Disorders and How it Affects Older Adults

Disorders in Older People Alzheimer's and Eating Disorders and how they affect Older Adults Alzheimer's and Eating Disorders and how they affect Older Adults Disorders in Older People Alzheimer's-Type Dementia Eating Disorders Disorders in Older People In considering the general health of the population, the larger elderly population does not necessarily imply that most of them live or are ill from severe disabilities. Age related disorders would occur to different people early or late in their lives.

People are living longer and healthier, with the elderly population achieving this in the higher age range of 5-10 years population cohort. However, there are key exceptions in the perspective of disorders and mental disorders in the older population. These are indicated by disorders like dementia, Alzheimer's and a wider spectrum of the disease and related disorders. Understanding the problem of mental disorders in older people is currently an area of interest.

In this study, a thorough review of literature is carried out to elicit data on two disorders affecting the elderly population. The interest is on understanding Delirium, Dementia, Amnesic and other Cognition Disorders and eating disorders, categories from the Diagnostic and Statistical Manual of Mental Orders (DSM-IV-TR) in older people. The cognition includes orientation, language, judgment, memory, and performance of actions, problem solving, and conducting of interpersonal relationships (Benjamin & Virginia, 2008).

Cognitive disorders are those that disrupt in one way or another these aspects and are complicated by symptoms in behavior. Delirium, Dementia, Amnesic and other Cognition Disorders, are exemplified by complex interfaces between psychiatry, medicine, and neurology. According to the DSM-IV-TR category, the three groups, dementia, delirium, and amnestic disorders are characterized by symptoms common to all disorders. This is impairment to the cognition, where Delirium is short-term confusion indicated by changes in cognition.

The causes of delirium are general medical conditions like infection, multiple causes like kidney and head trauma, not specified delirium, and substance induced delirium (Benjamin & Virginia, 2008). Dementia is indicated by severe impairment in judgment, memory, cognition, and orientation. There are six categories of dementia including Alzheimer's type dementia, occurring mainly in persons over 65 years and indicated by delusions, dementia, disorientation, and depression.

This also includes vascular dementia by thrombosis or hemorrhage in vessels, medical conditions like head trauma, pick's disease, substance induced, multiple etiologies, and otherwise specified (Benjamin & Virginia, 2008). Amnestic disorder is indicated by forgetfulness and memory impairment, caused by medical condition or hypoxia, medication or toxin induced. Of interest is the presentation of Dementia in the elderly population, especially the Alzheimer type dementia.

This is because Dementia is indicated by symptoms common to other disorders in the DSM-IV-TR category, indicated by impaired judgment, memory, cognition, and speech orientation as seen in the review of literature. While many studies investigate cognitive disorders in the elderly population, few studies investigate the trend of eating disorders in this population. This is because eating disorders are considered disorders among adolescents and middle age people. Eating disorders are investigated in this research for they are on the rise among the elderly population (Business Wire, 2013).

Eating disorders are indicated by two conditions, Bulimia Nervosa and Anorexia Nervosa, which are both characterized by an emphasis of body image. The review of literature indicates that eating disorders in the elderly develops have symptoms similar to those in younger sufferers, with a greater emphasis on body image. This research investigates eating disorders as a mental disorder affecting the elderly from issues like difficulty eating, dementia or forgetting to eat, cancer or illness related inability to cook and shop, poverty, elderly abuse and isolation.

Review of Literature Alzheimer's-Type Dementia More than 70 diseases and conditions can cause Dementia. Though rare, temporal dementia can be caused by substance abuse, urinary tract infection, or vitamin deficiency. Alzheimer's disease is the most common type of dementia, present in 70% cases of dementia (Sullivan & Sullivan, 2010).

Fraller (2013) states that it is more than 100 years since Alois Alzheimer published the case study of his patient, Auguste, a woman 51-year-old who displayed symptoms of "irrationality, memory loss, disorientation to time and place, paranoia, hallucinations, and difficulties with language and cognition." These symptoms all progressed to incontinence, being bedridden and nonverbal. Following the patient's death an autopsy showed " Atrophy, tangled bundles of neurofibrils and accumulations of an unknown substance in a miliary pattern" (Fraller, 2013, p.63).

The combination of "memory loss, loss of executive function, behavioral symptoms, and patterns of histopathological lesions" is what has been called Alzheimer Disease (AD). (Strassnig & Ganguli, 2005). There are three stages of Alzheimer's including moderate, mild, or early stage, and late or severe stage. The advancement of the disease from one stage to another is indicated by a progression and seriousness of symptoms. Studies identify that Alzheimer's is not a normal aging disease, often afflicting elderly persons 65 years and older.

According to Fairfield and Mammarella (2009), the results of individual longevity and population growth indicate that there are many elderly persons with Alzheimer's accelerator gene, proposed by Roses Allen. The study finds that persons will Alzheimer's type dementia indicate source-monitoring deficits. According to the source-monitoring deficit theory, people use two classes of information in discriminating memory origins. These include qualitative characteristics like contextual detail with associated cognitive operations, and conceptual type of information like general knowledge.

