Long-Term Management of Dementia PDF

Preface

Dementing conditions are becoming very common as the population grows older. Currently, it is estimated that 28 million people worldwide have dementia. This number will rise dramatically as the life expectancy of humans increases and as the populations in the United States and other countries age. Economic costs will also mount. Alzheimer's disease by itself is already the third most costly condition in the United States behind heart disease and cancer, when the costs of caregivers and nursing homes are taken into account. Until we find a cure, optimal long-term management is our best course of action to help alleviate the devastating costs and the impaired quality of life seen in our dementia patients.

Individuals with Alzheimer's disease will typically live 8 to 12 years after they start misplacing their keys or eyeglasses on a regular basis. After the diagnosis is made, there are many years of management decisions that lie ahead for the physician and caregivers. Every stage presents with new challenges. The patients' needs change and old issues become pass´e as new ones take their place. Caregiver roles must also change to keep up with the new issues. Some of these changes are predictable and others come as a surprise. Health care providers need to provide the correct timing of treatment and management direction that will optimize care. Pharmacotherapy, management of behavioral and functional problems, and appropriate referral to assist with social and legal issues are some of the important decisions that need to be made. There is a need to be proactive, efficient, cost conscious, and practical in the long-term management of dementia syndromes.

This book is intended to be a resource for solutions to common management problems that arise in caring for dementia patients over the long haul. Many monographs focus on diagnosis and treatment issues of dementia. Books that discuss long-term management are few. Our focus is more on the art than on the science of managing dementing illnesses. We wish to provide practical information and valuable insights regarding the many complex management problems that arise in dementia. Clinicians, nurses, social workers, therapists, caregivers, family members, and all that are involved in enhancing the quality of care for the dementia patient should find this book useful.

As background information, the first couple of chapters deal with the scope, risk factors, assessment, and diagnosis of the more common dementing conditions. Themanagement issues beginwith a discussion of the pharmacotherapy of cognition. Some treatments are indicated early in the course and others for later stages. There are standard, controversial, and unproven but widely used therapies. Neuropsychiatric symptoms are very common in dementia but currently there are no U.S. FDA-approvedmedications for treating the behavioral problems in dementia. The literature provides some suggestions regarding preferred drug approaches. Behavioral modification techniques are also very useful and may reduce the use of medications.

The rest of the book focuses on themanagement of specific issues in dementia. These topics range from managing instrumental and basic activities of daily living to resolving common ethical and legal dilemmas. Functional abilities are seldom regained once lost. Driving, safety, nutritional, and hygiene issues are frequent concerns for families. Maintaining patient functional abilities, being proactive regarding potential safety concerns, and knowing when to increase supervision improves the quality of life for patients. Paying for these dementiarelated services requires careful planning and important tips and caveats regarding financial decision making are discussed. Physicians play an important role in monitoring patients, in follow-up care, in direction of ancillary care, in the management of the medical complications of dementia, in end-of-life care, and in medical–legal issues. Caregivers have to deal with many issues over the long course of their loved one's dementing illness and need special attention from health care providers and support groups to avoid burnout and reduce stress. Readers can look up specific topics of interest. Our hope is that this book will become a useful companion and a helpful resource of information in caring for the individual with dementia over the entire course of their disease.