Susan Scanland, MSN, CRNP, GNP-BC, CDP: The Challenges of Living at Home with Alzheimer Disease

There are several challenges patients suffering from Alzheimer disease must overcome, especially when living at home. Everyday tasks like driving, cooking, and just walking throughout the house can be difficult, if not impossible.

In an interview with MD Magazine® during the 2^nd Annual Advanced Practice Collaborative on September 7, Susan Scanland, MSN, CRNP, GNP-BC, CDP, a gerontology nurse practitioner at Dementia Connection, explained just how difficult it is for these patients.



MD Mag: What are the most effective ways of supporting care for people Alzheimer disease living at home?

Scanland: The most effective ways to help people at home is again education because when a person's living at home there are safety factors to consider. Things like driving for example, 1 should not be driving once there is a diagnosis even in the early stages. We used to think it was safe to drive in the early stages of Alzheimer's disease and other dementias, but now we're finding the availability is impaired and understanding what's on.

A sign the ability to read words is impaired and that certainly can interfere with driving. So, driving is 1, adverse drug reactions is another, so we want to highly educate and be sure there's a system in place for that person taking their medication to prevent accidental underdose or overdose because what happens then it precipitates problems with all the other chronic illnesses diabetes. They're dealing with blood thinners and you know if someone's not giving their medicine or supervising their medicine that could result in a problem.

MD Mag: What is needed to better serve this segment of the population?

Scanland: House calls would be wonderful. If there were enough resources for primary care providers to come in and do that prevention. You know someone's living alone there's the risk of dehydration, malnutrition. Often adult children are living far away and in that case I recommend them getting a case manager and there's a national association of case managers that can come in and be sure, almost like a coordinator for the care.

They can speak with a physician, they can help them find places for the next stage of their illness. For example, the progression from living alone, which are going to assisted living or living at home and getting increasing amounts of homecare because probably half of the people stay or even more than half stay at home to the edge of their illness. So, whatever direction they choose to go in making sure home is safe or assisted living if especially if the adult children are far away and not able to be directly supportive is very important.

So, safety issues you know getting the right care not being afraid to hire someone, an agency to come into your house as long as they've been checked and bonded and all that so many older people don't want anybody to come into their house and that leads to the person being at risk. The other thing we need to prevent is caregiver burnout and stress because often it falls on one person in the family and that person ends up trying to do everything and then often the caregivers get depression and they're sicker than the person with Alzheimer's. From a physical standpoint because they're not going for their own health maintenance of their own health screening so caregiver burnout is huge and that's something we want to prevent when the patient is at home.