Thursday, October 9, 2008

Dementia in seniors

Aside from the natural aging process, dementia and delirium in old age have many identifiable characteristics. Dementia is associated with, but not limited to, Alzheimer’s disease, vascular dementia, alcoholism, toxic reactions to medications (a huge risk in seniors), infections, metabolic disorders, malnutrition, and brain tumours (Pinel, 2006). Dad could have been suffering from any of these things, but no one was able to help us diagnose it. There is some confusion between delirium, dementia, and depression, and these require clarification, as well as early diagnosis by geriatricians. In The Hazards of Health Care (Heckman, 2004), warnings are given for undiagnosed dementia and delirium. A recent study shows concern over those with dementia driving.

Dementia is an abnormal progressive deterioration of neural functioning. It means:

• Memory impairment
• Diminishing intellectual ability, i.e. confusion, forgetfulness,
• Poor judgment
• Difficulty with abstract thinking, e.g. math, time, thinking skills.
• Personality changes: including social skills, agitation, stubborness
• Repeating themselves
• Sleep disturbances

• Changes daily
• Disturbance of consciousness
• Disorientation, wandering attention, confusion, hallucinations
• Affects up to fifty percent of elderly hospital patients
• Can occur in response to stressors: illness, surgery, drug overdoses, interactions of drugs, malnutrition (Cole, 2004)
• Between 32% and 67% of hospital patients are discharged with undiagnosed delirium (Rudolph and Marcantonio, 2003)
• Delirium can result in increased LTC placements, infections, and increased mortality (Rudolph and Marcantonio, 2003)
• Some 16% of seniors are readmitted to hospital (Forster, et al., 2004) has a number of pointers. They counsel family members to watch for signs such as seniors repeating themselves, or asking the same questions over and over, becoming more forgetful, issues with short term memory, needing reminders to fulfill ADLs or IADLs, depression, problems with calculations, finances, getting lost, or using expressive language, especially using nouns.

Alzheimer’s disease accounts for 70% of dementia cases and affects 5% of the population age 65 and over (Blazer, 1996 and Regier et al., 1988, as cited in Pinel, 2008). It affects 40% of those over age 90 (Williams, 1995) and patients die, on average, eight to ten years after the onset of dementia symptoms. The number of Alzheimer’s cases is predicted to increase by twenty-five percent by the year 2010 (Cummings and Jeste, 1999). Yet no one had examined Dad for these signs. Not all dementia is Alzheimer’s disease, but the work done by the Alzheimer’s Society has provided much information on the signs that usually develop two to three years before dementia sets in: difficulty learning and remembering verbal material. The first significant sign is memory loss. It affects simple activities: eating, speaking, recognition of family members, and bladder control. Callahan, et al. (1995) found that 23.5 percent of those with moderate to severe dementia were identified as having a dementia syndrome.

It is predictable that a senior will have deterioration in hearing, eye-sight, mobility, memory, range of motion, or cognitive abilities. These are all issues that must be addressed be caring family members often to the detriment of their quality of life. For senior who live alone, or who have lost a spouse, they pose great risks for themselves, with a concomitant gradual lessening ability to manage their ADL or IADL. With the inability to perform 4 or more IADLs, seniors are at a high risk for illness, injury, or hospitalization. Another great predictor of ill-health is an empty refrigerator (Lancet 2000;356:563). In this study 31% of those with empty refrigerators were admitted to hospital in four weeks, compared with 8% of those with filled refrigerators. Of those surveyed (132 seniors, mean age of 81, 74 % female, 70% lied alone), those with empty refrigerators were three times more likely to be admitted to hospital (Lancet, 2000).

Dementia can be caused by many medical conditions: Alzheimer's being only one, Binswanger's disease (plaque on cells builds up and prevents the cells from functioning properly), Pick's disease, and so on. Of course, a physical cause, boxers suffer dementia what with the jarring of the brain.

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