Dementia in Older Adults

Abstract

Dementia is a disorder that requires new functional dependence based on progressive cognitive decline. Several underlying pathophysiological processes cause dementia. The most common type of dementia is Alzheimer’s disease, which comprises about 50 to 70% of the affected population. Pathological systems and clinical symptom of dementia diseases overlap significantly. The condition is common among older adults aged 65 years and above. The people suffering from the disorder are likely to triple in the coming 2-3 decades. The disease has several symptoms; however, memory loss is the main symptom of the disorder. The disorder has no cure but treatment options slow down the condition and prevent it from worsening. 

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Dementia in Older Adults

Getting older sometimes seems daunting – grey hair, wrinkles, sensory impairment, physical injury, mental health, and other unique health issues like chronic diseases. However, some older adults are not victims, though some medical conditions seem more severe and more common to them. As people grow old, learning new things and recalling information becomes a challenge to many. As a result, most of the people worry about being victims of dementia each time they have trouble remembering things like where one parked his/her car, an event, or even a word. In this essay, I am going to discuss cognitive health issue know as dementia.

Introduction to dementia

Dementia is a progressive disorder that affects the memory capacity of the brain and the way it functions. However, dementia is not a condition itself; it is a word referring to a set of symptoms related to memory language and understanding (Manouilidou et al., 2016). The common cause of dementia is Alzheimer’s disease. The other common type of dementia is vascular dementia; this disorder develops following a stroke or due to damage of a blood vessel in the brain. Frontotemporal lobe dementia and Lewy bodies are the least common types of dementia (Marie-Lee et al., 2019). It has symptoms like memory loss, decreased ability to make decisions, loss of understanding or judgment, changes in personality, and problems with speech, socializing, and coping with daily living.

Prevalence of Dementia

Dementia is a common condition among older adults because they are vulnerable to its risks. According to the recent data released on dementia, one among 70 people aged between 65 to 69 years has dementia. The situation is even worse for people from 85 years to 89, since one out of four has dementia (Marie-Lee et al., 2019). The disorder is a rare condition to people under the age of 65, and when it occurs in younger generations, it is called ‘younger onset dementia’. Many people have Alzheimer’s disease, which makes it a popular type of dementia. According to reports from the Alzheimer’s Association among the leading causes of death in the U.S., it ranks number six,  with more than 5.8 million Americans having the disease. For example, in 2014 only, the disease accounted for 92,604 deaths across the world. 

Population Suffering from Dementia

Diagnosis of dementia can have a considerable impact on the person suffering, her family, friends, and the community. Dementia is a widespread condition to a point where one person develops it every three minutes in the UK. Worldwide, more than 50 million people have dementia. The world records more than 10 million new cases of dementia every year. The estimated percentage from the general population above 60 years that suffers from dementia is about 5-8%. The population is going to double or even triple in a few decades to come according to Gale, Acar, and Daffner (2018). For example, the population is projected to be 82 million by 2030 and 152 million by 2050, and many will be from the low and middle-income countries.

When and why dementia occurs

Aging is the most risky factor when it comes to developing dementia. Dementia prevalence increases exponentially with an increase in age, and more than 90% of the people with dementia fall under Alzheimer’s disease. The estimated least age of having the disorder is 65 years. When it comes to why dementia occurs, several causes lead to its occurrence. The causes include neurodegenerative disease and the death of brain cells. Neurodegenerative disease is an ongoing death of brain cells that happens over time. It is also associated with most of the dementias. It not clear whether the death of the brain cells is the cause of dementia or it is the cause of death of brain cells. Other instances like having a brain tumor, a stroke, or a head injury can cause dementia (Fissler et al., 2017). Vascular dementia or multi-infarct dementia due to the death of brain cell is caused by health conditions like a cerebrovascular disease such as stroke. The disease prevents the normal flow of blood depriving brain cells of oxygen. 

