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Howland Family Alzheimer’s Disease NURS 480 Family Nursing: Theory and Assessment

Alice Howland Alice is a 50-year-old caucasian female and is a linguistics professor at Columbia University. She lives a healthy lifestyle as she enjoys running, and is often seen eating a variety of fruits and vegetables. Alice has a great relationship with her children: Anna, Tom, and Lydia. She is married to her loving husband, John, and they live in a house near Columbia University, New York. Her mother and sister passed away due to a car accident when she was 18-years-old, and her father passed away due to cirrhosis of the liver. Her intelligence is well-known as she is asked to be a guest speaker at many universities, and her doctoral thesis is “considered one of the cornerstones of linguistics education all over the world” (Genova, 2014). Alice begins to notice mild cognitive impairments after her 50th birthday, and she seeks out an opinion from a neurologist as she is worried that she has brain cancer. After undergoing a series of tests, Alice is diagnosed with early-onset familial Alzheimer’s Disease (EOFAD). She attempts to halt the progression of her conditions by taking medication, and actively participating in physical and mental exercise.

Alzheimer’s Disease Early-onset Alzheimer’s Disease occurs in roughly 5% of the entire population of those suffering from Alzheimer’s Disease (AD), and 2% of the 5% are inherited as an autosomal dominant trait (Tiedt, Luechow, Winter, & Muller, 2013). Autosomal dominant, or familial, AD causes family members from multiple generations to develop AD (Alzheimer’s Association[AA], 2018). As an autosomal dominant trait, a family member will have a 100% chance of developing familial AD if they inherit the dominant gene. Dementia is the a decline in mental ability that interferes with daily functioning, and AD is the most common type of dementia. Signs and symptoms of AD include loss of memory that disrupts daily activities, inability to tell time and place, difficulty completing common tasks, difficulty speaking or writing, misplacing objects, inability to retrace steps, inability to recognize family members, difficulty sleeping, agitation, and appetite changes (AA, 2018).

John John is a 55-year-old caucasian male who is Alice’s husband. He is a cancer cell biologist who also works at Columbia University, and he was recently offered a job at the Mayo Clinic in Minnesota (Genova, 2014). Although he believed it was too soon for Alice to develop AD, he cares for Alice and is patient with her when her condition progresses. He did not believe it was financially appropriate to step down from his career, but he hired a caregiver to look after Alice. He provided financial support for his family as he put Tom through medical school, and Anna through law school.

The Howland Family Anna

Anna is the oldest daughter at 31-years-old who is a lawyer, married, and recently gave birth to twins. Her genetics testing found her to be positive with the EOFAD gene, but she did not pass the genes on to her newborn twins. She was glad that she found out and was able to test her children before they were born. She plays Words With Friends with Alice.

Tom Tom is the middle child at 28-years-old and he is currently in his third year of medical school. His genetics test concluded that he did not inherit the EOFAD gene. He is close with his family and only wants the best for his mother.

Lydia Lydia is the youngest daughter at 24-years-old. She is the only one in the family who did not go to college as she was trying to pursue an acting career in California. She did not take the genetics test because she did not want to find out her results. Although she lives across the country, she finds time to visit during the holidays. They video chat often and she worries about her mother’s safety. When Alice’s condition worsens she moves back home to take care of her.




Strong communication between family members.

John struggles with his professional career and marriage by taking a promotion at the Mayo Clinic

Family provides strong financial and emotional support. John hired a caretaker to provide Alice with support when nobody is home. Lydia gives up her pursuit for an acting career in California to take care of Alice. Alice is loved by her family, and they only want the best for her.

Alice is frustrated that the language she once believed to be common knowledge is becoming a distant memory. Alice is unable to go to dinners with John’s employers. Alice frequently gets lost when she goes for a run. Communication will soon become difficult as she continues to deteriorate.

Family Structure The Howland family is a traditional nuclear family as it consists of two parents and their children. The family developmental stage is that of middle-aged parents/empty nest, which is when all the children have moved out and ends with the parents retiring. The family achieves during this stage of development as John and Alice have a strong marital relationship and they maintain this relationship as Alice’s condition deteriorates. Alice participates in a healthy promoting lifestyles as she exercises frequently and she attempts to halt the progression of her illness. Furthermore, she is able to maintain a strong relationships with all of her family members .

Culture and Traditions The Howland family participates in traditions that are common in a nuclear family that have a loving relationship with each other. They value celebrating important holidays, birthdays, and events together. They will have dinner every Christmas and go out to eat for a birthday party. Education is highly valued as John and Alice are willing to pay for all of their children to go to college. Everyone in the family, except for Lydia, has a bachelor’s degree and most of the family have achieved a higher education. Although Alice and Anna are not fond of Lydia’s choice to pursue a career in acting, they will still watch her act and commend her performance. The entire family sat in on the speech Alice gave about her experience with EOFAD.

Communication The Howland family uses verbal communication as they like to frequently have family gatherings. Lydia will often communicate with alice through video chat. They partake in courteous, sincere, and truthful conversations. Alice spoke John about her condition when she had enough evidence to support her diagnosis. Afterwards, Alice and John set up a family meeting to let their children know that Alice has AD and that they may have the gene as well. Everyone in the family will truthfully answer questions directed towards them. If anybody in the family has an issue they will openly speak up. Nonverbal communication is used to accentuate the love they have for one another. They’re always actively listening and assisting each other in any possible way. Alice begins to feel frustrated when she starts to forget words that were once common language to her. Her family is very patient with Alice’s deterioration, and they understand what she is trying to convey even when she cannot communicate efficiently.

Chronic Illness Framework

The Chronic Illness Framework was developed by Rolland to aid in the understanding of how chronic illness affects family (Kaakinen, Coehlo, Steele, Tabacco, & Hanson, 2015). The major points of this framework include types of illness, the illness overtime, and family functioning (Kaakinen et al., 2015).

