Term Paper: Disorders in Older People Alzheimer

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[. . .] In the management of Alzheimer's disease, the approved treatment includes Donepezil, rivastigmine, galantamine and tacrine in mild-to-moderate cognitive impairment in patients with AD. Donepezil has also been FDA approved for use in moderate-to-sever AD.

Apart from management, ongoing assessment is required for patients with Alzheimer's. According to Uriri-Glover, McCarthy and Cessaroti (2013), this entails the use of the standardized rating scale such as the Functional Assessment Staging Test (FAST) and the Global Deterioration Scale, or the Clinician's Interview-Based Impression are tests used in making a determination of the functional decline of the individual with AD and other forms of dementia. This research indicates that treatment is also done with Gingko and ginseng, the most commonly used herbs used for memory enhancement and in preventing cognitive decline.

In assessment of Alzheimer's disease, Dierckx et al. (2011) identifies that early identification is very importance. The study shows that early assessments are successful with episodic memory tasks, which have predictive power of early AD. The assessment measures deficits in encoding and storage processes of the patient, characteristic of Alzheimer's disease. The study identifies that the results can present challenges in diagnosis since they can also indicate other memory affects like depression. Studies indicate that depression is associated with many late life developments and disorders (Dierckx et al., 2011). The study sought to different Alzheimer's disease and depression, using a ten-1ord list-learning task to evaluate rate of forgetting and delayed recognition associated with loss of memory and low cognitive ability in mild Alzheimer-type dementia and depression. The results of the study indicate that in both mild Alzheimer-type dementia and depression, there was receiver operating characteristics of delayed recognition and forgetting. This indicated that in diagnosis, forgetting has the highest accuracy in mild AD and depression can be used in early detection (Dierckx et al., 2011). There seems to be a close link between depression and elderly disorders, as many studies indicate depression as a symptom of disorders like Alzheimer dementia and eating disorder.

The work of Abbilello and Rosenfeld (2013), reports on cognitive impairment in community and home settings. The research states that delirium which is a "temporary state of cognitive impairment and has been associated with increased morbidity and mortality in both the palliative care and geriatric population" (Abbilello and Rosenfeld, 2013, p.104). In fact, delirium is cited as adding to the lengths of stays in the hospital, to exacerbate medical conditions, and to increase poor outcomes in patients, further burdening both caregivers and the healthcare system. Additionally reported is a small study that had the objective of establishing if the question "Do you think [person] has been more confused lately? -- could be used to assess delirium" (Abbilello and Rosenfeld, 2013, p.29). The study findings report, "Cognitive impairment without dementia impacts an extremely large number of individuals although the study is reportedly inconclusive and more research is needed.

Eating Disorders

Eating disorders are identified as an emerging disorder among the elderly population, which until recently has not been studies in depth. According to Patrick and Stahl (2009), most studies focus eating disorders on late adolescence and emerging adulthood. These are seen in the studies of Pearson, et al. (2013) of brief eating disorder risk measures called the College Disorders Screen in a sample of 246 adolescents who completed a questionnaire. The study reported in the work of Stice, et al. (2013) reports a study that tested if undergraduate peer leaders are capable of delivering a dissonance-based eating disorder prevention program. In the first study, female graduates were randomized to peer- or physician-led groups or an educational brochure control. The study by Pearson, et al. (2013) indicates that there is a greater prepost reductions in risk factors and eating disorder symptoms than control, respectively with clinician vs. peer-led groups having higher attendance and competence rating and stronger effects at posttest and 1-year follow-up.

