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An intensive personalized primary care program (IPPC) for Alzheimer

dementia.

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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.

Keywords: Alzheimer dementia, primary care, IPPC


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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

practice are required to be searched and established.

Improvement in clinical practice: The innovative IPPC program1

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

at sub-urban and rural areas.

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

impairments, especially in the initial stage

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

Facts and Figures. (2019). Retrieved from https://www.alz.org/alzheimers-dementia/facts-

figures

Herrmann, N., Gauthier, S., & Lysy, P. (2007). Clinical practice guidelines for severe

Alzheimer’s disease. Alzheimer's & Dementia, 3(4), 385-397. doi: 10.1016/j.jalz.2007.07.007

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

Qaseem, A. (2008). Current Pharmacologic Treatment of Dementia: A Clinical Practice

Guideline from the American College of Physicians and the American Academy of Family

Physicians. Annals Of Internal Medicine, 148(5), 370. doi: 10.7326/0003-4819-148-5-

200803040-00008

Sanders, A., Nininger, J., Absher, J., Bennett, A., Shugarman, S., & Roca, R. (2017).

Quality improvement in neurology. Neurology, 88(20), 1951-1957. doi:

10.1212/wnl.0000000000003917