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dementia

Incontinence in Long-Term Care Residents with Dementia

Incontinence in Long-Term Care Residents with Dementia

Teaser: 

Jayna M. Holroyd-Leduc, MD, FRCPC, Assistant Professor, Department of Medicine, University of Toronto; Clinician-Investigator, University Health Network, Toronto, ON.
Cara Tannenbaum, MD, FRCPC, MSc, Assistant Professor, Department of Medicine, University of Montreal; Director, Geriatric Incontinence Clinic, McGill University Health Centre; Director, Institut Universitaire de Geriatrie de Montreal, Montreal, QC.

Urinary incontinence is a prevalent condition among long-term care residents, particularly those with dementia. The costs and morbidity associated with urinary incontinence are significant. Urinary incontinence can be easily assessed within the long-term care setting. Several modifiable risk factors should be identified and addressed. Effective behavioural treatment options for incontinence exist and several treatment strategies can be used successfully for patients with dementia.

Key words: urinary incontinence, dementia, long-term care, diagnosis, management.

Nonpharmacological Management of Agitated Behaviours Associated with Dementia

Nonpharmacological Management of Agitated Behaviours Associated with Dementia

Teaser: 


Dorothy A Forbes, RN, PhD, CIHR New Investigator, Associate Professor, College of Nursing, University of Saskatchewan, Saskatoon, SK.
Shelley Peacock, RN, MN, Faculty Member, Saskatchewan Institute of Applied Science and Technology, Saskatoon, SK.
Debra Morgan, RN, PhD, Associate Professor, Institute of Agricultural, Rural, and Environmental Health, University of Saskatchewan, Saskatoon, SK.

Strategies such as simulated presence therapy, pet therapy, light therapy, validation therapy, music, massage, therapeutic touch, aromatherapy, and multisensory stimulation have shown promising results in decreasing physical aggression, physical nonaggression, verbal aggression, and verbal nonaggression in older adults with dementia. Further research is needed to identify which strategies are most effective in managing symptoms of agitation associated with the different types of dementia and at different levels of cognitive impairment.

Key words: Alzheimer’s disease, dementia, nonpharmacological strategies, agitation, aggression, behaviour.

A Review of the Pharmacological Management of Cognition and Behaviour Problems in Older Adults with Advanced Dementia

A Review of the Pharmacological Management of Cognition and Behaviour Problems in Older Adults with Advanced Dementia

Teaser: 


The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme.htm

Ann Schmidt Luggen, PhD, GNP, Professor, Department of Nursing and Health Professions, Northern Kentucky University, Highland Heights, KY; Gerontological Nurse Practitioner, Evercare, Cincinnati, OH, USA.


Medical management of Alzheimer’s disease patients involves drugs that temporarily relieve or stabilize symptoms, or lessen the expected decline in cognition, function, and behaviour, but ultimately fail to halt progression of the disease. Commonly used agents in the management of early- to mid-stage dementias--albeit with modest outcomes--are the cholinesterase inhibitors (ChEIs). Antipsychotics have been used with mixed success to treat psychiatric symptoms that occur in 30-60% of patients with moderate-to-severe AD. In the terminal stages of dementia, palliation of symptoms and a focus on comfort care is important. Management of pain and relief from depression and anxiety are useful.

Key words: dementia, Alzheimer’s disease, cholinesterase inhibitors, behaviour, antipsychotics.

Dementia: Update for the Primary Care Physician

Dementia: Update for the Primary Care Physician

Teaser: 

The study of Alzheimer’s disease and other dementias was a wasteland for serious investigative efforts when I was in medical school. Now it is one of the most exciting areas in biomedical research. The NEJM addressed the complexity of Alzheimer’s disease in an editorial on March 3, 2005, noting that it is a result not just of genetics but of a complex mixture of environmental and genetic factors. Nevertheless, the study of the genetics of Alzheimer’s has provided us with our most powerful insights into the pathogenesis of the disorder. This has come particularly from the study of kin with autosomally inherited Alzheimer’s disease. Drs. Lan Xiong, Claudia Gaspar, and G.A. Rouleau update us on this exciting topic in their article, “Genetics of Alzheimer’s Disease and Research Frontiers in Dementia.” The hope is that such research will eventually result in more specific treatments that can halt the progressive neuronal loss observed in Alzheimer’s disease. For now, however, we must be satisfied with symptomatic treatment. Dr. Ann Schmidt Luggen provides a “Review of the Pharmacological Management of Cognition and Behavioural Problems in Older Adults with Advanced Dementia.”

