Interventions for Alzheimer's disease: A caregiver's complete reference
Ruth M. Tappen 1997, Health Professions Press, 239 pages, softcover, $35
One third of the United States workforce has some type of caregiving responsibility—6 million of them care for people who have a diagnosis of Alzheimer disease (AD). More than half of nursing home residents have a dementia-related diagnosis. Whether asked for advice by neighbors or coworkers or working in occupational health, acute, or long-term care settings, nurses need up-to-date information on dementia and its management, and any of these books will meet that need. Each of the authors stresses the importance of adequate testing to rule out other, possibly reversible causes of dementia rather than tossing all cognitive disorders into the wastebasket labeled AD.
Una Holden, author of Aging, Neuropsychology and the “New” Dementias: Definitions, Explanations, and Practical Approaches, is a consultant clinical psychologist in the United Kingdom. Information most nurses will find new is her description of cortical and subcortical encephalopathies, the former further divided into a comparison between frontal lobe dementia and AD, plus a description of slowly progressive aphasia and Balint's syndrome. Subcortical conditions described with brief case studies include progressive supranuclear palsy as well as that caused by acquired immunodeficiency syndrome. The section on cortical and subcortical encephalopathies includes some rare types, as well as the more common Lewy body dementia and prion disease in both animals and humans, with a discussion and diagram of prions and their action. Although these various categories are interesting and well described, they may not be essential knowledge for most nurses. That said, this book and the next two would be excellent reference books for the library of a school of nursing or for those who do staff development or consultation in long-term care or rehabilitation facilities.
More helpful is Holden's section on head injury and older people. Effects, complications, assessment procedures, recovery process, and two case reports precede suggestions for rehabilitation of elders with head injuries with specific and detailed instructions. The chapter on management, rehabilitation, and retraining would be easy to follow in setting up or improving an existing program and contains references that appear to supply additional useful information.
James Soukup is a licensed clinical psychologist in private practice. His book, Alzheimer's Disease: A Guide to Diagnosis, Treatment, and Management , is dedicated to his mother who died of AD and his father who cared for her with love and compassion for the last 7 years of her life. He writes with the depth and understanding of a family insider and caring clinician. Although two other books of his have been published, some of his writing is choppy and passive, and the transition from one topic to another is sometimes unclear. However, some chapters—such as that on advice for family members, in which he lists the steps to take when confronted with the diagnosis of possible AD—are written so clearly and with such compassion that the reader can imagine him sitting nearby, a box of tissues within reach.
Especially clear is his message, repeated from several aspects, that an accurate diagnosis is extremely important. He gives many case studies in which a too-brief diagnostic process erroneously concluded that AD was present, that describe the process followed to determine the real cause of the cognitive problems, and that detail how those problems were successfully managed. He also carefully explains the steps he goes through to accurately diagnose AD or other specific causes of dementia. He clearly describes what each medical and psychological test reveals, and in the final part of the book he covers the concurrent emotional and mental disorders common in the elderly.
The only errors or omissions relate to incontinence and Medicare coverage. He twice mentions that incontinence may be a problem but fails to say that incontinent people often can be helped to regain control in all but the later stages of dementia and that incontinence is found in one third of the community-dwelling population older than 60 years, regardless of mental status. He also states that Medicare will pay for respite benefits. That is true only under hospice care benefits in the terminal phase of dementia, which is difficult to establish in practice.
Dippel, a clinical and life-span developmental psychologist, and Hutton, a medical doctor directing a neurology research center in Texas, edited Caring for the Alzheimer Patient: A Practical Guide . The book is well written and organized, with the text flowing easily and understandably. Especially helpful are the chapters on techniques for enhancing memory, orientation, and communication in the Alzheimer's patient, on the behavioral management of secondary symptoms, and on creating optimal living environments. The latter chapter describes how to modify the home or nursing home to make it less confusing to someone with dementia.
A chapter on different types of long-term memory—episodic (or event), semantic, and implicit (or procedural)—and how people use them clarifies the difference between the memory problems of someone with AD and those that accompany normal aging. Episodic memory causes a qualitative decline in the former and a quantitative decline in the latter. Semantic memory declines in those with AD but not in healthy older people. Implicit memory is fairly stable in both.
Other chapters explain how caregivers can access an assortment of information resources ranging from the Internet sources to those commonly found in communities. The chapter on legal considerations gives such practical tips as finding an insurance agent familiar with AD to make sure policies cover damages that might be caused by someone with that condition. The chapter on the real or illusory aspect of medical breakthroughs explains in layperson's terms why media claims based on preliminary research results usually fall short. Fifteen of the 17 chapters in the book were revised for this third edition, with some statistics as recent as its copyright date and others out of date (eg, the cost of nursing home care estimated at $1,500 per month).
If the budget will permit the purchase of only one book, Tappen's Interventions for Alzheimer's Disease: A Caregiver's Complete Reference should be chosen. She is a fellow in the American Academy of Nursing, and much of her work has focused on the care of older adults, particularly those with long-term chronic conditions such as AD and related dementias. Hers is the only book that addresses the impact of incontinence and gives brief descriptions of how to manage it in two chapters written from different perspectives.
Her “pathophys” description of dementia is too detailed to sustain interest and did not contain as much unique information as Holden's description of the cortical and subcortical encephalopathies or such potentially useful information as Dippel and Hutton's types of memory and how they are affected by AD. However, the clarity of Tappen's diagrams and use of several easily understood theoretical frameworks to facilitate dementia management more than compensate. The other books contained no theoretical frameworks as nurses know and use them.
Tappen's book contains many tools, lists, and questionnaires. The chapter on rehabilitation in activities of daily living has a series of related assessment scales, formatted such that they could be copied and used as is. She discusses the increased risk of falling and the use and misuse of chemical and physical restraints. Among her psychotherapeutic strategies are suggestions for support groups for those in the early stages of dementia, with case descriptions of disruptive behavior and what was done to determine the cause as well as correct the problem. Her chapters on cognitive retraining and therapeutic recreation are unique and information on pharmacological intervention more complete than that of the previous writers. Tappen's description of the diagnostic tests used by medical doctors and what they reveal is more up to date than the other books. She also gives food for the spirit: Chapters begin with poignant quotations, some of which come from AD patients, including an especially touching one, “Life was simpler…before I lost all the instructions.”
AUDREY COCHRAN, MSN, RN, CS, is in private practice and consults on family elder care and gerontology. MARIANNE LaPORTE MATZO, PhD, APRN, BC, FAAN, is the GN book section editor.
Copyright © 2003 by Mosby, Inc
0197-4572/2003/$30.00 + 0
Marianne Laporte Matzo. PhD, APRN, BC, FAAN,
Book Section Editor
FULL TEXT