Alzheimer’s Disease with Malnutrition in Elderly

This assignment aims to conduct an aged care related case study via conducting an interview with an elderly person and one of his family members who is suffering from Alzheimer’s and is malnourished. It provides a detailed insight about the pathophysiology of the medical condition, including the contributing factor behind the disease development. The assignment also aims to throw light on the impact of Alzheimer and its associated malnutrition on overall health of the person along with model for care and associated legal or ethical dilemmas.

Running head: ALZHEIMER’S DISEASE
Alzheimer’s disease with malnutrition in elderly
Name of the Student
Name of the University
Author Note

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ALZHEIMER’S DISEASE
Alzheimer’s is one the common neuro degenerative disease among the older adults. It
is causes loss of quality of life along with cognitive and memory impairment (Jahn, 2013).
The following assignment aims to conduct an aged care related case study via conducting an
interview with an elderly person and one of his family members who is suffering from
Alzheimer’s and is malnourished. Based on the medical condition (Alzheimer’s and
malnutrition) gathered from the interview, the assignment will aim to provided a detailed
insight about the pathophysiology of the medical condition, including the contributing factor
behind the disease development. The assignment will also aim to throw light on the impact of
Alzheimer and its associated malnutrition on overall health of the person along with model
for care and associated legal or ethical dilemmas.
Health and Past History of the Interviewee
Mr. X is a 70 years old a retired government employee and was diagnosed with
dementia about two years ago. He lives alone in his two stored building after his wife passed
away three years ago. He has two sons and both of them are married and reside outside the
town due to job. During the interview, Mr. X was found saying that he could not remember
the exact incidence that turn around to his hospitalization. His son, he came to visit him in the
hospital informed that her felt lawn which resulted in traumatic head injury. Mr. X is also
malnourished and this is relevant from his severe muscle wasting and under weight. He said
that after his wife passed away, he developed depression. He also stated that during his 2
weeks admission in the hospital he stated forgetting things like taking medication. In his
discharge summary, the doctors highlighted that he has degenerative neuronal disease
(Alzheimer’s) that has progressed during his retried life, after his wife passed away. `the
discharge summary also highlighted that he is now on cholinesterase inhibitor. He is also
facing difficulty in feeding, moving around despite being on post-discharge medication.
During the interview, it was visible that he is facing difficulty in communicating because of

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his slurred speech along with occasional restlessness and agitation due to anxiety. His sense
of reasoning and judgement seemed to be distorted along with absence of coherence in
answering questions during the interview. Sometimes Mr. X repeats the same answers for
different questions. Based on the first hand information gather from one of his son, a mini-
mental state examination was undertaken one year age and it revealed 18 indicating signs of
cognitive impairment. Loss of memory, impaired judgement, and disruption of visual
perception, focus and reasoning are mostly observed among the patients suffering from the
neurodegenerative disease like Alzheimer’s (Jahn, 2013). Mr. X reported was also found
reporting that the food service that he has availed after the death of his wife, scarcely supplies
quality food on time. Moreover, he hates to go out to house and remains mostly seated and
suffers from loss of appetite. His son reported that he is also a patient of type 2 diabetes and
has sudden restriction of food and takes metformin regularly. He has also been detected with
mild symptoms of Alzheimer’s disease and hence has been on cholinesterase inhibitor for the
past 2 years.
Pathophysiology and contributing factor of Alzheimer’s among elderly patient
Alzheimer’s disease is one of the most common neurodegenerative diseases that
accounts for more than 80% of dementia cases worldwide (Kumar & Singh, 2015). It leads
towards the generation of progressive loss of memory, cognitive behavioural function and the
reduction in the ability to learn. Kumar and Singh (2015) have further opined that, amyloid
beta fibrils form oligomers in the brain which form amyloid plaques and thereby causing
synaptic impairment. Alzheimer disease falls under the umbrella disease of dementia.
Alzheimer’s disease mainly attacks the brain cells resulting in the significant loss of memory,
thinking and other cognitive impairment (Jack Jr, et al., 2013). Jack Jr. Et al. (2013) have also
stated that Alzheimer;s disease causes degeneration of the cortical and subcortical pyramidal
cells of the brains along with the degradation of the cholinergic neurons which are

