Alzheimer’s Disease and Pneumonia Essay
Ann is a seventy-seven-year-old grandmother. She has one daughter and three grandchildren. Two years ago, she was diagnosed with moderately advanced Alzheimer’s disease, which causes her to have periods of confusion, frustration, anger, and obsessive thinking. When speaking, she is uncertain and her speech patterns are choppy. Before her mental deterioration, Ann was a woman of love, intelligence, and patience. Realizing they were getting older, she and her husband, Frank, discussed their wishes should anything happen to them. She told Frank that if there was no chance of survival, she would not want to be hooked to a breathing machine. They never got around to filling any papers.Alzheimer’s Disease and Pneumonia Essay
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Frank is a sweet and sensitive man. His wife’s state frightens him. Ann’s love for him has been the focus of his life for sixty years. His urgent desire for the best care for Ann shows his devotion and love. Their daughter, Sarah, is a businesswoman. She is a hard worker and a good mother. She is forty-five, successful, and intelligent. Although she loves her parents dearly, she lives ten hours away. She regrets not seeing much of them, especially recently. Frank feels his role is to take care of Ann. He has spent the past year with her, watching after her, cooking for her, cleaning the home, and witnessing her deterioration. Finally, Ann is unable to walk alone safely and he finds he must have her admitted to a long-term care facility. He calls Sarah to come and help with the arrangements. After having Ann admitted to a local nursing home, both Frank and Sarah remember the pleading look in Ann’s eyes as they walk away.
After three weeks in the nursing home, Ann starts to cough and run a fever. She is seen by doctors and diagnosed as having pneumonia. She is transferred to a local hospital, where she is given intravenous antibiotics. Although the progress of her pneumonia is halted by the antibiotics, she stops talking and refuses to eat.Alzheimer’s Disease and Pneumonia Essay The physician calls Frank to insert a feeding tube. Frank calls Sarah to ask what to do. They wonder, Is a feeding tube equivalent to a breathing machine? Would it be possible to allow Ann to lie there and die of starvation? Is that murder? What would she want? What is the right thing to do? (Burkhardt & Nathaniel, 2008).
Up to 90 percent of people in the advanced stages of Alzheimer’s disease must be cared for in a nursing home at some point during their lives, and many of those are prone to serious infections like pneumonia. A new study in the Archives of Internal Medicine looked at the antibiotic treatment that Alzheimer’s patients with pneumonia received. Researchers found that while the drugs can prolong life, in many cases it could prolong suffering. YNNEX7XYHUJJ
The findings underline the importance of proper end-of-life care for people with Alzheimer’s, a disease that takes its toll not just on the brain but on the whole body. Indeed, Alzheimer’s is the seventh leading cause of death in the United States, accounting for nearly 75,000 deaths yearly and exceeding the deaths caused by diabetes or pneumonia and flu.
The researchers, from Rush Medical Center in Chicago, studied patients with advanced Alzheimer’s and other forms of dementia in 22 nursing homes in the Boston area. Over 40 percent of the patients had at least one bout of pneumonia during the 18-month study period. Antibiotics did prolong survival in patients with pneumonia. But overall, it did not make patients feel more comfortable, and in many cases increased discomfort.Alzheimer’s Disease and Pneumonia Essay
Antibiotics can cause well-known adverse effects like allergic reactions and severe digestive upset. But patients who received antibiotics also tended to suffer more pain, for a variety of reasons. In many cases, patients had to be transferred to hospitals for intensive treatment. There, antibiotics often had to be administered intravenously, leading to painful skin infections. The procedure might have to be repeated multiple times, as agitated patients tore drug lines out of their arms and the I.V. tubes had to put back in again and again.
In a commentary accompanying the study, Dr. Anna Chang and Dr. Louise Walter of the University of California, San Francisco, and the Veteran Affairs Medical Center in San Francisco note that patients and their families should carefully consider what it means “to treat pneumonia.” While most of us would not hesitate to pop an antibiotic if we got pneumonia, that may not be the best option for a frail and disoriented person in the final days of their life.
They call for greater awareness of all end-of-life issues for those with late-stage Alzheimer’s.Alzheimer’s Disease and Pneumonia Essay They note that nursing home staff are not adequately educated about the fatal course of Alzheimer’s, which is the seventh leading cause of death overall. In one study, for example, only 1 percent of nursing home staff believed that residents with advanced dementia had a life expectancy of less than six months, when more than 70 percent actually die within that time frame.
They further note that in many cases, patient and family wishes about end-of-life care is not well understood or followed by medical staff, aggressive treatments like tube feeding are overused, and medical problems like pain, bedsores and aspiration of food is not properly managed. Less than a third of nursing home residents who die of advanced dementia receive hospice care, which manages pain and usually makes patients more comfortable in their final months. Alzheimer’s Disease and Pneumonia Essay