Self Management of Chronic Disease: Alzheimer's Disease

173 Pages·2009·2.61 MB·English

by  Sabine Bährer-Kohler

Sabine Bährer-Kohler (Ed.)
Self Management of Chronic Disease
Alzheimer’s Disease
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Sabine Bährer-Kohler (Ed.)
Self Management
of Chronic Disease
Alzheimer’s Disease
With 13 Figures and 13 Tables
123
Dr. Sabine Bährer-Kohler
Postfach 3244, 4002 Basel
SWITZERLAND
ISBN 978-3-642-00325-7 Springer Medizin Verlag Heidelberg
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V
Preface
This book will support an issue as important as self-management of chronic diseases, espe-
cially AD, in finding its way into the daily life of patients and their caregivers as well as into
treatment worldwide. It is written for healthcare professionals, aging researchers/scientists,
patients with Alzheimer’s disease and their caregivers, managers of eldercare facilities, public
health authorities, umbrella organisations of Alzheimer associations, Alzheimer associations,
health care administrators, health economists and government officials.
It is my pleasant duty to thank Merz Pharma (Schweiz) AG in Allschwil-Switzerland to
purchase 40 copies of the book.
To finish this book, a long and sometimes arduous path had to be traveled. Now that it
is over, I feel profoundly thankful towards all authors for participating in this project, par-
ticularly Eva Krebs-Roubicek, MD for her contribution, the three models on the cover of
this book; and especially to Julie and Jean-Luc for their great understanding and loving as-
sistance.
Sabine Bährer-Kohler, Editor of the book
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VII
Foreword
Alzheimer’s disease is one of those diseases which is steadily increasing worldwide. Treating
Alzheimer’s disease is able to modify its course but does not yet cure it. Alzheimer’s disease is
an enormous challenge not only for the afflicted person but also for the relatives.
Many publications over recent years have described various topics related to Alzheimer’s
disease and means of coping with the condition. Coping concerns the way of dealing with the
disease by relatives as well as by the afflicted person. Coping strategies can be considered as a
part of self-management, as understood by the authors and editor of this book.
The topic of self-management has been described and introduced to the public by several
authors in many different countries, for example by Prof. Lorig and her co-workers in the con-
text of chronic diseases. In some of these publications training courses for self-management
of chronic disease are described, as they are offered by different institutions. Only seldom
these publications address Alzheimer’s disease. This lack might be due to different reasons,
for instance, directly related to the disease itself, as a consequence of cognitive decline. An-
other reason could be the doubt that a demented person could manage the disease, and if so,
for how long and in which form? It is also questionable whether a relative can take over the
role of an expert during the course of Alzheimer’s disease.
The aim of self-management in chronic disease is to improve coping mechanisms. It con-
cerns self-determination as well as acceptance byythe environment, and includes all questions,
problems and active adaptation to changing needs. It means also that during this difficult
phase of life one should not just let go, but actively and endurably pursue own interests, man-
age the activities of daily life and the emergency situations.
Prof. Lorig has clearly documented that a chronic disease is manageable. Training courses
concerning self-management in chronic disease can help towards this aim, to cope in a struc-
tured and informed way.
This book contains articles describing the work of authors from different professional
backgrounds and different countries. The book begins with basic information about self-
management, ageing and dementia. Further chapters are concerned with aspects of working
with relatives and other caregivers in their care for demented persons. The authors discuss
background thoughts as well as end-of-life care. They focus on worldwide used training pro-
grams for chronic disease in general, and particular self-management programs for patients
suffering from the Alzheimer’s disease and their relatives. The book does not avoid another
important aspect, the economic situation and applicability of the presented programs. Imple-
mentation of such programs will be only possible, if aspects of efficacy and of economic ef-
ficiency are considered.
One can only wish that the topic of self-management, with the help of this book, will find
its way into day-to-day clinical practice of caring for patients suffering from Alzheimer’s dis-
ease and their relatives.
Prof. Dr. Franz Müller-Spahn
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IX
Table of Content
1 Chronic Disease and Self-Management Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
– Aspects of Cost Efficiency and Current Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
Sabine Bährer-Kohler, Eva Krebs-Roubicek References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 3.2 Dementia. State of the Art – Cognitive,
Chronic Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Behavioural and Psychopathological
Chronic Disease Worldwide . . . . . . . . . . . . . . . . . . . . .2 Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Main Features of the Dementia Syndrome . . . . .34
Cardiovascular Disease . . . . . . . . . . . . . . . . . . . . . . . . .5 Common Cognitive Symptoms . . . . . . . . . . . . . . . .35
Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Impairment in Intellectual Functioning and
Alzheimer’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Disturbances in Executive Functioning . . . . . . . . .37
Self-Management of Chronic Disease . . . . . . . . . . .5 Physical and Neurologic Problems Related
Aspects of New Approaches Towards with Behavior in Dementia . . . . . . . . . . . . . . . . . . . .38
Self-Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Behavioral and Psychopathologic Symptoms
Benefits of Self-Management . . . . . . . . . . . . . . . . . . .8 of Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Cost of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
Current Legislation and Policies . . . . . . . . . . . . . . . .10
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 4 Alzheimer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Jerzy Leszek, Andrzej Kiejna,
Ulrich Michael Hemmeter, Ulrich Kropiunigg
2 Aspects of Aging . . . . . . . . . . . . . . . . . . . . . . . . .15 4.1 Alzheimer’s Disease – A Global Disease
Nicoleta Tătaru, Urs Kalbermatten Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
2.1 General Aspects . . . . . . . . . . . . . . . . . . . . . . . . .16 History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Alzheimer’s Disease (AD) . . . . . . . . . . . . . . . . . . . . . .44
Normal, Active and Successful Aging . . . . . . . . . .16 Expected Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
Morbid Aging and Mental Health . . . . . . . . . . . . . .17 Socioeconomic Factors . . . . . . . . . . . . . . . . . . . . . . . .45
Ageism, Elder Abuse and Stigma . . . . . . . . . . . . . .18 Epidemiology of Dementia in Poland . . . . . . . . . .46
Mature Mind and an Optimistic View References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46
of Aging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 4.2 S tate of the Art – Treatment of
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 Cognitive, Behavioral and Psycho-
2.2 Consequences for Dementia . . . . . . . . . . . . .20 pathological Symptoms of Alzheimer’s
Defining Old Age as a Phase of Life . . . . . . . . . . . .20 Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Life Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Pharmacotherapy of Alzheimer’s Disease . . . . . .48
Action Theory and Self-Organization . . . . . . . . . . .22 Nonpharmacological Therapy . . . . . . . . . . . . . . . . .53
Interaction and Dementia . . . . . . . . . . . . . . . . . . . . .23 Interventions for Behavioral and Psychological
A Wide View in Analysis and Promotion . . . . . . . .26 Symptoms (BPSD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
3 Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 4.3 An Alternative Description:
Ilkin Icelli, Ignat Petrov Alzheimer’s Disease as a Biographical
3.1 Mild Cognitive Impairment . . . . . . . . . . . . . . .30 Phenomenon . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
Historical Background and Definition . . . . . . . . . .30 The Medium is the Message . . . . . . . . . . . . . . . . . . .57
Causes and Risk Factors . . . . . . . . . . . . . . . . . . . . . . .30 Unintended Disclosures . . . . . . . . . . . . . . . . . . . . . . .58
Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Compensation and the Fragile Self . . . . . . . . . . . .60
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65