Alzheimers, Strokes, AIDS,

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Alzheimers, Strokes, AIDS, Palliative Care

• Ministry to the Unreachable Untouchable

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Alzheimers Disease 1

• An organic disease conclusively diagnosable only
  through brain tissue examination (biopsy or post
  mortem)
• Brain atrophy is usually present on CT or MRI
• Cognitive deficits develop slowly deterioration
  is progressive.
• Avg. life expectancy from onset to death is 8 to
  10 years great variance.

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Alzheimers 2

• Memory other cognitive deficits occur early
  motor dysfunction occurs late.
• First-degree relatives of early onset (lt age 65)
  are at increased risk
• Signature characteristics memory language
  impairment (aphasia, apraxia, agnosia,
  disturbance in executive functioning)

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Ten As for Alzheimers Care 1

• Arguments are useless
• Allow freedom independence (safety!)
• Actions help when verbalizations fail
• Assume that they hear understand
• Appreciate good days or moments

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Ten As for Alzheimers Care 2

• Appropriate activities help pass time
• Adapt the task to ability
• Agitation alleviated by calm, reassuring,
  respectful responses
• Adults are still adults (mental vs. social)
• Assessment is ongoing

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Pastoral Care Alzheimers

• Care of Person Family (Caregivers)
• They remain a spiritual being despite cognitive
  losses.
• Talk, pray, sing, read Scripture
• Face your own uneasiness dont be in a hurry
  give visual cues of who you are.
• KISP Keep It Simple, Pastor (or KISS,
  Stupid)

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Stroke (CVA) Victims 1

• CVA Cardio-vascular accident
• Typically occurs at night when blood flow slows
• Thrombotic, hemorrhagic (most dangerous),
  embolic, compression (worst prognosis) CVAs
• Better prognosis (1st three) if survive the first
  30 days

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Stroke (CVA) Victims 2

• Left-Brain Injury right hemiplegia speech
  disturbance
• Right Brain Injury left hemiplegia perceptual
  problems
• Effects emotional changes (organic) gt crying
  inappropriately swearing
• bladder incontinence

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Stroke (CVA) Victims 3

• Emotional Response Panic fear that God has
  deserted me fear of death, insanity feel
  complete hopelessness
• Family often takes 100 responsibility for the
  stroke
• Fears person will live as a vegetable
• Fears person will die
• Help family tolerate the panic

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CVA Chronically ILL

• Solitude boredom are two major enemies in
  recovery for chronically ill persons.
• Solitude boredom can exacerbate the depression
  that often is present

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AIDS Acquired Immune Deficiency Syndrome

• Caused by HIV (Human Immunodeficiency Virus)
• Death often comes through opportunistic diseases
  such as Pneumocystis carinii pneumonia. Kaposis
  sarcoma (cancer) also is common.
• AIDS is incurable

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Ministry to Persons with AIDS 1

• Condemn? No. Condone? No.
• Reconciliation Comfort? Yes!
• Many are rejected by family, friends, church
  community. Need a loving, caring, holy
  community.
• CONFIDENTIALITY is a must!!
• Do not be afraid to touch or hug

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Ministry to Persons with AIDS 2

• The primary pastoral response will be to the
  grief associated with AIDS
• Taking a leadership role in encouraging support
  by the church community
• If Gods children do not care, who will?
• What Biblical/theological warrant is there for
  neglecting those afflicted with AIDS?
• Wherein is God glorified?

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AIDS Ministry Resources

• Amos, William E, Jr. When AIDS Comes to Church.
  Westminster, 1988.
• Hoffman, Patricia L. AIDS and the Sleeping
  Church. Eerdmans, 1995
• Shelp, Earl E., Ronald H. Sunderland, Peter
  W.A. Mansell. AIDS Personal Stories in
  Pastoral Perspective. Pilgrim Press, 1986.

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Three primary phases in the natural course of a
disease

• Curative to restore health recover
  from disease
• Palliative to make less severe, without curing
• Terminal ending in death fatal

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Michael Ashby Brian Stoffell, Therapeutic
Ratio and Defined Phases Proposal of Ethical
Framework for Palliative Care, British Medical
Journal, 302, 6788 (June 1, 1991), 1322-1324.
InfoTrac 12-3-01
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The Caregivers Response

• Supportive of the patient and the family
• Healthy attitude toward death (not death as
  defeat)
• Manageable level of anxiety about dying
• Your limitations (inability to control outcome)
  and self-image
• Your grieving process and feelings of guilt,
  anger, sadness (responses to loss)

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• When you are struggling with holding on versus
  letting go, ask yourself, In light of the
  present realities (recovery cure is not
  possible), what if my patient could not die?
• Ask God to comfort you, your patient, family, and
  fellow staff members.
• Praise be to the God and Father of our Lord
  Jesus Christ, the Father of compassion and the
  God of all comfort, who comforts us in all our
  troubles, so that we can comfort those in any
  trouble with the comfort we ourselves have
  received from God. II Corinthians 13-4

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Two Other Common Diseases

• Diabetes - unable to use glucose (sugar)
  ketoacidosis
• Type I (IDDM (insulin-dependent diabetes
  mellitus 10 ) autoimmune disease no insulin
  requires insulin injections or insulin pump
  insulin reactions are a concern.
• Type II (NIDDM or non-insulin-dependent diabetes
  mellitus 90 ) metabolic disorder insulin
  resistance requires medication (often oral)
• Normal Blood Sugar 70-120 diabetic neuropathy
  amputations
• (ADA) www.diabetes,org www.cdc.gov/diabetes
  www.diabetesnet.com
• Exercise, diet, monitoring, medication are
  essential failure nerve damage
• Hypertension - (high blood pressure the silent
  killer kidney damage, strokes, aneurysms, etc.)
• Medications include diuretics (water pills),
  ACE inhibitors, etc.
• Normal BP 120/80

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Hospital Monitors

• Heart (60-80 bpm at rest) dont alarm patient
  focus on patient
• Lung (adults 14-16 bpm at rest up to 60 bpm
  with exercise infants 40-45 bpm at rest 25 bpm
  by age 5)
• Brain Intracranial Pressure (ICP) -
  Cerebrospinal fluid (CSF) pressure measured from
  a needle or bolt introduced into the CSF space
  surrounding the brain. It reflects the pressure
  inside of the skull. www.waiting.com/glossary
• IV (Intravenous) Pumps Alarms Tampering
  Staff must be aware that patients and visitors
  can open pump doors, remove syringes and
  administration sets, change settings and switch
  off pumps. www.ebme.co.uk/arts/art11
• Call Buttons may use to notify nursing staff of
  a problem