Caretakers should be assisted in establishing a routine for dementia patients. Nonpharmacologic approaches may aid in the management of behavioral disturbances in dementia. After the medical issues are resolved, realistic goals should be set and p.r.n. Therefore, the initial workup should include appropriate laboratory tests. First, any primary medical illness should be identified and treated for example, an infection (e.g., a urinary tract infection) or medications (e.g., steroids) can induce delirium and lead to behavioral disturbances in a patient with Alzheimer's type dementia.
The treatment of dementia patients with behavioral or psychotic disturbances should be driven by general principles. From a public health standpoint, the annual treatment of Alzheimer's type dementia in the United States costs an estimated $100 billion 9 and is likely to cost close to $200,000 per patient over the course of the illness. 8 Because a substantial number of patients with Alzheimer's disease exhibit psychotic and/or behavioral disturbances, these secondary manifestations of the disease are a leading cause of caregiver distress and patient institutionalization. 7 Delusions and hallucinations and/or behavioral symptoms are found in 50% to 90% of patients with Alzheimer's type dementia. 6 The incidence is approximately 1% of the population aged 60 years, doubling every 5 years of life, such that by age 85 years, about 1 in 3 individuals has Alzheimer's type dementia. 4 An estimated 3 to 4 million people in the United States have Alzheimer's type dementia, 5 and the number is expected to double by the year 2030. Because of these behavioral disturbances, elderly persons-particularly those who are agitated or aggressive-are often placed in nursing homes, 3 which leads to intensive and costly treatment, increased morbidity and mortality, and public health problems.Īlzheimer's type dementia is the most common form of dementia, and patients with Alzheimer's type dementia constitute half of all nursing home residents. Disturbances associated with dementia may also be psychotic in nature and may include delusions and/or hallucinations. In general, these behavioral disturbances are characterized by motor restlessness, verbal and physical aggression, withdrawal, irritability, dysphoria, disturbances of sleep and other diurnal rhythms, and other troublesome behaviors such as wandering. However, dementia is often associated with behavioral disturbances as well, for which the DSM-IV lacks a codable specifier and for which there is no widely accepted definition.
#Overly prim person manual
This article will discuss nonpharmacologic and pharmacologic treatment of psychosis in elderly patients with dementia, especially those living in long-term care facilities.Īccording to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), 2 the essential feature of dementia is the development of multiple cognitive deficits that include memory impairment and at least one of the following cognitive disturbances: aphasia, apraxia, agnosia, or a disturbance in executive functioning. Most of the studies of antipsychotic efficacy and safety have been conducted in schizophrenic patients, but there are differences in dosing schedules, efficacy, and compliance in elderly patients who have dementia with psychosis.
Unfortunately, dementia often presents with psychosis thus, many elderly patients are treated with antipsychotic medications. Old age is the number one risk factor for dementia. Moreover, hospitals are releasing convalescent patients sooner, thereby forcing nursing homes and skilled nursing facilities to take a larger role in subacute care. Of the 2.2 million persons who became 65 years old in 1990, almost half will enter a nursing home in their lifetime. Currently, the 16,500 nursing homes in the United States have approximately 2 million residents. The trend toward a longer life span increases the need for long-term care facilities.
1 By the year 2000, more than 35 million people will be over 65 years old, and an additional 5 million people will be over 85 years old. The fastest-growing segment of the population consists of individuals over the age of 85 years.
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