Time Phases of Illness:

Onset of Illness: Alice starts off in the acute phase of AD as she starts to see signs and symptoms of cognitive impairment. She is worried that it may be brain cancer. EOFAD does not have a cure with an onset between the ages of 45 to 59 years of age (Cabrera, Beattie, Dwosh, & Illes, 2015). Her condition transitions from acute to gradual as her family adapts with her mental deterioration.

Course of illness:

Alice’s condition is at the initial/crisis time phase as she has just been diagnosed with EOFAD. During this phase she was able to establish a positive relationship with her neurologist as he showed up to her speech at an Alzheimer’s Association meeting. She recognized that her AD was familial, and she began to accept her diagnosis. The placed initial stress on the family as her children decided whether to take a genetics test or not, and to plan for their Alice’s future wellbeing. Alice’s family has a strong relationship and they worked together to learn what her condition entails and what to do to help her. Alice’s family has the resources to take care of her such as being financially stable, having a strong education in medicine, and making time to provide care and support.

The family experiences progressive chronic illness as Alice’s memory fades away at a slow rate. They family has time to talk about what is best for her.. As her condition worsens, her husband takes a job promotion as it will provide financial support for Alice who had to leave her career as a linguistics professor. John unable to care for Alice on his own and hires a caretakers for Alice. Furthermore, Lydia takes it upon herself to leave her job in California and move back home to New York to take care of Alice.

Incapacitation: Alice experiences cognitive impairment as she begins to lose insight to who she is and who is closest to her. After Lydia’s performance she had forgotten her daughter for a brief moment. The family learns to be patient with her and must adapt to new communication skills.




Caregiver role strain r/t sudden change in role change, 24-hour care responsibilities, and inability to balance career and caregiving AEB Alice’s progressive cognitive deterioration, John’s new job promotion at the Mayo Clinic, Anna recently giving birth to twins, Tom is currently in medical school, and Lydia lives in California. (Ackley & Ladwig, 2014).

The Howland family will make use of their resources to reduce the strain of newly attained caregiver roles within the next 3 months.

Provide education to increase the caregiver’s knowledge of general EOFAD management and ways to decrease Alice’s behavioral disturbances. Introduce a cost-effective community based occupational therapy(OT) program that both Alice and her caregivers can attend. Rationale: Psycho-educational and group OT interventions were found to reduce caregiver distress, and significantly improve well-being (Zabalegui et al., 2014).

Interrupted family processes r/t shift in health status of a family member, power shift of family members, modification in family finances AEB Alice’s progression of EOFAD, Alice leaving her job, Lydia leaving her job to become Alice’s primary caregiver. (Ackley & Ladwig, 2014).

The Howland family will seek out appropriate assistance to meet physical, psychosocial, and spiritual needs within the next 3 months.

Refer the family to a mutual support group available for family caregivers with a relative who has AD. The mutual support group will consist of 12 1 hour sessions. The content will include sharing experiences, psychological support, problem solving, and education. Rationale: Mutual family support groups were proved effective in reducing stress and improving quality of life in family caregivers (Zabalegui et al., 2014).

Wandering r/t cognitive impairment, memory and recall deficits, separation from familiar places AEB Alice wandered off for hours while on a run, and she wandered off to find a restroom but could not find it in her own house.

The Howland family will create a safe environment for Alice within the next 3 months.

Educate the family on how to create a safe house environment by locking up guns, sharp objects, and exits. Create a familiar environment and disguise exits to look like bookcases, walls, or paintings. Rationale: Non-physical barriers have been used to create a non restraining intervention to prevent wandering (Raetz, 2013).

References Ackley, B. J., & Ladwig, G. B. (2014). Nursing diagnosis handbook: an evidence based guide to planning care (10th ed.). Maryland Heights, MO: Mosby. Alzheimer’s Association. (2018). Younger/early onset alzheimer’s and dementia. Retrieved from Cabrera, L. Y., Beattie, B. L., Dwosh, E., & Illes, J. (2015). Converging approaches to understanding early onset familial alzheimer disease: a first nation study. Open Medicine, 3, 1-8. Genova, L. (2014). Still alice. POCKET Books. Kaakinen, J. R., Coehlo, D. P., Steele, R., Tabacco, A., & Hanson, S. M. (2015). Family health care nursing; theory, practice, and research. Philadelphia: F.A. Davis Company. Raetz, J. (2013). A nondrug approach to dementia. The journal of family practice, 62(10), 548-557.

References Tiedt, H. O., Lueschow, A., Winter, P., & Muller, U. (2013). Previously not recognized deletion in presenilin-1 (p.Leu174del.) in a patient with early-onset familial alzheimer's disease. Neuroscience Letters, 554, 115-118. Zabalegui, A., Hmers, J. P., Karlsson, S., Leino-Kilpi, H., Renom-Guiteras, A., Saks, K., Soto, M., Sutcliffe, C., Cabrera, E. (2014). Best practices interventions to improve quality of care of people with dementia living at home, Patient Education and Counseling, 95, 175-184.

References [Untitled image of Alice]. Retrieved from [Untitled image of Alice teaching]. Retrieved from [Untitled image of Alzheimer’s Association]. Retrieved from [Untitled image of Alzheimer’s disease].Retrieved from [Untitled image of Anna Howland]. Retrieved from [Untitled image of family dinner]. Retrieved from [Untitled image of John Howland]. Retrieved from [Untitled image of Lydia Howland]. Retrieved from [Untitled image of Tom Howland]. Retrieved from [Untitled image of video chat]. Retrieved from


Chronic Illness Framework


Chronic Illness Framework