This case study examines the clinical presentation and management of Alzheimer's disease in a 73-year-old African American veteran, highlighting the intersection of racial health disparities, military service-related injury, and complex comorbid conditions. The paper documents the patient's rapid cognitive and functional decline following a hip fracture and mini-stroke, complications including dysphagia and aspiration, and the family's ethical concerns regarding interventions like feeding tube placement. By situating this individual case within epidemiological data showing African Americans experience Alzheimer's at twice the rate of whites, the paper illustrates how socioeconomic status, chronic illness, and medical complexity shape end-of-life outcomes in vulnerable populations.
Today, Alzheimer's disease afflicts more than 16 million individuals in the United States, but the etiology of this condition remains unclear (Sullivan, 2010). What is known is that Alzheimer's affects Black Americans twice as often as whites and Hispanics 1.5 times as often, and this discrepancy is believed to be attributed to lower socioeconomic status and higher rates of chronic illness among minority populations (Sullivan, 2010).
This case study examines a retired postal worker, a 100 percent disabled 73-year-old African American veteran living in Cleveland. In 2011, his wife of 50 years died, leaving him living alone for the first time in his adult life. At the time of his wife's death, he had been diagnosed with early-stage dementia but had been able to remain active and living independently for a period of one year in a long-term care retirement center.
During his military service in World War II, the patient received a shrapnel wound to the side of his head that made him deaf in his right ear. For this injury, he received a 100 percent total and permanent disability award from the Department of Veterans Affairs (VA) and receives $2,600 each month in compensation. His award was reduced by $250 per month following his wife's death, but he receives an additional $225 each month in aid and attendance due to her absence and inability to provide his daily living needs.
Following a suspected mini-stroke, the patient fell and broke his right hip. Following surgical reduction of the break, his condition rapidly deteriorated and he was diagnosed with Alzheimer's disease and moved into an intensive care facility in the community, an increasingly common intervention for the elderly with this condition (Zimmerman & Sloan, 2009). His diabetes—more common in African Americans compared to whites—along with his gender and race are thought to have placed him at especially high risk for Alzheimer's (Sullivan, 2010).
Since the onset of Alzheimer's, the patient's ability to communicate orally has diminished severely despite speech therapy sessions. He also receives regular physical therapy and has regained the ability to walk for short distances while holding onto the back of a wheelchair with the assistance of a nursing aide, though he eventually became bedfast. Although his family members visit him every week for short periods, he does not recognize many of them on occasion and appears confused whenever someone speaks to him. On many occasions, his family members are unable to awaken him at all.
Further exacerbating the patient's situation was the implant of a feeding tube in his side to facilitate nourishment, since he was experiencing problems with swallowing and routinely aspirated food and liquids. He has since been placed on soft water and tube feedings. These changes have further confused the patient since he does not comprehend the need for them.
"Feeding tube intervention and family disagreement"
"Case generalizability and treatment complexity in vulnerable populations"
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