Alzheimers, Dementia, and Other Related Diseases for CNAs and HHAs

Millions of people around the world and in the United States have dementia, and the number of people affected is expected to grow over the next 20 years. Since dementia impacts how patients are cared for, healthcare workers like certified nursing assistants (CNAs), home health aides (HHAs), and others need to learn about the disease and how to care for those who have it. This course covers the different types of dementia, its stages, and symptoms. It also explains the risk factors and causes of dementia. The course goes over important topics for caring for people with dementia, such as managing behavior, daily care activities, patient safety, caregiver stress, and end-of-life care.

Around the world, approximately 47 million individuals have some form of dementia. This is expected to increase to around 131 million by 2050. Dementia is a condition that leads to increased healthcare costs for the individual. It’s estimated that people with dementia have around $200,000 more healthcare costs in their lifetime than those without the disease (Emmady et al., 2022).

Alzheimer’s disease is a form of dementia. According to the Centers for Disease Control and Prevention (CDC), Alzheimer’s disease was the 7th leading cause of death in all adult Americans and the 6th leading cause of death in adult Americans who were 65 and older in 2022 (Centers for Disease Control and Prevention [CDC], 2024a). As of 2020, the CDC reported that around 6.7 million adult Americans had Alzheimer’s disease, which they thought to be underreported. Unfortunately, this number is expected to double by 2060, with estimates that around 14 million Americans will have the disease (CDC, 2024b). The rate of new cases of Alzheimer’s disease in patients who are 85 years and older is 6%. Women who are 85 or older have a slightly higher rate of developing Alzheimer’s disease than men (Kumar et al., 2024).

Individuals can decrease their risk of developing dementia (including Alzheimer’s disease) through healthy lifestyle changes. The CDC estimates that around 45% of all cases of dementia can be prevented or delayed through living a healthy lifestyle (CDC, 2024b).

Dementia is a type of brain disorder leading to a decrease in a person’s overall memory, thinking, and skills. Often, a person’s mental decrease causes them to lose their ability to do everyday tasks and activities of daily living (ADLs). Patients with dementia sometimes don’t understand their condition (Emmady et al., 2022). There are many types of dementia, with different causes. Some of these include:

• Alzheimer’s disease: This disease is caused by the death of neuronal cells (also called nerve cells that transmit impulses throughout the body and information). Alzheimer’s disease is the most common type of dementia and makes up 60-80% of dementia cases.
• Vascular dementia: Vascular dementia is caused by damage to the brain's blood vessels or lack of blood flow. It is the second most common type of dementia and makes up about 10% of all cases. Common causes of blood vessel damage are strokes, high blood pressure, or atherosclerosis (a condition where plaque builds up in the arteries and hardens).
• Lewy body dementia: The accumulation of abnormal proteins in the brain, called Lewy bodies, causes chemical changes in the brain.
• Frontotemporal dementia: This type of dementia affects the front (fronto/frontal) and side (temporal) regions of the brain. It commonly affects younger individuals. It’s thought to be caused by nerve cell damage. The process behind this condition is not really understood.
• Mixed dementia: This type of dementia involves several causes or combinations of the disease. For example, a patient may have vascular and Lewy body dementia (CDC, 2024b).

(*Please click on the image above to enlarge.)

People with dementia have different symptoms, which can depend on the type of dementia they have. Some symptoms are:

• Difficulty remembering or memory problems
• Difficulty with everyday decisions
• Trouble thinking or organizing thoughts
• Problems communicating
• Movement and balance problems
• Mood and personality changes

As dementia gets worse, patients’ symptoms can also become worse (CDC, 2024b).

Since Alzheimer’s disease is the most common type of dementia, it’s important to understand its many parts. First, symptoms develop slowly over time and are not reversible. This condition commonly affects older adults but is sometimes diagnosed earlier in life. If a person is diagnosed with Alzheimer’s in their mid-to-late 40s, this is referred to as early-onset Alzheimer’s disease (CDC, 2024a).

