Jun 2, 2016

Dementia Patients at Risk of Potentially Unsafe Behaviors

Older adults with probable dementia who are not aware of a dementia diagnosis are more likely to report engaging in potentially unsafe behaviors.

The findings should be a wake-up call to physicians who care for the elderly and family members whose loved ones might be developing dementia

Understanding the prevalence of potentially unsafe activities and living conditions could help caregivers and family members to be anticipate and manage the behaviors of those living with Alzheimer's and related dementia.

A study on data from more than 7,000 older Americans found that those who show signs of probable dementia but are not yet formally diagnosed are nearly twice as likely as those with the diagnosis to engage in potentially unsafe activities, such as driving, cooking, and managing finances and medications.

Please note. The study indicates that early on probable dementia patients are more likely to engage in dangerous behavior.

It is not uncommon for family members to allow potential Alzheimer's patients to drive, manage a checkbook, pay bills, take their medicine without supervision, and cook. This study should serve as a wake up call. About 1 in 3 persons age 80 are diagnosed with Alzheimer's. This means the general population, and especially doctors, need to be informed of these dangers.

One of our readers once told me that he discovered that his mother had written a check for $1,000 for the same service 3 straight months in a row. All three checks were cashed by the vendor. I then asked him if his mother was still living alone, writing checks and driving. He answered yes.
"When patients receive a formal dementia diagnosis, their families are typically aware that, at some point, their loved ones will not be able to drive or will need more help with their medicine. But when people are undiagnosed, families and friends may ignore or be unaware of functional problems that already exist." -  Halima Amjad, M.D., M.P.H., a fellow in the Johns Hopkins University School of Medicine's Division of Geriatric Medicine and Gerontology.
In the study all participants were asked about activities or living conditions that are potentially unsafe in dementia, including
  • providing care to another person, 
  • driving, 
  • preparing hot meals, 
  • handling finances, 
  • managing medications, 
  • going alone to doctors' visits 
  • or multiple falls.
In addition, they answered questions about unmet needs -- whether they ever went without eating, bathing, clean laundry and groceries, or stayed in the home or in bed because they had insufficient help.

Analysis showed that those with dementia, either diagnosed or undiagnosed, were less frequently engaging in potentially unsafe activities than those with possible or no dementia.

The study results revealed that those whose dementia was undiagnosed were significantly more likely to be taking part in unsafe activities, compared to those with a formal dementia diagnosis. For example, while about 17 percent of the volunteers with diagnosed dementia were still driving, nearly 28 percent of those with undiagnosed dementia were doing so.

"There are a couple of important questions we are raising in this research," says David Roth, Ph.D., director of the Johns Hopkins Center on Aging and Health and professor of medicine at the Johns Hopkins University School of Medicine. "First, are those with dementia receiving adequate medical care, including accurate and up-to-date diagnoses? Second, are diagnoses of dementia being properly communicated to patients and their families?"

The findings should be a wake-up call to physicians who care for the elderly and family members whose loved ones might be developing dementia, Amjad says.

"If elderly patients are having difficulty with activities, they may benefit from a physician formally screening them for dementia," she says. "But families are really the front line in recognizing when someone shouldn't be driving or needs more help with managing medicines. That means being watchful and aware as loved ones get older and dementia is more likely."

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These finding where reported in the Journal of the American Geriatrics Society
Potentially Unsafe Activities and Living Conditions of Older Adults with Dementia
DOI: 10.1111/jgs.14164