11/15/98

Health care workers find new ways to aid Alzheimer's patients

By Genna McLaughlin

TRIBUNE-REVIEW

They could have gone on for hours about the human suffering they've seen, these health care workers.

But they didn't.

They stopped with the story of a woman who made love to her husband of 30 years and, minutes later, turned to him and asked him his name.

It's a story Deborah Crowley-Lisowski can't shake no matter how many Alzheimer's patients come through the Geriatric Behavioral Health Services unit at Monsour Medical Center in Jeannette. It's a story about how the disease tears families apart.

"He was crying, devastated," recalled the gerontologic clinical nurse specialist as she sat with other members of the center's geriatric unit.

Four million people nationwide suffer from Alzheimer's, a degenerative disease of the brain that destroys nerve cells and causes memory loss, disorientation and loss of language skills, hand-eye coordination and attention span. Another 19 million people have a family member with the disease, according to the Alzheimer's Association.

As researchers continue to battle for a cure, health care workers look for better ways to care for those who are symptomatic.

"We can't cure this," said Elaine Dively, program coordinator for the Greater Pittsburgh Chapter of the Alzheimer's Association. "But we can give these people more pleasure in life."

November is National Alzheimer's Disease Month and while the prevalence of the disease is increasing, Dively reports a "big improvement" in Alzheimer's care - some of which she has witnessed while traveling in the chapter's six counties: Fayette, Greene, Washington, Allegheny, Beaver, and Butler.

"We're learning more about what people who have Alzheimer's are going through," she said. "We're learning how important the environment is to them and how to talk to them in a way that reduces their anxiety."

As the millennium approaches, the need for such techniques grows. The Alzheimer's Association projects that the number of sufferers could reach 14 million by 2040.

The medical community is preparing by opening specialized geriatric units that can treat Alzheimer's, such as the one at Monsour Medical Center and one at Indiana Hospital that opened in June.

"There is a great need for it," said Marlene Kozak, program director of Monsour's geriatric unit. The two-year-old inpatient unit treats patients older than 55 for depression, dementia and Alzheimer's. It has been so successful that the center is planning to open a similar outpatient unit.

"We have a very specialized team of people here to deal with health issues that affect the elderly," said Kozak. "Our goal is to help patients through a critical time and get them to be independent or to smooth the transition into a personal care home."

The Alzheimer's Association estimates that 75 percent of Alzheimer's patients spend time in a nursing home. Usually it becomes a necessity when the patient requires around-the-clock care. Until recently, many nursing homes didn't accept Alzheimer's patients, leaving a family with few alternatives.

"(Nursing homes) tend to panic because of the symptoms of the disease, especially the wandering," said Brook Jennings, executive director of the Laurel Mountain Chapter of the Alzheimer's Association.

Now, thanks to a growing trend toward dementia units in nursing homes, Jennings can refer families to nursing homes in Westmoreland, Indiana, Somerset, Armstrong, Bedford or Cambria counties that have units created specially for Alzheimer's. The Redstone Highlands retirement community in Greensburg is just one of several.

"They don't survive as well if they're housed in straight-up institutions," said Amy Ernst, director of dementia care services at the facility. Ernst has noticed a change in patients who were moved from the standard-care unit to the 13-bed dementia unit when it opened two years ago. "They're very calm. They're very happy here. This is home."

The unit's patients wear tracking bracelets to prevent them from wandering off. The hallway is locked at each end by large white doors that, like everything on the floor, were designed with dementia in mind.

"You have to look at what would distract them from carrying on a pattern," said Ernst, as she led the way down the bright hallway. The floor and walls are also white - a splash of color could agitate the residents.

"If the doors were brown, I would have patients walking back and forth, from one to the other, all day long," she said.

Instead resident Jack Cannon walks the unit's dog, Tyler, through a cozy lounge area, out to a fenced-in patio and yard, back into the small kitchen where residents are playing with colored tiles under the direction of an employee, and back into the hall again.

No one attempts to stop him.

"We've learned a lot about dementia," Ernst said. "It's about control, security and making choices."

What a change, said Elaine Dively. Years ago, facilities worried only that Alzheimer's patients were fed and clean.

"There are ways to reduce their anxiety," said Dively. "We educate people about them and most say `I wish I had known this years ago.'"

Less anxiety can mean more peace of mind for caregivers, another large population that Alzheimer's groups are targeting.

The Alzheimer's Association knows of at least 70 family support groups for Alzheimer's in western Pennsylvania. And there are likely many more run by geriatric units and nursing homes that are now incorporating family support into their dementia programs.

"There is aggressive research on the people who take care of people with Alzheimer's - daughters, sons, spouses," said Dr. Steven DeKosky, director of the Alzheimer's Research Center in Pittsburgh. "We're trying to find the best ways to support caregivers - a group of people who live 36-hour days."

Better care and a deeper understanding of Alzheimer's could be the best answer - next to a cure.

The smallest things - such as validating a sufferer's thoughts and feelings rather than trying to correct them when they're confused, or designing smaller dining areas with fewer distractions so they eat more - can make a huge difference, according to Dively.

"These are things that can be done anywhere," she said. "In a nursing home, at home. (Alzheimer's sufferers) are moving back in the past. We have to be in the time zone that they are in."

Larry Anlauf had that thought in mind when he designed the new 120-bed dementia unit at Huntingdon Ridge in North Huntingdon. He decorated the unit with pieces of vintage furniture, such as an old non-working stove and a piano, that might remind elderly residents of the past and make them more comfortable.

"Even if I reach one resident, make one person smile," he said, "it will be worth it."