The DFW Hospital Council is posting blogs submitted by our Associate Members. The following was provided by the Alzheimer’s Association. For guidelines, please contact Chris Wilson at firstname.lastname@example.org.
By Dr. Stephanie Woods, Texas Woman’s University, Conclusions drawn from Community Conversations (2017)
The Community Conversations Health Care Series on Alzheimer’s Disease is a community stakeholder driven initiative designed to promote collaborative, solution minded dialogue. Created by Eli Lilly and sponsored by the Alzheimer’s Association Greater Dallas Chapter and Texas Woman’s University, community leaders representing the diverse constituency and unique organizational landscape of Dallas convene on the topic of current healthcare practices for individuals with Alzheimer’s disease, the limitations of those practices and solutions for connecting clients with resources.
The ultimate goal of this intellectual collaboration is the advancement of timely detection and diagnosis of Alzheimer’s disease in order to improve the care coordination for these individuals and their care partners.
I am an experienced nurse and nursing educator. Dementia has been a common challenge for nurses, but it has been largely accepted as inevitable and often unmanageable. Representing Texas Woman’s University in these Community Conversations about Alzheimer’s has completely changed my perspective.
During my education, there was little covered on dementia. It was a foregone conclusion that old people get confused. I can remember pleasantly confused patients, one in particular who was still able to call square dances but couldn’t remember his wife. I had one elderly male who was convinced there were kittens under his bed. I concocted a great plan. I went to get a broom from the housekeeping closet and made great show of sweeping out those kittens. The patient seemingly bought my ruse, and asked how many were there. I told him there were 3! Nope he replied, there were 4. Note to self, don’t enter into other’s delusions!
Alzheimer’s frightens us. We debate with our friends what is better to have a sound body or a sound mind, as if we can actually choose the outcome. Fear only motivates us temporarily. My specialty is cardiac nursing. I cannot tell you how many patients I have cared for who when faced with cardiac surgery will commit to a healthy diet and frequent exercise. However, after they live through the surgery the fear abates, their wives tire of trying to get them to do the right thing, and life returns to pre-surgery habits.
This is not about fear. It is about knowledge, accessing best in class care and support. It is about creating a safety net for those facing dementia, whether due to Alzheimer’s or other causes through community collaboration.
Sadly, our education has not prepared current practitioners or future caregivers to effectively manage the patient with dementia. While I am an academic administrator for nursing, I am not just concerned with the ability of nurses to treat dementia patients. Patient care is a team sport. There are many disciplines on the team.
Community Conversations in Dallas has shown a bright light on the numerous resources available in our area. It has also helped us to pinpoint the interventions that can make the greatest difference. We are failing miserably in areas of early diagnosis. It begins with all healthcare practitioners doing the Mini-Cog assessment during patient’s annual visit. Mini-Cog stands for the mini-cognition test. It is a simple but effective tool to assess dementia and can be administered by anyone trained to do so. Once cognitive impairment is identified, getting that patient to caregivers who are expert in this area is imperative.
It is my commitment to help the nursing students at Texas Woman’s University understand how to assess and manage patients with dementia. TWU also trains nurse practitioners, and they are pivotal in creating a safety net for patients with dementia. The curriculum for both new nurses and for nurse practitioners must focus on early diagnosis. Understanding the pathology of Alzheimer’s is also key. All nurses do history and physical assessments of their patients, but other key diagnostics including neuroimaging must be covered.
The most powerful role a nurse can play is that of advocate for the patient and family. When dementia is being assumed as a natural part of aging, when testing is not being done, the nurse can emerge as a partner to the patient and family, initiating conversations with their physician peers. A nurse or nurse practitioner can advocate for consultations, more effective drug regimens and point the family to available resources.
If you hear nothing else in my remarks, please hear this. Undiagnosed dementia is not being kind, or sensitive, or supportive. Hiding your own symptoms, or hiding those of someone you love is putting you and others into danger. A person with undiagnosed dementia is not safe.
During this series, I learned an astounding fact. In one scientific study, dementia is the best predictor that a patient with heart failure will be admitted to the hospital. The best predictor! Higher in predictive ability than your weight, your oxygenation or even fatigue. A person with dementia cannot effectively take their medications, understand their disease, or manage their health. They may not be safe drivers and they can jeopardize their own financial futures through poor decisions.
Technology also plays a huge role in the care of patients with dementia. At TWU we are training nurses how to use telehealth. Telehealth uses your phone, your tablet or computer to allow access to healthcare. The challenges of getting a person with dementia to their healthcare provider can be overwhelming, particularly if the caregiver is elderly. But imagine being able to see your nurse practitioner from the comfort of your favorite chair. Imagine a time where a rural resident can go to their local clinic and be seen by an expert physician in Dallas without ever getting onto a major highway.
For the citizens of Dallas, the resources are absolutely astounding. But if no one helps the patient and family access these resources, what is the benefit? We cannot be well-meaning people doing amazing work, unaware of other well-meaning people doing the same work. It takes a community. The challenge of dementia is great but our greatest opportunities lie in accessing care from experts. Prevention and early assessment are key, care overseen by experts will ensure best outcomes and support of caregivers must be relevant to their needs. Be part of the solution.
Join our next Community Conversation Checkup. For information, contact the Alzheimer’s Association at 1-800-272-3900 or www.alz.org/greaterdallas.