Running head: DEMENTIA 1
Dementia
Student’s Name:
Institutional Affiliation:
DEMENTIA 2
In patients diagnosed with dementia, and that is greater than 60 years old, does the dual
treatment of anti-dementia and anti-depressant medication have greater incidence of falls
versus anti-dementia medication as monotherapy?
Dementia refers to a large group of conditions that cause a progressive decline in brain
functioning, thus causing deterioration in memory, thinking, behavior, social abilities, and the
ability to perform daily activities. Its multifaceted nature presents a significant challenge in
adequate treatment (Foley, P. (2020). As a result, despite everyday studies identifying the
effective treatment of dementia, most of the existing treatments are ineffective. As a result, the
prevalence of dementia continues to rise globally, affecting more than 50% of the aging
population, despite not being a normal part of aging. Globally, dementia affects approximately
50 million people, and it is one of the significant causes of disability, dependency, and increased
need for healthcare among older people (Walsh, 2020). Dementia has a physical, psychological,
social, and economic impact on people with dementia and their carers, families, and society at
large. These negative implications necessitate studies to determine the most effective dementia
treatments among the available.
The current study will compare the fall risk associated with dementia treatment using
dual treatment of anti-dementia and anti-depressant medication and anti-dementia medication as
monotherapy, in patients diagnosed with dementia and that is greater than 60 years old. Age is
one of the most significant dementia risk factors. Therefore, dementia is most prevalent among
older adults aged 60 years and above. Patients are diagnosed with dementia if they portray
progressive cognitive changes: Memory loss, difficulty communicating, impaired reasoning,
difficulty with coordination and motor functions, and psychological changes like personality
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changes, depression, anxiety, paranoia, agitation, and hallucinations not attributed to any other
condition.
Both cognitive impairment and psychological changes are responsible for the increased
risk of falls in elderly individuals with dementia. Falls in dementia patients are frequent and
often result in fractures, incapacitation, and death. There is no definite treatment for dementia;
therefore, treatment focuses on symptoms management, slowing down progress, improving
patient independence, and preventing complications like fall incidences. The most commonly
used treatment approaches in dementia patients are anti-dementia Medications and anti-
depressants (Tisher & Salardini, 2019).
Project Objectives
The study's primary objective is to compare the fall risk associated with dementia
treatment approaches in elderly patients with dementia. The study will compare the fall risk
associated with combining anti-dementia and anti-depressant medication and using the anti-
dementia medication as monotherapy.
Statement of Problem
Dementia is increasingly gaining the attention of the American public, health care
providers, and policymakers due to its enormous burden on families, the financial costs, and the
projected tripling in the number of affected adults over the four decades. There is currently no
curative treatment, and much of the increased research funding is targeted toward discovering
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preventive therapies or therapies for altering its course. The available dementia treatment is used
to slow down symptoms and manage them to improve independence. The FDA-approved anti-
dementia drugs are cholinesterase-inhibitors and the NMDA-receptor-antagonist memantine
(Tisher & Salardini, 2019). Cholinesterase inhibitors aim at boosting levels of a chemical
messenger involved in memory and judgment. At the same time, Memantine regulates glutamate
activity, a chemical messenger involved in brain functions, such as learning and memory.
Studies show that these Anti-dementia drugs are not effective in most dementia forms,
such as Alzheimer’s (O’Brien et al., 2017). Despite the evidence showing anti-dementia drugs
are ineffective in most common forms of dementia, clinicians continue to prescribe them when in
the challenging situation of managing a person with progressive cognitive loss that is also
associated with problematic behaviors and psychotic symptoms. Some clinicians are now opting
to integrate antidepressants in dementia treatment plans to manage psychological problems like
depression, sleep disturbances, hallucinations, agitation, and dizziness associated with dementia
(Kormelinck et al.,2019).There have been claims that the integration of antidepressants promotes
better outcomes.
