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Behavioral and psychological symptoms (BPSDs), such as anxiety, appear in almost all persons with dementia (PwDs) sometime over the course of the illness.
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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.
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Anxiety manifests through fearfulness, worries, restlessness, and irritability, as well as physical symptoms, such as
Anxiety and Stigma in Dementia: A Threat to Aging in Place
Section snippets
Key points
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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Rationale and study design for decision making & implementation of aging-in-place/long term care plans among older adults
2021, Contemporary Clinical Trials CommunicationsCitation Excerpt :Older adults who remain in their own homes often report greater satisfaction and less depression, and maintain their physical function better than those residing in assisted living or nursing home settings [4]. Over time older adults face increasing frailty and disability, requiring additional support to remain in their homes or placement in long term care facilities [5–7]. The lifetime probability of becoming disabled in at least two activities of daily living or being cognitively impaired is 68% for people age 65 and older yet individuals underestimate the likelihood that they will need assistance in the future [8,9].
Modifiable factors associated with anxiety in persons with dementia: An integrative review
2020, Geriatric NursingCitation Excerpt :Anxiety is an emotional status characterized by apprehension and somatic symptoms of tension.8 Symptoms of anxiety commonly include worried thoughts, restlessness, fast breathing, increased heart rate, and muscle tension.8, 9 However, detecting anxiety in PWD is more difficult than in persons without dementia.3,10
Dementia literacy and worry among older Chinese Americans in Arizona: A comparison between 2013 and 2017
2023, International PsychogeriatricsFactors Associated With Psychological Wellbeing in Home Care Older Adults With Alzheimer’s Disease: A Longitudinal Analysis
2024, Journal of Applied GerontologyRisks and Benefits of Clinical Diagnosis Around the Time of Dementia Onset
2023, Gerontology and Geriatric MedicineThe Social Construction of Dementia: Implications for Healthcare Experiences of Caregivers and People Living with Dementia
2023, Journal of Patient Experience
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.