The Functional Rating Scale Symptoms Of Dementia:
This scale was developed by J. Thomas Hutton and his associates to measure changes in everyday behavior, such as eating and dressing, that appeared to be most noticeably affected by the disease. The scale is included here to describe various behaviors that can be expected to change as the disease progresses. For example, in the early stages of the disease, the patient may have no difficulty eating with the appropriate utensils. Later, eating with utensils is accomplished with great difficulty, and eventually the patient will need to be fed.
Rate of progression of disease:
Scores on the Functional scale may range from 0(no impairment) to 42(severe impairment). In a small but interesting study conducted by Dr. Hutton and his colleagues, fourteen Alzheimer patients were monitored over two years.
Functional Scale scores were measured every six months throughout the two-year period. At the beginning of the study some patients had only mild impairment (functional Scale scores of less than 21), while in others, the disease was in its more advanced stages (Functional Scale Scores of greater than 21). This study found that Alzheimer’s disease caused significantly more impairment in functional ability at each time of measurement. Thus the disease progresses at a relatively stable rate. It would be uncommon, for example, for someone to go for over six months without showing some obvious decline in ability to respond to his environment.
Nursing Home Placement:
During this study, twelve of the fourteen. Patients were placed in nursing homes by their families. It was discovered that at the time the families decided that they were unable to care for their Alzheimer family member at home, the patient had scores on the Functional scale in the low 30s. In this study, individuals who had moderate impairment at the beginning of the study were typically placed in nursing homes approximately eighteen to twenty-four months later. Individuals who were more severely impaired at the beginning of the study were typically placed in nursing homes within six months to one year.
There is much variability in the rate of progression of the disease for individual patients. Although life expectancy following the onset of Alzheimer’s disease is generally five to ten years, this time may vary widely. The estimates provided here should serve only to aid in planning for eventual nursing home placement. There are sometimes waiting lists for preferred nursing homes, and financial planning will be necessary. Having an idea of when other families have found it necessary to establish residence in a nursing home may help the caregiver to plan for the best possible care for the Alzheimer patient at later stages of the disease.
Several key items on the Functional Scale -
(1) Incontinence
(2) Inability to speak coherently
(3) The need for assistance with bathing and grooming, were closely associated with institutional placement.
By the time an Alzheimer individual is unable to speak coherently, recognize his family, or tend to his own care, the disease has progressed sufficiently that constant supervision and care is required. Other health problems are likely to emerge, increasing the need for skilled nursing care. Once the Alzheimer patient is no longer able to communicate or recognize family members, it may also become easier for the family to let go and consider hospitalization as a more emotionally acceptable alternative. There is general1y no one reason that institutionalization becomes necessary. It is more typically the result of a combination of factors that lead to the primary caregiver becoming overwhelmed by the responsibilities.
The Functional sacle may be useful in gathering information regarding the patient’s level of functioning, but this information should be combined with all other relevant medical, psychological, social, and economic data before decisions regarding nursing home placement are made. The decision to place a loved one in an institutional setting is perhaps the most difficult decision a family must ever make. Despite the myth that older people are placed in institutions because the family does not care or does not want to be bothered, the opposite is more likely true. Its far more common that an Alzheimer victim is cared for in the home long after the caregiver has exhausted emotional and physical resources.
In between the early stages and the last stages of the disease there will be wide variability in the patient’s abilities. Good patient care and man agement can greatly ease the transitions that the patient and his family will go through. The progression of the disease cannot be modified medically and there is no cure. Education will be the most important means to provide the best quality of life for both the patient and his family. It will assist in making difficult decisions, in finding support from the community, in learning how to structure the home environment to reduce stress and improve patient functioning, in learning how to manage difficult behavior, and perhaps most significantly, learning the importance of taking care of the caregiver.
Tags:alzheimer patients, Alzheimers Disease, mild impairment, nursing homes, speak coherently symptoms of dementia
|