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responsible for the maintenance of cognitive functions of the brain. The neuropathological
hallmarks of Alzheimer’s are detected by the presence of senile plaques (commonly known
as amyloid deposits) along with the deposition of the neurofibrillary tangles in the autopsied
brains. These neurofibrillary tangles are made up of hyperphosphorylated tau protein, which
are situated within the neurons, whereas senile plaques are mainly composed of amyloid-P
species, which aggregate within the extracellular space of the neurons (Jahn, 2013). These
signatures neuropathological changes begin in the entorhinal cortex and in the hippocampus
of the brain, which later spreads into the temporal, parietal, and frontal cortex of the brain.
All these neurological complications lead to the generation of memory loss along with
decrease in the cognitive function (Jahn, 2013). Alzheimer’s also leads to dementia due to
signification loss of the equilibrium of the association cortex. This disruption in the
equilibrium of the brain impairment in judgement, language, speech and gross motor
movements all these disrupts the normal daily activities. Alzheimer’s disease is known to be
associated with the decrease in the intake of food as people tend to forget about what they
have ate or whether they have consumed food or not and thereby leading to the development
of malnutrition of under nutrition (Droogsma, Van Asselt, Scholzel-Dorenbos, Van Steijn,
Van Walderveen, & Van der Hooft, 2013).
In case of Mr. X there are several contributing factors that have been responsible for
the development of Alzheimer and subsequent malnutrition. The first contributing factor
behind the development of Alzheimer’s in case of Mr. X is depression. Depression generated
during the later stages of life increases the susceptibility of mild cognitive impairment and
thereby increasing the chance of developing Alzheimer’s disease (Steenland, Karnes, Seals,
Carnevale, Hermida, & Levey, 2012). Comorbid depression leads to neuropsychiatric
complications that increase the susceptibility of developing Alzheimer’s disease (Sepehry,
Lee, Hsiung, Beattie, & Jacova, 2012). Sepehry et al. (2012) have further opined that

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serotonin reuptake inhibitors fails to give adequate protection against the cormorbid
depression and thus the development of Alzheimer’s during the later stages of life inevitable.
Alzheimer’s disease and its relation to malnutrition in case of Mr. X can be linked with the
research findings of Droogsma et al. (2013) which states that Alzheimer’s disease leads to
loss of memory and the affected individual forgets to take food and thereby causing
manutrition. Alzheimer’s disease leads to frontotemporal lobar degeneration which leads to
decrease in apetite along with reduction in total protein content of the body and thereby
leading to malnutrition along with muscle wasting among the Alzheimers patients ( (Koyama,
et al., 2016). Cholinesterase inhibitor is also responsible for the development of significant
weight loss along with malnutrition (Droogsma, Van Asselt, Scholzel-Dorenbos, Van Steijn,
Van Walderveen, & Van der Hooft, 2013). The other factors that have contributed towards
the development of Alzheimer disease include lack of socialization and looniness in case of
Mr X.
Theories of aging
Disengagement Theory of Aging is a psychological theory of ageing which states that
aging is inevitable. Ageing causes mutual withdrawal or disengagement resulting in decrease
in the level of social interaction. The theory also claims that this kind of withdrawal
symptoms from socialization is acceptable in case of older adults. Disengagement postulates
that man's central role in life is work and woman's central role in life is marriage and family.
When the individuals abandon themselves from their central roles, they at once lose their
social life space and also suffer from crisis along with extreme demoralisation unless they
assume something different roles in their life in their disengaged state (DeLiema, 2017). In
case of Mr. X, he is a retired person, thus he has withdraw himself from his central role in life
and further loss of this wife has created a sense of void leading towards his disengagement or
repulsion towards socialization.

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Stress theory of ageing states that aging is defined as imbalance in the body resulting
out of biological dysfunction. The main stress factor which propagates ageing is
neurodegenration. Stress theory emphasizes that stressful environments leads to damage of
the cellular mechanism leading to the disruption in the cellular functions and senescence
(Cesari, Vellas, & Gambassi, 2013). Mr. X is 70 years old and at in age group the normal
ageing process initiates this lead to the neurological damage leading towards the development
of breast cancer. Moreover, ageing leads to oxidate stress via generating reactive oxygen
species and thereby leading to the development of Alzheimer’s (Padurariu, 2013).
Impact of Alzheimer’s on health
Alzheimer’s is a progressive disease and hence its impact of life of the survivors is
not limited to only specific physiological effects. Alzheimer’s has significant impact on the
psychological, emotion and physical health of the person. The main psychological
complications that affects the mental health of a person in Alzheimer’s disease include
sadness, depression, sudden loss of temper, a sense of paranoid, worry and stress (Conde-
Sala, et al., 2013). Alzheimer’s disease also hampers the quality of life via creating
disequilibrium in cognitive thinking (Leroi, McDonald, Pantula, & Harbishettar, 2012). Leroi
et al. (2012) is of the opinion that even mild to moderate levels of cognitive impairment
increases the rate of disability along with impairment of the overall function which acts in
tandem with the further cognitive decline. Furthermore, decrease in the cognitive status in the
elderly person leads to the decrease in appetite and thereby promoting weight loss and muscle
wasting and same is in the case of Mr. X. The Australasian Nutrition Care Day Survey
(ANCDS) revealed that both poor intake of food and malnutrition are responsible for increase
in hospital mortality rate in the Australian (Agarwal, Banks, Batterham, Bauer, Capra, &
Isenring, 737-745). Main impact of malnutrition on the health of Mr. X include increase
amount of accidental falls, increase in the vulnerability of infection, loss of energy and