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Although no many studies have focused on this topic, clinicians and families are willing
to integrate anti-dementia and antidepressant drugs in dementia treatment rather than watch their
loved ones waste away. Despite the dementia treatment regime's positive progress, the dual
therapy of anti-dementia drugs, and anti-depressants, some researchers and patients claim the
therapy is associated with increased fall incidences (Kormelinck et al., 2019).This is primarily
due to the significantly high risk of falls associated with antidepressants.
Need Assessment
Dementia has become one of the most significant health issues today, both globally and
in the US. The conditions affect approximately 5.7 million Americans, and the number is
anticipated to triple in the next four decades if the treatment gap is not addressed (Walsh, 2020).
Its enormous negative implications necessitate for more studies to identify a practical treatment
approach. Dementia has resulted in a significant increase in healthcare costs in America. The
cost includes anti-dementia drugs, increased need for more caregivers, and the need to establish
more elderly care facilities for inpatient care of elderly individuals with dementia (Frank et al.,
2020).
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The disease has also contributed to a significant loss of productivity, as individuals
diagnosed with dementia cannot continue working due to the cognitive and psychological
changes. Others have been forced to resign to take care of family members with dementia
because they require long term care. Another significant impact of dementia, which is attracting
both government and researchers' attention, is fall. Historically, the risk of falls in elderly
patients has been attributed to aging changes, such as loss of bone density, muscle strengths,
hearing, and eyesight. Evidence-based strategies have been identified to control these factors.
Dementia has been blamed for the rising fall incidences among elderly individuals. This is due to
poor management of dementia symptoms like cognitive changes resulting in physical weakness,
gait Changes, poor balance, poor judgment, and psychological changes like confusion, dizziness,
low concentration, and hallucinations.
The side effects of dementia treatment have also been associated with an increased risk of
dementia patients' falls (Park et al.,2019).The increased falls arising from dementia and side
effects of dementia treatment therapies has contributed to significant injuries such as a fracture,
severe soft tissue injury, or traumatic brain injury, thus further increasing healthcare costs. This
also increases the dependency rate. Falls are significant contributors to functional decline and
DEMENTIA 7
health care utilization among elderly individuals. Falls in dementia patients have increased
morbidity and mortality due to injuries and impairments of the ability to adequately utilize
healthcare (Lapeyre-Mestre, 2016).
Framework
The proposed change application was guided by The Adaptation Model of Nursing,
founded by Sister Callista Roy in 1976 (Jennings, 2017). According to Roy, human beings
comprise a set of interrelated systems, affected by varying stimuli. Therefore, to attain health,
they strive to attain and maintain a balance between these various stimuli. She also assumes that
human beings are in constant interaction with the environment, impacting their ability to adapt to
changes. The theory asserts that nursing entails obtaining data regarding patients' capacities and
needs, assessing the stimuli, expanding their adaptive abilities, and creating an environment that
supports their transformation during change. Therefore, nursing goals are to promote adaptation
for individuals, thus contributing to health, wellbeing, and quality of life. This is done by
assessing behavior and factors that influence adaptive abilities and by intervening to expand
those abilities and enhance environmental interactions.
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The major concepts of the theory are person, health, environment, nursing, and
adaptation. The theorist defined a person as a holistic being comprised of many parts that
function in unity, in constant interaction with the environment, with an adaptive system
comprised of innate and acquired factors that enable them to respond to the environmental
changes. She defined the environment as external changes that necessitate an individual to adapt,
thus influencing humans' development and behavior. She defined health as the ability to
continually and holistically adapt to stimuli. She defined Nursing as the process of facilitating
adaptation by assessing the patient’s adaptation needs and creating an environment that supports
positive adaptation. She defined Adaptation as the process and outcome whereby thinking and
feeling persons or groups use conscious awareness and choice to create human and
environmental integration (Jennings, 2017). Roy stated that nurses have a role in administering
interventions that enable patients to process physiological coping mechanisms, and mental
coping mechanisms, thus adapt to change.
Application of the Framework to Project
The framework is applicable to the prevention of falls associated with dementia therapies.
This will entail the adoption of a holistic approach in the treatment of dementia patients.
