The Ministry of Health & Social Services has declared November Alzheimer's Awareness Month with the aim of increasing public knowledge about the disease and how improvements can be made in the management of patients suffering from the disease.

In the following article, Ms Corita Saunders, RN, MA, Co-ordinator for the Aged and Handicapped, discusses various aspects of the Ministry's goals.

Alzheimer's is a devastating neurological disorder which not only erodes the quality of life of its victims, but seriously affects the lives of those around them.

The cause of the disease is unknown, and there is no cure. In North America, it is one of the most common causes of death.

"In Alzheimer's, the brain steadily wastes away or shrinks in both size and weight. Cognitive and behavioural disturbances are hallmark features of this dementing disease,'' Miss Saunders explained. "Because many other disorders can be confused with Alzheimer's, a comprehensive medical examination is essential.'' She noted that, due to the shift in population towards a higher percentage of elderly persons, it is projected that the number of Alzheimer's patients will double by the year 2000.

"Research on the causes and treatment of this disease therefore becomes increasingly compelling,'' she said.

In North America, the co-ordinator said, Alzheimer's was the "fourth or fifth'' most common cause of death.

"Alzheimer's is age-related,'' Ms Saunders explained, "although onset may occur in the forties, fifties or even thirties. Over age 80 a person has a 400-fold chance of getting the disease as compared to someone under 60.'' While those afflicted could live "between two to 14 years'', the average life expectancy was six to eight years.

"Alzheimer's cuts the life expectancy of a 70-year-old from nine years to two and a half in a man, and from eleven to three in a woman of the same age.'' Hard though the disease was on patients, it was even harder on their families, friends and caregivers, who had to cope with their increasing disorientation and inability to care for themselves while trying to cope with their own lives.

With better understanding, however, the strain on loved ones and caregivers could be eased.

"We have to keep reminding ourselves of capacities the Alzheimer's victim no longer has,'' Ms Saunders said. "The following guidelines will help in learning how to cope:'' Reasoning ability: A person with Alzheimer's can no longer reason effectively.

Therefore, trying to reason, argue or persuade has no meaning, and can only serve to confuse and frustrate the victim and ourselves. Don't to try to reason or argue as this can trigger a catastrophic reaction.

Rather, you can distract the victim from worry to pleasure. Try dignifying him with a request to help you -- "Sort these papers, please'', for example.

Choosing the Right Words: Talk in the simplest possible language and supply the words to finish thoughts and sentences.

Capacity to Understand: Limit each thing you say to one simple idea. Even a phrase such as "Come and eat'' might be too difficult. Instead, simplify it to: "come to the table'', "pull out your chair'', "sit down'', "put on your napkin'', and so forth. This task break-down can be effective with most activities such as bathing, brushing teeth, getting dressed.

Timely Reactions: Any sudden movement, change or new idea only confuses the patient. You cannot move quickly, or expect them to.

Short-term Memory: Recent events have no meaning, so reality orientation -- the posting of today's date and the next approaching meal or holiday -- are not really effective as the disease progresses. However, you can still get to know the person by asking about parents, childhood home, schooldays, career choices and so forth. Trigger such memories with old photos and gather them into an album for the person to look at again and again.

Tolerance for Frustration: Help the person to stay calm, even if it means agreeing with delusions -- "Thank you for asking me'' to an offer of marriage -- then change the subject. Trying to talk the victim out of his ideas can trigger extreme agitation.

He may no longer recognise faces; he cannot match faces with names or memories. He also has no recognition of repetition. Endless questions are triggered by a deep sense of confusion. This means you can keep the person occupied with the same task, like setting and unsetting a table or filling or refilling a box or handbag. As long as you give a simple, reassuring message, you can make the same answers work again and again.

While such guidelines are useful, it is also recognised that those caring for Alzheimer's victims at home need outside assistance or relief from the status quo. Because many caregivers are not aware that such services exist, Ms Saunders defines them as follows: Surrogate Caregivers: A limited number of home resource aides are available to assist with personal care and daily chores, as needed.

Community Occupational Therapist: Available for consultation and support in adapting the home and implementing devices which assist the victim to have a better quality of life. These include installing special home safety measures such as special locks on doors and master switches on the stove, which the victim will have difficulty figuring out.

Day Care Centres: An invaluable resource for monitoring the victim, and allowing him to participate in such activities as crafts, exercise and reality orientation.

Respite Care: An institutional care programme which admits patients for approximately weeks in order to allow caregivers to take a break from their responsibilities. Should be planned a few months prior to the intended dates.

Social Gatherings: Useful for decreasing isolation and providing an opportunity to interact with others. See Seniors' Handbook for music, social clubs and dancing.

Alzheimer's Family Support Group: Meets second Tuesday of each month at 5.30 p.m. in the Activities Lounge of the KEMH Extended Care Unit. A support group for people with Alzheimer's and their families.

Professionals: There is a network of professional support, in particular the Geriatric Assessment Placement Team (GAP), which can be of invaluable assistance to Alzheimer's victims and their families. Professionals provide advice on home care issues and how the family can function better, thus improving the quality of life and well-being for all.

LOSING TOUCH . . . The effects of Alzheimer's, a progressive neurological disease, are devastating. As it progresses, victims undergo marked behavioural changes and lose the ability to comprehend or reason.

HEALTH HTH