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alzheimer’s: the difference women can make The worst-case-scenario diagnosis: Alzheimer’s disease. Ask anyone fifty and older, and they will tell you that their greatest fear is certainly not infection and or even cancer. The most feared affliction has become late-onset Alzheimer’s disease, also known as “the big A.” Most people fear dementia, in general, which is an umbrella term to describe memory loss severe enough to impair physical and social functioning. The most common cause of dementia is Alzheimer’s disease, closely followed by vascular dementia and then Lewy-body dementia. The majority of cases of dementia are Alzheimer’s-related or a mixed case of Alzheimer’s and vascular dementia. The most common form of Alzheimer’s disease, accounting for 90 percent of cases, is late onset, which occurs after age sixty-five. For those who have aged well, it represents the greatest threat to independence and quality of life in remaining years. Alzheimer’s disease manifests as a slow, progressive decline in mental, social, and physical functioning. It is the most predictive factor in physical and financial dependence for older adults. Most of the population of older adults—more than half—opposes screening for dementia, which could offer individuals treatment to slow progression of the disease or an opportunity to plan financial and healthcare powers of attorney. Women—because they live longer—are more likely than men to contract Alzheimer’s; they are also more likely to be a caregiver for someone with the disease. There are ways to reduce risk for the disease, although many are challenging, particularly for women. The fear of Alzheimer’s disease is certainly understandable when one looks at the projected demographic data for the U.S. in the next twenty-five years. The population is aging, with the fastest-growing group of citizens in the eighty-five and older category. The prevalence of Alzheimer’s disease is expected to quadruple, until someone is diagnosed with it every eleven seconds by 2030. In light of this looming burden, two primary strategies can help proactively address this problem: community education toward possible prevention and clinical research to cure the disease. The U.S. has made some impressive strides as a developed nation. The leading causes of death have evolved from accidental and infectious to chronic and declining. This change certainly speaks to our public health efforts in the realm of sanitation and vaccination. However, our most pressing health concerns involve the management of chronic illnesses, most of which have a prevention component. The difficulty in preventing Alzheimer’s disease is, first and foremost, a lack of knowledge that prevention is even possible. Recent research has focused on factors that have predicted the onset of Alzheimer’s disease through cohort studies, as well as those factors common to people who were not affected by the disease. These studies offer key messages that can reduce or increase risk for Alzheimer’s. Factors for late-onset Alzheimer’s disease include both genetic and environmental influences, both within and outside individual control. Risk-increasing factors include:
Risk-reducing factors include:
Certain social structures predispose women to some of these factors. For example, victims of spousal abuse are more often women. If this abuse involved head trauma, then the victim has an increased risk for Alzheimer’s disease. Also, higher education and cognitively demanding careers are protective factors that may have been unavailable to some women. Some studies have shown that the genetic predisposition for Alzheimer’s disease has a greater influence in women than in men, overriding the protective effects of higher education. For women, this disease has multiple potential effects, both as a patient and as a caregiver. Although the prevalence of Alzheimer’s disease is higher in women than men, the actual prevalence in women is not higher when age is not a factor. However, more women are affected by the disease indirectly. It is well known that Alzheimer’s disease caregivers are predominantly women. In fact, I often tell my patients to have as many daughters as possible as the best defense in avoiding nursing home placement. A colleague of mine drives a car with one of my favorite bumper stickers, reminding us that if caregiving is not your issue now, it will be! Working toward a goal of cure and treatment, the National Institute on Aging has funded Alzheimer’s Disease Research Centers across the country, including a center at Emory. The center is the only one of its kind in the Southeast and describes its research as on the cusp of a groundbreaking treatment for late-onset Alzheimer’s disease. The center supports a dementia clinic, staffed by advanced-practice nurses and neurologists, and provides opportunities for individuals to participate in research studies on Alzheimer’s disease. As women who stimulate our minds regularly, it will be up to us to influence the gloomy forecast regarding this epidemic affecting older adults. Women historically have taken the lead in terms of lifestyle change for themselves and their male cohorts, but in this case we also must influence public policy in order to fund Alzheimer’s research and caregiving programs for those who are being burdened. We need to support one another as a group of potentially affected individuals and as caregivers for spouses and parents. Together, we can win the fight against Alzheimer’s. Contact the Atlanta chapter of the Alzheimer’s Association today for information on how you can help through fund-raising and community awareness. Carolyn Clevenger received her BSN from West Virginia University, her MSN from Emory University, and her DNP from the Medical College of Georgia. She is a clinical assistant professor in the Nell Hodgson Woodruff School of Nursing and codirector of the Education Core of Emory’s Alzheimer’s Disease Research Center. She has an active practice in Lawrenceville, where she sees elderly patients in their homes for management of chronic illness and caregiver support.
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