The individuals with dementia experience memory loss and the reduction of cognitive abilities caused by the degenerative processes in their brain. Today, more than 47 million worldwide are diagnosed with dementia, while it is anticipated that their numbers will grow (Livingston et al., 2017). Dementia is identified by the scholarly evidence as one of the most critical challenges in geriatric care and healthcare in general.
This disease affects primarily people aged 65 and over as well as their families and friends who should properly respond to the needs of the former. In addition, dementia affects the society since people with it require social attention and impose financial health care burden. This paper will thoroughly explore the problem, including its background, existing reporting and surveillance methods, epidemiology, and diagnostics. A comprehensive care plan will be designed as a result of the analysis to address the identified chronic condition.
Problem Background
Dementia is a progressive decline in cognitive abilities, namely, in thinking and memory, which leads to the inability of a person to perform daily functions independently. Koller and Bynum (2014) describe this disease as a state with the limited emotional language, and intellectual abilities. The symptoms of dementia include memory impairment, thinking disorder, loss of orientation skills in time and space, inability to concentrate, and difficulties with speech. Often, a person has several of the mentioned symptoms. As a result, a person cannot take care of himself or herself and be responsible for his or her actions. Among the most common signs, there are problems with planning and decision-making, simple home tasks that become challenging, poor judgment, and difficulties with understanding images.
Organic pathology of brain tissue acts as the cause of the disease, which allows distinguishing between various types of dementia. Alzheimer’s disease is the immediate etiological cause of almost a half of cases, while it can also be caused by vascular pathology, brain tumor, hydrocephalus, et cetera (Koller & Bynum, 2014). Other types of the given disease include frontotemporal dementia, Lewy body dementia, and mixed dementia. Compared to the US prevalence of dementia estimated at 8.46, Florida shows relatively lower results (see Table 1 for details).
Table 1. Dementia prevalence (Koller & Bynum, 2014).
Surveillance and Reporting Methods
In the US, there are several programs initiated to monitor and document dementia. The Behavioral Risk Factor Surveillance System (BRFSS) is a system introduced by the Healthy Aging program of the Centers for Disease Control and Prevention (CDC). It focuses on self-reports of patients who note declines memory and thinking abilities. The data collected by BRFSS is available to the public via CDC’s official website, which creates the foundation for health improvement in the specified population (“Surveillance,” 2016).
More to the point, this surveillance method contributes to a better understanding of gaps and opportunities that may vary among states. The National Health and Nutrition Examination Survey (NHANES) is another tool that is the result of the collaboration of the National Center for Health Statistics and CDC. It aims at evaluating the involvement of the cognitive component while considering adults aged 60 and older (“Surveillance,” 2016). The main task of NHANES is to assess older adults’ health by examining their memory, speed of reactions, and attention, thus providing a detailed analysis that can be used for prevention and treatment options.
The mandatory reporting regarding people with dementia largely refers to ensuring their safety and security and those of other persons. There is no national standard or law that require patients or healthcare professionals to report about dementia (Dong, Chen, & Simon, 2014).
However, some states have their specific requirements with regard to older adult abuse and driving. In the US society, a stigma against people with dementia exists in the form of abuse directed towards their emotions and behaviors (Dong et al., 2014). In this connection, many states set mandatory reporting statutes to protect older victims of abuse: some states declare that all parties should do it, others claim that only professionals should provide relevant information. The similar situation may be observed with driving and reporting of people with dementia.
Epidemiology Analysis and Diagnostics of Dementia
The risk of dementia increases with age, and the growing size of the elderly population makes the problem even more alarming. This disease is usually diagnosed in people over 65, but it may appear at an earlier age. Most often, the disease begins with a disorder of short-term memory, when a person easily forgets information received recently, while reproduces facts and data relating to the past. The comparative study by Langa (2017) who reviews dementia levels in the US between 2000 and 2012 shows that people aged between 65 and 74 are the most vulnerable population. Within the mentioned years, their risks decreased moderately, but people older than 74 preserved the tendency to deterioration. In other words, age was found the main factor that should be considered in detecting dementia.
Education is another factor that should be discussed in terms of dementia epidemiology. According to Langa (2017), people with higher education and those who studied continuously in their life are less likely to develop the given disease. For example, people with 16 and more years of education are regarded as the group with the lowest risk. This is largely associated with the so-called cognitive reserve phenomenon that implies building and accumulation of cognitive abilities. Also, education provides more opportunities in career, which allows practicing cognitive skills and learning throughout the life.
