Alzheimer’s disease is the most common cause of dementia in older people. Alzheimer’s disease is an irreversible and progressive brain disease that slowly destroys memory and other important mental functions, which is due to degeneration between the brain cells and the brain cell receptors (Alzheimer’s Stages & Behaviors, 2014). Alzheimer’s disease results in the loss of intellectual and social skills (Alzheimer’s Stages & Behaviors, 2014). According to the Alzheimer’s Association there are 7 stages to this disease (Alzheimer’s Stages & Behaviors, 2014). The first signs of Alzheimer’s disease are typically forgetfulness or mild confusion (Alzheimer’s Stages & Behaviors, 2014). Stages 1 through 3 show mild cognitive decline, Stage 4 is moderate cognitive decline, Stage 5 is moderately severe, Stage 6 is severe cognitive decline and Stage 7 is very severe cognitive decline (Alzheimer’s Stages & Behaviors, 2014). Accurate staging of an Alzheimer’s patient is difficult, because some stages overlap with one another (Alzheimer’s Stages & Behaviors, 2014). This week’s case discusses Mr. Jones, an 83-year-old man, diagnosed with mild dementia. Mr. Jones is admitted to the Emergency room with respiratory distress and complications due to Diabetes. While in the Emergency Room the attending physician notices Mr. Jones has gangrene on his right foot up to his ankle. The nurse believes his dementia is due to his respiratory distress and the disorienting atmosphere of the Emergency Room. Mr. Jone’s daughter is his caregiver, but has not been designated as an advanced directive surrogate nor does Mr. Jones have an advanced directive in place. Mr. Jones insists that he has lived long enough and does not want to have his leg amputated, but the daughter insists that surgery be performed or she will sue the hospital. In 2013, an estimated 5.2 million Americans of all ages have Alzheimer’s and it is the sixth leading cause of death (Alzheimer’s Stages & Behaviors, 2014). In 2012, 15.4 million caregivers provided over 17.5 billion hours of unpaid care (Alzheimer’s Stages & Behaviors, 2014). There is no specific test to diagnose Alzheimer’s and only after death can a accurate diagnosis be made, so clinicians must perform various tests to determine the cause of dementia in order to rule out Alzheimer’s (Alzheimer’s Stages & Behaviors, 2014).
In 1988, the MacArthur Treatment Competence Study was designed to provide clinicians and policy makers with information to address questions about decision-making capacities of patients with mental impairment (Applebaum, 2007). This test takes about 20 minutes and measures abilities that the legal system identified as relevant to decision-making competence (Applebaum, 2007). Although, this is the most widely used tests there are other tests available to practitioners. The ability to state a choice, understand relevant information, understand their own situation and...