A community health nurse is preparing an educational activity on Alzheimer's disease. Which of the following risk factors should the nurse include as the greatest risk for this disease?

Rationale:

A. Hospice care is not limited to hospitals or inpatient facilities. It can be provided in various settings, including the client’s home, nursing homes, assisted living facilities, or inpatient hospice units. The primary focus is comfort and quality of life, regardless of the location. Limiting hospice to a facility is incorrect and does not reflect its flexibility or patient-centered approach.

B. Hospice care is specifically designed for clients who are terminally ill, typically with a prognosis of six months or less if the disease follows its usual course. The focus is on palliative care, symptom management, psychosocial support, and spiritual care, rather than curative treatment. Hospice provides comprehensive support to both the patient and the family, emphasizing quality of life in the final stages of illness.

C. Hospice care can be discontinued if a client’s condition improves or if they choose to pursue curative treatment or more aggressive interventions. Clients and families retain the right to withdraw from hospice at any time, making this statement inaccurate. Hospice is voluntary and flexible, and care plans are tailored to the client’s current needs and preferences.

D. The goal of hospice is not to prolong life, but to enhance quality of life, manage symptoms, and provide comfort and support. Life prolongation may occur incidentally in some cases, but it is not the primary objective. Hospice philosophy emphasizes dying with dignity, rather than focusing on curative treatments or extending life at all costs.

Rationale:

A. In the terminal phase of Alzheimer’s disease, clients often experience severe physical decline, including loss of mobility and muscle strength. They may become completely bedridden and unable to sit up independently, reflecting the progressive degeneration associated with late-stage Alzheimer’s. This finding is an expected part of the terminal phase and indicates the need for comprehensive supportive care, including repositioning, skin care, and prevention of pressure injuries.

B. While needing cueing to eat is characteristic of moderate to late-stage Alzheimer’s disease, it is not specific to the terminal phase. By the terminal stage, clients often lose the ability to feed themselves entirely and require total assistance with eating or may be receiving alternative nutrition such as enteral feeding.

C. Needing help with finances occurs in the earlier or moderate stages of Alzheimer’s disease when cognitive decline interferes with complex tasks. In the terminal phase, the client’s deficits are far more profound, affecting basic activities of daily living rather than higher-order tasks like managing finances.

D. Speech degradation to a few words generally occurs in the late stages of Alzheimer’s, but in the terminal phase, clients may lose verbal communication entirely. The inability to sit up is a more definitive and observable physical marker of the terminal stage.