Guidelines for Alzheimer’s Disease Management

The impact of Alzheimer’s disease on caregivers and families is staggering. Fortunately, there are effective strategies for overall management that are covered in this guideline.

The Guidelines for Alzheimer’s Disease Management were developed through the California Workgroup on Alzheimer’s Disease Management. These guidelines provide basic recommendations for the ongoing care and management of persons with Alzheimer’s Disease.

The guidelines are intended for primary care providers including physicians, nurse practitioners, physician assistants, social workers and other practitioners who provide care to persons with Alzheimer’s and their families. It is assumed that a proper diagnosis of Alzheimer’s Disease has been made before these recommendations are followed.

California’s Caregiver Resource Centers and the Alzheimer’s Association are the two organizations identified for caregiver education and support.

For more information on the guidelines or to order an information packet, please contact Elizabeth Heck at the Los Angeles Alzheimer’s Disease Association at (323) 938-3379.

GUIDELINES FOR ALZHEIMER’S DISEASE MANAGEMENT

Conduct and document an assessment of:

  • Daily function, including feeding, bathing
  • Dressing, mobility, toileting, continence and ability to manage finances and medications
  • Cognitive status using a reliable and valid instrument (e.g. the MMSE)
  • Other medical conditions
  • Behavioral problems, psychotic symptoms, or depression

ASSESSMENT

  • Reassessment should occur every 6 months or more frequently, if indicated.
  • Identify the primary caregiver and assess the adequacy of family and other support systems.
  • Assess the patient’s decision-making capacity and whether a surrogate has been identified.
  • Assess the patient’s and family’s culture, values, primary language, and decision-making process.

Develop and implement an ongoing treatment plan with defined goals. Include:

  • Use of cholinesterase inhibitors, if clinically indicated, to treat cognitive decline
  • Referral to appropriate structured activities such as exercise, recreation and adult day care services
  • Appropriate treatment of medical conditions

TREATMENT

Treat behavioral problems and mood disorders using:

  • Nonpharmacologic approaches, such as environmental modification, task simplification, appropriate activities, etc.
  • Referral to social service agencies or support organizations, including the Alzheimer’s Association’s Safe Return Program for people who wander
  • Medications, if clinically indicated

PATIENT & CAREGIVER:

EDUCATION & SUPPORT

Discuss the diagnosis and progression of AD with the patient and family in a manner consistent with their values, preferences and the patient’s abilities.

Refer to support organizations for educational materials on community resources, support groups, legal and financial issues, respite care, future care needs and options. Organizations include:

  • Alzheimer’s Association 1-800-660-1993 www.alz.org
  • Caregiver Resource Center 1-800-458-8106 www.caregiver.org
  • or your own social service department

Discuss the patient’s need to make advance directives and to identify surrogates for medical and legal decision-making.

REPORTING REQUIREMENTS

Abuse: Monitor for evidence of and report all instances of abuse to Adult Protective Services or police department, as required by law.

Driving: Report the diagnosis of AD in accordance with California law (Sections 2500 and 2572 of Title 17, California Code of Regulations).

Prepared by the California Workgroup on Guidelines for Alzheimer’s Disease Management on September 30, 1998. Supported in part by the federal Health Resources and Services Administration’s Bureau of Primary Health Care and the Administration on Aging through a grant to the California Department of Health Services and the Alzheimer’s Association of Los Angeles. Version 93098 - 1998.