Hygiene Care and Alzheimer's Disease: A Nursing Perspective

This essay delves into Alzheimer's disease, examining its causes, impact on the health and well-being of older adults, and the implications for personal hygiene care. The first part of the essay discusses the causes and risk factors of Alzheimer's disease, including genetic, lifestyle, and environmental factors, and how these factors affect the management of personal hygiene. It highlights the cognitive and behavioral changes associated with the disease and their impact on hygiene practices. The second part focuses on clinical decision-making by registered nurses in providing personal hygiene care within an acute care setting. It defines clinical decision-making, identifies relevant decisions nurses make during assessment, planning, implementation, and evaluation of care, and emphasizes evidence-based practices to optimize health outcomes. The essay covers interventions related to mobility, pain management, cognition, and co-morbidities, with a focus on providing privacy, environmental adjustments, and assistance to improve hygiene care for patients with Alzheimer's disease.

The Older Person
1

Introduction:
In this essay, gerontological condition like Alzheimer’s disease will be discussed. For the
provision of the effective intervention, it is necessary to understand background of the disease
causes and risk factors. Alzheimer’s disease is the chronic condition and it affects health and
well-being of the person. Hence, effect of Alzheimer’s disease on health and well-being of
the individual will be discussed. Improper personal hygiene is one of the important factors
responsible for the deterioration of health and well-being of an individual (Freeman et al.,
2014). Hence, different aspects related to personal hygiene like clinical decision making by
the registered nurse and responsibility of nurse in clinical decision making will be discussed.
In order to implement effective decision making, it is necessary to understand meaning of
clinical decision making. Hence, meaning of clinical decision making will be elaborated.
Moreover, nurse’s clinical decision-making role in each step of intervention like assessment,
plan, implementation and evaluation of intervention will be discussed. Intervention related to
mobility, pain management, cognition and co-morbidities will be discussed.
Discussion:
Part A :
It has been demonstrated that Alzheimer’s disease (AD) mainly caused due to combination of
factors like genetic, lifestyle and environmental factors. It is evident that less than 1 % people
develop AD due to genetic factors (Hersi et al., 2017). Exact cause of AD has not been
completely demonstrated; however, alteration in brain protein is mainly responsible for
occurrence of AD. Alteration in brain protein results in disruption of working of brain cells
and release of toxic mediators which results in abnormal functioning of brain (Panpalli Ates,
Karaman, Guntekin, and Ergun, 2016).
Age is also one of the most prominent risk factors for the occurrence of AD. AD is not a part
of normal aging process; however, with the increase in age there is more probability of
occurrence of AD. It is evident that two of every 1000 people develop AD within age group
65 to 74 years, eleven of every 1000 people develop AD within age group 75 to 84 years and
thirty-seven of every 1000 people develop AD with age group above 85 years (Robinson,
Lee, and Hane, 2017). First-degree relative like parent or sibling is one of the most
prominent risk factors for the existence of AD. However, genetic mechanisms among
families of AD patients are not fully explained; hence, genetic factors related to AD are being
considered as more complex. APOE e4 variation of apolipoprotein E gene (APOE) is mainly
2

