Looking Into the Many Faces of Dementia


More than 4.5 million Americans are diagnosed with Alzheimer's disease every year. By 2050, the number of those affected by the disease is projected to balloon to 16 million. In fact, the most common mental health issue among the elderly is severe cognitive impairment or dementia, particularly caused by Alzheimer's disease. As America's population ages, the need for mental and behavioral health services continue to increase.

Alzheimer's is the most common cause of dementia. It is estimated that 47.5 million people worldwide are living with dementia and there are 7.7 million new cases each year. Dementia is an umbrella term describing a variety of diseases and conditions characterized by a deterioration in memory, thinking, behavior and the ability to perform everyday activities. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement. The impairment in cognitive function is commonly accompanied and occasionally preceded by deterioration in emotional control, social behavior or motivation. Dementia can affect each person in a different way depending on the impact of the disease and the person's personality before becoming ill. People with dementia often suffer from depression, paranoia and anxiety.

Unfortunately, aggression can be an unexpected byproduct. Behaviors such as cursing, hitting, grabbing, kicking, pushing, throwing things, scratching, screaming, biting, and making strange noises. Aggression, due to Alzheimer's disease, is one of the main reasons most people seek treatment. Fortunately, new medications and coping methods can help. Geriatric Behavioral Health is a growing field of medicine dedicated to the diagnosis and treatment of mental disorders in older adults.

Kris Moore

"As baby boomers are living longer, the need for more geriatric-based services is growing," said Kris Moore, Care Transition Coordinator for Tennessee Health Management, Inc. Behavioral Health Center - Martin. "When we first started our geriatric behavioral health program, we wanted to be on the forefront and so we put it where we saw the greatest need, a rural area. We looked at Martin, which would not typically have specialized treatments like this, but we wanted to offer care like you would expect in an urban area. Since we opened in June 2005, there have been other facilities that have opened within a 60-mile radius of Martin. THM has also added programs in Memphis, Columbia and Clarksville as well as in Huntsville, Alabama."

Programs to address geriatric behavioral issues can be found as a part of an inpatient unit in a hospital, outpatient day program or in a freestanding hospital, such as the Martin program. Staffing can include medical personnel, social workers, therapists, psychiatrists and psychologists. "We have a medical internist on staff that monitors a patient's medications and physical health while in the program," said Moore. "Our psychiatrist, nurse practitioners and therapist assesses them to determine where they are in the disease process as well as cognitively. All our staff receive extra training in crisis prevention and as certified dementia practitioners. This is a way to educate staff on how to work with patients and give them best care while with us."

Family involvement can be an integral part of the program says Moore. "We treat the whole person and educate their family. When family comes in and their loved one is not the person they used to be, it can be very stressful. They can be going through the various stages of grief," she said. "We educate them on the disease process so we can help them through it and involve them in the treatment process. We discuss goals and the expectations they have while their loved one is here as well as what their plans are for after discharge. It is important to try to alleviate their anxiety about where to go from here."

Patients are also assessed to ensure they are physically well enough to complete the program, which has an average length of stay of 14 days. "We have to make sure there are no medical issues that need to be addressed," said Moore. "We assess their medications for side effects or contraindications or ones that may be contributing to some of their issues. We try to regulate their medications as needed and add more effective ones that can better address issues while keeping them safe."

Cognitive stimulation is a key element of the program. "We have five group sessions throughout the day," said Moore. "Group activities are specific to the stage of the disease the person is in as well as individualized for the person's needs. We treat the specific behaviors that go along with the diagnosis and there can be lots of different issues ranging from depression to hallucinations to delusional thoughts."

Education is an integral part of the program for not only family members but for healthcare professionals and long-term care facilities. "We accept referrals from different providers. This includes medical professionals, long-term care facilities, medical facilities and family members," said Moore. "If there is a need for someone to be in our program, we want them to know it exists and we are here to help. This can be one of the hardest issues someone will go through but it can be managed. When your loved one gets the diagnosis, you may think that you are, but you are not alone - there are others that have been in the same situation."


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