Basically, the market consists of the disposable contact lens and the extended-wear contact lens, depending on how much maintenance one is prepared to give. Disposable lenses are simply thrown away at night, and you’ll get a new pair each morning, while extended-wear lenses might need a little cleaning. Whatever model you choose, you are however likely to be satisfied with your choice, as the general product quality of lenses is very high.

Will patients have easy access to the places they will need to go restrooms, dining rooms, and activity rooms? Are there pictorial signs in easily observed places to facilitate the patient finding important places such as a restroom and perhaps his own room? For example, all restrooms might be painted orange with a picture of a toilet on the door. Perhaps the patient’s picture and name in large letters might be on the door to his or her room. When confronted with a corridor of many doors all of which look alike, the Alzheimer patient can become quite confused and frustrated.

Good housekeeping practices are essential. The simple effort of removing wastepaper baskets and locking closets can prevent problems for the patient. It is important to ask if the patient will be allowed to live in one room for a long period of time or are frequent moves likely? Frequent changes in the environment result in difficult adjustments for the Alzheimer patient.

Brain Disorder

When Alois Alzheimer described in 1907 the disorder that now bears his name, he did so by describing microscopic brain abnormalities. These brain changes consist of neuritic (senile) plaques and neurofibrillary tangles. Neuritic plaques are believed to be degenerating treelike branchings of brain cells that may surround a central core of protein (amyloid). Neurofibrillary tangles are seen within brain cells and consist of a coarsening and thickening of the usually delicate filaments (threadlike tissues). Increasing numbers of neuritic plaques and neurofibrillary tangles correspond to increasing severity of dementia. They may also be seen in normal older brains, but in lesser numbers.

The second concept-nonsegregation of the Alzheimer patient allows those suffering from Alzheimer’s disease to be integrated into the regular program of the nursing home. Too frequently this arrangement does not provide adequately for the special needs of patients. The general trend is to establish separate units with specialized programs and trained staff. However, the success of Alzheimer programs will mainly be deter mined by the staff and how well they are trained. Nursing homes that seem to be the most effective are those where the staff believe that constructive things can be done for and with the Alzheimer patient. Families need to look for those homes that are flexible and open-minded in their approach to the patient. It is extremely important that the staff demonstrate understanding and affection toward Alzheimer patients. When visiting a nursing home, notice the interaction of the staff with the patients, Are patients introduced by name? Does the administration have someone on staff to show the facility, to point out special features and programs designed for Alzheimer patients, and to answer any questions that might arise? Are there specialized activity programs for Alzheimer patients?

Standards

Nursing homes must comply with state and local laws, whose standards have been developed for the care and protection of the patient. Each state has its own survey system for assuring that patients receive adequate care. Until recently the process focused on structural requirements more than on patient outcomes. This is beginning to change with new guidelines being developed to assess the quality of care provided by facilities. Standards of care include such things as ensuring that patients are receiving the specific diets ordered by their doctors, that grooming meets acceptable standards, and that medications are being dispensed properly. Accreditation reviews are very thorough, and generally take a full week to complete.

Part of the process of selecting a nursing home for Alzheimer patients involves determining that the prospective home complies with existing state regulations. Inquiries should also be made into what rating the home has been given, if a rating system exists in the caregiver’s state. Is the home considered to be superior? These questions can be answered by the nursing home administrator.

When visiting a home, ask the administrator for the Bill of Rights for Residents of Nursing Homes, which all nursing homes are required to provide.

The Bill of Rights should include the following principles -

1. The rights of Citizenship
2. The right to Dignity
3. The right to Privacy
4. The right to Personal Property
5. The right to Information
6. The right to Freedom
7. The right to Care
8. The right to Choose
9. The right to Residence
10. The right to Expression

Most states currently do not have separate standards and guidelines for the development of specialized nursing homes for Alzheimer patients. Some states are just beginning this task. The development of standards for Alzheimer facilities requires special consideration due to the uniqueness of the disease. The traditional programs will not suffice for the Alzheimer patient. There are different phases of the disease, and required treatment varies in each phase. A progressive program must be put in place, one that will allow for the various changes that take place in the patient’s behavior.

