Writing articles for this web site has made us acutely aware of the needs of the elderly in our society. As the baby boomers mature and reach their senior years, the system of health delivery is going to be greatly taxed and will endeavor to come up with "creative " methods to meet the demands. There is no doubt that new technology and medications will aid in enhancing the services given to the elderly. But will the stigma of old age be erased and will the aged bear the scrutiny of budget analysts and related policy makers? With this in mind, we would suggest that our readers make themselves more familiar with ethical principles that do not consign individuals to a "natural" process that is inevitable and unchangeable.

Along these lines, we recommend reading the Benbow and Reynolds article in Hospital Medium, March 2000, 61(3): 174-177 entitled "Challenging the Stigma of Alzheimer’s Disease." This is a philosophical paper stressing a humanistic approach to treatment of Alzheimer’s disease.

In discussing aging, they point up "the stigma of old age is such that memory problems may be assigned to dementia without investigation, as if dementia is a natural component of the aging process." Their core point is that health-care professionals need to tailor their level of care to the individual, not assuming that things are unchangeable. Treating personnel need to "determine changes in function [that] can be identified, rather than inevitable deterioration being assumed, assessment must involve obtaining information about the person’s function before and during their hospital admission." They stress this concept time after time: "If health-care professionals attempt to be sensitive to their own prejudices and those of others, they will be open to other ways of understanding the "problem" of Alzheimer’s disease, which do not seem then as part of an inevitable decline…and not assume that people with a diagnosis of AD lack the capacity to make any decisions.".

They cite, from Post’s book entitled The Moral Challenge of Alzheimer’s Disease (John’s Hopkins University Press), six principles of ethical care of people with Alzheimer’s disease that we think is worth repeating:

1. Something can be done with people with AD.
2. Many factors cause excess disability among individuals with AD. Identifying and changing these factors will reduce excess disability and improve the person’s function and quality of life.
3. People with AD have residual strengths. Building on these strengths will improve the individual's function and quality of life.
4. People with AD express understandable feelings and needs through their behavior and responding to those feelings and their needs will reduce behavior problems.
5. Aspects of social and physical environment affect function of people with AD. Appropriate environments will improve an individual’s function and quality of life.
6. Addressing the needs of individuals with AD and the needs of their families and involving families in the care of individuals with AD, will benefit all concerned.

Finally, Benbow and Reynolds suggest the following "actions points" for treating health-care professionals.

• Diagnose and treat medical/surgical conditions
• Establish an accurate diagnosis of a dementia
• Establish a functional baseline. (They note that in a hospital individuals tend to function below their baselines "because of the different environment and change in their routine.")
• Involve the individual and respect their wishes.
• Involve the family and respect their wishes
• Changing attitudes/challenge negative views.

Many of us may someday be in the position of being diagnosed with a dementia. We would want to be treated with dignity and respect. It is up to us to set an atmosphere that is reasonable and applicable to the needs of those with dementia by making sure ethical principles and action points like those cited above are part of permanent treatment protocols.

References:

Benbow, Susan M. & Reynolds, David. Challenging the stigma of Alzheimer’s disease. Hospital Medium 2000;61(3):174-177

Post SG (1995) The Moral Challenge of Alzheimer’s Disease. The John’s Hopkins University Press: Baltimore and London.

 FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "HOW TO SELECT A NURSING HOME"

By Harold Rubin, MS, ABD, CRC, Guest Lecturer
March 21, 2000
http://www.therubins.com

email: hrubin12@nyc.rr.com or rubin@brainlink.com

See: Alzheimer's Disease Part I-Medications for Alzheimer's.
See: Alzheimer’s Disease Part II- Selegiline and AD.
See: Alzheimer's Disease Part III- Use of Gingko Biloba in memory problems of Alzheimer patients.
See: Alzheimer's Disease PartIV-Alternative Treatment.
See: Alzheimer's Disease Part V-Possible New Drugs for Alzheimer's Disease Treatment.
See: Alzheimer's Part VI -Early Diagnosis.
See: Alzheimer's Part VII -New Medication-Metrifonate
See: Alzheimer's Part VIII-Implications of Longer Life Expectancies
See: Alzheimer's Disease Part X-Estrogen and Alzheimer's Disease
See: Alzheimer's Disease Part XI-Pocket Smell Test (PST)
See: Alzheimer's Disease Part XII-MAO-B
See: Alzheimer's Disease Part XIII-Critical Flicker Fusion Threshold Test
See: Alzheimer's Disease Part XIV-Donepezil
See: Alzheimer's Disease Part XV-Cerebrolysin
See: Alzheimer's Disease Part XVI-MCI
See: Alzheimer's Disease Part XVII-Summary
See: Alzheimer's Disease Part XVIII-NO Releasing NSAIDs
See: Alzheimer's Disease Part XIX-Vitamin E
See: Alzheimer's Disease-Part XX-Clinical Trials
See: Alzheimer's Disease Part XXI-The Brain
See Dementia with Lewy Bodies- Part XXII-by Gourete Broderick
See: Alzheimer's Disease-Part XXIII-HMG
See: Alzheimer's Disease-Part XXIV-A Prequel
See: Alzheimer's Disease-Part XXV-Psychosis
See: Alzheimer's Disease-Part XXVI-Amyloid-beta Hypothesis Controversy
See: Alzheimer's Disease-Part XXVII- AD and Diabetes
See: Alzhemeir's Disease-Part XXVIII - Insulin and AD

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