Again, symptoms are different for each person, but early symptoms like memory loss and forgetfulness are common. As the disease progresses, patients may have problems with activities of daily living (ADLs), like preparing meals, performing personal hygiene practices, and other tasks. Poor judgment, trouble managing finances, and behavioral changes are common (CDC, 2024a). Wandering and loss of bladder and bowel control may occur in the later stages of the disease (Kumar et al., 2024). Below is a table outlining the different stages and some related symptoms of dementia (Reuter-Sandquist et al., 2022).

There are several causes and risk factors thought to be connected to developing dementia and Alzheimer’s disease. Some causes and risk factors of Alzheimer’s disease include:

• Age: The biggest risk factor for developing Alzheimer’s is advanced age.
• Genetics: People with a family history of Alzheimer’s and/or dementia are at increased risk of getting the disease. Certain genes also increase a person’s risk. People who have a first-degree relative with Alzheimer’s are 10-30% more likely to develop the disease themselves. Also, people with two or more siblings with the disease are three times more likely to develop Alzheimer’s compared to others.
• Medical conditions: Patients with certain medical conditions are more likely to develop Alzheimer’s. Some of these conditions include depression, traumatic head injuries, and cardiovascular or cerebrovascular disease (Kumar et al., 2024).

Other risk factors for dementia depend on the type of dementia. People who have certain medical conditions have an increased likelihood of developing vascular dementia. Some of these conditions include diabetes, hypertension, and high cholesterol. Smoking increases the chances of developing Alzheimer’s and vascular dementia (Emmady et al., 2022).

There are several things the CNA, HHA, or other health professional can do when caring for patients with any form of dementia. These methods can improve parts of patient care and health outcomes.

Supporting the patient's daily activities is important to patient care. It can help keep patient function and independence as much as possible. Some examples of ADLs are keeping clean and bathing, eating and drinking, mobility, and going to the bathroom. Any nursing assistant can help perform ADLs. Before doing so, it is important to coordinate care with the nurse to talk about the patient’s needs, preferences, level of functioning, and mobility. For example, if the patient is on strict bed rest, walking the patient in the hallway for exercise would not be the right thing to do. If the patient is calmer after a bath, a bath shortly before bedtime may be better than a bath in the morning. Think about what the patient can do, like whether they can assist with bathing or require full assistance (Reuter-Sandquist et al., 2022).

While helping with ADLs, help the patient be independent as much as possible, but you still need to have oversight. Some patients may remember how to do activities on their own, like brushing their teeth or dressing.  Others may need frequent instruction and reminders. If a patient does not remember how to do a task, then gently instruct them how to do it instead of doing the task yourself. Give the patient options (if appropriate) to help keep their independence. If providing options to the patient, be aware of cultural beliefs and differences (Reuter-Sandquist et al., 2022).

Keeping patients' privacy and dignity is another important thing when helping with ADLs. Before helping with ADLs, tell the patient what you have planned. When doing personal hygiene things (like dressing or bathing), make sure privacy is maintained by using privacy curtains and closing the doors. Also, when helping with bathing, make sure that the patient’s body areas that are not being washed are covered with towels. This is very important with private areas and genital. When talking with the patient, use appropriate language and terms. Do not use terms that can be considered a put-down, like “honey,” “sweetie,” “potty,” etc. (Reuter-Sandquist et al., 2022).

People with any form of dementia have more safety concerns. Falling is one of them. Making sure a patient is safe is extremely important. There are many things that nursing assistants can do to promote safety. These are:

• Keep the patient’s room free from clutter. This is important for the floor and around their bed. Throw rugs can be a tripping hazard, so remove them.
• Have the patient wear non-slip socks or shoes with rubberized soles when walking.
• Use assistive devices like walkers, canes, and gait belts.
• Make sure the patient is wearing their glasses and/or hearing aids.
• Make sure other staff or family members are close in case extra help is needed.
• Clean up spills on the floor as soon as possible.
• Place the patient’s call light or telephone nearby so they can call for assistance.

If a patient falls, do not attempt to move them. Instead, call for help first since trying to move them can actually cause further harm to the patient, or you can even injure yourself (Reuter-Sandquist et al., 2022).

