RAJIVGHANDHIUNIVERSITY OF HEALTH SCIENCES, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
1.NAME OF THE CANDIDATE AND ADDRESS / Ms. ROOPA P.MDR.SHYAMALA REDDY COLLEGE OF NURSING,
NO:111/1,SGR MAIN ROAD, MUNNEKOLLALA, MARTHAHALLI,
BANGALORE - 560037
2.NAME OE THE INSTITUTION / Dr. Shyamala Reddy College of Nursing
3.COURSE OF THE STUDY AND SUBJECT / M.Sc. Nursing 1rst year
Psychiatric Nursing
4.DATE OF ADMISSION TO COURSE / 09-06-2008
5.TITLE OF THE TOPIC / A comparative study on knowledge of adults regarding Alzheimer’s disease in selected rural and urban areas of Bangalore.
6.0. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“From the brain and the brain alone arise our pleasure, joy, laughter and jestas well as our sorrow, pain, and grief”
-Hippocrates
Good health is the pre-requisite for good quality of life. Active in society and family makes the old age people younger.Aging is a normal universal and inevitable change, which takes place even with the best of nutrition and health care. Elderly people are vulnerable to physiological, mental, and social crisis and to a typical presentation of illness common to the age. They also crave love and tender care. They could like to interact, be heard, be visible and would like a bit of space of their own and have a constructive and creative role to play in society. The absolute number of elderly has grown from 19 million in 1947 to 70 million in 1995 in the world wide. The life expectancy in India has doubled from 32 years in 1947 to 62 years in 1995. By the year 2020, the ultimate population of the elderly will be 142 million about 11% of the country’s population.
Alzheimer’s disease is one of the most common and most feared terminal illnesses among ageing person in the industrialized world. This incurable degenerative and terminal disease was first described by German psychiatristAlias Alzheimer in 1901. It gradually robs patient’s intelligence, awareness and even the ability to control their bodily functions and finally kills them. And it is rapidly becoming an epidemic in the United States. Alzheimer’s disease is the most common form of dementia. Is one of the most costly disorders among the elderly? It is a terrible and devastating disease that causes loss of brain function.
Age is the most important known risk factor for Alzheimer’s disease. The number of people with the disease doubles 5 years beyond age 65.The family history, genetic factor, heart disease, stroke, high BP, high cholesterol, and low levels of the vitamins, folate many also increase the risk of Alzheimer’s disease. Experts are calling the great increase in Alzheimer’s cases a looming public health disaster that could potentially turn in to an unmanageable health care crisis.
An estimated 26.6 million people world wide was elicited with Alzheimer’s in 2006: this number may quadruple by 2050. The number of diagnosed patients is staggering: over 4 million people are affected by Alzheimer’s disease .The number estimated to increase to 77million by 2030.
The clients with Alzheimer’s disease is manifested by irritability, anxiety, depression, delusion, loss of memory, difficulty with day to day tasks and changes in mood and behavior, no recognition of familiar people, assistance needed with basic ADL, reduced mobility etc.
6.1. NEED FOR THE STUDY
Alzheimer’s disease is a chronic and progressive neurodegenerative disorder. Alzheimer’s disease is the fourth leading cause of death after seventy five years of age. It is to be expected that the cost of caring for these patients is enormous. And the incidence of Alzheimer’s disease increases with age, it is particularly between 65 and 85years of age and is present in every race and ethnic group. The onset of symptoms occurs after 45years of age in 96 percent of cases and between 45 and 65 years in 80 percent of cases.
From the review of literature, it is estimated that there are currently about 18 million people worldwide with Alzheimer’s disease. This figure is projected to nearly double by 2025 to 34 million much of this increased will be in the developing countries and will be due to the aging population. Currently, more than 50 percent of people with Alzheimer’s disease live in developing countries and by 2025 this will be over 70 percent.
In the United States Alzheimer’s disease prevalence was estimated to be 1.6 percent in the year 2000 over all and in the 65-74 age group, with the rate of increasing to 19 percent in the 75-84 age group to 42 percent in the greater than 84years of age group.World Health Organization (WHO) estimated that in 2005,there were 0.37 percent of people world wide had dementia. The prevalence rate of Alzheimer’s disease would increase to 0.44 percent in 2015 and 0.55 percent in 2030. Dr. Kalyan bagehi president of the society of gerontological research. A Delhi based NGO says that it is quite possible that today there may be thousands of patients totally undetected and undiagnosed.
