Running head: DEMENTIA

Dementia in Aging Populations

Elizabeth M. Stucki
Brigham Young University- Idaho

NURS400-04
Sister Anderson
February 18, 2015

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Dementia in Aging Populations

Dementia is a prevalent disease in todays society, and it seems that it is only becoming
more rampant as the population of oldest adults (Baby Boomers) increases. To put things into
perspective, the number of Americans aged 65 years and older has tripled in the last 100 years,
and dementia affects as many as half of the worlds population who are 85 years of age or older
(Smeltzer, Bare, Hinkle, & Cheever, 2010; Tom et al., 2015). Additionally, it was estimated in
2010 that 35.6 million people worldwide live with dementia. That number is expected to
increase to 65.7 million in 2030 as well as 115.4 million by 2050 (Tsaroucha, Benbow, Kingston,
& Mesurier, 2013). Because it is increasing at such a dramatic rate, this paper strives to help
nurses and other caretakers understand what dementia is, what the signs of dementia are, and
what interventions can be done to treat this crisis. Doing so will ensure that nurses and
caretakers are able to keep up with and meet the needs of the Baby Boomer generation.
What is Dementia?
Dementia is a broad term for a syndrome characterized by a general decline in higher
brain functioning, such as reasoning, with a pattern of eventual decline in ability to perform even
basic activities of daily living, such as toileting and eating (Smeltzer et al., 2010, p. 200). There
are many forms of dementia with the two most common types being Alzheimers disease (5060% of cases) and vascular dementia (10-20%) of cases. Other forms include Parkinsons
disease, acquired immunodeficiency syndrome- related dementia, and Picks disease. No one
can pinpoint the exact cause of dementia, but many factors play a part in forming this disease
such as genetics, neurotransmitter changes, vascular abnormalities, stress hormones, circadian
changes, head trauma, and even seizure disorders. There is currently no cure for this disease and

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no way to slow its progression. Treatment is focused on maintaining what cognitive abilities
each patient has left (Smeltzer et al., 2010).
Signs and Symptoms
While dementia is primarily a disease of cognitive function, there are some physical
manifestations of the Alzheimers form of this disease that help scientists understand its
pathophysiology. Such manifestations include neurofibrillary tangles (tangled masses of
nonfunctioning neurons) and neuritic plaques (also known as senile plaques) found within the
brain. Unfortunately, these manifestations can only be found at autopsy. Because of this, a
definitive diagnosis of dementia can only be made after the death of the victim. Furthermore, the
enzyme that produces acetylcholine, a neurotransmitter, is decreased in dementia patients
causing many patients to display generalized muscle weakness and slow reaction times (Smeltzer
et al., 2010).
Other signs of dementia are found in the behavior of the victim. Forgetfulness and
memory loss characterize the early stages of dementia. These behaviors slowly progress over
time into the inability to recognize familiar faces, word-finding difficulties, inability to think
abstractly, getting lost, and constantly misplacing important objects such as keys or reading
glasses. Some victims exhibit extreme impulsive behavior such as stripping naked in public on a
hot day. Perhaps the most troubling symptom of dementia is the agitation many victims
experience that can quickly escalate into violence. There have been many reports of victims
becoming so confused that they physically beat their own caretakers, not knowing who they are.
Eventually, people suffering from dementia lose almost all ability to perform activities of daily
living (Potter, Perry, Stockert, & Hall, 2013; Slaughter, Hopper, Ickert, & Erin, 2014; Smeltzer
et al., 2010).

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Nursing Interventions/ Discussion of Literature

Most of the literature that concerns dementia comes from qualitative studies. These
studies include interviews of caretakers of dementia patients that strive to understand what the
caretakers perceive to be the most effective methods of dealing with patients who have dementia.
Most of the literature agrees that the most powerful tool to treat this disease is a knowledgeable,
motivated, skillful staff and/ or caretakers who have the proper resources and support in addition
to an adequate understanding of this disease. The literature suggests that staff be frequently
trained in methods of handling dementia patients in order to provide optimal care (Konno, Kang,
& Makimoto, 2014; Monahan, Neighbors, & Green, 2011; Potter et al., 2013; Smeltzer et al.,
2010; Tsaroucha et al., 2013).
Speaking of a skillful staff, the most important skill to possess is possibly the ability to
communicate effectively with dementia patients. This can be done by speaking in a calm, even
tone and getting down to the level of the patient for face-to-face interaction. Caretakers should
also use simple and direct commands when asking the patient to complete a task. Doing so
reduces the level of threat perceived by the patient and reduces the probability of them becoming
confused, agitated, and violent (Smeltzer et al., 2010; Tsaroucha et al., 2013). If agitation or
violence does occur, it is best to leave the room for about 15 minutes, come back, and start the
conversation over like nothing had ever happened. Another tactic to deescalate violence is to say
assuring phrases to the patient such as, I see why you would think that (Monahan et al., 2011).
Violence can also indicate that a need has been unmet, so caretakers should ask questions such as
when did the patient last eat, use the toilet, or receive pain medication? Use of restraints should
be a last resort as these can harm the patient or increase agitation and violence (Konno et al.,
2014; Slaughter et al., 2014).

