Preliminary Care Coordination Plan

Topic: Geriatrics
Words: 941 Pages: 3

A care coordination plan (CC) is an essential healthcare practice delivering the coherent organization of patients’ care activities and information interchange among all participants in patient care to guarantee satisfactory health outcomes. Due to such plans, medical providers can ensure that the related people are acquainted with the patient’s characteristics, needs, and preferences in advance to reduce healthcare costs and severe staff errors. This paper aims to develop a preliminary care coordination plan examining a health care problem, namely, Alzheimer’s disease, and related best practices, establishing specific goals and identifying necessary community resources to improve patients’ status.

Problem Analyzation

Alzheimer’s disease (AD) is regarded as an irreversible, neurodegenerative disorder, the most dominant form of dementia. The primary AD symptoms, mainly visible at over 65, include a substantial and progressive deterioration in memory, especially short-term, and other cognitive capabilities, morbid behavioral changes, and the conclusive inability to perform everyday activities (Alzheimer’s Association, 2020). Nearly 50 million individuals currently suffer from AD in the world, and the figure is anticipated to achieve 130 million by 2050 (Liang et al., 2018). The overall assessed global cost of dementia amounts to approximately $800 billion (Liang et al., 2018).

Herewith, several studies revealed that most incidents occur among Americans and Hispanics and in low- and middle-income countries. (Alzheimer’s Association, 2020). Overall, AD inflicts a heavy physical, psychological, and social burden on patients, their families and caregivers, and the healthcare system.

Pathophysiology and Causes

Scientists presently have a humble understanding of the causes and development of Alzheimer’s disease. The disorder is considered to develop when considerable amounts of proteins, principally tau proteins and beta-amyloid, congest the brain’s capillaries and penetrate the cells (Alzheimer’s Association, 2020). Precisely, tau tangles hinder nutrient transportation, especially glucose, and other vital substances inside neurons, while plaques of beta-amyloid lead to the neurons’ impairment and death by upsetting the connection between neurons at synapses. Because of concomitant inflammation, the degenerative processes are amplified by the activated immune system that cleanses the brain from damaged and dead cells. The root cause of these protein dysfunctions is vague and requires further in-depth and prolonged research.

Best Practices

The search for effective interventions still continues since, despite the existence of different methods, their effect on the disease’s prevention or course is not adequate. Concerning the disease prophylaxis, physicians usually advise a balanced diet that contains an ample amount of fruits and vegetables, cereals, various nuts, olive oil, healthy seafood, and red wine. Physical activity (PA), primarily aerobic exercise, is also associated with a lower risk of AD and its severity. Finally, intellectual activities, including reading, board games, and active communication, can defer the onset of the disease and decelerate its progression.

Moreover, doctors offer pharmacologic and non-pharmacologic therapies to better patients’ physical and mental status. The US Food and Drug Administration (FDA) supported five main medicines for mitigating AD’s symptoms, including rivastigmine, donepezil, memantine, galantamine, and donepezil with memantine (Alzheimer’s Association, 2020). Excluding memantine, these medications can temporarily enhance cognitive abilities by increasing the brain’s neurotransmitters.

For example, transcranial magnetic stimulation (TMS) exhibits evident effectiveness concerning AD (Limori et al., 2019). Additional beneficial psychosocial interferences can comprise music therapy and computerized cognitive training (CCT). For example, the meta-analysis by Liang et al. (2018) inferred that PA and CCT showed tangible improvements in patients’ conditions. The studies also suppose that non-pharmacological treatments may be more advantageous than pharmacological therapies.


Although AD’s ultimate treatment is not available, the medical providers should follow specific objectives intended to alleviate the disorder’s course. Firstly, all individuals, regardless of their racial, social, sex affiliations, should possess access to quality healthcare services at affordable prices. The second imperative is primarily related to nurses who should aid patients with AD in performing their daily tasks and physicians’ recommendations, such as dressing up, going to the toilet, taking pills, and walking outside. The final goal is that nurses should deliver the necessary and correct information and collaborate with caregivers to better patients’ wellbeing.

Community Resources of Maryland

Maryland, regarded as one of the most economically developed states, possesses sufficient material and staff resources to provide adequate support for people with AD. Nevertheless, as of 2020, nearly 110000 persons have Alzheimer’s disease in Maryland, and this number is projected to reach 130000 by 2025, that is, over 18 percent, according to Alzheimer’s Association (2020). Concerning particular clinics and organizations, The Johns Hopkins Hospital is the largest private medical and research center in Baltimore, possessing almost 2,600 full-time attending physicians and 1,160 licensed beds (“Excellence and discovery,” 2021).

The hospital provides contemporary medical approaches to improving the conditions of patients with AD and conducts related research. Specifically, the department “Neurology and Neurosurgery” has nine specialized doctors, including Albert Marilyn, Brandt Jason, and Gordon Barry (“Memory Disorders Center, n.d.”). Other organizations include MedStar Southern Maryland Hospital Center (7503 Surratts Rd, Clinton), Walter P. Carter Center (701 W. Pratt St. Baltimore), or Maryland Access Point (301 West Preston Street Suite 1007, Baltimore). Hence, the given resources deliver psychological and medical support and caregivers’ education, which favorably reflects on the safe and effective continuum of care.

In summary, the paper has analyzed AD and respective best practices to improve patients’ conditions. In particular, Alzheimer’s disease is an irreversible, neurodegenerative illness characterized by a noticeable decline in memory and other cognitive abilities in people mainly aged over 65. Although treatment for this disease is absent, medical professionals can recommend various supportive methods, such as PA, music therapy, TMS, CCT, and medications: donepezil, rivastigmine, memantine, and galantamine. The core goals to address this problem include general population access to healthcare service, timely diagnosis, identifying and treating comorbidities, and developing comprehensive treatment.


Alzheimer’s Association. (2020). 2020 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 16(3), 391–460. Web.

Excellence and discovery: An overview. (2021). Johns Hopkins Medicine. Web.

Liang, J.-H., Xu, Y., Lin, L., Jia, R.-X., Zhang, H.-B., & Hang, L. (2018). Comparison of multiple interventions for older adults with Alzheimer’s disease or mild cognitive impairment: A PRISMA-compliant network meta-analysis. Medicine (Baltimore), 97(20), e10744. Web.

Limori, T., Nakajima, S., Miyazaki, T., Tarumi, R., Ogyu, K., Wada, M., Tsugawa, S., Masuda, F., Daskalakis, Z. J., Blumberger, D. M., Mimura, M. & Noda, Y. (2019). Effectiveness of the prefrontal repetitive transcranial magnetic stimulation on cognitive profiles in depression, schizophrenia, and Alzheimer’s disease: A systematic review. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 88, 31−40. Web.

Memory Disorders Center: Our team. (n.d.). Johns Hopkins Medicine. Web.

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