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Geriatric Behaviors in Individuals Suffering from Dementias -
An Overview and Meet my Mom
In this chapter, there will be a brief introduction to the problems presented by individuals with a diagnosis of dementia, reasons why this problem will be epidemic as the elderly population explodes, and a discussion about reversible causes of confusion in elders which are not caused by dementia. The story of my Mom will begin here.
Caring for a person whose perception of reality is altered due to a disease which causes dementia can be overwhelming. Each day brings different behaviors, new demands and may present opportunities as the caregiver copes with a person's changing levels of ability. Confusion and disorientation are common occurrences for individuals who have a diagnosis of dementia. This can make it increasingly difficult for the person to maintain a normal life due to the behavioral issues presented. Memory impairment and delusional beliefs are common in elders with dementia and may result in inappropriate behaviors in social situations or even at home resulting in difficult situations. Psychotic behaviors can also present in individuals with dementia which include hallucinations - usually visual, delusions, and delusional misidentifications. Hallucinations are false sensory perceptions that are not merely distortions or misinterpretations.
Delusions are beliefs that are untrue events but the events are not out of context with a person's social and cultural background Geriatric Behaviors in Individuals Suffering from Dementias Delusional misidentification may result from a combined decline in visual function and recent memory problems: individuals may suspect that a family member is an impostor, believe that strangers are living in their home, or fail to recognize their own reflection in a mirror.
Other troubling issues can include non-psychotic behaviors associated with dementia: agitation, wandering, sexual disinhibition, and aggression.
Individuals who display physical or verbal aggression, which is associated with delusional misidentification, usually require a treatment plan which uses a combination of pharmacologic and non-pharmacologic treatments (Rayner et al, 2006). Abrupt changes in behavior may pose a greater challenge to management than cognitive decline for individuals with dementia and their caregivers. The nature and frequency of problematic behaviors varies over the course of an illness, but in most individuals, these symptoms occur more often in the later stages of disease (Rayner et al, 2006). Management of individuals with a diagnosis of dementia requires a comprehensive approach and incorporating a combination of strategies. It begins with an accurate assessment of symptoms, awareness of the environment in which symptoms occur, and identification of factors which precipitate symptoms as well as how the symptoms affect individuals and their caregivers. Nonpharmacologic interventions are the foundation of care and include creating a simplistic and safe environment, a predictable routine, counseling for caregivers about the unintentional nature of psychotic symptoms, and offering strategies to manage as well as cope with troubling behaviors. Approaches for an individual suffering from dementia involve a structured environment, behavior modification, appropriate use of sensory intervention, and maintenance of routines such as providing meals, exercise, and sleep on a schedule. Pharmacologic treatments should be governed by a "start low, go slow" philosophy: a mono-sequential approach to prescribing - adding a single agent, titrating until the targeted behavior is reduced, side effects become intolerable, or the maximal dosage is achieved (Rayner et al, 2006). Goals of managing the care of individuals suffering from dementia and the behavioral issues which occur should include symptom reduction and preservation of quality of life.
Introduction to the Problem: Explosion of the Older Population
As of the year 2000, 16.3% of the entire US population was over 60 years of age, a 12% increase in this demographic group since 1990 (ASCLS, 2003). An increase in the geriatric population has been projected. In 2010 the elderly population had grown to 39 million, an increase of 17% since 2000. It is estimated there will be a rapid rise in numbers of elders between the years 2010- 2030, increasing the elderly population to 69 million due to an aging baby boomer cohort. Elders are expected to increase by 75%. And between the years 2030-2050, the growth rate of elders is projected to increase another 14%, bringing the geriatric population to 79 million.
Aging & Characteristics of the Older Population
Aging is a process - it is universal, progressive, and unavoidable, occurring in all living individuals. Everyone will age as time marches on but all will age a bit differently. Aging is not a disease; it is the cumulative changes that occur in an individual over time. It is a series of biological, psychological, and spiritual changes (Cora, 2003).
The elderly population is currently healthier and living longer than generations before them. Most elders are able to live independently and manage their everyday activities but there are some conditions which can cause psychiatric problems in elders including dementia and depression. Normal aging does not cause a person to have problems with memory. A full medical work-up should be conducted on any older person who has problems with memory, has a personality change, or exhibits problematic behaviors in order to obtain an accurate diagnosis, to rule out treatable problems (which if appropriately treated may reverse the confusion) and develop an appropriate plan of care. The goal is to optimize an individual's quality of life and maintain, as well as encourage, as much independence as is possible.
The geriatric population is exploding in numbers and statistics report there are a number of medical issues which have not been as apparent as in previous years. Although the older population is much healthier than their parents, they are physically healthy but there is currently an increase in the number of individuals with some form of confusion. Confusion can be caused by dementia which often presents challenges in care. BUT not all older people will develop dementia. It is NOT a normal part of the aging process. Dementia is physical disease just like any other medical condition, such as hypertension and diabetes, but its symptoms are often exhibited as psychiatric or behavioral problems. (Byrd, 2003).
Of all the causes of dementia, Alzheimer's disease is the most common cause of dementia in the elderly population. As of 2010, only 10% of the population over the age of 65 had a diagnosis of Alzheimer's disease, meaning 90% did not. Healthcare providers, as well as society, must not assume an older person is destined to be confused or 'senile' as it was once termed, because this is stereotyping and this is not appropriate (and not true). Any older person who presents with confusion must be evaluated to determine if there is a cause of the confusion which can be treated and the problem reversed so the confusion will go away. Common reversible causes of confusion include depression, dehydration, infections, and medications, as well as other medical disorders.