The prevalence of dementia in the United States is 3% to 11% in those age 65 or over and 30% to 50% in those over age 85. Dementia is costly, with annual estimates exceeding $100 billion. It is also a common reason for institutionalization and in its early stages is associated with an increased incidence of depression (Martin & Evans, 1995. Recognition and management of anxiety and depression in elderly patients. Mayo Clinical Proc.; 70-999-1006).
Dementia is a general term to describe problems with memory and thinking. Early signs can be very subtle and not immediately obvious. Common symptoms are: memory loss, particularly recent memory; confusion; personalty change’ withdrawal; loss of ability to do everyday tasks. Alzheimer’s disease is the most common form of dementia. Other cases of dementia include: Vascular dementia; Picks disease; Dementia with Lewy bodies; Alcohol related Korsakoff’s disease; and other rare conditions.
A dementia workup should include a careful history and physical, neurologic, and mental status examinations. In many cases, additional tests and procedures may be helpful such as safety, laboratory test, and self-functioning tests. Treatment of dementia consists of identifying and addressing a treatable basis for the underlying condition (if one exists), treating secondary disorders such as anxiety or depression, educating patients and their families as to the nature of the condition, and assisting caregivers with safety and management issues. In addition, clinical trials have demonstrated benefits of pharmacologic agents that may directly improve cognition and functional capacity of dementia patients, or at least slow their decline.
Social Issues & Barriers to Care
The vulnerable elderly demented patients present multiple challenges to health care providers. Often, the provider is caring for the family or the caregivers in addition to the patient. Many providers feel ill-equipped to care for these patients, lacking experience, knowledge, or practice infrastructure needed to coordinate the care required for frail elders (Adams, McIlvain, & Lacy, et al., 2002. Primary care for elderly people: Why do doctors find it so hard? Gerontologist, 42:835-842).
Common pitfalls in caring for the elderly:
- Understanding benefits is difficult for patients and providers.
- Benefits for the elderly are not comprehensive.
- Lack of appropriate nutrition is common.
- Mental illness, substance use and dementia go undetected.
Many barriers to health care and understanding including physical and mental limitations, culture, literacy, and education are particularly significant in the elderly.
Multiple challenges and limited reimbursement reduce the numbers of providers willing to care for the elderly.
Alzheimer’s Association: 24/7 number (1-800-272-3900)
Elder abuse: Contact local adult protective services, or for local elder abuse hotline numbers (1-800-962-2873 or 1-800-96A-BUSE)
Family Caregiver Alliance : 800-445-8106
Alachua County Alzheimer’s Association – 352-372-6266
Alachua County Elder Care Services: 352-265-9040
Comfort Keepers 352-331-7760
Alzheimer’s disease is a progressive, irreversible and fatal disease which attacks brain cells and kills them.
Abnormal material call “tangles” builds up in the centre of the brain cells, while “plaques” accumulate outside the cells, disrupting messages and memory.
Alzheimer’s is characterized by confusion, memory loss and possible personality change.
Subtle, early phase symptoms can include vagueness, taking longer to perform routine talks, losing the point of a conversation or repeating oneself.