A study found that Alzheimer’s disease may affect any one older than 40 years of age,although it occurs more often in those older than 65 years. When the disease occurs in families, it tends to affect both sexes equally. When it occurs in old age it tends to affect women slightly more frequently than men.
The studies showed that the cause of Alzheimer’s disease is unknown however; several factors are thought to be implicated in this disease. These include neuro chemical factors such as deficiencies in the neuro- transmitter acetylcholine, Somatostatin, substance P and nor epinephrine, genetic studies showed that an autosomal dominant form of Alzheimer’s disease is associated with elderly causes early death, accounting for about 100,000 deaths a year. A family of Alzheimer’s disease and the presence of Down syndrome are two established risk factors. Alzheimer’s disease is not exclusive to the elderly population its onset begins in middle age in 1 percent to 10 percent of cases.
Recent research in India and Africa suggests that the risk of Alzheimer’s disease was possibly higher for urban as compared to rural areas and have suggested that those with higher education are at a lower risk for Alzheimer’s disease than those with less education.
A cross sectional study done in south India, Mumbai and the Northern state of Haryana have reported higher rates of occurrence of Alzheimer’s disease in those at 65 years of age and older, ranging from about 1 percent in rural, North India to 2.7 percent in urban Mumbai .
SeemaPuri,Senior Lecturer at the institute of home economics in DelhiUniversity explains- relatively little is know about Alzheimer’s in India and here caution that people must now sit up and take notice of a disease. Which according to one estimate kills one out of four Indians over the age of 80?
The cruelty of Alzheimer’s disease is that it attacks the brain profoundly. It steals from us our most basic functions and fundamental pleasures at the very time when we should be enjoying the fruit of life. Asour society ages and more people are afflicted, the need to hunt down and stop this killer disease in its tracks has never been greater join our team in the fight against Alzheimer’s.
Currently there is no cure for Alzheimer’s disease as there is no treatment that stops the underlying progression of the illness. The more research is done, the greater the likelihood of discovering treatments to improve the quality of life of person with Alzheimer’s disease.
The role of the caregiver is often taken by the spouse is a close relative. Alzheimer’s disease is known for placing a great burden of caregivers which includes social, psychological, physical or economic aspects. Home care is usually preferred by patients and families. This option also delays or eliminating the need for more professional and costly levels.
6.2. REVIEW OF LITERATURE
Alzheimer’s disease is now often cited as the number one mental health problem among our rapidly increasing population .Alzheimer’s disease is a progressive disorder characterized by stages of increasing impairments and dependency. Althoughmemory impairment is generally characterized as the key diagnostic criteria for Alzheimer’sdisease, the objective sign more often be of a behavioral type. These may include behavior such as suspiciousness and irritability, aggression or angry out burst, withdrawal, or a report from others of poor performance at work. Although a person with Alzheimer’s may live as many as 2years or more from theonset of symptoms, the average duration of the illness is 8 years.
The related literature is organized and presented in the following headings:
1. Definition of Alzheimer’s disease.
2. Incidence and prevalence of Alzheimer’s disease
3. Etiology and Risk Factors
4. Clinical features of Alzheimer’s disease
5. Management of Alzheimer’s disease
1. DEFINITION OF ALZHEIMER’S DISEASE
Alzheimer’s disease is an irreversible, progressive brain disorder that occurs gradually over time and results in memory loss, unusualbehavior personality changesand decline in thinking abilities.
2. INCIDENCEAND PREVALENCE OF ALZHEIMER’S DISEASE
The incidence of Alzheimer’s disease is to be 15percent in older than 65years, 47percent in people older than 85 years.Itis to be estimated that there are currently about 18millionpeople world wide. This figure is projected to nearly double by 2025to 34million.And there is a new case of dementia at every seven seconds. Currently, more than 50percent of people with Alzheimer’s diseaselive in developing countries and by 2025 this will be over 70percent.