responsible for ADD; however, every individual with APOE e4 do not develop AD. People
with Down syndrome are at higher risk of development of AD. Three copies chromosome 21
and three copies of gene for protein responsible for β-amyloid are responsible for AD. People
with AD exhibit AD symptoms approximately 10- 20 years earlier in Down syndrome people
as compared to people without Down syndrome (Xue et al., 2017; Dauphinot et al., 2015).
There is less difference in AD prevalence among men and women; however, it has been
demonstrated that women are at higher risk of AD as compared to the men (Niu, Álvarez-
Álvarez, Guillén-Grima, and Aguinaga-Ontoso, 2017). People with Mild cognitive
impairment (MCI), poor sleep pattern and head trauma are at higher risk of AD development
(Niu, Álvarez-Álvarez, Guillén-Grima, and Aguinaga-Ontoso, 2017). Lifestyle factors like
lack of exercise and smoking are also responsible for the development of AD. Metabolic
diseases like obesity, high blood pressure, high cholesterol and type 2 diabetes are also
responsible for the occurrence of AD (Xue et al., 2017; Dauphinot et al., 2015).
AD is a form of dementia and people with dementia are associated with progressive decline
in mental functioning. People with AD experience memory loss, lack of skills to plan
activities, mental confusion, lack of reasoning, problem in language and communication.
Moreover, people with AD also exhibit behavioural and personality alterations (Hane et al.,
2017). Majority of AD patients about 80 % exhibit pure dementia; however, few of the
patients exhibit combined degeneration like cerebro-vascular disease due to diminished blood
circulation to the brain. People with AD are associated with low level quality of life
(Bosboom and Almeida, 2014).
Most of these dementia people are socially isolated and these people develop certain kind of
stigma. It is difficult to engage these AD patients with meaningful activities for longer
duration; hence, there is disruption in social interaction and relationship with others. It affects
well-being of the person with AD. Depression and anxiety are the very common behavioural
health issues associated with AD (Hane et al., 2017). Moreover, AD patients are not willing
to express their depression and anxiety. Hence, depression and anxiety might remain
untreated in patients with AD. Hence, it affects overall physical and mental health of AD
patients (Trigg, Jones, Knapp, King, and Lacey 2015).
It has been reported that AD patients tend to eat very less or miss essential nutrients. Less
consumption of nutrients leads to reduced resistance to illness (AA, 2016). On the contrary, it
has also been demonstrated that AD patients tend to consume fatty and sugary food. Hence,
3

there is possibility of occurrence of obesity in patients with AD (Pase et al., 2017). Older
people with AD usually perform less physical activity; hence, these people are at higher risk
of development of constipation. AD patients exhibited confusion about day and night. Hence,
it can affect their sleep pattern. Disturbance in sleep pattern of an individual produce overall
impact on health of AD patients. AD patients are usually associated with hearing and
eyesight problem; hence, these people are associated confusion (Lacey, Bobula, Rüdell,
Alvir, and Leibman, 2015).
It is very common in dementia patients to forget or lose interest for bathing or changing
clothes. These activities by the AD patients; are usually puzzling and upsetting for the family
members and care givers. It is necessary for the healthcare providers to understand the cause
behind the poor hygiene to implement effective intervention in AD patients. Healthcare
provider and family members need to understand that washing and dressing are the very
much private activities of the individual. Hence, provision of privacy for washing and
dressing would be helpful in improving personal hygiene of the AD patients (Coyer,
O'Sullivan, and Cadman 2011; Redfern, 2014).
Person with AD might forget place of bathing or feel uncomfortable due to alteration in the
mental status. AD patient might feel bathing room too hot, cold or dark. Hence, provision
need to be made in such a way that AD patients reach correct place to take bath. Moreover,
sufficient lightning needs to be provided in the bathing room and ensure that room in
adequately warm. Hence, AD patient feels comfortable in taking bath in the assigned bathing
place. Hence, improvement of environment would be helpful in improving bathing in the AD
patient to maintain appropriate hygienic condition.
Part B :
Clinical decision making is the planned problem-solving approach or process in which
inferences are made based on the actual or perceived patient requirements or responses. Made
inferences or conclusions can be useful in effective implementation of the care plan (Lee,
Abdullah, Subramanian, Bachmann, and Ong, 2017).
Registered nurse needs to make appropriate decisions for providing personal hygiene in older
person. It is necessary for the registered nurse to take proper decision whether, nurse should
focus on the assessment, planning, implementing and evaluating care to the older person
(Lewallen and Van Horn, 2019). Nurse should take practical decisions at each step because
correct decisions during assessment would be helpful in providing appropriate care to the
4

