Anxiety and Stigma in Dementia: A Threat to Aging in Place

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Key points

  • Behavioral and psychological symptoms (BPSDs), such as anxiety, appear in almost all persons with dementia (PwDs) sometime over the course of the illness.

  • BPSDs are discomforting to the person with dementia; diminish his or her quality of life; and increase the risk for institutionalization, morbidity and mortality, more costly hospitalizations, and greater caregiver distress.

  • Anxiety manifests through fearfulness, worries, restlessness, and irritability, as well as physical symptoms, such as

Dementia-related anxiety

Cognitive deficits have traditionally been the focus of treatment for persons diagnosed with dementia; however, PwD often exhibit behavioral and psychological symptoms (BPSD) that are disruptive to caregivers, and others in the environment.6 Although they may fluctuate, behavioral symptoms appear in almost all PwDs sometime over the course of the dementia, regardless of etiology.7 Anxiety and other BPSDs are important to consider, as they result in personal discomfort, diminished quality of

Case study—part 1

Mrs Bernice Stasi is a 78-year-old widowed white woman who currently lives alone in a 2-bedroom apartment in a small Midwestern college town. Once very active in her church circle and bridge club, and an avid golfer, she seldom leaves her apartment these days, refusing all invitations from friends, family, and organizations she used to belong to because she “doesn’t want people to know she is losing her mind.” Approximately 3 years ago, she was diagnosed with probable mild cognitive impairment

Treatment

Nurses and other health care professionals can play an important role in the treatment of anxiety and stigma, and are often involved in the evaluation of cognitive concerns. Therefore, it is important for them to be familiar with BPSDs54 and to have an understanding of the progression of the disease.55 This may help to guide treatment and to manage BPSDs (including anxiety), which often worsen as the disease progresses.56 Treatment options can include medication, therapy, stress reduction,

Case study: part 2

Dr Townsend contacted the visiting nurse, Ms Carson, who had previously worked with Mrs Stasi and her family during her late husband’s illness. He asked that they work together to address Bernice’s anxiety behaviors that accompanied her early-stage dementia, and the debilitating stigma she was experiencing that contributed to her social isolation, feelings of shame and embarrassment, and that put her at risk for institutionalization. Together Dr Townsend and Ms Carson, in cooperation with Mrs

Special considerations for aging in place: transitional care and “live alones”

PwDs tend to move back and forth between settings (eg, home, hospital, nursing home).76 Transitions between levels of care are an important consideration for nurses in all these settings, as well as ensuring that PwDs have access to high-quality behavioral health services. This is especially critical for PwDs who may be temporarily residing in an institutional setting to ensure that they are able to return to their preferred home and neighborhood. As the process of transitioning across settings

Summary

Both anxiety and dementia-related stigma are common among PwDs, especially in the early stages of the disease. Research by the authors and others has demonstrated a relationship between anxiety and stigma in this population. Nurses can play an important role in the assessment and treatment of these understudied and undertreated conditions in PwDs through psychosocial and pharmacologic interventions, educational programs, and support for health care professionals and caregivers of PwDs. These

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    Funding Sources: National Institute of Nursing Research, National Institutes of Health grant R03 NR010582-02 to Dr S. Burgener, PI.

    R.J. Riley’s dissertation research, University of Iowa, 2012 (3552027), was supported by a grant from the National Institute of Nursing Research, National Institutes of Health, grant R03 NR010582-02.

    Conflict of Interest: None.

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