On Dementia: A Review of Treatment and Care Options - Research Paper Example

On Dementia: A Review of Treatment and Care Options Introduction Dementia is a term used to describe the decline in a person’s ability to remember and function independently (Medlineplus, 2010). Studies on the treatment and care of persons with dementia abound, highlighting the growing number of persons with dementia within the population. The cost of caring for persons with dementia globally has been estimated to be at US$ 600 billion and will continue to grow. With the increasing demands that caring for persons with dementia will place on society, it is important that resources be put into the further study of dementia, its causes, treatment and care options and in educating all who are involved with the care of persons with dementia. Dementia Defined There are several ways to define dementia. For this paper, Dementia is the term used to describe the gradual or sudden decline in a person’s ability to remember and to perform daily activities of living (www.jrank.org; MedlinePlus; www.behavenet.com, 2010) in such a way that he or she is no longer able to live independently, thereby requiring the care of another person to be able to do so. Dementia can be caused by many diseases or disorders, the most common of which are Alzheimer’s Disease (AD) and stroke (www.medicinenet.com and Medlineplus, 2010). Some forms of dementia affect individuals younger than 65 years old (called early-onset dementia). Most cases of dementia affect persons who are older than 65 years. Individuals diagnosed with dementia typically live on for 7 to 10 years after they start showing its symptoms. As a result of the loss of independence of these patients, dementia is now considered one of the major health disorders of our time. Van der Flier and Scheltens (2005) studied the epidemiology and risk factors of dementia, stating that this is an area that requires further study in view of the cost that caring for patients with dementia places on society. Objective The objective of this paper is to provide an overview of the most recent studies on treatment and care options for patients with dementia using articles from journals found in the Internet. Dates of publication of journals reviewed are from 2005 to 2010. This is, however, not a comprehensive review due to limitations of time and resources. Treatment for Dementia There were several studies reviewed on the treatment of dementia. Atkins, Bulsara & Panegyres (2010) studied the relationship of cerebrovascular risk factors such as hypertension and diabetes among 123 patients with early-onset AD and frontotemporal dementia (FTD). Their study proposed that these factors were involved with the development of early-onset AD but not early-onset FTD. The findings of this study are important in the selection of treatment options for AD and FTD patients. Drugs are prescribed for the treatment of some types of dementia. To treat dementia of the Alzheimer’s type, antipsychotic drugs such as thioridazine, chlorpromazine, haloperidol, trifluoperazine and risperidone are used. In a study of said drugs in the United Kingdom, it was seen that patients with AD who used antipsychotics over a long period of time faced a higher death risk than those who were under placebo treatments. This study strongly emphasized the need to pursue additional studies that will identify other options that will not endanger the lives of the patients being treated (Ballard et al., 2010) Patients with dementia living in care homes were also studied in terms of the relationship between the quality of their lives, neuropsychiatric symptoms and use of psychotropic medication. The study showed that each of the following factors strongly affected the quality of life of these patients: agitation, depression, psychosis, psychomotor agitation and psychotropic medication. The study concluded that for those patients that are in moderate to advanced stages of dementia, neuropsychiatric symptoms, cognition and the use of psychotropic drugs each negatively affected their quality of life (Wetzels, Zuidema, Jonghe, Verhey & Koopmans, 2010). Schneider et al (2006) also studied the effectiveness of three atypical or second generation antipsychotic drugs namely olanzapine, quetiapine and risperidone compared with placebo on patients diagnosed with AD and psychosis, aggression or agitation. Available literature questions the effectiveness of these drugs compared to placebo. They concluded no major clinical benefit derived from the use of these medications compared to the placebo. For safety reasons, the physicians who took part in the study would quickly change the prescribed drugs should it show no positive effect or negative effects as early as 2 weeks into the treatment. The study showed that these medications were more effective than placebo but for the safety of patients these benefits are limited. These drugs may be prescribed to those patients who show no or few side effects to them, and only if there are benefits that can be clearly seen. Savva et al (2009) questioned the relevance of research findings derived from a wide age range. They stated that current diagnostic criteria used to define Alzheimer’s disease, vascular dementia and Lewy body dementia cannot be applied with the same accuracy to all older persons. Their study on donor brains revealed that neuropathological changes associated with normal ageing do not differentiate youngest old persons with dementia from the older old persons without dementia. They found that the characteristics of the brains of younger old persons diagnosed with dementia were very similar to the brains of the oldest old persons without dementia. This study is important because of the ageing population and increasing prevalence of dementia. Common treatment options have been developed based on research on dementia among younger old persons and may not be completely applicable to the older old patients with dementia. Care of Dementia Patients Individuals with dementia require the care of other individuals in order to be able to continue on with their lives. Non-drug treatment options that would utilize the environment patients lived in to meet the needs of said patients resulted in reduced dependence on caregivers for normal daily tasks and other functions, and enhanced social interactions for the patients. The well-being and confidence of caregivers also improved. The study also showed that one or more caregiver-identified problems were eliminated using these non-drug treatments (Gitlin, Winter, Dennis, Hodgson & Hauck 2010). With the treatment and care options currently available, the cost of dementia care to societies all over the globe is now estimated to