patient. Moreover, correct decisions during care planning would be helpful in achieving goals
set at the time of assessment (Maddineshat, Hashemi, Besharati, Gholami, and Ghavidel,
2018).
During the assessment phase of the nursing intervention, nurse should ensure that accurate
reason for unhygienic condition should be identified. Through conclusive decision during
assessment, nurse would be able to identify accurate problem and act to address on the
identified problem.
It is necessary for the nurse to perform assessment in the acute setting. Nurse should perform
cognitive level assessment through cognitive assessment tool like Allen Battery of Screening
tools. This tool is useful for the primary level of cognitive function. This tool is useful in the
cognitive disability like Alzheimer’s disease or dementia. Provision of information related to
the cognitive level is beneficial in feeling valued and fulfilled to live high quality of life.
Information related to the cognitive level of patient is also beneficial for the nurses or
caregivers because it reduces stress and burnout in them and they can take appropriate
decisions about the hygiene of the patient. Cognition level can be classified into different
classes like 0 – coma, 1 – awareness, 2 – large body movements, 3 – manual actions, 4 –
familiar activity, 5 – learning new activity and 6 – planning new activity. Older patient is
with cognitive level 3 which require supervision and help in the daily activities. Provision of
cues would be helpful in completion of activities in patients with cognitive level 3 (Hane et
al., 2017).
Nurse should provide cues or orientation for patient for alerting patient for the completion of
daily activities like changing dress and bathing. Schedule of patient for completion of daily
activities should be monitored by the nurse and ensure that patient is completing daily
activities according to the schedule. It is necessary for the nurse to provide information to the
patient regarding use of shower while taking bath. Nurse should asses that whether patient
can perform all the hygiene related activities like bathing, dress changing, brushing, toileting
and hand washing. Selection of appropriate action to maintain personal hygiene would be
helpful in improving outcome of the intervention which would be implemented for
maintaining personal hygiene. Patient might complete few of the activities on their own;
however, for few of the activities patient might need assistance (Fazio, Pace, Flinner, and
Kallmyer, 2018). Hence, nurse should provide assistance to the patient where patient seek
assistance because patient might feel burdened due to repeated instructions. It is necessary for
5

the nurses to assess the quality of activities of patient because effective completion of the task
can be considered if it upto the standards established for this particular activity (Diaz et al.,
2008). Nurse should provide training to the patient to perform the hygiene related activities;
hence, effective hygiene can be maintained. Patient should adequate amount of nutrients like
protein, vitamin C and zinc to prevent formation of pressure sores. Development of pressure
might lead to probability of infection. Consumption of inadequate amount of food might lead
to insufficient energy for the completion of tasks (DeFina, Moser, Glenn, Lichtenstein, and
Fellus, 2013; Miklossy, 2017).
Decision making during evaluation of care is helpful in the assessment of the effectiveness of
implemented care. Evaluation need to be performed in unbiased manner. Hence, it would be
helpful in more accurate assessment of the implemented care. Person not involved in the
intervention, need to be incorporated in the evaluation of the care. Hence, involvement of
unfamiliar person in evaluation would be helpful in unbiased assessment of effectiveness of
hygiene care. Nurse also should take proper decision, whether hygiene care need to be
provided through caregiver or family member. Few of the older person might be more
comfortable with family members for the provision of hygiene care. Hence, more effective
hygiene care can be provided through the family members (Aisen et al., 2017; Goodman et
al., 2016).
AD patients are usually become immobile due to older age and psychological anomaly.
Hence, nurse need to assess functional ability for mobilisation. Nurse need to allocate
sufficient time for the nurse to perform mobility related activities. Nurse need to encourage
AD patients to perform range of motion exercises and use of restraints (Arriaga and Han,
2017). It is necessary to assess shift in thought process of AD patient. Moreover, nurse should
observe cognitive working, memory alteration, confusion, problem in communication and
alteration in though process (Wilson, 2017). Nurse need to listen to AD patient carefully and
provide opportunity for the social interaction. Family members need to be incorporated in the
care of AD patients and patient’s attention need to be diverted from the dangerous or
hazardous behaviour. Careful assessment tool for pain assessment is necessary in dementia
patients to administer correct type and level of analgesia. Both pharmacological and non-
pharmacological pain management intervention need to be provided to the AD patient (Surr,
Griffiths, and Kelley 2018; Morikawa et al., 2017).
Conclusion:
6