However, few studies thoroughly investigate eating disorders among people in midlife and late life. The lack of extensive research in the field implies little is known on the interaction between age and predictors in maintenance, development, and treatment of eating disorders among elderly people. Patrick and Stahl (2009), indicate that the lack of adequate research in the area and the rareness of the disorder, do not indicate the disorder does not occur in late life. The study carried out an online survey of 125 people, representing 43 late adolescents, 26 emerging adults, 27 midlife adults, and 29 late life adults, all between the ages of 18 and 88. The results indicate that the age differences did not merge in eating-related cognition disorder. The mean levels for all age groups were relatively low, indicating less healthy or more disordered eating cognition across the age and gender groups. Using path analysis Patrick and Stahl (2009) identify that there was dissatisfaction with appearance and eating-related cognition. The analysis also found that BMI and age showed direct links with eating disorder. The results are important for this result for they show that models used in eating cognitive disorders can apply to all ages from adolescents, emerging adulthood, middle life, and late life.

The most common indicator of eating disorder among the old as well as the young is obsession with body image. According to Pruis and Janowsky (2010), body image among young women was compared to that in older women using questionnaires. The study indicates that the most common response was thinner and fatter images in describing bodies. The study indicates that some facets of body image is influenced by age, with ratings of body image not differing among young, healthy, normal, or older women. This study implies that even in older women, eating disorders occur and can be associated with symptoms like fear of gaining weight, especially that caused by some medications and fear the physical challenges of deformities. Older persons also experience eating disorders triggered by late life stressors like the death of a spouse, and use laxatives, diuretics, dietary supplements, exercise, dieting, and smoking like the young to look as young as possible.

Peat, Peyerl, and Muehlenkamp (2008) also indicate that body image as a key part in the development of an individual's self-concept, and are linked to psychopathological body dissatisfactions, often indicated by eating disorders. The study investigates this psychopathological disorder among the elderly since many studies have focused on adolescents and college-aged individuals. The study finds that elderly persons, especially women experience eating disorders associated with dissatisfaction with body image. The study reviewed literature and found that "older women aged 60-70 years found that 3.8% of the sample met criteria for an eating disorder, and 4.4% reported a single symptom of eating disorders (e.g., bingeing, using laxatives or diuretics, vomiting" Mangweth-Matzek et al., (2006) cited in Peat, Peyerl, and Muehlenkamp (2008). This indicates like other disorders eating disorders among the elderly population warrants intervention. The challenge is the misdiagnosis and un-treatment of the disorder. This is due to the lack of knowledge of the existence of the disorder in elderly population from late-onset eating disorders. These are associated to behavior to early and consistent recurring patterns of eating disorder in earlier diagnosis, succumb to social pressure to remain thin and young, and poor coping associated to loss of loved ones.

A further review of literature indicates that eating disorders affect elderly persons in similar manner as they do younger people. According to Peat, Peyerl, and Muehlenkamp (2008), bulimia nervosa and anorexia nervosa are reported in later life, as the older also suffer from clinical features, close relationship with oilier psychiatric conditions like obsessive-compulsive disorder and depression, and maladaptive psychological functioning. The etiology in elderly person's eating disorder is indicated to be multifactorial as they are exposed to vulnerability factors and precipitating factors. The most common eating disorder among the elderly especially those in hospital and community settings is food refusal. This often leads to malnutrition and loss of weight, with adverse consequences on functioning and independence. The management of eating disorders among the elderly is therapeutic as well as diagnostic challenge, which calls for clinicians to have combined skills of nursing and medical staff. The causes of eating disorders in the elderly are multifactorial and need repeated and careful assessment of the patient's psychological, social, and medical history. Therapeutic treatment requires the adoption of ethical and cultural considerations as elderly persons often feel loss of loved ones, close relationships, and social circle.

The review of literature indicates that eating disorders in the elderly especially those above the age of 60, mostly have bulimia. Elderly persons with eating disorders are more likely to abuse laxatives that purge as the young people do (Pruis and Janowsky, 2010). However, the elderly experience eating disorder from physical and psychological issues that affect them. These are like the increased dependence of medication and medical treatments that makes it difficult to consumer or digest food (Pruis and Janowsky, 2010). The elderly experience eating disorders from physical difficulties like poor digestion, bowel issues, problems in chewing and swallowing, and medication, which leads to appetite loss.… [END OF PREVIEW]

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