Articles Posted in Cognitive Issues

What is wandering?

Wandering is an aimless action that elderly people with dementia can sometimes engage in. Someone who is wandering is not specifically looking for an exit, but rather to move around. If they do exit a skilled nursing or assisted living facility, it is because they chanced upon an exit and walked out, or were aided by someone misinformed but with good intentions. 

Wandering is common in nursing homes: “Thirty six percent of community dwellers and sixty five percent of nursing home residents wander” (Smith, M., Schultz, S., Great Escapes: The wandering dilemma. The University of Iowa Geriatric Education, Iowa city, IA, www.mediciantuiowa.edu/igec/). Wandering may eventually lead to elopement, so the wanderer should be treated as a risk for elopement unless there is evidence that this is not a risk. 

As the older adult population continues to grow worldwide, age-related health issues will further increase the high clinical, economic, and social challenges of caring for the elderly.  Alzheimer’s disease and dementia are two cognitive health problems that are increasing in prevalence among older adults.  Currently, no cure for dementia exists, and available treatment options provide primarily symptomatic reliefs. Therefore, finding ways to prevent or delay the development of dementia through implementing lifestyle changes, such as diet, is critical.

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A long-held, popular belief in the health stratosphere is that supplements such as ginko biloba, fish oil, and many others have the power of boosting memory and preventing cognitive-related illnesses. In fact, millions of dollars are spent on these memory supplements every year.  According to the Nutrition Business Journal, Americans spent almost $91 million on ginkgo biloba in 2015.  However, many of the positive cognitive effects revolving around these supplements have been refuted by scientific experts and recent studies.

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Ensuring that dependent older adults with complex health problems receive high quality long-term care has been a long-standing challenge for the health care systems around the world.  Currently, the need is greater than ever, considering that older adults battling with a multiple of chronic diseases and functional and/or cognitive disabilities are becoming more prevalent as the elderly population worldwide continues to expand.  Nursing home facilities provide 24-hour intensive care for individuals who are commonly physically or cognitively disabled, or both.  The delivery of quality of care and maintenance of quality of life in nursing homes are often unsuccessful, however, and has long been a great concern to consumers, providers of care, and policy makers.  The evidence that nursing home residents frequently suffer from preventable adverse outcomes (such as negative drug events, bed sores, falls resulting in serious injury, physical and pharmaceutical restraint use, delirium, and elder abuse) continues to grow and increase the risk of morbidity and mortality.

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Dementia is a serious group of cognitive conditions that promotes progressive deterioration in cognition, increased apathy, and reduced level of physical functioning.  Many older adults, especially those living in long-term care settings such as those in nursing homes or assisted living facilities, suffer from dementia. According to recent reports, more than half of the elderly nursing home population suffer from symptoms of agitation and almost 40% suffer from depressed mood.  These findings are highly similar to those of international studies that have explored the prevalence of neuropsychiatric symptoms expressed in nursing home patients with dementia.  Specifically, they found that the prevalence of neuropsychiatric symptoms significantly increases with severe dementia.  Therefore, it is no surprise that substantial evidence has proven that there is a strong association between dementia’s symptoms of depression and behavioral disorders and decreased quality of life.

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A critical issue that has long been a challenge to manage is apathy among older adult residents in long-term care settings, such as assisted living and nursing home facilities.  Apathy is commonly seen in residents with neurodegenerative disorders.  For those with Alzheimer’s disease, apathy is the primary behavioral syndrome. It also may occur in the early of stages of mild cognitive impairment (MCI) and could act as an indicator for future development of dementia, especially in older adults with apolipoprotein E ε4.  The progression of dementia exacerbates the severity of apathy, and apathy may represent a behavioral marker of a more serious form of dementia, indicated by a faster development of mental, functional, and emotional deterioration.  Older adults with Lewy bodies and Parkinson’s disease also express apathy, even if they do not have dementia.  It is also a prominent syndrome in dementia related to alcohol.

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As the older adult population continues to rise worldwide, an increasing number of people are being diagnosed with Alzheimer’s disease.  For many, mild cognitive impairment is the initial sign. Mild cognitive impairment occurs prior to dementia and significantly increases one’s vulnerability of developing Alzheimer’s in the future months or years. Recent studies from the Albert Einstein College of Medicine and Montefiore Health System (both located in New York) have explored the association between chronic stress and amnestic mild cognitive impairment (aMCI), which is the most common form of mild cognitive impairment, the main characteristic of which is memory loss.  507 participants were enrolled in the Einstein Aging Study (EAS) in which they were tested for a wide variety of cognitive issues.
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According to the International Association of Gerontology and Geriatrics consensus conference paper, a patient is entitled to early detection of cognitive impairment.  The paper also encourages the implementation of medical and lifestyle interventions as an effective way to delay or improve cognitive decline.  Screening promotes prevention or treatment.  Physical activity is especially important in combating the progression of cognitive impairment.

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A significant number of older adults with dementia live in nursing home facilities. Young-onset dementia (YOD), dementia that develops before the age of 65, is a crucial social and clinical problem that leads to critical consequences for patients and their overall wellbeing.  Neuropsychiatric symptoms (NPSs) that occur due to YOD have a serious impact on both patients and their families.  They include agitation, depression, and apathy.  A recent study published this year in the Journal of the American Medical Directors Association sought to understand the prevalence and factors that determined neuropsychiatric symptoms in elderly nursing home residents with YOD, due to its importance for treatment and planning of care services.  Researchers of the study hope that its findings will contribute to improving quality of life of nursing home patients with YOD, as well as their families and professional caregivers.

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Alzheimer’s disease is one of the primary causes of death in the United States.  An estimated 60,000 people die from the disease every year.   The risk of developing Alzheimer’s disease increases with age.  Researchers at Stanford University have recently claimed that they have found a way to prevent and even cure Alzheimer’s disease by boosting the immune response of the brain.

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