AD is the life-threatening disease in the older person. Since, it is multifactorial disease, it is
necessary for the nurses to understand risk factors associated with AD. It proved helpful for
the nurses for accurate clinical decision making and planning effective nursing intervention.
AD affects quality of life of patient in multiple ways; hence, nurses aimed to improve the
health and well-being of the AD patients. It has been demonstrated that addressing personal
hygiene of the AD patient proved beneficial in improving health and well-being of the
patient. Nurse should perform effective assessment related to personal hygiene; which proved
effective in planning effective intervention for AD patients. Nurse should carry out clinical
decision making in step-wise-manner. Nurse should take appropriate decision for each step of
the nursing intervention because outcome of one step of nursing intervention is dependent on
another step. Nurse should provide targeted intervention after the assessment of the patient.
Nurse should consider multiple factors while planning care to the AD patient because AD is a
multifactorial disease.
References:
Aisen, P.S., Cummings, J., Jack, C.R., Morris, J.C., Sperling, R., … and Dubois, B. (2017).
On the path to 2025: understanding the Alzheimer's disease continuum. Alzheimer's
Research & Therapy, 9(1), 60. doi: 10.1186/s13195-017-0283-5.
Arriaga, M., and Han, E.B. (2017). Dedicated Hippocampal Inhibitory Networks for
Locomotion and Immobility. Journal of Neuroscience, 37(38), 9222-9238.
Bosboom, P.R., and Almeida, O.P. (2014). Do changes in specific cognitive functions predict
changes in health-related quality of life in people with Alzheimer's disease?
International Journal of Geriatric Psychiatry, 29(7), 694-703.
Coyer, F.M., O'Sullivan, J., and Cadman, N. (2011). The provision of patient personal
hygiene in the intensive care unit: a descriptive exploratory study of bed-bathing
practice. Australian Critical Care, 24(3), 198-209.
Dauphinot, V., Delphin-Combe, F., Mouchoux, C., Dorey, A., Bathsavanis, A.,…and Krolak-
Salmon, P. (2015). Risk factors of caregiver burden among patients with Alzheimer's
disease or related disorders: a cross-sectional study. Journal of Alzheimer's Disease,
44(3), 907-16.
DeFina, P. A., Moser, R. S., Glenn, M., Lichtenstein, J. D., and Fellus, J. (2013). Alzheimer's
Disease Clinical and Research Update for Health Care Practitioners. Journal of Aging
Research, 207178. doi: 10.1155/2013/207178.
Diaz, M.H., Silkaitis, C., Malczynski, M., Noskin, G.A., Warren, J.R.,…and Zembower, T.
(2008). Contamination of examination gloves in patient rooms and implications for
transmission of antimicrobial-resistant microorganisms. Infection Control & Hospital
Epidemiology, 29(1), 63-5.
Fazio, S., Pace, D., Flinner, J., and Kallmyer, B. (2018). The Fundamentals of Person-
Centered Care for Individuals With Dementia. Gerontologist, 58(1), S10-S19.
7