Four years later Newsweek reported “tacrine hydrochloride is of limited usefulness and only in the early stages of the disease”. In the fall of 1996 Time recounted that “while some patients who take tactine benefit from subtle to moderate improvements in mood and short -term memory, many others do not. Moreover, tacrine can produce a raft of side effects”. The test using spinal fluid is not yet the diagnostic tool predicted in 1990 and its results and application are still being examined; yet is has recently been touted once again as a “new diagnostic tool” . News reports in 1994 heralded: “There’s still no cure in sight, but a new test, using eye drops, could be a breakthrough”. The article described how the eye drops caused the pupils of Alzheimer’s patients to dilate approximately four times as much as normal controls. Nineteen ninety-five brought announcements of the discovery of more “new genes thought to be responsible for Alzheimer’s disease” and in 1996 the “possible antidotes to Alzheimer’s” were reported to be estrogen and aspirin. Newsweek and Science News recounted in 1996 that Alzheimer’s disease may soon be predicted through brain scans and changes in writing samples .

Such articles tantalize readers, but are these claims of medical breakthroughs real or illusory? The reporting in these news articles was no better or worse than the many others published, but they can be used to illustrate the difference between medical advancements and the much-hoped­for breakthroughs in finding the cause of, effective treatment for, and potential cure for Alzheimer’s disease. Interpreting such announcements with a critical eye can reduce unrealistic public expectations and still allow hope for the future .

Practical and useful education programs are required for those staff members assigned to work with the Alzheimer patients. Coping with behavioral problems of Alzheimer patients requires skill, commitment, understanding, and patience. The staff must be willing to adjust to patient needs and change the programs and the environment to accommodate patient requirements rather than try to change the behavior patterns.

The lack of knowledge regarding the intellectual impairment caused by the disease and its various phases presents the staff with a great number of management problems. A basic fact that all staff should understand but often do not, is that Alzheimer’s disease does impair memory, reasoning, judgment, and orientation-and it is irreversible. The nursing home staff also needs to be trained in how to handle such symptoms as depression, confusion, bewilderment, and emotional instability.

Training of staff members should be an ongoing process. This can be accomplished by using the various phases of the disease as guideposts for planning and conducting training sessions and in-house workshops. The staff needs to know what takes place in the life of the patient in the pre­diagnosis period. This provides an opportunity to link the patient’s present behavior with previous patterns of behavior. For example, in one nursing home, the nurses were having a very difficult time getting one of their favorite patients to wear shoes. Much time and effort was expended getting Mr. R. to put on his shoes. When staff discussed this problem with his wife, it was learned that he never wore shoes at home throughout their forty years of marriage. Understanding previous behavior certainly facilitated their understanding of his present behavior.

Knowledge of the patients’ general decline will help staff members better understand the drastic changes that have already taken place in the lifestyle of the patients and their family members. The last two phases, severe memory loss and total collapse of self-management skills, are usually the point where nursing home staff enter into the life of the patient. Special training regarding these crucial periods is essential if the staff is to understand and improve its skills in working with the patients, their families, and the larger community.

A third reason for attributing so much importance to Alzheimer’s disease is its status as a major killer, ranking fourth or fifth among our nation’s most frequent causes of death. It is known that a person diagnosed as having Alzheimer’s disease will, on average, live only one third to one half as long as a person of the same age who does not have the disease. If this increased mortality rate is combined with the incidence of the disease in the general population, it can be demonstrated that Alzheimer’s disease is a principal cause of death, with only heart disease, cancer, and stroke taking a higher toll of human life.

However, it is rare to see Alzheimer’s disease listed on a death certificate- more typically, pneumonia is indicated as the cause of death in the Alzheimer victim. It is logical to assume that the fatal infection would not have been contracted were it not for the debilitated state that directly resulted from the Alzheimer’s disease.

The prevalence, cost, and suffering that result from Alzheimer’s disease will increase dramatically over the next forty years unless the cause md the cure are found. This increase will result from a doubling of the population of older persons within our society. The subgroup that will show the most rapid increase in population is those persons over the age of eighty-five years. These oldest of the old have the highest risk for developing Alzheimer’s disease. It is also these oldest of the old who are at risk for contracting other chronic diseases, all of which increase the need for nursing homes. This will place an increased burden on such facilities.

At present, it is estimated that 40 to 60 percent of the nation’s nursing home residents suffer from dementia (senility). Of those individuals with dementia, the majority are victims of Alzheimer’s disease. Only recently has the significance of this disease entered the public’s consciousness. We have begun to realize that with the aging of our society, America will soon be confronted with an epidemic of age-related medical problems, the most devastating of which will be Alzheimer’s disease.