New findings in the neuropathophysiological relationship between psychiatric disorders and dementia are shedding light on a number of areas including predictors of dementia, psychosis in dementia, the impacts of psychiatric disorders on dementia, and clinical management of older adults with both psychosis and a dementia-related disorder. The vast majority of long-term residents have at least one psychiatric disorder which calls for more training and education of nursing home staff, a multidisciplinary approach to care and a number of interventions to address both conditions while maximizing quality of life.
Scope of the Problem
Over 3 million residents in long-term care are diagnosed with Alzheimer’s disease alone, and hundreds of thousands are either diagnosed or undiagnosed with other dementia-associated illnesses. This also means that over half of all residents in skilled nursing facilities around the country have dementia. On top of this, between 65% to 78% have at least one identifiable psychiatric illness including mainly anxiety, depression and insomnia. Other psychiatric disorders likely to accompany dementia include:
- Adjustment disorder
- Bipolar disorder
- Personality disorder
- Delusional disorder
- Schizophrenia
- Schizoaffective disorder
Rise in Prevalence of Psychiatric Disorders in Skilled Nursing Care
It’s been reported for some time now that there is both a high and growing prevalence of psychiatric disorders among residents living in skilled nursing facilities across the country and around the world. Many residents with a dementing illness also experience secondary psychiatric disorders like those listed above. All in all, this adds up to more suffering for the resident and family, and more stress for caregivers.
What’s the Connection Between Dementia and Psychiatric Disorders?
In many studies, it has been shown that psychiatric disorders often precede cognitive decline associated with many dementing illnesses. Interestingly, Emil Kraepelin in 1899 described a condition he called “dementia praecox”, which was later called schizophrenia and had hallmark symptoms of cognitive disintegration, hallucinations and delusions. It appears that depression is associated with an increase in risk for developing dementia in later life and this risk increases with the severity of depressive symptoms, admission to a psychiatric hospital and bipolar disorder.
The Impacts of Dementia with Psychiatric Disorders
In long-term care, the psychiatric signs and symptoms get more attention than dementia, for the most part. Why is this? It’s due to the distress, unpredictability and disruption they bring to the residential setting. Psychiatric disorders mixed with dementia can exacerbate and cause greater caregiver stress, anxiety and burnout, not to mention staff turnover. More time and resources are also spent on such residents. Of great concern are the ultimate impacts – severe cognitive and functional disability, and a faster progression from severe dementia to death.
Final Thoughts on Dementia and Co-Occurring Psychiatric Disorders
It’s clear through much research that dementia co-occurs with many psychiatric disorders, mainly anxiety, depression and insomnia, but there are plenty more. The nursing home population is growing significantly and more than half of them will contain residents who are diagnosed with both dementia and at least one psychiatric illness. Staff must be aware of diagnoses, develop person-centered care and be prepared to deliver high levels of care and quality of living.