Although the cause of this disease remains unclear, good clinical management is nonetheless critical. Every effort should be made to maintain the patient's independence within the limits of safety. Measures to maintain orientation, such as memory aids, eyeglasses, hearing aids, calendars, diaries, adequate lighting, and organization of the patient's personal items, are helpful (Eisdorfer and Cohen 1981). Appropriate locks to prevent unsafe wandering, and suitable safeguards on dangerous household appliances must be utilized. Of course, the patient should not be permitted to drive.

Providing quality care, however, requires an un derstanding of the health care delivery system in which physicians and patients find themselves. Psychosocial management is based on enhancing the function of the care system that surrounds the patient. This usually involves several family caregivers, who should receive accurate information concerning the disease and the prognosis. Caregivers must take care of themselves and may benefit substantially from referral to a support group of the Alzheimer's Disease and Related Disorders Association. Caregivers should be made aware of the factor that most insurance does not cover either community services or long-term care in nursing homes. A competent legal adviser and appropriate financial counselor can be of substantial help. Even though many families want to keep elderly individuals in the home, in-home support services are expensive and often not available.

Alzheimer's disease remains a major challenge not only to modern medicine but also to the health care delivery system, and to society at large. Not only is further research necessary in the diagnosis and management of the disease itself, but also major changes are necessary in the health care delivery system if patients afflicted with this illness are to get the care that they need.

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