Holistic Care Plan for Alzheimer's Disease: A Nursing Report

This report provides a comprehensive overview of Alzheimer's disease from a nursing perspective, incorporating an analysis of the movie 'Still Alice.' It delves into the disease's clinical manifestations, prevalence, and the impact of cultural and spiritual factors on patients. The report explores various treatment modalities, including both pharmacological and non-pharmacological approaches, and addresses ethical dilemmas associated with Alzheimer's care. It examines the stages of the disease, its impact on daily living, and the challenges faced by patients, including cognitive decline, behavioral symptoms, and social isolation. The report also discusses the genetic predisposition, risk factors like diabetes, and the role of cholinesterase inhibitors and other medications in managing symptoms. Finally, it offers recommendations related to the movie and the disease, providing a holistic understanding of Alzheimer's and its management within a nursing context.

Running Head: MENTAL HEALTH- NURSING
Mental health- nursing
Name of the Student
Name of the University
Author Note

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Dementia is the umbrella term that is used for several symptoms including loss of social,
behaviour and cognitive skills and changes in the brain structure. The most common cause of
dementia is not known to be Alzheimer’s disease. It is the progressive neurodegenerative disease
of brain that severely damages the neurons, resulting in memory impairment, loss of executive
skills, decreased ability to make decisions, altered speech and language difficulties. Currently,
there is no permanent cure for Alzheimer’s disease. However, the symptoms can be improved
temporarily by medications and management. It is necessary to help the patients of Alzheimer’s
to manage the activities of daily living independently. The aim of the assignment is to develop
the holistic care plan for Alzheimer’s disease. This is done by watching a movie and relating the
same with the clinicians, researchers and their trials. The assignment presents the overview of the
Alzheimer’s disease, the main theme of the movie named “Still Alice”, the clinical
manifestations of the disease, current prevalence, influence of the cultural and spiritual factors on
disease, treatment modalities, ethical dilemma associated with it and lastly recommendations for
movie and disease.
Still Alice is the movie based on Alzheimer’s disease, which illustrates the people about
the sufferings of patients. The story is centered on Alice Howland, smart, confident and
talented women living a happy married life with three children. She works as
linguistics professor at University of California, Los Angeles and is an
independent woman. Alice spends her free time with word games.
Her life changes as the symptoms of Alzheimer’s tend to emerge.
While teaching on several occasions she failed to recall words, and lost the
speech sequences. Alice did not stop at these problems. She communicates
with her youngest daughter Lydia about her future and career plan. On a

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usual day in New York, Alice unexpectedly lost herself. She tends to wander
on streets, not knowing where to go and forgetting location. She somehow
managed to get back to her house. Later on some more symptoms emerged
that ultimately made her realise that something was wrong with her health.
She visited the doctor and on presenting her health issues, several
laboratory and diagnostic tests were conducted. She was diagnosed with
Early-onset Alzheimer's disease. Alice was shocked by her diagnostic results
and was devastated to know the genetic nature of her illness. The risk of
transmitting the disease to her children was the biggest catastrophe for
Alice. She met her daughters and family to announce about her diagnosis.
She recommends her children to undergo health assessment and
examination. Lydia, her youngest daughter refused to do the test. Her son
was negative, while her elder daughter was positive.
As the disease started to progress, Alice faced challenges with her job.
She was unable to teach her students in usual organized manner. The
students failed to comprehend her ideas and link with the study syllabus. It
made them feel uncomfortable and the class turned noisy. Eventually, the
diseases worsened Alice’s professional, social and married life. The disease
was challenging and made her life really hard.
Alzheimer’s disease includes three stages and slowly progresses
through each stage. The three different stages are early stage where the
symptoms are mild, followed by middle-sage, where the disease progress

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moderately and in last stage, the disease turns severe. The symptoms of this
neurodegenerative disease, worsens over time, where the symptoms in each
patient is manifested differently. According to Stages of Alzheimer's (2016),
a person diagnosed with Alzheimer’s can live for 4-8 years. As the factors of
the disease vary from person to person, a person may also live upto 20 years
with Alzheimer’s.
Part 2
Alzheimer’s makes a patient’s life very challenging with increasing
episodes of forgetfulness, difficulty word recall, wandering and lost. The
patient suffers from anxiety and depression, with deterioration of the
professional, social and personal life. It increases social isolation and
loneliness while depriving the patients of their independence and self
esteem. An individual with Alzheimer’s also struggle with the cultural and
spiritual influences, which also have impact on the family and community. Spirituality has
subjective nature and it is difficult to define this intangible multidimensional concept
(Dyson, 1997). As per the literature evidence the people with Alzheimer’s fail
to accept the illness, and they lose meaning of life. They struggle to find the
purpose of life. They tend to lose interdependence, and the transcendence.
The beliefs of the disease vary from culture to culture. In African/ American
community, mostly people belief that it is normal to demonstrate the
symptoms of Alzheimer’s with aging. In this community, People cope up with
their illness by praying to God. In Islam, people consider everyone as similar