Occurrence of Dementia

Up to this day, no test has been developed to determine if a person has dementia. Physicians diagnose Alzheimer’s disease and other related diseases based on laboratory tests, physical examination, a careful medical history, and characteristic changes in behavior, daily functioning, and thinking related to each type of dementia. It is possible for doctors to determine if an individual has dementia with a high certainty level. However, it is not easy to arrive at the specific type of dementia the individual could be suffering because brain changes and symptoms of the types of dementias can overlap (Fissler et al., 2017). Thus, in some cases, doctors diagnose “dementia” without specifying the exact type of dementia. In such incidences, it advisable to consult or compare notes with specialists such as neuropsychologist and neurologist to know the specific type of dementia a patient has. In some cases, dementia is roughly categorized into four stages. Mild cognitive impairment is the first stage, which is characterized by general forgetfulness. The second stage is mild dementia where an older adult will experience cognitive impairment, which will affect the daily life of the person. Some of the symptoms in this stage include memory loss, personality changes, getting lost, confusion, and experiencing challenges when it comes to planning and performing tasks. 

Moderate dementia is the third stage. An older adult in this stage experiences several challenges in coping with daily life, which calls for assistance from relatives and close friends. The symptoms here are the same as those in mild dementia, only that in this stage, they are intense. An older adult will now need help for the basic thing he or she used to do on his/her own like combing hair and dressing. During this stage, the older adult is likely to show early signs of personality changes: for example, becoming agitated or suspicious without any reason. Sleep disturbance is also a common symptom in this stage. Severe dementia is the last stage of dementia. According to Luppi (2018), the symptoms have worsened in this stage, in that an older adult may have challenges communicating and the person requires full-time care. Fewer people in this stage can control their bladder. Besides, simple things like holding one’s head and sitting become impossible for the older adult. 

Impact of aspects of human diversity on dementia

Different aspects of human diversity affect people who have dementia in different following ways: 

Ethnicity

The number of people who have dementia varies from one ethnicity to another as follows:

  1. The United States. In the United States, the Hispanics seem to have a higher prevalence of dementia compared to the Native Americans (Gale, Acar & Daffner, 2018). Black Americans have even lower rates compared to Native Americans.   
  2. Asia and America. Recent reports on dementia show that rates of dementia are similar in Europe and Asia. However, there is a difference in the distributions of subtypes of dementia; many people in Asia has vascular dementia whereas in Europe they have Alzheimer’s disease 
  3. South America. In South America, especially in Brazil, the rates of dementia seems to equal to that of Europe. The rates are also comparable to that of the United States.
  4. Africa. Africa is least affected by dementia. In the recent past, no authentic case related to dementia has been reported in the indigenous black Africans. It has few cognitive health issues though their functionality is intact.
  5. India. The population that suffers from dementia is low. One of the recent studies on dementia shows that only 1.74 per 1000 person aged 55 and above has dementia and 3.24 for those who are 65 and above years.

Gender

Historically, women are at higher risk of suffering from dementia compared to men. Nearly three-quarter of the population suffering from dementia, particularly Alzheimer’s disease are women (Peitsch et al., 2016). 

Sexual orientation

The lesbian, gay, bisexual and transgender (LGBT) older adults population suffering from dementia experiences double stigmatization (old age and sexual identity). The LGBT older adults with dementia are discriminated, disadvantaged and suffer from prejudice, which harms their health and social care experience.

Disability

The main disability here is learning and is common among people who have Down’s syndrome. These individuals have been at a higher risk of having dementia, and this is an additional challenge to their existing disease and old age.

Social class

Studies show that dementia is high among those in lower Socio-economic status. A class can also be an essential role when it comes to diagnosis, care, and treatment. 

Race

Disparities in dementia increased between whites and Hispanic and decreased between whites and blacks. Adjustments for the risk factors decreased though did not eliminate disparities.