Income, race, and sex may also determine the risk of dementia. People with higher income are likely to be more resistant to dementia as well as males. Also, African-Americans and Hispanics have higher rates of Alzheimer’s disease development (Langa, 2017). As for the financial costs, according to Langa (2017), by 2030 the cost of maintaining patients with dementia will exceed $ 1 trillion. Today, approximately 70 percent of the cost of such patients falls on the United States and Western European countries, where demographic aging is most pronounced. In these countries, caring for patients with dementia requires much more money than patients suffering from other serious illnesses. The societal costs of dementia in the US compose $818 billion in annually.
During the examination, a health professional identifies a primary diagnosis and the degree of preservation of mental and cognitive functions, giving patients special tests. According to the U.S. Preventive Services Task Force (USPSTF), such instrumental methods for the study of the brain as radiography, computed tomography, MRI, and encephalogram are recommended. Using these national standards screening guidelines, it is possible to easily determine the degree of damage to the brain and its individual parts, to identify the etiological cause of the disease – Alzheimer’s disease or vascular pathology.
The Mini-Mental State Exam (MMSE) is a test prescribed by Alzheimer’s Association due to its sensitivity (87%), positive predictive value (PPV) of (86.3%), specificity (82%), (Creavin et al., 2016). While the costs of MMSE are relatively low, it provides a relevant tool to evaluate patients’ mental state. CDC recommends using the described tool to screen patients over 65 with early signs of dementia that were discussed earlier in this paper.
Practice Plan
Speaking about the treatment of dementia, one can target only impeding the process, relieving symptoms, as well as the personal and social adaptation of a patient. The goals of treating dementia are minimizing behavioral disorders, improving cognitive functions, and improving the quality and expectancy of life. One of the modern approaches to the prevention of dementia is an integrative concept of therapy, which includes a range of actions (Livingston et al., 2017).
The primary intervention should target early detection based on paying attention to signs and symptoms. The existing risk factors, education, environment, and other necessary points should be considered. The secondary prevention is to prescribe relevant medications and therapies to address the disease while its symptoms are not severe. In Alzheimer’s type of disease, dopamine receptor stimulants, phosphatidylcholine, memantine, and acetylcholinesterase inhibitors are to be prescribed (Livingston et al., 2017). In vascular dementia, it is possible to take drugs that improve cerebral circulation and vascular tone – nootropic drugs, metabolic stimulants, and vitamin complexes.
As for the tertiary intervention, psychotherapy with patients and their families may be conducted in a group therapy and special self-preservation therapy for working with memory. This intervention should be carried out by experienced psychologists and psychiatrists. Unfortunately, not all relatives of patients understand what this line of therapy provides, and the importance of psychotherapy for elderly patients is largely underestimated.
In the early stages of the disease, when the ability to maintain a conversation, critical thinking, and assimilation of information in patients remains, psychotherapy is able to correct their behavior (Livingston et al., 2017). It is also possible to increase their adaptive abilities and direct mental activity on the right track. The social therapy may include counseling on problems with memory, legal aspects, providing proper care, and creating a comfortable living environment for a patient.
The results of the mentioned interventions may be measured based on the level of anxiety and confusion in patients. The periodical test results are also representative of patients’ state and are useful in tracking the disease development. As for health policy advocacy efforts, the focus should be made on developing policies that would meet the needs of people with dementia, eliminate abuse, and promote better life quality.
Conclusion
To conclude, dementia is a term that describes a range of diseases connected to the decline of cognitive abilities, especially in older adults aged 65 and over. Reduced memory, thinking, and decision-making skills, the inability to orient in space and time are the key symptoms. The surveillance and reporting methods show that dementia is a national and global challenge that requires more attention from the public, which may be expressed in proper treatment and advanced therapy. African-Americans and Hispanics, female patients, and those with low income and a lack of education are at a higher risk. The best treatment should include the combination of early disease detection, medication, and psychotherapy.
References
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Dong, X., Chen, R., & Simon, M. A. (2014). Elder abuse and dementia: A review of the research and health policy. Health Affairs, 33(4), 642-649.
Koller, D., & Bynum, J. P. (2014). Dementia in the USA: State variation in prevalence. Journal of Public Health, 37(4), 597-604.
Langa, K. M., Larson, E. B., Crimmins, E. M., Faul, J. D., Levine, D. A., Kabeto, M. U., & Weir, D. R. (2017). A comparison of the prevalence of dementia in the United States in 2000 and 2012. JAMA Internal Medicine, 177(1), 51-58.
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