Dementia

Unique to Older Adults

This section provides information to help older adults and their caregivers consider their disease or condition in conjunction with other health issues.

As older adults live longer, they may have more than one chronic disease. Or, they may have a health problem that can lead to another condition or injury if not properly managed. The older adult may also experience healthcare in various settings, such as the hospital, assisted living facility, or at home. These situations can affect the health and function of the older adult and therefore require careful management to ensure proper care and improve or maintain quality of life.

Managing Additional Health Problems in Older Adults with Dementia

Dementia is rare in adults younger than 60. But after age 60, dementia becomes increasingly common. While 7% of adults 60 and older have dementia, nearly 30% of those 85 and older do. The two most common causes of dementia are Alzheimer’s disease and vascular dementia.

Alzheimer's disease damages and kills brain cells. Vascular dementia is caused by “mini-strokes” or blockages in the brain’s blood vessels that keep brain cells from getting the oxygen they need to survive. Additional causes of dementia include infections, Parkinson’s and other diseases, thyroid gland problems, serious head injuries, vitamin deficiencies, and long-term heavy drinking. Dementia caused by infections, vitamin deficiencies, and medications can be improved  by treating the underlying problem. But Alzheimer’s disease and vascular dementia can’t be cured. They can, however, be treated in ways that help people function as well as possible and have the highest possible quality of life.

People who have dementia often have other health problems at the same time. And this can complicate their care. Several factors cause people with dementia to have additional health problems:

  • Dementia is more common in later life, and with increasing age, people are more likely to develop additional health problems.
  • Certain diseases and health problems can either cause or increase your risk of developing dementia.  Some examples of these are Parkinson’s disease, some brain infections, heart disease, stroke, high blood pressure, diabetes, vitamin deficiencies, thyroid problems, and delirium. As a result, people who have these diseases and health problems are more likely to develop dementia too.
  • Some diseases and health problems that can cause or increase risks of dementia also cause or lead to additional complications, such as vision and hearing loss, paralysis due to stroke, loss of bowel and bladder control, difficulty drinking and eating, malnutrition, difficulty walking, falls, and injuries due to falls. Because of this, people may develop these additional complications in addition to dementia.  
  • Dementia can lead to complications too. These include malnutrition, falls, osteoporosis (“thinning bones”), bone fractures, frailty, sleep problems, anxiety, agitation, delirium, and disturbed behavior.

Caring for an older adult with dementia who has other health problems can be challenging because a standard treatment for one problem sometimes makes other problems worse. And some medicines can interact with other drugs in harmful ways. Healthcare professionals need to weigh the benefits and drawbacks of various treatments, especially when patients have multiple health problems. 

If you or someone you’re caring for has complex health problems that include dementia, consider seeing a geriatrician. 

Geriatricians are physicians who have advanced training in the care of older adults, including those with multiple healthcare needs. Gero-psychiatrists or neurologists who specialize in memory disorders, and other geriatrics healthcare professionals, such as geriatrics nurse practitioners, also have advanced training in caring for older people with dementia and other health problems.

For example, geriatrics healthcare professionals may care for an older adult with vascular dementia and other health problems. The healthcare professionals might work with the patient and a caregiver to:

  • Lower the risk of additional strokes and heart attacks by treating high blood pressure and high levels of “bad” cholesterol, and by taking steps to prevent the formation of blood clots.
  • Find behavioral approaches to manage symptoms of dementia such as loss of bladder control, anxiety, and agitation. For example, they may treat someone with dementia who has agitation.   Rather than using drug treatment to treat the agitation, they might recommend creating a soothing atmosphere at home, such as using low lighting, soft music, and other non-drug strategies. 
  • Make sure that the patient gets enough calcium and vitamin D to lower the risk of osteoporosis and bone fractures, and vitamin B12 supplements to protect against dementia due to vitamin B12 deficiency.
  • Design a nutrition and exercise plan to help lower risks of falls, and improve balance and sleep, and prevent malnutrition, bone, weight and muscle loss, and frailty.
  • Make sure that the patient gets enough fluids to avoid dehydration and constipation.
  • Treat other conditions that can contribute to vascular dementia, such as diabetes.
  • Monitor all medications to prevent drug-drug interactions, and complications from multiple medications.

To find a geriatrician or other geriatrics healthcare professionals in your area, use the online Referral Search Form or call the American Geriatrics Society’s Foundation for Health in Aging at 212-308-1414. 

 

Last Updated September 2017