Drugs with proven efficacy against severe dementia have only recently become available in Canada. Dr. Dorothy Forbes, Shelley Peacock, and Dr. Debra Morgan have provided us with an important article, “Nonpharmacological Management of Agitated Behaviours Associated with Dementia.” Dr. Christine Fruhauf continues this theme with her article, “Dementia Care: Suggestions for Managing Behavioural Disturbances.” Drs. Dale Lund, Scott Wright, and Michael Caserta highlight the benefits of respite care in their article, “Respite Services: Enhancing the Quality of Daily Life for Caregivers and Persons with Dementia.” Drs. Jayna Holroyd-Leduc and Cara Tannenbaum address a completely different aspect of dementia management in their article, “Incontinence in the Long-Term Care Residents with Dementia.”

Our non-dementia articles this issue include a review of “New Antibiotics for the Older Adult” by Drs. Joseph Blondeau and Glenn Tillotson. Dr. Wilbert Aronow discusses “Therapy for Older Patients with Hypertension,” while Drs. C. Giede and A.M. Oza discuss “Metastatic Cervical Cancer in Older Patients.” Finally, we complete the issue with a book review by Dr. Jackie Gardner-Nix, entitled “Living with Chronic Pain.”

Enjoy this issue,
Barry J. Goldlist

Screaming in Dementia

Screaming in Dementia

Teaser: 


Nages Nagaratnam, MD, FRCP, FRACP, FRCPA, FACC, Consultant Physician in
Geriatric Medicine, Formerly of Department of Geriatric Medicine, Blacktown-Mt-Druitt Health, Blacktown, NSW, AUS.
Kujan Nagaratnam, MB, FRACP, Consultant Physician in Geriatric Medicine, Department of Geriatric Medicine, Blacktown-Mt Health, Blacktown, NSW, AUS.

Screaming is widely viewed as a common behavioural disturbance in dementia. It influences the performance in daily life of the patient, adds to the burden and embarrassment experienced by the caregiver and the frustrations encountered by the treating physician, and is a decisive factor for institutionalization. This article outlines an approach to screaming and its possible neuroanatomical substrates and neurotransmitter systems. The ultimate basis for discussion will be the strategies available for management of this challenging behaviour.

Key words: screaming, disruptive vocalization, dementia, limbic system, frontal-subcortical circuitry.

Radiation Therapy in Older Adults

Radiation Therapy in Older Adults

Teaser: 

Loren K. Mell, MD, Department of Radiation and Cellular Oncology, University of Chicago and the University of Illinois at Chicago, Chicago, IL, USA.

Arno J. Mundt, MD,
Department of Radiation and Cellular Oncology, University of Chicago and the University of Illinois at Chicago, Chicago, IL, USA.

Radiation therapy (RT) is commonly used in the treatment of older cancer patients. RT may be used as definitive therapy for benign or malignant tumours, as adjuvant therapy with surgery and/or chemotherapy, as palliative therapy when cure is no longer possible, and as alternative to surgery in patients with multiple comorbidities. However, RT is often not given to older patients who might benefit from it, due to biases, misapprehensions about potential toxicity, and social factors particular to this patient population. The preponderance of data suggest that RT is well tolerated in older adults and treatment decisions should be based on prognostic factors irrespective of age. Emerging RT technologies may particularly benefit aged patients by reducing potential toxicities, shortening treatment times, and improving tumour control.

Key words: age, radiation therapy, toxicity, cancer, procedures.

