Tips for managing patients with Alzheimer's disease.

Patients suffering from Alzheimer's disease or related disorders (ADRD) can be treated effectively in the dental practice, according to an article in Inscriptions--Journal of the Arizona Dental Association. The article by Daniel L. Hall, DDS, MS, and Geri Richards Hall, PhD, ARNP, CNS, outlines some basic strategies to provide oral care and help maintain patient weight and swallowing function in patients with dementia.

The authors say that early symptoms of ADRD include problems with short-term memory, time-related concepts, judgment, reasoning ability, abstract thought, reading comprehension, and spoken language comprehension. As the disease progresses, functional decline worsens, increasing dependence on dental professionals.

Treatment programs need to take into account the patient's diminished capacity for self-care over time, the need to maintain nutrition, infection prevention, and the need to maintain patient comfort, the authors note. They suggest that all instructions and teachings be given to a caregiver as well as the patient. They recommend that, while providing dental care, the dental professional approach the patient from the side, as a frontal approach can frighten the patient. Oral care should be provided while the patient is seated in a recliner and the caregiver is seated alongside.

Tips for the Appointment

* Request that the patient bring a caregiver to help him or her.

* Keep the appointments short--no more than 45 minutes.

* Schedule the appointment during the patient's best times, usually mornings.

* Remind the patient of the appointment 24-48 hours ahead of time.

* Keep in mind that patients with ADRD generally report being able to give more self-care than they really can.

* Take extra precautions recommending medications as the ability to take medications appropriately is one of the first losses experienced in ADRD.

* Make sure the patient empties the bladder before treatment.

* Have the caregiver stay with the patient unless the caregiver becomes overly nervous.

* Provide treatment with as much quiet and privacy as possible.

* Provide follow-up care instruction to both the caregiver and the patient. In addition, provide written instructions for caregivers who often become so stressed during appointments they forget teachings.

Tips for Treatment

* Avoid treatment plans requiring expensive labor or postprocedural care.

* Plan multiple short appointments as opposed to few long appointments.

* Avoid treatments that complicate home care for the patient or caregiver.

* Use local anesthetics with the shortest possible duration.

* Avoid long explanations of the treatment, since patients cannot retain the information and it will add to their anxiety.

* Explain the treatment and post-treatment instructions thoroughly to the caregiver.

* Follow up with the caregiver regarding pain or discomfort, increased confusion or agitation after the visit. Reinforce any directions for care given during the visit.

Where Caregivers Can Turn for Help

According to the American Health Association Foundation, over 70% of America's four million Alzheimer's patients are cared for in the home. Many caregivers live under the same roof with the patient but others have the added challenge of trying to manage care from afar.

There are sources of help for caregivers, but those resources are fragmented. Navigating the maze of services can be a formidable job. The following are some resources that can help caregivers find help in their own community or answer crucial questions about managing their loved one's affairs. Much of this information is free.

Alzheimer's Disease Education and Referral Center (ADEAR)

1-800-438-4380

www.alzheimers.org

Founded as a part of the National Institutes of Health, the ADEAR Center offers up-to-date information about Alzheimer's disease for patients, caregivers and professionals. The center has a large national database and can put one in touch with state, regional and federally funded services available in the community.

American Association of Retired Persons (AARP)

202-434-2277

This nonprofit membership organization is an excellent source of information on long-term care options, caregiving, legal and financial planning, Medicare and Medicaid, and legislative issues affecting the elderly.

American Health Assistance Foundation (AHAF)

1-800-437-2423

www.ahaf.org

A nonprofit organization that funds major research, AHAF also offers a variety of published materials about Alzheimer's disease for patients and caregivers. Publications are aimed at assisting the whole family, including children, in coping with Alzheimer's disease. The foundation also provides cash grants of up to $500 to caregivers in need through its Alzheimer's Family Relief Program.

Area Agencies on Aging

Check your phone book under "Aging" in the State Government pages

Each state has an Agency on Aging office located in its capital city. The state agency will refer callers to one of its Area Agency on Aging offices in their community. They can make referrals for a wide range of services, including home meal delivery, home health workers, transportation services and caregiver sup-port groups.

Eldercare Locator

1-800-677-1116

www.aoa.dhhs.gov

This national organization, provided by the U.S. Dept. of Health and Human Services, offers information and referrals for a wide variety of services for older people in their communities. These include adult day care, respite for caregivers, transportation, home health care, meals on wheels, assistance with housing and other services available locally

Medicare General Information Hotline

1-800-MEDICARE

www.medicare.gov

Tracking an older patient's medical bills and insurance payments can be a nightmare. Medicare operates this toll-free hotline to answer questions about coverage and to get information about a patient's claims.

Social Security Information Hotline

1-800-772-1213

www.socialsecurity.gov

If you have questions about Social Security payments or eligibility, this hotline will direct you to the proper office or department.

While no amount of assistance can ease the grief of watching a loved one slowly deteriorate from Alzheimer's disease, knowing where to turn for help can ease some of the stress. For more information about Alzheimer's disease and how to cope with it, call the Alzheimer's Family Relief Program, a program of the American Health Assistance Foundation at 1-800-437-2423 or write to them at 15825 Shady Grove Rd., #140, Rockville, MD 20850.

TAKE GOOD CARE OF YOURSELF

So far, no one has found a magic bullet to stop the disease process once it has begun, nor can it be prevented altogether. But in recent years, according to the AHAF, scientists have found ways to delay the onset and slow its course ... perhaps for as long as five years. The risk of developing Alzheimer's rises as we age with 10% of Americans over the age of 65 having the disease. After 85, the incidence is almost 85%.

Alzheimer's Disease Research, a research foundation headquartered in Clarksburg, MD, makes the following recommendations:

* Control your blood pressure. If your systolic pressure is 130 or higher, limit salt intake and take any blood pressure lowering medication your doctor prescribes.

* Maintain a low blood cholesterol level. High cholesterol levels also contribute to the risk of stroke-related dementia. Taking a cholesterol lowering "statin" drug is also associated with a lower risk of Alzheimer's.

* If possible, take an anti-inflammatory drug daily. Nonsteroidal anti-inflammatory drugs such as ibuprofen and sulindac or prescription arthritis drugs such as indomethacin have been shown to delay the onset. Because some can cause gastrointestinal problems they are not right for everyone and you should always check with your physician before beginning a daily regimen.

* Get your antioxidant vitamins. There is now a significant body of research suggesting that the antioxidant vitamins ... (particularly E and C) can prevent or delay the development of Alzheimer's. Some scientists recommend 400 International Units of Vitamin E and 500 mgs of C a day for prevention. If you're having memory problems take the same dosages twice a day and if Alzheimer's has already been diagnosed, up your dosage to three times per day.

* Take a cholinesterase inhibitor if you have memory problems. This is a prescription drug that includes all four of the drugs approved by the FDA for Alzheimer's. They increase the brain's supply of neurotransmitters, called cholinesterase, and are known to slow the course of the disease.