NRNP Week 9: Prescribing for Older Adults and Pregnant Women

Alzheimer in Older Adults Comprehensive Nursing Essay Example

Alzheimer’s disease (AD) progresses slowly, affecting thinking and memory patterns to a point where patients struggle with activities of daily living and other basic tasks. Most people with AD develop symptoms later in their life. Approximately 6 million individuals in the US have AD and most are 65 years and over, although estimates vary. Alzheimer’s is a significant cause of death in the US, currently ranking at number 7, and also the most frequent contributor to dementia in older persons (National Institute on Aging, 2023). Even so, the reasons behind Alzheimer’s disease in most people remain unknown to scientists. Older age is linked to brain alteration, which in addition to genetic factors, the surrounding environment, and lifestyle factors, are linked to AD development. However, the level of risk of developing AD a person is exposed to due to these factors varies based on individual characteristics. (Alzheimer in Older Adults Comprehensive Nursing Essay Example)

Risk Assessment for AD Treatment

AD has no cure, but specific medications and therapies can manage symptoms and slow down the progression of the disease. However, different people react differently to these medications and therapies, stressing the importance of conducting a risk assessment to ensure a medication has optimal health outcomes. For the risk assessment, it is essential to consider the type of Alzheimer’s disease and whether the medication is suitable for this type. It is also vital to consider the likelihood of side effects and ensure the benefits outweigh the risks. The practitioner should also determine or inquire about any other health condition or current treatment to determine the potential for drug interactions, which can be detrimental to the patient.(Alzheimer in Older Adults Comprehensive Nursing Essay Example)

FDA-Approved Drug for Alzheimer’s Disease

The only medication that the FDA has licensed to treat moderate to severe AD-associated symptoms is memantine (Namenda). Memantine functions by lowering the brain’s concentration of the neurotransmitter glutamate (McShane et al., 2019). It can be used with a cholinesterase inhibitor or without one. Memantine may cause headaches and dizziness as side effects. Other side effects might include constipation and shortness of breath. Patients should be monitored for agitation and other CNS events.(Alzheimer in Older Adults Comprehensive Nursing Essay Example)

Off-label Medication for Alzheimer’s Disease

Combining quetiapine and sodium valproate is a more efficient and appropriate treatment for AD. Few evidence sources are available regarding the effectiveness of this combination. However, in a study conducted to assess the effectiveness of this combination, the experimental group’s mental behavior dropped from 8.2 prior medication therapy to 0.5, whereas the control group’s reduced from 7.1 prior medication therapy to 2.6 (Zhang et al., 2022). It is evident that the experimental group’s scores changed following their administration of sodium valproate and quetiapine, suggesting that the combination was effective. However, quetiapine can lead to thinking disorientation, drowsiness, struggling to control body movements, or vision impairment, which may contribute to falls, fractures, and other injuries.  (Alzheimer in Older Adults Comprehensive Nursing Essay Example)

Psychotherapy

Cognitive stimulation therapy (CST) is used to address AD. CST is a short group treatment founded on the theoretical ideas of reality orientation and cognitive stimulation for those with reporting mild or moderate Alzheimer’s disease (Gonzalez-Moreno et al., 2022). It takes seven weeks and fourteen sessions of themed activities, usually held twice a week. When comparing CST to no treatment, there were significant improvements in participant-rated quality of life and cognition in a multicenter randomized controlled experiment. These improvements in cognitive function were on par with those obtained from medicine, and CST turned out to be affordable.(Alzheimer in Older Adults Comprehensive Nursing Essay Example)

Clinical Practice Guidelines for AD Treatment 

Clinical practice guidelines for treating AD exist. The National Institute of Clinical Excellence’s (NICE) most recent guidelines exclusively suggested cognitive stimulation as a treatment for AD-associated dementia’s cognitive symptoms (NICE, 2019). Per the NICE, the CST has proven effective in enhancing memory, confidence, and self-esteem. (Alzheimer in Older Adults Comprehensive Nursing Essay Example)

References

Gonzalez-Moreno, J., Satorres, E., Soria-Urios, G., & Meléndez, J. C. (2022). Cognitive Stimulation in Moderate Alzheimer’s Disease. Journal of applied gerontology : the official journal of the Southern Gerontological Society, 41(8), 1934–1941. https://doi.org/10.1177/07334648221089283(Alzheimer in Older Adults Comprehensive Nursing Essay Example)

McShane, R., Westby, M. J., Roberts, E., Minakaran, N., Schneider, L., Farrimond, L. E., Maayan, N., Ware, J., & Debarros, J. (2019). Memantine for dementia. The Cochrane database of systematic reviews, 3(3), CD003154. https://doi.org/10.1002/14651858.CD003154.pub6(Alzheimer in Older Adults Comprehensive Nursing Essay Example)

National Institute on Aging. (2023, April 5). Alzheimer’s Disease Fact Sheet. National Institute on Aging. https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet(Alzheimer in Older Adults Comprehensive Nursing Essay Example)

NICE. (2019). Running Cognitive Stimulation Therapy (CST) Groups as Part of Core Community Mental Health Team (CMHT) Work. NICE. https://www.nice.org.uk/sharedlearning/running-cognitive-stimulation-therapy-cst-groups-as-part-of-core-community-mental-health-team-cmht-work(Alzheimer in Older Adults Comprehensive Nursing Essay Example)

Zhang, Z., Xu, J., Xu, P., Liu, W., He, X., & Fu, K. (2022). Quetiapine Combined with Sodium Valproate in Patients with Alzheimer’s Disease with Mental and Behavioral Symptoms Efficacy Observation. Journal of healthcare engineering, 2022, 1278092. https://doi.org/10.1155/2022/1278092 (Retraction published J Healthc Eng. 2023 Oct 4;2023:9860560)(Alzheimer in Older Adults Comprehensive Nursing Essay Example)

https://www.ncbi.nlm.nih.gov/