Artificial Nutrition and Hydration in the Management of End-Stage Dementias

Artificial Nutrition and Hydration in the Management of End-Stage Dementias

Teaser: 

Rory Fisher, MB, FRCP(Ed)(C), Professor Emeritus, Department of Medicine, University of Toronto, Toronto, ON.

Eoin Connolly, MA, Clinical Ethics Fellow, Joint Centre for Bioethics, University of Toronto, Toronto, ON.

Canada's aging population makes appropriate end-of-life care a priority. Alzheimer's disease and related dementias become increasingly common with aging. The terminal stages are characterized by severe cognitive and physical incapacity with a poor prognosis. Artificial nutrition and hydration may be provided by feeding tubes; however, there is no
evidence of benefit, and there are significant side effects to be considered. Barriers to appropriate end-of-life decision making are identified, and current evidence indicates that this patient population should be treated with appropriate palliative care.

Key words:
Alzheimer’s disease, artificial nutrition and hydration, dementia, end-of-life care, ethics.

Home, Safe Home: Minimizing the Risks for the Cognitively Impaired in the Community

Home, Safe Home: Minimizing the Risks for the Cognitively Impaired in the Community

Teaser: 

David B. Hogan, MD, FACP, FRCPC, Professor and Brenda Strafford Foundation Chair in Geriatric Medicine, University of Calgary, Calgary, AB.

Dementia is a common condition that places its victims at risk for injury. This article provides an overview of home safety for those with dementia. A conceptual approach to this management challenge is the Home Safety / Injury Model described by Hurley and colleagues. I focus on two common safety concerns: wandering and falls. Unfortunately, most recommendations are based on “common sense” (i.e., what seems reasonable). Whether these approaches actually decrease the likelihood of harm is largely unknown. It is anticipated that future research will lead to evidence-based recommendations.

Key words: dementia, home safety, wandering, falls.

Family Therapy in the Context of Families with Older Members and Members with Dementia: Part II

Family Therapy in the Context of Families with Older Members and Members with Dementia: Part II

Teaser: 

D’Arcy Little, MD, CCFP, lecturer and Academic Fellow, Department of Family and Community Medicine, University of Toronto; Director of Medical Education, York Community Services; 2002 Royal Canadian Legion Scholar in Care of the Elderly, Toronto, ON.

Part II of this series briefly reviews the literature on the success of family therapy in families with dementia. A case from the author’s practice (with significant details modified to conserve privacy) is then presented with a view toward applying family therapy. Finally, as the author has an interest in medical education, a proposal on how to integrate family therapy for families with dementia into an educational program is briefly described. The author welcomes comments and suggestions at darcy.little@geriatricsandaging.ca.
Key words: dementia, Alzheimer’s disease, family therapy, family, Systems Theory.

Family Therapy in the Context of Families with Older Members and Members with Dementia: A Review

Family Therapy in the Context of Families with Older Members and Members with Dementia: A Review

Teaser: 

D. Little, MD, CCFP, Lecturer and Academic Fellow, Department of Family and Community Medicine, University of Toronto; Director of Medical Education, York Community Services; 2002 Royal Canadian Legion Scholar in Care of the Elderly, Toronto, ON.

Seniors are one of the fastest growing population groups in Canada.1 Approximately 20% of our population is over the age of 65, and this phenomenon has been referred to as the “graying” of the population.1,2 Families often play a central role in the lives of older people. “Life’s rhythms and seasons” are usually marked within the context of the family.3 Whether independent or dependent, older people view the family as integral to their daily life and wellbeing.4 When dependent, the family offers crucial support,3 especially in cases of dementia. Alzheimer’s disease (AD) is the most common cause of severe intellectual deterioration in the aging.5 Approximately 8% of people over 65 years and 35% of people over 85 years suffer from dementia.6 The majority of patients with dementia live in the community and are cared for by family and/or friends.7 However, research into and the clinical application of family therapy techniques and principles in older people and their families has been slow to develop.