Interview with Kathy Naufel R.N.

Kathy Naufel is a registered nurse who has worked in several nursing homes/ senior care facilities as the director of nursing and charge nurse. She is very experienced with caring for patients with the diagnosis of Alzheimer's disease.

Why did you choose to work in the healthcare field?

I choose to work in the healthcare field so that I could have a direct impact on society. In my eyes I am doing something that actually impacts people on a very personal level; it is very rewarding work.

How often to you encounter a patient with Alzheimer’s disease?

I encounter patients with Alzheimer's disease, unfortunately, more often than one would want. 70-80% of my patient's have a diagnosis of Alzheimer's of Dementia.

Can you think of any interesting stories involving one of those patients?

There are many interesting stories; one that stands out in my mind is about a patient who is a retired nurse. She is probably in the 6th stage of Alzheimer’s, she is at the point where she still responds to her name but has forgotten the routines of daily living, like brushing teeth, combing hair, using the bathroom etc. She is one that unfortunately still has moments of lucidness every now and then; you can see the shame she feels when she realizes that she is in a nursing home unable to care for herself and unable to explain what is happening to her. Unfortunately in our society our geriatric population feels that shame, they view themselves not as a sick person with a disease but as less of a person who is losing their mind which can be heartbreaking to watch. This particular patient actually lights up at times and often goes up to the medicine cart and wants to take care of other patients on her unit. She calls them her patients and at times she actually will catch things that our staff may miss. One time she was in the dining area and she saw a patient clutching her chest, she yelled out for someone to get help, and said “call 911 Ethel is having a heart attack!”. And she was right. Later when she was asked how did knew to call for help, she simply said "she was cyanotic and clutching her chest". But sadly two seconds later she couldn't remember where her room was, or what is she was suppose to be doing. This is a very cruel disease.

How important is the search for a cure for Alzheimer's disease?

A search for a cure is pivotal for our aging population. Finding a cure can mean so many things for this population: a better quality of life, a healthier long-living body, and (most importantly)the ability to live, age, and die with dignity and the ability to experience as much as possible in life.

What do you think about using grid computing in this search?

I think grid computing may have a great impact on finding diagnostic implications and genetic ties to Alzheimer's, but I don't think that it would have much impact on actual implication of practice for interventions for everyday problems that this disease presents. While Alzheimer’s is a defined disease process, it effects every individual differently and it would be hard to compile information that may fit and categorize people, every patient is a unique individual with very specific habits and needs.

What misconceptions exist about Alzheimer’s disease?

One misconception is that a patient with a below average intelligence level is at a higher risk for developing Alzheimer’s. While research shows that keeping the mind engaged and stimulated may lesson your chances of developing Alzheimer's, there is just as much research that shows that the your genetic disposition has a much bigger impact and can contain triggers for developing the disease. We have had a president that died of Alzheimer’s, in my career I have had patients that worked as doctors, lawyers, accountants, and CEO's; this disease doesn't discriminate.

Another miss-conception is that this very fragile population is crazy. Unfortunately when patients enter the healthcare system many get miss-diagnosed with things other than Alzheimer’s (like psychiatric disorders, explosive behavior disorders, or major depression). All of these may accompany a diagnosis of Alzheimer’s but many in the healthcare field see a psyche diagnosis and do not look beyond it, so these patients end up on psyche medications that may actually advance the disease process. In the end this hurts this population by delaying effective proper treatment and interventions.

Also, some family members have a hard time understanding the disease so when a loved one doesn't remember them or lashes out they take it personally, and do not see it as a disease process like they might if they had a cancer diagnosis.

Is the progression of the disease variable in independent patients? (Meaning can it progress very rapidly in some and slower in others. ) Could there be genetic factors that affect this?

I think the progression of the disease is different in each individual, which could have some genetic influence. There are 7 stages to Alzheimer’s and each individual is unique. I have seen some go from stage 3 to stage 6 in a month’s time (not years). On the same the opposite end of the spectrum, I have seen some stay in stage 4 or 5 for several more years than expected. There may be a genetic factor that affects this.

What are the classifications for the levels of severity of the disease in individuals?

There are 7 stages; the classifications we use are based on the stage and level of functioning. Stages 1-4 fall under level one because most patients can still function in society with help from family and the community. Stages 4-5 require 24 hour supervision because there is a moderate to severe cognitive impairment and the individual needs help usually with all or most of activities involved in daily life. Level 3 is usually stages 6-7 which are severe cognitive end stages of the disease.

These levels help us in identifying the interventions used for a specific group and the appropriate activity level needed for cognitive stimulation.

Most of the medications for Alzheimer’s disease are still being researched, in your experience are there any medications that you feel are the most helpful(or harmful) or does it vary from patient to patient.?

There has been an increase in research for new medicines, but I have not had a more positive or negative experience with one particular medication over another. Usually it is a combination of meds like Aricept and Nemanda. If given early enough, I have seen the disease process actually slowing down. Yet, most patients sadly don't get diagnosed in the first or second stage thereby limiting how much impact pharmaceuticals can deliver.

As the population of older individuals increases, do think that if a cure or ways of prevention of Alzheimer’s disease has not been found, that it will reach epidemic proportions among the elderly?

There is a lot of speculation about this disease in the future; many say that with the baby boomers we will see a large increase of the Alzheimer’s population. I think an epidemic is very possible because we are going to have an increased incidence of aging population period which will mark an increased incidence of Alzheimer’s.

Is there any other personal insight relating to the disease that you would like to add or discuss?

My experience with Alzheimer’s patients has opened my eyes to living my life to the fullest and not taking for granted the gift of our mind. I have seen many families struggle with loved ones and their Alzheimer's diagnosis. I think most of them blame themselves somehow for not noticing earlier or just feel guiltily for having to keep them in a nursing home. I think we need to put more money towards educating the public about early signs of the disease so that we can diagnose patients earlier, and hopefully get them started earlier on medications sooner. That may slow down the progression of the disease which can dramatically improve their quality of life.