Alzheimer’s disease is an irreversible neurodegenerative disease which involves the progressive decline in cognitive functions, such as memory, abstract reasoning and orientation (Burns & Iliffe, 2009). It usually affects late adults, which aged 65 years and above, even though there are rare cases of earlier onset (Ferri et al., 2005). In addition, the population of elderly is increasing throughout the world. In Malaysia, the proportion of elderly is expected to increase from 6.3% in the year 2000 to 12% by 2030 (Mat & Taha, 2003). Currently, the late adult population increased by 4% from the year 2014 to the year 2016 (Department of Statistics Malaysia, 2016). It will eventually lead to the increase in a number of Alzheimer’s patients among elders. Based on statistics, it is estimated that the number of people with dementia in Malaysia will increase one fold from the year 2030 (261 000 people) into 590 000 people by the year 2050 (Alzheimer’s Disease International, 2014).
Despite Alzheimer’s irreversible and incurable impact, it raised concerns about the quality of life for both the Alzheimer’s patients and also caregivers during the end-of-life care. During the advanced stage of Alzheimer’s disease, patients lose the ability to take care of their basic needs, conduct basic psychomotor skills and develop psychological symptoms of dementia (Burns & Iliffe, 2009). It may take more than 10 years for a late adult to live with Alzheimer’s disease depends on the time where a diagnosis is given, while the end stage may last from two to three years prior to death (Shuster, 2000; Brookmeyer, Corrada, Curriero, & Kawas, 2002). Considering the extended time-frame, caregivers providing end-of-life care are at a higher risk of developing negative mental and health outcomes, such as depression, maladaptive immune system, and mortality (Varela, Varona, Anderson, & Sansoni, 2011). Some of the factors are role strain, family finances and decision making for end-of-life care of their family members with Alzheimer’s disease (Alzheimer’s Association, 2013).
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