Persons with Alzheimer's disease have diminished capacity in using either category of information to discriminate memory. To prove the deficit of this theory in elderly Alzheimer's patients, the research examined cognitive operations between internally and externally generated events in pathological and healthy aging persons. Fairfield and Mammarella (2009) results indicate the older adults have difficulty that younger adults in discriminating between memories in performed and imagined performing. The study also found that elderly patients with Alzheimer's type dementia had marked difficulties in attributing the sources of imagined actions.

Carreiras, Baquero, and Rodriguez (2008) investigated syllable congruency frequency effect and syllable congruency effect in Alzheimer patients, young adults, and elderly persons presented similar results to Fairfield and Mammarella (2009). The results of the study indicate that syllable congruency effects existed, but were different in the three test groups (Carreiras, Baquero, & Rodriguez, 2008). The syllable congruency response in young adults is higher than in elderly and Alzheimer patients.

Young adults responded more slowly to high frequency syllables and highly to low frequency syllables, while the elderly and Alzheimer patients responded slowly to low frequency syllables and highly to high frequency syllables. This is an indication of cognition impairment that affects speech orientation. The findings of this research are in agreement with the report by Nursing Home & Elder Business Week (2012) which identifies that Alzheimer's disease is defined by memory problems.

The study's intention was to produce results that could create insight into the development of intervention measures for prevention and causes of symptoms of Alzheimer's disease. The research studies 658 adults of age 65 and above, free from dementia. The study group was given MRI scans, tests to measure language, memory, speed of processing information and visual perception (Nursing Home & Elder Business Week, 2012). By the end of the study, 174 had silent strokes. The result indicated that people with silent strokes scored slightly lower in memory tests than those without silent strokes.

The results were also indicated in persons with small hippocampus, the memory center of the brain. The study linked the fact that Alzheimer's is associated with memory problems and linked this with the noted memory problems in persons with silent strokes and small hippocampus. The location of the cause to impaired cognitive and memory loss is associated with the brain function. This review further finds Alzheimer's because of the impairment in the brain from the study by Strassnig & Ganguli, 2005 cited in: Fraller (2013).

In (Strassnig & Ganguli, 2005 cited in: Fraller, 2013, p.63) The Fraller (2013) reports that the Alzheimer's Disease Neuroimaging Initiative (ADNI) is an "…ongoing longitudinal international research collaboration funded by the National Institute of Aging (NIA), multiple pharmaceutical companies and private donations via the Foundation for the National Institutes of Health (NIH)" (p.64). This project resulted in the development of "new biomarkers and brain imaging techniques" which enable the ability to see AD pathology in a patient while they are still alive.

These techniques in combination with patient history and cognitive testing are such that may well serve to bring about improvement in "certainty of the diagnosis of AD and enable diagnosis of AD earlier in the disease process." (Fraller, 2013, p.64) There would be many benefits. Over the past five years research has indicated that there may be benefits on patient's cognition who have AD using vitamins E, B12, B6, folic acid; omega 3 in fish oil; and ibuprofen. These studies indicate the role of assessment and management of Alzheimer's disease.

In Fraller (2013), management entails the use of using vitamins E, B12, B6, folic acid; omega 3 in fish oil; and ibuprofen (p.64). This also involves the improvement of Alzheimer patient's speech using light and physical therapy. 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. This leads to starvation of the brain, and associated dementia. Clinical studies indicate that dementia in the elderly is closely associated with anorexia, making the two conditions self-perpetuating Patrick and Stahl (2009).

Moreover, if an elderly persons is suffering from memory loss due to dementia, they may forget to eat or if they have eaten leading to eating disorders. Discussion and Conclusion Interestingly, the review of literature identifies a significant factor in disorders that affect the elderly, which was not considered at the beginning of the research. The research finds from an analysis of studies by Pruis and Janowsky (2010) and Patrick and Stahl (2009) that dementia and eating disorders in the elderly are self-perpetuating.

The evidence from studies by Sullivan & Sullivan (2010), Fraller (2013), and Fairfield and Mammarella (2009) that Alzheimer sufferers indicate memory loss, low language and speech orientation, and diminished cognitive ability. This implies that persons suffering from Dementia, or Alzheimer's type can easily suffer from eating disorders to the associated symptom of lack of memory. On the other hand, since the elderly population is experiencing late life stresses from physical and psychological factors, which cause eating disorders and consequently dementia.

The implication of Pruis and Janowsky (2010) and Patrick and Stahl (2009), findings is that factors like loss of loved ones, medication that loses an individual's appetite, medical assistance can cause eating disorder. The most common disorder among the elderly is the refusal to eat, which leads to the denial of food to the brain. A starving brain easily slips into dementia, thereby leading to the conclusion that dementia and eating disorders in the elderly are self-perpetuating.

A second important discovery in the review of literature is the indication of depression in Alzheimer Dementia as reported by Dierckx et al. (2011). This is an important aspect for it shows that in early detection of Alzheimer's forgetfulness and delayed recognition are also markers of depression. Moreover,.