Freeman, M.C., Stocks, M.E., Cumming, O., Jeandron, A., Higgins, J.P., … Curtis, V.
(2014). Hygiene and health: systematic review of handwashing practices worldwide
and update of health effects. Tropical Medicine & International Health, 19(8), 906-
16.
Goodman, C., Dening, T., Gordon, A.L., Davies, S.L., Meyer, J.,… Zubair, M. (2016).
Effective health care for older people living and dying in care homes: a realist review.
BMC Health Services Research, 16:269. doi: 10.1186/s12913-016-1493-4.
Hane, F.T., Robinson, M., Lee, B.Y., Bai, O., Leonenko, Z.,… and Albert, M.S. (2017).
Recent Progress in Alzheimer's Disease Research, Part 3: Diagnosis and Treatment.
Journal of Alzheimer's Disease, 57(3), 645-665.
Hersi, M., Irvine, B., Gupta, P., Gomes, J., Birkett, N.,… and Krewski, D. (2017). Risk
factors associated with the onset and progression of Alzheimer's disease: A systematic
review of the evidence. Neurotoxicology, 61, 143-187.
Lacey, L., Bobula, J., Rüdell, K., Alvir, J., and Leibman, C. (2015). Quality of Life and
Utility Measurement in a Large Clinical Trial Sample of Patients with Mild to
Moderate Alzheimer's Disease: Determinants and Level of Changes Observed. Value
in Health, 18(5), 638-45.
Lee, D.S., Abdullah, K.L., Subramanian, P., Bachmann, R.T., and Ong, S.L. (2017). An
integrated review of the correlation between critical thinking ability and clinical
decision-making in nursing. Journal of Clinical Nursing, 26(23-24), 4065-4079.
Lewallen, L.P., and Van Horn, E.R. (2019). The State of the Science on Clinical Evaluation
in Nursing Education. Nursing Education Perspectives, 40(1), 4-10.
Maddineshat, M., Hashemi, M., Besharati, R., Gholami, S., and Ghavidel, F. (2018). The
effectiveness of clinical teaching of mental health courses in nursing using clinical
supervision and Kirkpatrick's model. Electron Physician, 10(1), 6265-6272.
Miklossy, J. (2017). Handbook of Infection and Alzheimer's Disease. IOS Press. Amsterdam,
Netherlands.
Morikawa, T., Maeda, K., Osaki, T., Kajita, H., Yotsumoto, K.,…and Kawamata, T. (2017).
Admission of people with dementia to psychiatric hospitals in Japan: factors that can
shorten their hospitalizations. Psychogeriatrics, 17(6), 341-347.
Niu, H., Álvarez-Álvarez, I., Guillén-Grima, F., and Aguinaga-Ontoso, I. (2017) Prevalence
and incidence of Alzheimer's disease in Europe: A meta-analysis. Neurologia, 32(8),
523-532.
Pase, M.P., Himali, J.J., Jacques, P.F., DeCarli, C., Satizabal, C.L.,… Seshadri, S. (2017).
Sugary beverage intake and preclinical Alzheimer's disease in the community.
Alzheimer's & Dementia, 13(9), 955-964.
Panpalli Ates, M., Karaman, Y., Guntekin, S., and Ergun, M.A. (2016). Analysis of genetics
and risk factors of Alzheimer's Disease. Neuroscience, 14(325), 124-31.
Redfern, R. (2014). Alzheimer's Disease Rehabilitation in 30 Days. Naturally Healthy
Publications. United Kingdom.
8

Robinson, M., Lee, B.Y., and Hane, F.T. (2017). Recent Progress in Alzheimer's Disease
Research, Part 2: Genetics and Epidemiology. Journal of Alzheimer's Disease, 57(2),
317-330.
Surr, C.A., Griffiths, A.W., and Kelley, R. (2018). Implementing Dementia Care Mapping as
a practice development tool in dementia care services: a systematic review. Clinical
Interventions in Aging, 26(13), 165-177.
Trigg, R., Jones, R.W., Knapp, M., King, D., and Lacey, L.A. (2015). The relationship
between changes in quality of life outcomes and progression of Alzheimer's disease:
results from the dependence in AD in England 2 longitudinal study. International
Journal of Geriatric Psychiatry, 30(4), 400-8.
Wilson, D. (2017). Calculable People? Standardising Assessment Guidelines for Alzheimer's
Disease in 1980s Britain. Medical history, 61(4), 500-524.
Xue, H., Sun, Q., Liu, L., Zhou, L., Liang, R., …and Yu, H. (2017). Risk factors of transition
from mild cognitive impairment to Alzheimer's disease and death: A cohort study.
Comprehensive Psychiatry, 78, 91-97.
9