid Services have called for an additional 15% reduction by 2019.
Additional progress has included the President of the United States, Donald Trump to sign into law a $414 million increase for Alzheimer’s and dementia research funding at the National Institutes of Health (NIH) and Kevin and Avonte’s Law, important legislation to protect “those who wander” (memory-loss patients) in March 2018 (“MAJOR ALZHEIMER’S AND DEMENTIA RESEARCH FUNDING INCREASE SIGNED INTO LAW”)
Next, let’s address the treatment methods in China. According to the 2013 Alzheimer’s Disease International report, about 10 million people were living with dementia in 2013. This number is expected to reach an estimated 75.6 million by 2030 and within 25 years, at least 25% of China’s population is expected to be over 65 years old. (“Impact of Alzheimer’s on China”) Given the rapid growth of the elderly population in China, Alzheimer’s is expected to create challenges to the national health-care system and to the sustainable development of the national economy. (“Economic Burden on China’s Economy”) China’s previous one-child policy has created an additional problem in this scenario because now there will be even less people to care for this tremendous population when they age and develop Alzheimer’s. There is a social stigma in China that people stoically accept that society cannot provide a lot of medical assistance, except for dire emergencies. The symptoms of Alzheimer’s are just seen as consequences of aging and are accepted as a normal part of life. There is a lack of diagnostic skills and knowledge of the disease. There is a deficiency of infrastructure to combat this disease in China.
Today, there are fewer than 500 beds in China for patients needing specialized Alzheimer’s treatment. (“Alzheimer’s: China’s Looming”)The majority of Alzheimer’s “care” is given at the patients home by family members (89%), not medical professionals. (“Impact of Alzheimer’s”) To build infrastructure to care for patients, in the form of education and treatment facilities, a tremendous toll on the Chinese and world economy will be taken. Quality healthcare in China is only available mainly in large national hospitals located in major cities. (“Alzheimer’s: China’s Looming”) There is no professional care easily accessible for patients in rural areas. The number of Alzheimer’s patients in these areas are growing fast. Progress to solve this problem has varied between education efforts and international intervention. For example, a French company, Orpea, has opened a world-class treatment facility in Nanjing. Additionally, the Chinese government has made an effort to raise the standards of healthcare in small cities and rural areas across the country. https://onlinelibrary.wiley.com/doi/10.1002/gps.2561 https://www.aboutpharma.com/blog/2017/07/03/hna-elderly-care-service-partners-with-frances-orpea-to-expand-dementia-care-program-in-china/
Next, let’s address the treatment methods in the the Sub-Saharan Africa. According to an Alzheimer’s Disease International study in 2015, approximatley 2.13 million people were living with Alzheimer’s disease in Sub-Saharan Africa. This number is estimated to reach 3.48 million by 2030, and 7.62 million in 2050. They project that the largest increases will be in Eastern and Central SSA regions. The increase in these new estimates is estimated to be driven by both population aging and the slightly higher estimate of prevalence of dementia in SSA, based on extensive research by the Alzheimer’s Disease International. (“Dementia in Sub-Saharan Africa: Challenges and Opportuities) These developments represent challenges to national and community-based health services. Currently, there are no governmental policies in the region regarding the treatment requirements of Alzheimer’s patients. In the Arab world, women traditionally bear the responsibility of caring for providing family care. Today, women enter the labour force more often for reasons of personal choice and economic needs and are no longer available to care for their elderly family members. Governments in the region are still assuming that families are taking care of their elderly relatives and therefore have not put emphasis on developing a strong health-care industry. MENA countries do not have a large amount of infrastructure (health care professionals, hospitals, and treatment facilities) to care for patients long-term. Studies have shown that the physicians and nurses that are available need more clinical practice with Alzheimer’s and memory loss patients. They are not giving the patients the specific care they require. There is not enough technology available for advanced procedures and treatments. Progress to solve this problem has varied between education and research efforts. Numerous Middle-Eastern researchers have conducted studies to attempt to find a cure for Alzheimer’s. (“Prevalence of Aging Population”) International organizations, such as the United Nations have attempted to assist in educating the people of the MENA region on the diagnosis and treatment methods for Alzheimer’s patients.
Finally, after identifying the methods of how Alzheimer’s patients are cared for across the world, it is clear that action needs to be taken. UN??A global policy
In 2011, the United Nations (UN) adopted a political declaration to address the growing worldwide burden of non-communicable diseases (NCD). NCDs – such as diabetes, heart disease, and cancer – are the leading cause of death worldwide. The declaration urges countries to develop national NCD prevention plans, reduce risk factors and social determinants for NCDs, and strengthen the capacity for research and development.
“. . . mental and neurological disorders, including Alzheimer’s disease, are an important cause of morbidity and contribute to the global NCD burden for which there is a need to provide equitable access to effective programmes and health care interventions.”
—UN Political Declaration on NCDs
Read the UN Non-Communicable Disease Political Declaration
needs to be implemented in order to have an universal plan on how to combat the aging population.
A study found that there were no significant geographic differences in the rates of increase of Alzheimer’s around the world. (“Forecasting Global Burden”) This means that this is a problem that countries in all six inhabited continents are experiencing. When analyzing all of the data and projections, we must keep in mind that the data of the disease prevalence is most likely not accurate in some under-developed regions (Africa, Latin America) because some countries do not have the resources and knowledge to properly diagnose and care for citizens with Alzheimer's.
Emphasis should be put on solving the problem in developed countries first, so that they can provide monetary assistance and advice to under-developed countries. Also, emphasis should be put on the education of under-developed countries regarding the diagnosis of Alzheimer’s. In an email interview with Mary Ann Urbashich, an Alzheimer’s Association representative, she stated that the “largest problem regarding care methods of Alzheimer’s patients was lack of knowledge/education about the disease and support for the family – both within and out.” Numerous cultures still believe that Alzheimer’s symptoms are just a natural part of aging and that they should not be taken seriously.
Now, if this problem is solved, then the world will no longer have to worry about how their loved one is treated when they are no longer able to take care of them. The world will be prepared to combat the significant increase in the disease in the future. According to the Alzheimer’s Association, “The time to act is now. Every four seconds another person in the world is diagnosed with dementia. It will truly take a global effort to ensure a world without Alzheimer’s.” However, it will truly take a global effort to ensure that the patients with Alzheimer’s are treated in a humane and proper manner first, taking the first leap to combat this terrible disease.