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morbidity. Moreover increase in the level of confusion associated with stress may lead to the
generation of dementia in Mr. X. Malnutrition may also cast an impact on the oral health
status of the Mr. X (Van Lancker, Verhaeghe, Van Hecke, Vanderwee, Goossens, &
Beeckman, 2012).
Model of cares
Model of care for Mr. X will be Eden’s Alternative Principles of Care. According
to this model, loneliness, boredom and helplessness are plagues of human spirit (Thomas,
2013). Mr. X is departed from his wife and his sons also do not visit often and this is the main
cause of his depression which has taken the form of malnutrition. Eden model suggests close
and contact with children and loving companion ship is helpful to fight loneliness and
depression (Thomas, 2013). This is because receiving and giving care are regarded as
antidotes towards helplessness. Another model of care for Mr. X will be person centred care
which deals with treating each person as individual while respecting person’s dignity and
thereby developing therapeutic relationships. Moreover, person centred or patient centred
care will be suitable for Mr. X because it covers eight major dimensions including patient’s
preferences, emotional support, physical comfort, proper information and education,
continuity followed by transition, proper co-ordination of care, optimal access of care and
inclusion of family and friends (Brownie & Nancarrow, 2013)
Strategies and resources to maintain and improve quality of life
Apart from pharmacological interventions, the main non pharmacological
interventions that will be utilised in case of Mr. X include encouragement of social
participation via promotion of the community activities. This will help to keep Mr. X pre-
occupied and thereby increasing his involvement with the community members. This increase
in involvement will help him to fight against his depression while giving a break from his

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sedentary life (Lai, Hiles, Bisquera, Hure, McEvoy, & Attia, 2013). Another strategy that can
be proved to be effective is rotation of food items in the diet plan while keeping the
nutritional quotient intake. This rotation of the food items will help to break the monotony of
the same repetitive yet tasteless food as served by the food delivery service (Correia, et al.,
2014). Moreover, Mr. X also needs round the clock assistance coming from either care givers
or his family members to carry out daily living activities. Coping strategy-based on family
carer therapy either in the absence or presence of patient’s activity intervention helps to
improve the quality of life of people living with Alzheimer’s at home (Cooper, et al., 2012)
Legal and ethical issues
The main ethical issues that must be taken into consideration informed consent and
shared decision making and this will fall under the ethical domain of autonomy. In order to
practice autonomy, advanced care planning must be used and thus allowing Mr. X to make
decision if he becomes unable to speak at any point of time during the care (Houben, Spruit,
Groenen, Wouters, & Janssen, 2014). Another ethical consideration that must be taken into
account as per the Nursing and Midwifery Board of Australia include maintenance of privacy
or confidentiality and this signifies that the personal information that will be shared by Mr. X
during counselling and while at interview would never be disclosed to any other person
without the informed consent of Mr. X (Hofmann, 2013). In the legal ground, power of
attorney must be signed. The power of attorney lays down a framework for legal consent for
neurodegenerative patients like Mr. X to enjoy the assistance of proxy decision makes on his
behalf. (Wang, Yu, & Hailey, 2013). Moreover, while practising care, the care providers if
coming from any defined organisation is required to submit General Purpose Financial
Report (GPFR). Along with this, unaudited Aged Care Financial Report (ACFR) is also
required as per Australian norms in order to avoid legal complications (Potter, Ravlic, &
Wright, 2013). Moreover, legal complication may bridge in if Mr. X is admitted to hospital

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for a routine checkups of curial parameters. This legal complexicity may come in the form of
neglect and abuse and thus required detailed attention include the person-centred-care plan
(Australian Human Rights Commissions 2017).
Thus from the above discussion, it can be concluded that Mr. X is suffering from
Alzheimer and malnutrition arising from that neurodegenerative disorder. This neuro
degenerative disorder can be effectively be linked with the theories and aging and thereby
providing relevance towards aging and depression. The main models of care that will help
Mr. X for speedy recovery include Eden's Alternative Principles of Care, Person Centred
Care. However, while procuring care to Mr. X numerous legal and ethical issues must be
taken into consideration like advanced care planning and power of attorney.

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Appendix: Interview Transcript
1. What is your name?
My name is XXX.
2. What is your age?
My age is 70
3. Tell me something about yourself
I am a retired government employee and is survived by two sons. My wife passed away three
years ago and I live alone in this home.
4. Where are your sons?
They are busy with their life and are married they live far away from the city and come to
visit me once in a while
5. How do you spent the day?
I start my day with a cup of coffee over chair and that is the only thing which I can make by
my own. After my wife passed away, I booked a home delivery service to provide me with
my lunch and dinner but they serve tasteless food. However, since I have no options I use
their service but very often I discard their food into trash.
6. Any physical activity you do to sat fit?
Without my wife, I do not feel any urge of doing anything. I hate to move out of my house
and response to the unwanted queries of my neighbours regarding my wife’s death and my
sons. I stay mostly at home and my day starts and ends over this chair. Even these days, TV
serials are non-sense so I have disconnected the cable connection.

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7. What do you love to eat?
I used to love sweets but diabetes ruined everything
8. How do you feel while staying alone?
I feel nothing, but I have no options.
9. You look underweight what do you do about that?
Keeping my age and my miserable life I do not care for any thing
10. Do you miss you wife?
Yes I do, I miss her every second and I wish if I can go and her meet anyhow. I also miss my
sons but they do not bother to visit me.
11. Do you suffer from memory loss?
I don’t know, at times may be yes.