Medical Solutions to Dementia

Unfortunately, there is no cure for dementia. The only hope is the treatment that can ease some of its symptoms. Memantine (Namenda) and cholinesterase are the common medicines for dementia, particular for Alzheimer’s disease (Schoonover-Shoffner, 2018). Memantine is mostly prescribed for people in moderate to severe stages of Alzheimer’s disease. It could help in improving memory, reasoning, attention, and language. Memantine can be prescribed together with donepezil (Aricept). It helps in balancing glutamate (also a “messenger chemical”) crucial for learning and memory. Studies show that it can prevent delusion, hallucination, aggression, agitation, and irritability (Schoonover-Shoffner, 2018). It can also help with disorientation besides easing daily activities. The medicine comes in oral drops, immediate, and extended-release tablets. Memantine side effects are as common or as bad as those of cholinesterase inhibitors are and include constipation, headache, fatigue, dizziness, confusion, and increased blood pressure.

Cholinesterase Inhibitors prevents a “messenger chemical” called acetylcholine in the brain from breaking down. The messenger chemical is essential in memory, mood, and learning. Cholinesterase inhibitors delay the rate at which Alzheimer’s symptoms worsen. Cholinesterase inhibitors include Rivastigmine (Exelon), Galantamine (Razadyne, Razadyne ER, Reminyl) and Donepezil (Aricept). The medicines have benefits like better concentration and memory, improved motivation, and less anxiety. In some cases, some of them resume their normal daily activities after medication, but the improvement takes a short period of about 6 to 12 months. Generally, medication delays the worsening of the disorder. All three medicines have the same function; however, one might work well for one older adult compared to other elders or medicines (Cacchione et al., 2018). Cholinesterase inhibitors have some side effects like nausea, loss of appetite, muscle cramps, fatigue, insomnia, and headaches: though it happens to only a few.

Conclusion

From the above discussion, dementia is a disorder common among alder adults aged 65 and above. Alzheimer’s disease is leading among all the types of dementia disorder, followed by vascular dementia. Many people suffer from it, and the number is bound to increase rapidly in the next few decades up to triple the current population. The leading cause of the disorder is brain cell death though there are other minor causes. Different aspects of human diversity affect dementia differently. For example, more women have dementia compared to men. Currently, the disorder has no cure, though there are medicines that at least slow down the disorder.

References

Cacchione, P. Z., Pike, K. M., Spaeth‐Rublee, B., & Pincus, H. A. (2018). Health and Aging Policy Fellows: Dementia and Mental Health Policy to Improve Lives of Older Adults. (Journal of the American Geriatrics Society.)

Fissler, P., Müller, H.-P., Küster, O. C., Laptinskaya, D., Thurm, F., Woll, A., Elbert, T., … Kolassa, I.-T. (2017). No Evidence That Short-Term Cognitive or Physical Training Programs or Lifestyles Are Related to Changes in White Matter Integrity in Older Adults at Risk of Dementia.

Gale, S. A., Acar, D., & Daffner, K. R. (October 01, 2018). Dementia. The American Journal of Medicine, 131, 10, 1161-1169.

Luppi, Elena. (January 01, 2018). Training in non-pharmacological approaches to dementia and Alzheimer. Ricerche Di Pedagogia E Didattica. Journal of Theories and Research in Education; Vol 13, No 3 (2018); 123-152.

Manouilidou, C., Dolenc, B., Marvin, T., & Pirtošek, Z. (2016). Processing complex pseudo-words in mild cognitive impairment: The interaction of preserved morphological rule knowledge with compromised cognitive ability. (Clinical linguistics & phonetics, 30, 49-67.)

Marie-Lee Yous RN, BScN, MScN, Jenny Ploeg RN,. .PhD, Sharon Kaasalainen RN,. .PhD, & Lori Schindel Martin RN,. PhD. (January 01, 2019). Nurses’ Experiences in Caring for Older Adults With Responsive Behaviors of Dementia in Acute Care. Sage Open Nursing.

Peitsch, L., Tyas, S. L., Menec, V. H., & St, J. P. D. (2016). General life satisfaction predicts dementia in commun-ty living older adults: a prospective cohort study. (International psychogeriatrics.)Schoonover-Shoffner, K. (January 01, 2018). Dementia: An Opportunity for Grace. Journal of Christian Nursing, 35, 4, 209.

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