Does Having Alzheimer’s Disease and Dementia Affect Severity of Delirium?

Journal of the American Geriatrics Society Research Summary

Forms of dementia, including Alzheimer’s disease, gradually affect your cognitive function by harming your memory and your ability to think and make decisions. By 2050, experts project that 13.8 million older adults in the United States will develop Alzheimer’s disease and related Dementias (ADRD). Although Alzheimer’s disease is the most common form of dementia, other forms include Lewy Body dementia, frontotemporal dementia, and vascular dementia—all of which have upsetting consequences for people with dementia and their families.

Since no cure or treatment yet exists for ADRD, healthcare providers currently focus on preventing the treatable risk factors that can lead to dementia. This strategy could potentially slow the onset and progression of ADRD.

Hospitalization poses risks to people with ADRD and can have life-threatening consequences, including predisposing us to delirium (the medical term for a rapid change in mental state, often marked by confusion), a decline in mental or physical function, being admitted to long-term care facilities, and even death.

In particular, delirium can worsen the course of an illness, quicken physical and mental decline, lengthen hospital stays, and cause higher rates of hospital re-admission and death. One in 8 hospitalized people with ADRD who develops delirium will have at least one serious problem, including cognitive decline, possibly leading to admission to long-term care or death.

Here’s the good news: Experts say 30 to 40 percent of delirium cases are preventable. But until now, we have not studied how delirium and its severity affect hospitalized older adults with and without ADRD. Continue reading

A Creative Way to Expand the Geriatrics Workforce

Journal of the American Geriatrics Society Research Summary

Geriatrics is the field of health care focused on care for older adults. Experts suggest that our current geriatrics workforce needs better preparation to care for the 5.7 million people living with dementia in this country. To help meet this challenge, the Institute of Medicine has called for enhancing educational and training programs for improving the competence of the workforce, and to ensure that our workforce reaches the level needed to serve the growing population of older adults with dementia.

Despite these ongoing efforts, the shortage of geriatricians makes it difficult to meet these urgent educational needs. For this study, a team of researchers looked “outside the box” to learn more about whether creative solutions could offer valuable opportunities for addressing these issues. In this new study, the researchers outlined the results and outcomes of an undergraduate service-learning course that used music and filmmaking to teach person-centered approaches to dementia.

The course, which included music, filmmaking, and reflective writing components, focused on service at local dementia care settings and was conducted in collaboration with Music & Memory, a non-profit organization dedicated to bringing personalized music playlists to people living with dementia or other serious medical challenges.

The three-credit undergraduate service-learning course was developed and taught by a music professor over three consecutive semesters with 16 to 18 students each term.

The students worked in pairs at one of two dementia care settings. Students received initial classroom training on dementia, ethnomusicology (music anthropology), ethnographic fieldwork methods (the technical term for expert research based on studying people and culture), filmmaking basics, and creative aging. Continue reading

Can Home-Based Physical Therapy Benefit Older Adults with Dementia?

Journal of the American Geriatrics Society Research Summary

Dementia is the leading cause of disability for more than 5 million people aged 65 and older in this country. By 2050, that number is predicted to quadruple. Dementia can cause memory, language and decision-making problems, mood changes, increased irritability, depression, and anxiety.

Dementia also can cause poor coordination as well as balance problems and falls. These difficulties can affect quality of life, reduce caregiver well-being, and increase healthcare costs.

Researchers designed a study to learn more about whether physical therapy (PT) rehabilitation services could improve dementia-associated declines. They published their findings in the Journal of the American Geriatrics Society.

The researchers noted that we understand that physical activity and exercise programs provided by physical therapists can improve balance and reduce fall risk. However, we don’t know whether providing PT in the home could benefit people with dementia. The researchers wanted to learn whether home health PT could help older adults with dementia improve their ability to perform daily functions. These functions include activities like grooming, dressing, bathing, being able to get to and from the toilet (and being able to clean yourself properly after using the bathroom), getting from bed to a chair, walking, eating, being able to plan and prepare light meals, and being able to use the telephone. The researchers also wanted to learn what amount of home-based PT services resulted in the most improvement with these essential tasks. Continue reading

Physical and Mental Exercise Lower Chances for Developing Delirium After Surgery

Journal of the American Geriatrics Society Research Summary

After having surgery, many older adults develop delirium, the medical term for sudden and severe confusion. In fact, between 10 and 67 percent of older adults experience delirium after surgery for non-heart-related issues, while 5 to 61 percent experience delirium after orthopedic surgery (surgery dealing with the bones and muscles).

Delirium can lead to problems with thinking and decision-making. It can also make it difficult to be mobile and perform daily functions and can increase the risk for illness and death. Because adults over age 65 undergo more than 18 million surgeries each year, delirium can have a huge impact personally, as well as for families and our communities.

Healthcare providers can use several tools to reduce the chances older adults will develop delirium. Providers can meet with a geriatrician before surgery, review prescribed medications, and make sure glasses and hearing aids are made available after surgery (since difficulty seeing or hearing can contribute to confusion). However, preventing delirium prior to surgery may be the best way to help older adults avoid it.

A team of researchers from Albert Einstein College of Medicine designed a study to see whether older adults who are physically active before having surgery had less delirium after surgery. The research team had previously found that people who enjoy activities such as reading, doing puzzles, or playing games experienced lower rates of delirium. The team published new findings on physical activity in the Journal of the American Geriatrics Society.

Continue reading

High Blood Pressure Treatment and Nursing Home Residents

Journal of the American Geriatrics Society Research Summary

Although 27 percent of all older adults who live in nursing homes in this country have both high blood pressure and dementia, we don’t have enough research yet to inform healthcare providers about the best way to treat their high blood pressure.

Specifically, we don’t know when the benefits of taking medication to lower blood pressure outweigh the potential risks, especially in older adults who also have moderate to severe dementia and a poor prognosis (the medical term for the likely course of a disease). That’s because clinical trials for high blood pressure treatments typically do not include older adults who have severe chronic illnesses or disabilities.

 A team of researchers designed a study to learn more about the best high blood pressure treatments for older adults who live in nursing homes. Their study was published in the Journal of the American Geriatrics Society.

The research team used information from Medicare records. The team identified 255,670 long-term nursing home residents in the United States during 2013 who had high blood pressure. Of these, nearly half had moderate or severe dementia-related difficulties with thinking and decision-making. Slightly more than half of them had no or only mild cognitive impairment. Continue reading