dementia.
[Institutional Affiliation(s)]
Author Note
Abstract
Alzheimer’s disease is a burden on US economy owing to the need for personal care of patients
suffering from this progressive refunctioning of the neural and cognitive functions. Since, the
morbidity from this syndrome is on increase with the increase in the median age of survival and
the changing life styles, a need to find innovative tools clinical practice arise. In this article a novel
approach called an “Intensive personalized primary care program (IPPC)” for Alzheimer disease
has been proposed. The program will be organized and funded by the federal government with
community participation, in which trained nurses will be utilized. The program is intended to target
the economically downstream population of US living in sub urban and rural areas.
Alzheimer dementia
Introduction
Alzheimer dementia is a syndrome that includes a progressive global loss of brain function
in old age that results in memory loss, loss of cognitive skills and an irreversible compromise of
daily activities and decision making. It is the most common dementia in UK and USA and as of
estimates tell that above 5 million US citizens encountered Alzheimer dementia in 2014 (Matthews
et al., 2019). The disease symptoms first appear in mid 60s and acquire an irreversible progression
that demands a need for an intensive and regular care of the patients. With the rise in median age
of living, the number of patients continue to increase and with the change in lifestyle and social
structure, the number are projected to double every 5 years. Hence, new paradigms in clinical
A detailed guideline for the management of Alzheimer’s dementia is already available (Qaseem,
2008; Herrmann, Gauthier & Lysy, 2007). The primary care is in fact the one and the only significant
means of management of this syndrome. Primary care however, has been provided to the patient
by their close family members. It is estimated that over 18 billion hours of caregiving has been
invested by the family members without any pay ("Facts and Figures", 2019). In many cases the
family members are untrained, unaware of the community resources and government policies and
hesitate to seek help from others. The situation becomes worse in low socio-economic strata living
Hence, I propose an intensive personalized primary care program (IPPC) for AD for low income
groups of sub-urban and rural areas, for persons in the age group of 60-65yrs. This personalized
primary care program will constitute a “Trained Nurse” in which one nurse will take supervise the
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daily 24x7 care of at the most 5 patients. The training for the nurse would be provided on
subsidized rates by Federal government funded institutions such as NIH and State Universities.
These nurses would not only be provided clinical management training but also for psychoanalysis
and psychological control. A universal phone number would be provided to every citizen, and any
family member of any suspected dementia patient can register his case. Upon registration the
patient family member will be directed to the contact details of the trained nurse. For a specific
locality a nurse would be allotted. The salary of the nurse would be partly bear by family member
and partly by the federal govt. After the primary registration the nurse will visit the patient house
and interact with the patient for a day or two for differential diagnosis, because in one setup the
diagnosis is often challenging (Sanders et al., 2017). Alzheimer dementia should be properly
differentially diagnosed and separated from conditions such as delirium and mild cognitive
Specifications.
The IPPC program thus proposed will take care through trained nurse assigned to the
specific localities, once the initial diagnosis has been confirmed. The responsibility of the follow-
up checkups, laboratory tests and medicines if required lies with the nurse who will take decisions
of when the patients or a group of patients assigned would be brought to the primary health center
clinician. The nurse will register them, analyze their progress, record their daily activity, their
“dementia score” empirically on a datebook provided to the nurse by the primary health care. The
contact details of the nurse will be there with the family members of the patient. The nurse will in
turn instruct the family members how to take care of the patient in the absence of nurse in off hrs.
say in the night and early morning. Rest of the day care would be provided by the nurse.
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The program would be supervised in each district headquarter by the federal government
representatives, but locally it would be governed by the citizens group of the locality. This will not
only decentralize the responsibility, but a better recording and feedback. And I hope that this will
not only drastically improve the primary healthcare for Alzheimer’s dementia, but also
revolutionize the whole paradigm of disease management of the ageing population of USA. In
addition, it would boost the economy because a huge population of the family members of the
patients can be able to divert their attention and utilize their energy for other job activities.
References
figures
Herrmann, N., Gauthier, S., & Lysy, P. (2007). Clinical practice guidelines for severe
Matthews, K., Xu, W., Gaglioti, A., Holt, J., Croft, J., Mack, D., & McGuire, L. (2019).
Racial and ethnic estimates of Alzheimer's disease and related dementias in the United States
(2015–2060) in adults aged ≥65 years. Alzheimer's & Dementia, 15(1), 17-24. doi:
10.1016/j.jalz.2018.06.3063
Guideline from the American College of Physicians and the American Academy of Family
200803040-00008
Sanders, A., Nininger, J., Absher, J., Bennett, A., Shugarman, S., & Roca, R. (2017).
10.1212/wnl.0000000000003917