Being a caregiver can lead to stress, strain, and burnout. Healthcare professionals need to understand and recognize the signs of caregiver strain. They also need to recognize these signs in themselves. Common symptoms of caregiver strain are denial, anger, social withdrawal, depression, sleeplessness, exhaustion, irritability, and many others. Some ways to prevent caregiver strain are:

• Know what resources are available. Many community programs include adult day programs, meal delivery services, and respite care services (NIA, 2024d).
• Join local support groups that can help with emotional and spiritual well-being. Support groups are even available for healthcare professionals.
• Use relaxation techniques to help lessen stress. Simple activities like breathing exercises, meditation, warm baths, or reading a book can improve your overall well-being. Share these activities with caregivers. Suggest they also take time for themselves.
• Knowledge is power. Help find educational opportunities for caregivers. This will help them to understand dementia or Alzheimer’s disease. Nursing assistants can provide pamphlets, suggest community educational resources, or coordinate with the nurse for more input (Alzheimer’s Association, n.d.c).

People in the later stages of Alzheimer’s disease require more care. To help patients feel comfortable, move them every 2 hours. Use pillows, blankets, or cushions to make them comfortable. Give the patient smaller amounts of food during mealtimes and cut big pieces into small bites. Give them finger foods and softer foods when able. These make it easier for the patients to feed themselves. Many patients will need full assistance with eating. Sometimes, patients will need you to help feed them, especially if utensils are involved. Thicken liquids to help with swallowing.  Do not use straws (NIA, 2024e).

Patients with advanced dementia and Alzheimer’s disease often have skin problems. To help prevent sores, apply moisturizers to keep the skin moist and soft. Sometimes, these patients are nearing the end of life. Provide emotional and spiritual comfort whenever possible. Comfort the patient by telling them stories, listening to calming music, or looking through family photos (NIA, 2024e).

*Please note that this case study is not all-inclusive of potential tasks and is meant to serve as a guide.

Background: Mrs. Johnson is an 80-year-old patient diagnosed with Alzheimer’s disease. She has memory loss and confusion and sometimes has a hard time doing daily activities. She has a hard time recognizing familiar faces. She sometimes forgets her daily routine and often needs reminders to finish simple tasks. Her family has counted on the long-term care facility to provide her with the needed support for her needs.

Nursing Assistant’s Role: The nursing assistant, Jackie, plays an important role in providing personal care, watching the health status, and watching out for the comfort of patients like Mrs. Johnson.

In order to make a good routine for Mrs. Johnson, Jackie makes sure that Mrs. Johnson’s activities, meals, and medication times are the same each day. This routine helps decrease her confusion and anxiety, making her feel more safe.

Jackie also makes sure to communicate effectively with Mrs. Johnson by talking clearly and slowly. She uses short and simple sentences. She is patient and gives extra time for Mrs. Johnson to respond. She avoids arguing or correcting Mrs. Johnson if she becomes confused or forgetful.

Since many patients with Alzheimer’s may have impaired judgment, Mrs. Johnson may be at higher risk for accidents. Jackie makes sure that Mrs. Johnson’s room is free of tripping hazards like rugs or cords. She keeps the door closed and locked to decrease any wandering. She also watches Mrs. Johnson closely during activities like bathing or walking to prevent falls.

Sometimes, Mrs. Johnson seems irritated. When this happens, Jackie uses familiar activities, such as listening to music or looking through photo albums, to help Mrs. Johnson feel better. She also talks about Mrs. Johnson’s past.

Sometimes, Mrs. Johnson needs a little help with dressing, mostly to button her shirt properly. To help her remain as independent as possible, Jackie lines up the button holes and then has Mrs. Johnson finish buttoning the buttons.

When Jackie arrived one morning, Mrs. Johnson indicated that she did not feel well. Jackie quickly reported this to her nurse supervisor, who called the family members to ask them to take Mrs. Johnson for a checkup.

Caring for an 80-year-old patient with Alzheimer’s disease takes a lot of planning. By thinking about the patient’s need for routine, safety, communication, emotional support, and independence, Jackie, the nursing assistant, provided good care that helped the patient’s quality of life and dignity.

Caring for patients with any form of dementia can be complex and challenging at times. So, it’s helpful for nursing assistants and other health professionals to understand what care these patients need to provide the best care possible. Remember, a large portion of the patient’s care involves safety and communication.

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