The prevalence of Alzheimer’s disease among adults ages 70 to 79 in India and the rate of dementia is expected to double between 2001 and 2040 in developed nations. It is fore cast to increase by more than 300 percent inIndia and China. The 1991 census revealed that 70million people were over 60 years and this number increased in 2001to about 77million, or 7.6 percent of the population.
Shaji etal., (2000) conducted a community based study in the city of Cochin, investigated the prevalence of various dementing disorder, psychosocial correlates of the morbidity and risk factors. Thirty out of 178parts of CochinCity were randomly selected and a door to door survey was conducted in each of the selected clusterstoidentifythe elderly people aged 65years and above. Total of 1934persons were screened with the vernacular adaptation of the Mini Mental Status Examination (MMSE). All those scored 23 and below had a detailed neuropsychological evaluation by Cambridge Mental Disorders of the elderly Examination(CAMDEX-B) and care givers of the patients with confirmed cognitive impairment were interviewed to confirm the history of deterioration in social or occupation function by CAMDEX-H.Sub categorization of dementia was done by international classification disorder-10(ICD-10) diagnostic criteria. The prevalence rate of dementia was 34 per 1000, 53 percent of dementia cases were diagnosed as Alzheimer’s disease, 40 percent satisfied the criteria for vascular dementia, 7 percent was due to others causes like infection, tumor and trauma.
Chandra et al., (2000) conducted a study to determine the prevalence of Alzheimer’s disease and other dementias in rural elderly Hindi speaking population in Ballabgarh in Northern India. A total of 536 subjects (10.5%)who met operational criteria for cognitive and functional impairment and a random sample of 270 (5.3%) underwent standardized clinical assessment for dementia using the Clinical Dementia Rating Scale (CDR). It was found that an overall prevalence rate of 0.84 percent for all dementias with a CDR score of at least 0.5 in the population aged 55yrs and older, and an overall prevalence rate of 1.36 percent in the population aged 65years and older. The overall prevalence for Alzheimer’s disease was 0.62 percent in the population aged 55+ and 1.07 percent in the population aged 65+. Greater age was associated significantly with higher prevalence of both Alzheimer’s disease and all dementias, but neither gender nor literacy was associated with prevalence.
3. ETIOLOGY AND RISK FACTORS
1. Age:
The greater risk factor is increasing age
- Below the age of 65, dementia affects one person in 1000
- Over the age of 65, it affects four or five in 100.
- By the age of 80 it affects one person in 100.
Wilson et al., (2007) conducted a study on frequent cognitive activity in old age has been associated with reduced risk of Alzheimer’s disease. More than 700 old people underwent annual clinical evaluation for up to 5 years. A baseline, they related current and past frequency of cognitive activity with the current activity measure administered annually thereafter. Those who died underwent a uniform postmortem examination of the brain. Amyloidal burden, density, tangles, and presence of Lewy bodies were assessed in eight brain regions and the number of chronic cerebral infarctions was noted. During follow-up, 90 people developed Alzheimer’s disease. More frequent participation in cognitive activity was associated with reduced incidence of Alzheimer’s disease. A cognitively inactive person (score 2.2, 10th percentile) was 2.6 times more likely to develop Alzheimer’s disease than a cognitive active person (score 4.0, 90th percentile) results level of cognitively stimulating activity in old age is related to risk of developing dementia.
2.Education:
Some research studies have suggested that those with higher education are at a lower risk for Alzheimer’s disease than those with less education.
Schaie (1983) cited that people who show high intellectual ability, early in life and receive favorable education and environmental opportunities tend as adultstohave an engaged life style marked by complex,intellectually demanding occupational and social activities.Engaging in activities that challenge,cognitive skills in turn promotes the retention or growth of those skills.
Bouter et al., (2000) conducted a study on Depressive symptoms and risk of Alzheimer’s disease in more highly educated older people. Correlations between symptoms of depression and risk of Alzheimer’s disease have been investigated in older people with more than 8 years of education to see whether specific symptoms of depression that predict Alzheimer’s disease can be identified. Depressed mood and subjective Bradyphrenia seem to be indicative of sub clinical Alzheimer’s disease in this group and Alzheimer’s disease may become apparent in a relatively short period of time versus other groups.