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Reducing stimulation is a key point emphasized by much of the literature. Often, when a
patient suffering from dementia becomes angry or combatant it is because they are
overstimulated by their environment and do not know how to cope. Stimulation can be reduced
by turning down bright lights, maintaining a quiet sleep environment, limiting visitors, and
limiting the number of times a nurse enters the patients hospital room (Monahan et al., 2011;
Smeltzer et al., 2010; Tsaroucha et al., 2013). Nevertheless, some stimulation may be good for
the patients cognitive function by stimulating higher brain activity. Appropriate activities to
stimulate brain function include, but are not limited to, sorting items into categories, completing
crossword puzzles, and playing soft music. Cognitive function stimulation activities should only
be done as tolerated by the patient (Konno et al., 2014; Milders, Bell, Lorimer, MacEwan, &
McBain, 2013; Potter et al., 2013).
Many other resources of literature agree that another powerful tool to treating dementia is
repetitious reorientation. Caretakers and nurses can ask dementia patients where they are, and
what day and time it is; then, reorient the patient as necessary. Other methods of orientation
include placing easy-to-read clocks and calendars close to the patient so they can attempt to
orient themselves, or placing pictures of close friends and family near the patient to remind the
patient of who their loved ones are. Nurses and caretakers should be careful to constantly
introduce themselves to the patient to avoid being perceived as a threat. Because of their
cognitive impairment, many dementia patients have been known to think of caretakers as jailers,
thieves, kidnappers, and many other threatening roles (Monahan et al., 2011; Smeltzer et al.,
2010).
As stated before, treatment of dementia is focused on maintaining the level of cognitive
function each patient has left because there is no cure and no way to slow the progression of this

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disease. The literature on dementia agrees, for the most part, that cognitive function can be
maintained through promotion of self-care activities. These activities include toileting, eating,
bathing, and dressing. Helping the patient to accomplish self-care tasks can be done through the
use of techniques such as modeling the action, or using the hand-over-hand method for activities
such as bathing (Foreman, Fulmer, & Milisen, 2009). In addition to following a set schedule and
being predictable, activities should be short and simple to follow so as to promote a sense of
accomplishment in the patient that will encourage them to cooperate with the activities. Patients
should be given the ability to make their own choice, but caretakers must ensure the choices
made are appropriate (Smeltzer et al., 2010). For example, patients should not be allowed on
insisting that shorts and a T-shirt be worn when it is 20 degrees below zero outside. While
supervising the patient during self-care activities, the nurse and other caretakers must ensure that
autonomy and dignity of the patient is maintained. Just because a patient has a cognitive deficit,
does not mean that they cannot sense when they are being made fun of, or being treated as a
child (Slaughter et al., 2014; Smeltzer et al., 2010). Many other interventions exist for the
treatment of dementia; however, due to the limitations of this paper only those interventions that
were most commonly mentioned by the literature have been discussed.
Conclusion
Dementia is a rapidly growing disease that primarily effects the quickest growing
population on earth. As incidences of this disease increase, nurses and other caretakers will need
to be more knowledgeable and skilled in the art of treating this disease in order to meet the needs
of their patients (Smeltzer et al., 2010; Tom et al., 2015; Tsaroucha et al., 2013). Dementia
affects the cognitive functioning of its individuals; some to the point of completely losing their
ability to take care of themselves and perform activities of daily living (Smeltzer et al., 2010).

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Other signs include impulsive behavior, neuritic plaques, inability to recognize familiar faces,
violence, word finding difficulties and more. As dementia has no cure, the only thing that can be
done to treat this disease is support cognitive function in order to avoid losing more of it (Potter,
Perry, Stockert, & Hall, 2013; Slaughter, Hopper, Ickert, &Erin, 2014; Smeltzer et al., 2010).
Treatment includes activities to stimulate brain function such as crossword puzzles, checking for
unmet needs, frequent reorientation, promoting patient participation in activities of daily living,
promoting a low stimulation environment to avoid agitating a patient, treating each patient with
respect, and communicating effectively with dementia patients (Foreman et al., 2009; Konno et
al., 2014; Milders et al., 2013; Monahan et al., 2011; Potter et al., 2013; Slaughter et al., 2014;
Smeltzer et al., 2010; Tom et al., 2015; Tsaroucha et al., 2013 ). The above listed interventions
are just a few of countless interventions that could be useful when working with patients who
suffer from dementia. However, they were the most commonly pointed out by the literature to
be effective in treatment of dementia and should be seriously considered in dementia care.

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References

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