Case workers who specialize in elder care are beset with the challenges of caring for a growing number of Alzheimer's and dementia patients. The CDC estimates that the number of people living with Alzheimer’s will nearly triple by 2060 to more than 14 million.
Diagnosis
- In a recent study conducted on over 5,000 elderly living in the suburbs of London, over one-half (54%, 2,718) had been diagnosed with Alzheimer’s disease, which is caused by plaque deposits and tangles in the brain.
- One-fifth (20%, 1,022) had vascular dementia, which is caused by damage to blood vessels in the brain.
- Over one-quarter (26.5%, 1,330) had other or unspecified dementia.
- Dementia can cause changes in memory, abilities to perform complex tasks, personality changes, and other symptoms.
- The elderly resist and avoid timely Alzheimer's or dementia tests and diagnosis. It is difficult to admit that something may be wrong or changing within us.
Alzheimer's Education
In accordance with the person-centered care indicated for Alzheimer's and dementia patients, it is crucially important to recognize each person living with dementia as a unique individual with unique changes. We must no longer be counting solely on individuals with personal connections to dementia to educate us. Information about dementia needs to be a part of any basic training for all disciplines and all workforces. We all need more education about dementia related symptoms, causes, and conduct.
Community Education
Education on dementia is valuable not only to health professionals but also to all members of a community.
The dramatic case of an older man in California with dementia who was shot and killed after mistakenly being seen as someone defying police orders and having a gun, (which later was found to be a crucifix) motivated that police department to include dementia education as part of their basic training.
This incident illustrates how important information about dementia is—not only for community stakeholders such as the police but for all members of a community.
- The Alzheimer's Foundation of America (AFA) is committed to educating all community stakeholders.
- Through the national toll-free helpline, telephone-based caregiver support groups, National Memory Screening Programs, and Monthly Care Connection webinars, AFA provides education and resources to anyone in need.
- Additionally, AFA's signature training program, AFA Partners in Care, supports individuals living with dementia and provides an opportunity for any professional to learn more about this illness.
Case Workers on the Team
Social workers often use their skills to establish trust and build rapport; conduct in-depth, meaningful assessments; and provide brief solution-focused counseling.
- A common aspect of geriatric assessment teams is a specialty in dementia diagnosis and treatment. The importance of a comprehensive physical exam—including diagnostics such as lab, MRI/CT scan, or bone density scan as well as evaluation of medication management issues—is widely recognized as part of the diagnostic process.
- Social workers often participate in administering such diagnostic tools as the Mini-Mental State Exam or the Montreal Cognitive Assessment. In addition, screening for depression using the 15- or 30-point Geriatric Depression Scale is frequently included to rule out depression as a possible cause for dementia symptoms.
- Medications are evaluated to assess possible side effects of drug interactions and identify medication management issues, such as lack of adherence to instructions for taking medications, lack of understanding, or limitations in access to medication. Social workers contribute to this process through assessment questions targeting problem areas.
- A typical format for communication between the patient, caregivers, and the health care team is a family summary conference which is done after a thorough physical exam. This meeting is usually attended by physicians, neuropsychologists, social workers, and sometimes nurse practitioners.
- Another aspect of social worker services involves counseling with caregivers, educating them, and providing ongoing support as they face challenges in caring for a person who has dementia.
- Social workers provide links to community resources for transportation, financial assistance, housing relocation, and companion/sitter services to match need for changing levels of care.
- In addition, social workers encourage open lines of communication with the health care team, model a proactive interdisciplinary team approach to problem-solving, guide family members as they struggle with caregiving challenges, facilitate advance care planning, provide brief emotional support counseling as issues of patient well-being and safety arise, and promote coordination of family member roles.
- Social workers also reenforce health care team recommendations with patients and family members concerning the importance of organizing systems for medication and financial management, taking precautions to ensure patient safety and implementation of routines, which include a variety of activities as well as social interaction.
- All the care team members make home visits to at-risk patients, particularly if they were recently discharged from a hospital to a private residence, an assisted living facility, or an independent senior living facility. The goal is continuity of care, timely follow-up, and prevention of re-hospitalization.