DEMENTIA 9
Cognitive and psychological symptoms characterize dementia, and they both significantly
contribute to fall risk. Treatment with anti-dementia drugs only focuses on managing cognitive
changes, while antidepressants focus on managing psychological changes. Therefore, to
adequately manage dementia, healthcare providers must adopt a holistic approach to care
planning. This will entail the treatment of both psychological and cognitive changes and the
management of treatment side effects, specifically fall. Increased falls associated with the recent
integration of antidepressants in dementia treatment indicates poor adaptation to change in the
treatment regime.
In that regard, the framework will guide healthcare providers in helping the patient adapt.
Their role will include assessing patient factors that increase the fall risk in dementia patients and
creating an environment that helps them overcome the barriers. The environment will be created
by implementing fall prevention strategies. The framework will also guide healthcare providers
in creating a nursing care environment that enables the implementation of favorable changes to a
patient's adaptation mechanism. This will entail advocating for more studies to identify anti-
dementia treatment therapy that addresses cognitive and psychological changes and is not
associated with the increased risk of falls.
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Outcomes
The project's outcome indicated that although treating dementia patients with anti-
dementia medication and antidepressants resulted in the management of both cognitive changes
and psychological changes, it was associated with a significant rise in fall incidences. This is due
to the increased fall risk associated with antidepressants. On the other hand, treatment with anti-
dementia drugs as a monotherapy resulted in the management of cognitive changes only,
therefore inadequate management of the disease. However, it was associated with a lesser
increase in fall incidences. This indicated that in elderly patients diagnosed with dementia, dual
treatment of anti-dementia and anti-depressant medication have greater incidence of falls versus
anti-dementia medication as monotherapy.
Contribution to Evidence-Based Practice
The project will provide evidence-based data on the efficiency and side effects of the
various dementia treatment approaches. Therefore, it will offer nurses a framework for the safe
DEMENTIA 11
treatment of elderly patients with dementia, thus reducing the risk of falls. This will promote
better treatment outcomes and reduce the risk of side effects.
Recommendations for Practice
The project topic is significant to advanced psychiatric nursing. Identifying a dementia
treatment approach associated with lesser fall risks will directly and indirectly affect nurses. It
will reduce dementia complications thus promoting better care outcome, essential for nursing
motivation and morale. It will also increase the need for healthcare services thus hospital
congestion, which causes nurse burn out and stress, thus affecting their health and ability to
provide quality care. The reduced cost of care associated with reduced falls impacts on
organization’s ability to offer nurse salaries and other benefits.
There is adequate evidence indicating that dual treatment of anti-dementia and anti-
depressant medication has greater incidence of falls versus anti-dementia medication as
monotherapy. There is also adequate evidence indicating that the dual therapy attains better
treatment outcome than monotherapy. However, the fall risk in patients treated with dual therapy
varies depending on specific patient factors. Ethical principles of nursing require them to avoid
intentionally causing harm to patients. It is also illegal for care providers to portray negligence
DEMENTIA 12
regarding not assessing patient risk factors that may increase the risk of falls before
administering the therapy. Therefore, there is a need for a proper protocol to enable care
providers to assess for fall risks before prescribing the dual therapy adequately. However, with
respect to patient diversity, further studies are needed to identify a practical treatment approach
for dementia patients at a high risk of falls. This will ensure that they receive adequate care for
their cognitive and psychological changes without the risk of falls.
DEMENTIA 13
References
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(2020). Contributions of persons living with dementia to scientific research meetings.
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dementia and their caregivers. The American Journal of Geriatric Psychiatry, 28(4), 421-
430.
Jennings, K. M. (2017). The Roy adaptation model: a theoretical framework for nurses providing
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Kormelinck, C. M. G., Van Teunenbroek, C. F., Kollen, B. J., Reitsma, M., Gerritsen, D. L.,
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Lapeyre-Mestre, M. (2016). A review of adverse outcomes associated with psychoactive drug
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Park, H., Satoh, H., Miki, A., Maki, H., Asai, K., Shiraishi, A., ... & Sawada, Y. (2019).
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