Alzheimer's disease Alzheimer's disease is the most common cause of dementia in older people. Alzheimer's disease is an irreversible, progressive brain disease that slowly destroys memory and other important mental functions, due to degeneration between brain cells and brain cell receptors (Alzheimer's Stages & Behaviors, 2014). Alzheimer's disease causes the loss of intellectual and social skills (Alzheimer's Stages & Behaviors, 2014). According to the Alzheimer's Association there are 7 stages of this disease (Alzheimer's Stages & Behaviors, 2014). The first signs of Alzheimer's disease are typically forgetfulness or mild confusion (Alzheimer's Stages & Behaviors, 2014). Stages 1 to 3 show mild cognitive decline, stage 4 is moderate cognitive decline, stage 5 is moderately severe, stage 6 is severe cognitive decline, and stage 7 is very severe cognitive decline (Alzheimer's Stages & Behaviors, 2014). Accurately staging an Alzheimer's patient is difficult because some stages overlap with each other (Alzheimer's Stages & Behaviors, 2014). This week's case involves Mr Jones, an 83-year-old man, who has been diagnosed with mild dementia. Mr. Jones is admitted to the emergency room with breathing difficulties and complications due to diabetes. While in the emergency room, the attending physician notices that Mr. Jones has gangrene from his right foot to his ankle. The nurse believes her dementia is due to difficulty breathing and the disorienting atmosphere of the emergency room. Mr. Jone's daughter is his caregiver, but she has not been designated as an advance directive surrogate nor does Mr. Jones have an advance directive in place. Mr Jones insists he has lived long enough and does not want to be caught in the middle of the decision-making process. Overlooking questionable capacity is unethical and could lead to civil liability (Pozgar, 2014). Mr. Jones has not designated an advanced directives surrogate and with a history of Alzheimer's a capacity evaluation is required. The health problems that brought Mr. Jones to the emergency room are progressing slowly, which gives doctors time to evaluate before proceeding with or without surgery. This extra time may also give Mr Jones time to think about amputation. Despite the need for an amputation, his doctors are ethically obligated to accept his healthcare decisions as long as he is deemed capable. If Mr. Jones is found to be incapable of making decisions, he will be assigned a surrogate. Because his daughter is his carer and is involved in his care, she will be named until there is evidence of elder abuse.