be over US$ 600 billion annually. By 2030, this is estimated to go up by 85%. Globally, informal care makes up forty percent of this cost. This is critical because the availability of informal support is projected to decline globally. The provision of informal care is critical to patients with dementia, and thus needs to be strengthened in view of the increasing prevalence of dementia particularly in low- and middle-income nations (now at 5 -7 % amongst individuals who are 60 years and above who have reported the diagnoses). As the global population ages and incidences of dementia increases, the need to increase dementia research and improve provision of informal care cannot be understated (The Lancet Neurology, 2010). While many studies have focused on treatment and care options for patients, few have dealt with the challenges that caregivers face. In a study on abusive behavior of patients with dementia, it was found that over a third of the subject caregivers received psychological and physical abuse from the patients they cared for. The severity of the abuse that caregivers received was associated with the strategies they used to cope with the behaviors of the patients. Those who experienced more abuse saw a greater deterioration in their relationship with the patient. The study highlights the need to strengthen the abilities of caregivers to positively respond to these abusive behaviors in order to lower their incidence (Cooper, Selwood, Blanchard & Livingston, 2010). Another study dealing with the care of patients with dementia was by Livingston (2007), which looked at the relationship between social interactions, subjective mental health, health perception, activities of daily living and wellbeing over a period of time (in the study this was 18 months after first interview) as a function of “successful” ageing. The study concluded that successful ageing was common among the cohort group with dementia. In a similar study, Miranda-Castillo and Woods et al (2010) showed that social networks and interactions affected the needs that were not met by caregivers and quality of life of persons with dementia who lived at home. These needs were identified as: (a) enjoyable activities for the patients, (b) having persons to converse or interact with and (c) assistance with psychological distress resulting from dementia. Failure to meet these felt needs were strongly associated with the patients’ exhibiting many behavioural and psychological symptoms, diminished interactions with their community and social networks, presence of a young caregiver and the distress felt by the caregiver. Schmid and Ostermann (2010) conducted a review of studies applying home-based music therapy as part of the treatment for patients who are unable to leave their homes, and for those who are in hospice and palliative care facilities. Dementia patients, those suffering from depression and children with socialization and learning disabilities were among the subjects of the studies they reviewed. They concluded that in most of the studies the findings revealed that the music therapy contributed to positive feelings of well-being among the subjects, caregivers and family members who were involved in the therapy process. It also highlights the need for further research into the applications and effects of home-based music therapy. Hudson et al (2010) conducted a review of psychosocial interventions for family caregiver of palliative care patients over the past ten years. They saw minor improvement in such interventions but noted that more needs to be done in terms of studying effective ways to provide psychosocial support to family caregivers. Donath et al (2010) looked at the relationship between the training of general practitioners and the frequency of use of support groups and benefits of caregiver counseling. While it was found that patients who were diagnosed for the first time were rated the same as those who were diagnosed in the past, there was an increase in the rate of referral of the patients to a specialist. There was also an increase in both the number of dementia medication prescribed and the use of support groups and counseling for patients diagnosed after the training compared to those patients who were diagnosed before the general practitioner received further training. Just et al in 2010 developed a curriculum aimed to teach palliative care to third year nursing and medical students. The interdisciplinary curriculum is designed to equip future healthcare practitioners through an inter-professional approach to maximize the benefits of working together in the care of elderly patients. This study is significant as it has been established in previous studies that the global elderly population is growing rapidly and with it the need for providing quality palliative care. The four main categories developed for the curriculum were Geriatrics, Palliative Care, Communication and Patient Autonomy, and Organisation and Social Networks. Conclusion From the review of these studies, several conclusions may be drawn: 1. Current drug treatments present a mortality risk to patients with dementia and need to be used with caution; 2. Non-drug related treatments such as music-based therapy and using the living environment itself to improve the quality of life of persons with dementia are effective in decreasing some of the symptoms associated with dementia; 3. Caregivers also need support in order to be able to provide quality care to their patients, and to avoid burnout from their responsibilities; 4. Training and education play a role in helping healthcare professionals and caregivers to better treat and help patients with dementia. All of the studies reviewed highlight the need for further research in these areas. The growth of the number of persons with dementia is a certainty. There is an urgent need to devote resources to the further study of dementia, its causes, related treatments as well as interventions on a global scale because of the significant cost that dementia places on societies both at present and in the future. References Atkins, E.R., Bulsara M.K., Panegyres, P.K. (2010), Cerebrovascular risk factors in early-onset dementia. Journal of Neurology, Neurosurgery & Psychiatry, doi:10.1136/jnnp.2009.202846 Ballard, C., Hanney M.L., Theodoulou, M., Douglas, S., McShane, R., Kossakowski, K.,…Jacoby, R. (2009). The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. The Lancet Neurology, 8 (2), 151 – 157. doi:10.1016/S1474-4422(08)70295-3 Behavenet.com (n.d.) Retrieved November 29, 2010 fromhttp://www.behavenet.com/capsules/disorders/demgmcTR.htm Cooper, C., Selwood, A., Blanchard, M., & Livingston, G. (2010). 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