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The Growing Burden of Alzheimer’s Disease

It is a dispatch call to the Walmart parking lot.  An elderly woman, wearing only a nightgown, is wandering in front of the store, she appears confused and agitated.  On the other end of town officers are responding to a missing at risk call; a 90 year old male has wandered from his care center, last direction of travel is unknown.  Calls related to the elderly are becoming much more familiar and officers can expect an exponential increase in these calls as our population continues to age.  Most typically, police contact with the demented individual include:

•             wandering, getting lost

•             auto accidents

•             indecent exposure

•             homicide, suicide, domestic violence

•             suspicion of DUI, suspicion of intoxication

•             abuse, neglect

•             trespassing

•             shoplifting, petty theft

Alzheimer’s Disease

Dementia is defined as a significant loss of intellectual abilities such as memory capacity, severe enough to interfere with social or occupational functioning.    Alzheimer's disease is the most common cause of dementia, accounting for 60-80% of all cases. Alzheimer’s disease is a brain disorder that breaks down the connections between nerve cells in the brain and is not a normal part of aging.   Symptoms usually develop slowly and progressively get worse.   In its early stages, memory loss is mild, but in the late-stage individuals lose the ability to carry on a conversation and respond to their environment. Alzheimer’s can cause mood disturbances, anxiety, paranoia, agitation, delusions, and hallucinations. Eventually, people with the disease are no longer able to care for themselves. Alzheimer's disease is fatal; it is the 6th leading cause of death in the United States.  Alzheimer’s is the only cause of death (among the top 10) in America without a way to prevent, cure, or even slow its progression. 

The world’s population is aging at unprecedented rate.  Starting last year 100,000 baby boomers each day are reaching age 65. Today over 5 million people are living with the Alzheimer’s disease.   It is projected that by 2050, 16 million will have Alzheimer’s; it will be the leading cause of adult death in the country.

The Burden of Alzheimer’s

Of Americans aged 65 and over, 1 in 8 has Alzheimer’s;  nearly half of people aged 85 and older have the disease.  The average life expectancy for someone with Alzheimer's is 8-10 years after the onset of symptoms. However, individuals with Alzheimer's have been known to live up to 20 years after the first signs emerge.

It was estimated last year that the cost of caring for those with Alzheimer’s in the U.S. has totaled $183 billion. This is an $11 billion increase over 2010; a rate of increase more than four times inflation. By 2050 it is projected that costs will total $1.1 trillion.  This translates into a major crisis in the country’s financial and correctional systems. 

The elderly constitute the fastest-growing sector of the inmate population.  In 2010 the elderly (55 and older) represented 8% of the prison population.  That was a 6 fold increase over the past fifteen years. The main reason for this trend is that prisoners are getting the long sentences including life without parole.  Additionally, there has been an increase in the number of older offenders entering the system.

States are obligated to treat medically and mentally ill inmates related to the cruel and unusual punishment clause of the Eighth Amendment to the U.S. Constitution.  The treatments the elderly population require are far more costly than those of younger inmates.  For example, in Georgia, the cost of taking care of an elderly inmate is 9 times higher than a younger inmate.   Additionally, prisons were not designed to be geriatric facilities.  Cells need to facilitate an elderly person’s physical and mental handicaps.  States are being forced to house older and demented prisoners in special units.  

Nearly 15 million dementia caregivers provide an estimated 17 billion hours of unpaid care to loved ones (valued at $202 billion/year).   Research has shown that caregivers suffer both physically and emotionally related to the high level of anxiety of caring for someone with Alzheimer’s.       

Alzheimer’s and First Responders

First responders may observe the following common symptoms in people with Alzheimer’s disease:

•             Using nonsensical words while speaking

•             Disoriented to space time and place

•             Poor judgment (wearing inappropriate clothing)

•             Wandering or becoming lost; not knowing where one lives.

•             Rapid mood swings, anxiety, suspiciousness, or agitation.

•             Blank facial expression.

•             Walking characterized by a slow shuffling gait.

Alzheimer’s Disease and Wandering

Over 60% of people with dementia will wander at some point, many do so repeatedly.  In the United States over 125,000 Alzheimer's disease subjects become critical wanderers annually. It estimated by 2040, this number will increase to over half a million wanderers per year. The wanderer usually has a purpose or goal in mind; searching for something, escaping from something, or reliving the past.

The consequences of wandering are staggering, including death and severe medical compromise.  The leading causes of death for wanderers are hypothermia, dehydration and drowning. Finding the wanderer as soon as possible is paramount. Survivability rates are also related to weather conditions. 94% of Alzheimer's subjects will be found within 1.5 miles.  75% of all wanderers have been found on or within 33 yards of a road or a trail. Subjects with Alzheimer's are drawn towards light. Studies indicate that 75% of wanderers head south. The best tactic for starting a search is to head SE or SW (toward the light), depending on the time of day the victim was last seen.  Learning from family members the history of other wandering attempts may also assist rescuers. 

After the initial crisis has been resolved officers need to encourage the family to contact the Safe Return program’s nonemergency number at 1–888–572–8566 to register the individual as a wanderer.

Responding to Individuals Who Have Alzheimer’s Disease

If you suspect an individual has Alzheimer’s disease, expect conversations to be difficult.  Move the individual away from crowds or other noises; turn off your light and turn your radio down.  To avoid suspiciousness approach the individual from the front, establish, and maintain eye contact.  Introduce yourself as a law enforcement officer and explain that you have come to help. You may have to repeat this information several times.   To prevent agitation, talk in a reassuring manner, use simple sentences and familiar words.  Request to see identification, also notice if he/she has a Safe Return bracelet, necklace, lapel pin, key chain, or label inside their clothing collar. Check for evidence of physical impairment especially dehydration or hypothermia.  Call paramedics if you have any concerns.  Determine if they are a victim of any crime, including abuse or neglect.  Never challenge victims’ logic or reasoning.  Make any instructions simple; use nonverbal communication skills if the individual remains confused.  Yes and no questions are best.  Do not leave the individual alone, he/she may wander. 

Signs and Symptoms of Alzheimer’s Disease

There are many different causes of memory loss.  If you, a parent, or grandparent is experiencing symptoms of dementia, talk to your doctor so the cause can be determined. The following is a list of symptoms of Alzheimer’s disease by the Alzheimer's Foundation of America:

•             Relying on memory helpers

•             Trouble finding words

•             Struggling to complete familiar actions

•             Confusion about time, place or people

•             Misplacing familiar objects

•             Onset of new depression or irritability

•             Making bad decisions

•             Personality changes

•             Loss of interest in important responsibilities

•             Seeing or hearing things

•             Expressing false beliefs

The National Institute on Aging's ADEAR Center offers information and publications for families and caregivers related to the diagnosis, treatment, patient care, caregiver needs, long-term care, education and training, and research related to Alzheimer's disease.

Although there is no current cure for Alzheimer’s there are treatments than can slow the worsening of symptoms and improve an individual’s quality of life.  Research continues to offer hope for the future.

 

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About The Author:

Pamela Kulbarsh, RN, BSW has been a psychiatric nurse for over 25 years. She has worked with law enforcement in crisis intervention for the past ten years. She has worked in patrol with officers and deputies as a member of San Diego's Psychiatric Emergency Response Team (PERT) and at the Pima County Detention Center in Tucson. Pam has been a frequent guest speaker related to psychiatric emergencies and has published articles in both law enforcement and nursing magazines.

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