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irrespective of illness. Guided by Quran and Sunna, a Muslim must fulfil his or
her responsibility towards others and parents, with love, support and
sympathy. People with illness are not viewed from different perspective in
this community and care each other as they care Allah. They respect their
God by caring for ill elders.
There is increasing incidence of Alzheimer’s in UAE. The prevalence of
the disease is also increasing in different parts of the world. It is also
highlighted in the National newspaper, that the Alzheimer’ cases may soar
high by 2030 (Carroll, 2014). Based on the current statistics it is estimated
that, by 2030 the number of cases of Alzheimer’s and other memory-loss
disorders may increase from 4,300 to 32,000 (Carroll, 2014). The
contributing factors of the Alzheimer’s are genetic predisposition, ageing,
cardiovascular diseases like hypertension, diabetes as risk factor and severe
head injuries. The pathophysiology underlying the cardiovascular disease is
the increasing risk due to diabetes that damages the heart and blood
vessels. Alzheimer’s results due to damage of blood brain vessels. There are
multiple evidences on exacerbation of diseases. As per the International
Diabetes Federation, currently in UAE, around 19.3% of the population are
living with diabetes (Diabetes facts, 2011). Throughout the UAE there is an
increase in Diabetes awreness initiatives, development of different
prevention and management programs. In US the Alzheimer’s disease was
recognised to be the 6th leading cause of death, in 2016. Currently, the
strength of Americans living with Alzheimer’s exceeds 5 million. Every 66

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seconds a person is newly diagnosed with Alzheimer’s (ALZHEIMER'S
DISEASE FACTS AND FIGURES , 2016).
As Alzheimer’s is the progressive neurodegenerative disease, there is
no permanent cure to prevent the progressive death of the brain cells. No
treatment has been proved to be effective in delaying the onset or clinical
manifestation of the disease. Alzheimer’s severely damages the cognitive
function, which ultimately leads to behaviour and psychosocial stress in
patients. The disease affects memory, speech, organising and planning
ability, language, and ability to judge, logical thinking, reasoning ability and
awareness. The behavioural symptoms may occur at later stages of the
disease. In early stage, a patient is more likely to demonstrate the irritability,
anxiety, and depression. In the last stage the sleep disorder is manifested,
where the patients experience insomnia, like conditions. Insomnia is the
condition characterised by wakefulness at night due to trouble falling asleep.
In the later stages, hallucination and agitation becomes a frequent episode,
where a patient may see or feel things that are unrealistic to other people.
Delusions are other common clinical manifestations of Alzheimer in later
stages, where a patient cultivates false beliefs about situations or events.
Both pharmacological and non-pharmacological treatment is available for
these symptoms.
The National Institute for Health and Care Excellence (NICE) and the US
Food and Drug Administration (FDA), has approved three drugs for treating

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the cognitive symptoms of Alzheimer’s. Cholinesterase inhibitors are drugs
administered to preserve adequate amount of acetylcholine. It helps in
facilitating the nerve cells’ communications. The drug breaks the
acetylcholine into chemical messenger for nerve cells and is essential for
learning and memory. Donepezil (Aricept®), is one such drug. It is approved
for use in mild stage of Alzheimer’s disease in 1996 and in 2006, it was
approved for administering in severe stage (Alzheimer’s Association , 2015).
Thr other drug rivastigmine (Exelon®) is used for management of the mild to
moderate stages and galantamine (Razadyn) is also administered in these
stages. In several cases, Cholinesterase inhibitors have been found effective
and were highlighted in Alzheimer’s Society that this drug showed beneficial
effect in 40-70% patients (Alzheimer’s society, 2015). The drug Memantine
(Namenda®) belonging to glutamate regulator category is also approved to
treat the Alzheimer’s symptoms particularly delusions and aggression.
Glutamate acts as messenger and is released in high amount in respond to
nerve cell damage in brain. In some cases, the combination of donepezil and
memantine, is administered. It was approved for use in 2014 as it was found
effective in managing patients with moderate to severe symptoms. In the
movie Still Alice is taking this combination of drugs. According to Consumer
Reports Best Buy Drugs, (2012) these drugs have side effects and people in
20 to 25 percent of cases stop taking the medications. One such drug that is
avoided recently fir its side effects is tacrine (Cognex). It damages liver and
is thus rarely prescribed nowadays. The minor side effects of the drugs

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prescribed in Alzheimer’s includes diarrhea, nausea, headache, vomiting and
dizziness. Severe side effects of these drugs include gastric ulcer, dizziness,
slow heart rate, unusual weakness and seizure. Therefore, the physicians
must be careful when administering these drugs and consider the other
health problems of the patients.