Care for the Advanced Alzheimer's Disease

The Course of Alzheimer's Disease

Every person with Alzheimer's disease (AD) or a related disorder is unique. No one has the ability to predict which symptoms will occur or how rapidly the disease will progress with a particular individual. Even the most common symptoms vary in severity or may never appear at all.

What to Expect as the Disease Progresses

It is difficult to know when the disease has reached a terminal o. Pneumonia in the Elderly - A brief overview Betsy Finley, RN Pneumonia is a severe infection of the lungs. It may be caused by bacteria or a virus. Aspiration, the inhalation of food or fluids, can also cause pneumonia. This is often seen in ill persons or elders who have difficulty swallowing. Pneumonia is the fifth leading cause of death in persons weakened by age or chronic illness. These chronic illnesses may include, but are not limited to chronic lung disease [COPD], diabetes or end stage Alzheimer's Disease.

Symptoms

Younger people with pneumonia will display symptoms including cough, sputum [ or phlegm ] fever, chills, pain with breathing or obvious difficulty breathing. However, elderly persons may not always exhibit these classic symptoms. Some elders with pneumonia may not have any fever or chills and very little cough or sputum. Some may complain only of back pain. Often the elder will behave differently: they may seem weaker, disoriented or confused. This confusion is due to the infection causing a lack of adequate oxygen for the brain. The person with pneumonia may appear to have some increased difficulty breathing, that is breathing at a faster rate than usual. In all ages, when the chest is listened to with a stethoscope "crinkles" or "rattley" sounds may be heard. This is the sound of air moving through air ways or lung tissue that contain varying amounts of fluid. When no air movement or breath sounds are heard at all, the lung tissue may be completely filled with fluid.

Diagnosis

Pneumonia is usually diagnosed by a physical examination and additional testing which often includes blood work and a chest X- Ray. The blood test is looking for increased White Blood Cells, which are a sign of the body's attempt to fight infection. The Chest X- Ray is looking for signs of infiltrate or fluid in the lung tissue.

Treatment

The treatment of bacterial pneumonia includes the use of antibiotics to fight the cause of the infection. Viral pneumonia will not respond to antibiotics. However, viral pneumonia can lead to a secondary bacterial pneumonia which can be treated with antibiotics. Oxygen may be used for persons with severe difficulty breathing to make sure they are receiving adequate oxygen levels. Rest and fluids are important as well. Some people may take in adequate amounts of fluids by drinking. Others may need IV fluids if they are too weak to eat or drink adequate amounts. Recuperation from pneumonia may take several weeks. The person may feel very weak, tired and frustrated at their slow progress. Taking it easy will insure recuperation for most people. Persons with chronic illnesses may remain weakened after their bout with pneumonia.

The decision not to treat pneumonia

Some individuals who have lived with a chronic illness for many years, may opt not to have treatment for pneumonia, knowing full well it may end their lives. While some people are not comfortable with this decision, others are, and they may exercise this option when the time seems right. It is important to have this discussion with your family and your Doctor and to complete an Advance Directive to this effect. States vary in their laws so a discussion with your physician is imperative. As the infection progresses, the person becomes weaker and less responsive. Their ability to drink even small amounts decreases. Care givers provide comfort measures which may include medications for fever or pain; massage and support from loved ones.

Prevention

An annual flu vaccine is recommended for people over age 65 and those with chronic illnesses. The flu vaccine is based on a new batch of viruses every year and thus must be given annually. It is sometimes confused with the pneumovax vaccine. Pneumovax is given to prevent pneumococcal pneumonia. It is recommended for people over 50 or those with heart, lung or diabetes. In the past, one shot was felt to give adequate protection. Now it may be repeated after 5 years. Speak with your physician regarding these two helpful vaccinations. For those who are at risk for choking or aspirating food or fluids, a discussion with your Doctor may result in obtaining advice from a Speech Therapist or Dietitian. These professionals can assess and give advice regarding helpful preventive measures such as altering the texture or consistency of your food. Other basic, yet effective, approaches to prevent pneumonia include good handwashing to remove bacteria and viruses from the hands and avoiding being around those who are ill. Maintaining your health with good nutrition and exercise is also important.

Summary

Pneumonia remains a significant illness for elders and can be fatal in some individuals. It is important that all caregivers of elderly persons be aware of the potential causes and signs of this infection. When in doubt, ask your Doctor to examine the person to be certain this treatable illness is not overlooked.

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