The problem of dementia remains relevant in modern times, and the issue is especially acute in nursing homes. This topic was placed in a separate section of the Healthy People 2020 program, along with Alzheimer’s disease (Healthy People, 2020). The incidence is widespread worldwide: more than 55 million people are in low-income countries (World Health Organization, 2022). With a prevalence of 10 million new cases per year, dementia is the seventh leading cause of death in the elderly (World Health Organization, 2022). In the age group over 65, the number of patients doubles every five years. The global prevalence of dementia in the world among the general population is 0.5%, and among those aged 65 years and older – 5-8%. In general, as a rule, women earn these diseases more often than men (World Health Organization, 2022). Accordingly, the main factor of epidemiology is the age of a person. Finally, the treatment of dementia leads to severe costs in the field of medicine; according to the World Health Organization, for 2019, it is more than 1 trillion dollars (2022). These costs are among the main ones in nursing homes and hospices and could triple in a decade.
In this regard, this paper proposes to consider aspects of non-drug and pharmacological treatment of dementia in nursing homes. Since this disease significantly impacts social and economic structures at the national level, this issue needs to be addressed with the help of federal authorities. From a social perspective, people with dementia are often denied certain services, and their rights are violated. In economic terms, there is a need for ever-increasing financial support for the relevant institutions to care for the elderly. Accordingly, the following organizations should monitor this issue to improve the non-drug and pharmacological treatment of dementia in nursing homes. First, it can help to attract personnel and specialists from the largest healthcare organizations, such as HCA and CommonSpirit. Their interest may lie in the scientific study of dementia to improve the quality of care. Second, the Public Health Service, with the Mental Health Services Administration, can provide data and experience and raise funding from relevant sources, covering the quantitative aspect of the issue. Finally, this policy can be brought to the attention of the US Department of Health and Human Services, which will regulate not only the funding of specific institutions but also the legislative framework for the care, maintenance, and development of the fight against dementia. The disappointing spending projections by 2030 may likely convince policymakers to take the issue to the highest level.
First of all, the policy will be aimed at achieving the goal of reducing the incidence of dementia. This work will be divided into two areas: first, it is to improve the quality and accessibility of care for those who are already ill; secondly, it is the prevention of morbidity through extraordinary measures to attract the elderly to public life and health education. The policy should regulate the financial and resource capacity, importance, and control of implementation by the relevant institutions. Attracting pharmacological companies as sponsors will solve the problem of an economic and resource nature. Practice will show the direct impact of interventions and health education practices that protect older adults from alcohol, tobacco, excess weight, cholesterol, and blood sugar. Involvement in public affairs should be accompanied by moderate physical activity and, if possible, the observance of an appropriate diet while providing food for the elderly population. Drug treatment should be carried out under the supervision of relevant specialists and with a total fixation on the values of health indicators for a certain period. Finally, the results will show the specific features of known correlations and help to identify new ones concerning other demographic indicators and medical experience. As a result, clinical practice will receive practical outcomes interpreted in the scientific community and used directly by caregivers in nursing homes and other institutions fighting this disease. In fact, this policy implies a range of activities aimed at one result that can only be achieved with such a comprehensive approach: reducing the prevalence and incidence of dementia and selecting the best treatment practices with and without medication.
This policy is supported by current research. First, these interventions, including physical activity, diet, cognitive exercises, and monitoring key health indicators, can reduce by more than 50% (Livingston et al., 2020; Zucchella et al., 2018). In addition, other factors that influence the disease’s development should be considered: depression, mental disorders, and even dirty air (Hachinski et al., 2019). Secondly, drug treatment is offered at the moment when dementia is diagnosed, and it is no longer possible to solve the problem exclusively in a non-pharmacological way. Consequently, acetylcholinesterase inhibitors and NMDA-glutamate receptor antagonists are used in this case (McDermott & Gruenewald, 2019). In the case of working with the elderly, the supervision of specialists is mandatory since these drugs have relatively strong side effects, as well as due to the consequences of the pandemic (Simonetti et al., 2020). Finally, the literature review fully supports this policy from the point of view of science, and questions of an organizational and economic nature must now be resolved.
References
Hachinski, V., Einhäupl, K., Ganten, D., Alladi, S., Brayne, C., Stephan, B. C. & Khachaturian, Z. S. (2019). Preventing dementia by preventing stroke: the Berlin Manifesto. Alzheimer’s & Dementia, 15(7), 961-984. Web.
Healthy People. (2020). Dementias, Including Alzheimer’s Disease. Web.
Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S. & Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 396(10248), 413-446. Web.
McDermott, C. L., & Gruenewald, D. A. (2019). Pharmacologic management of agitation in patients with dementia. Current Geriatrics Reports, 8(1), 1-11. Web.
Simonetti, A., Pais, C., Jones, M., Cipriani, M. C., Janiri, D., Monti, L. & Sani, G. (2020). Neuropsychiatric symptoms in elderly with dementia during COVID-19 pandemic: definition, treatment, and future directions. Frontiers in Psychiatry, 11, 579842. Web.
World Health Organization. (2022). Dementia. Web.
Zucchella, C., Sinforiani, E., Tamburin, S., Federico, A., Mantovani, E., Bernini, S. & Bartolo, M. (2018). The multidisciplinary approach to Alzheimer’s disease and dementia. A narrative review of non-pharmacological treatment. Frontiers in Neurology, 9, 1058. Web.