General Principles of Alzheimer Care Units

Publié le 30/11/2004 à 13h31

A working group of the National Institute on Aging (NIA) in the United States has recently stressed the following points which justify the creation of special care units for Alzheimer patients :

  • There is always "something that can be done" for patients with dementia. After two years follow-up, cholinergic agents have confirmed their efficacy and appear particularly valuable in the severe stages of the disease, acting not only on cognitive problems but also on autonomy and the psychiatric complications.
  • Excessive disability in Alzheimer patients may be related to a number of factors. These patients are often elderly and have associated diseases or deficits which must be diagnosed and adequately managed in order to improve overall health status. Such factors are often difficult to detect in this population and sometimes require specific approaches to diagnosis and treatment.
  • Individuals with Alzheimer disease usually have reserves of strength which we must recognise and develop. Some patients possess not only physical capacities and the ability to adapt, but judgement, emotion and feeling may also long remain present.
  • Behavioural problems in an Alzheimer patient generally reflect the patient’s feelings or needs. A behavioural problem requires nosological classification and its underlying cause must be sought : anxiety, fear, a change in living conditions, physical pain, an emotional event. It is also necessary to be familiar with the patient’s past and take it into account. - Numerous physical, social and environmental factors affect the functioning of individuals with Alzheimer disease. They are at high risk of weight loss and malnutrition and this must be guarded against. Similarly, various factors in the surroundings, the environment or the architecture, can have either a tranquillizing or on the contrary a disturbing influence.
  • Individuals with Alzheimer disease and their families form a whole. Management of the patient must always go hand in hand with education and follow-up of the family, especially as the patient is often elderly. Various studies have shown that more than 30% of relatives become depressed and are at high risk of weight loss and decompensation of other disorders. Diagnosis and medical follow-up of patients with Alzheimer disease clearly require genuine specialization, not only of the medical staff but also of the entire team. In addition, patients are often disoriented, disturbing other inmates. This frequently leads either to refusal of admission to a conventional care unit, to segregation or to the use of physical or pharmacological restraints with a highly negative effect on the patient’s state of health and the risk of confinement to bed. Specific units for the management and care of patients with Alzheimer disease have therefore been set up to meet this need.