3. Heart disease
4. Stroke
5. Low levels of vita mine folate
6. Diabetes
Snowdon et al., (1996) cited that the diet,exercise and other life style factors also may play a part. African, American and Indian are two to three times more likely to develop Alzheimer’s disease than Nigerians. Nigerians have lower risk factor for stroke, such as hypertension, high cholesterol due to diet, wich includes fruit and vegetables, bread, wheat and other cereals, olive oil, fish and red wine may all individually or together reduce the risk and cause of Alzheimer’s disease.
Yaukov et al., (2008) conducted a study on Dibetes; high Blood pressure may hasten death in people with Alzheimer’s disease. The study involved 323 people who had no memory problems when first tested but later developed Dementia.Memory test and physical exams were given at every 18 months.The study found that after an Alzheimer’s diagnosis was made, people with diabetes were twice as likely to die sooner than those without diabetes who had Alzheimer’s disease. People with Alzheimer’s disease who had high Blood pressure were two and a half times more like to die sooner than those with normal Blood pressure.
7. Culture, Race, and Ethnicity
Larson et al (1999) conducted a study on Alzheimer’s disease symptoms severity in Blacks and Whites. Compared the cognitive impairment of 38 Africans and Americans to that of 415 Caucasians. Result found that the Africans, Americans have more sever symptoms ofAlzheimer’s disease.
Mc Dougall et al., (2003) cited that race, culture and ethnicity also may be important factors when calculating the impact of Alzheimer’s disease. In one study of race and Alzheimer’s disease, black men were found to have more anxiety and depression and less formal education than white men. But were no different in terms of actual memory performance. However significant differences were found in the subjective aspects of memory evaluation, which affected the ability of black man in this study to know whether they were maintaining memory function or declining with age. This information may have important implications for the manner in which patients and family are evaluated and understood.
4. CLINICAL FEATURES OF ALZHEIMER’S DISEASE
- Mild cognitive impairment
- Behavioral problems
- Anxiety
- Irritability
- Delusions Delirium
- Difficulty in performing normal activities of daily living
Willis et al., (1994) cited that the strong relationship between fluid intelligence and certain practical skills that tend to decline with age, such as the ability to read a map or news paper or to perform every day tasks. As the people get older, an important test of cognitive competence is the ability to live independently as measured by seven instrumental activitiesof daily living,
- Managing finance
- Shopping for necessities
- Using the telephone
- Obtaining transportation
- Preparing meals
- Taking medication and
- House keeping
5. MANAGEMENT OF ALZHEIMER’S DISEASE
There is no cure for Alzheimer’s disease, available treatments offers
relatively small symptomatic benefit but remains palliative in nature.
- Follow the nutrition plan paying special attention to avoiding sugar.
- Eat plenty of high quality omega-3 fish oil.
- Avoid aluminum, such as in antiperspirants cookware etc.
- Exercise, three to five hours per week.
- Eat plenty of vegetables according to your metabolic type.
Gold stone et al., (1988)conducted a study showed that circulating glucose may controlacetylcholine synthesis and enhance memory in older individuals. Many Alzheimer’s patients develop cravings for sweets and positron emission tomography (PET) and single positron emission computed tomography(SPECT) data show deficits in glucose metabolism in the brain of these patients. Age related memory deficits in elderly individuals might be alleviated by better control of blood glucose levels achieved through dietary control or medications. It is important to maintain a balanced nutritional status of the patient and family members should be taught to do so.
Woods et al., (1995) conducted a study on using selected memories to manage problems behavior in Alzheimer’s disease patients.An alternative intervention for behavioral disruption has found that reminiscence by a special family member provides calming effects. The intervention used, called Simulated Presence Therapy (SPT) was designed to replicate a care giver’s presence through the use of an audio tape of a family member reminiscing about the clients cherished memories , loved ones, and family anecdotes. The client listened to the tape through a portable cassette player and headphones. The study involved 27 cognitively impaired residents whose age ranged from 76 to 94 years of age. Family members of these clients made a 15 minute long tape which conveyed affection and positive emotion through reminiscence. For one month, the tapes were played for the clients when they displayed disruptive behavior, and they recorded the clients’ behavioral responses as either improved unchanged, worsened behavior. Results show that 22 out of 27 subjects (81.5%) representpositive responses to SPT.