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

Foley, P. (2020). Psychopharmacology: a brief overview of its

history. NeuroPsychopharmacotherapy, 1-41.

Frank, L., Shubeck, E., Schicker, M., Webb, T., Maslow, K., Gitlin, L., ... & Nicholson, B.

(2020). Contributions of persons living with dementia to scientific research meetings.

results from the national research summit on care, services, and supports for persons with

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

care to individuals with anorexia nervosa. ANS. Advances in nursing science, 40(4), 370.

Kormelinck, C. M. G., Van Teunenbroek, C. F., Kollen, B. J., Reitsma, M., Gerritsen, D. L.,

Smalbrugge, M., & Zuidema, S. U. (2019). Reducing inappropriate psychotropic drug use

in nursing home residents with dementia: protocol for participatory action research in a

stepped-wedge cluster randomized trial. BMC psychiatry, 19(1), 298.

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Lapeyre-Mestre, M. (2016). A review of adverse outcomes associated with psychoactive drug

use in nursing home residents with dementia. Drugs & aging, 33(12), 865-888.

O’Brien, J. T., Holmes, C., Jones, M., Jones, R., Livingston, G., McKeith, I., ... & Sampson, E.

L. (2017). Clinical practice with anti-dementia drugs: a revised (third) consensus

statement from the British Association for Psychopharmacology. Journal of

Psychopharmacology, 31(2), 147-168.

Park, H., Satoh, H., Miki, A., Maki, H., Asai, K., Shiraishi, A., ... & Sawada, Y. (2019).

Medications and fall risk: a case–control study in nursing home residents in Japan. Aging

clinical and experimental research, 1-8.

Tisher, A., & Salardini, A. (2019, April). A comprehensive update on treatment of dementia.

In Seminars in neurology (Vol. 39, No. 02, pp. 167-178). Thieme Medical Publishers.

Walsh, E. (2020). Cognitive transformation, dementia, and the moral weight of advance

directives. The American Journal of Bioethics, 20(8), 54-64.

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