Cardiovascular Disease in Older Adults with Dementia and Antipsychotic Medication Use

Running head: ASSESSMENT 1
Assessment 1: Physical Health/Pharmacology
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Author Note

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ASSESSMENT 1
Introduction
According to Australian Institute of Health and Welfare (2018), at least 4-million
people were estimated to have experienced mental health complications during 2015. One of
the common medicines used among the people with mental health illness is antipsychotic
medications. The survey conducted by Brett et al. (2017) highlighted that though there is a
decrease in the incidence of the reported cases of the mental health complications during the
tenure of 2007 to 2015, there is an increase in the usage or consumption of the antipsychotic
medications by 2.6%. The high usage of anti-psychotic medication is not only attributed to
the people suffering solely from the mental illness but also attributes to a significant portion
of population who are suffering from long-term chronic diseases (Brett et al., 2017). The
reports published by CDC (2012) highlighted that people who are under anti-psychotic
medication for a prolong period of time are more likely to develop chronic illness or non-
communicable disease. The following paper will focus on the development and prognosis of
cardiovascular disease under the action of antipsychotic medication among older adults
with dementia (Gareri et al., 2014). The primary aim of the paper is to provide a brief
overview of the selected population and the health impacts of cardiovascular disease. The
secondary aim of the paper is to highlight implications to nursing practice. Under this, the
paper will highlight interventions to mitigate the vulnerability of developing this chronic
health condition and barriers in effective implementation of the interventions. At the end, the
paper will discuss the strategies to overcome such barriers.
Overview of population affected by cardio-vascular disease with concurrent
antipsychotic medication use
According to Prince et al. (2013), individuals with serious mental illness experiences
high level of morbidity and mortality arising out of the development of the cardiovascular

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disease. Cardiovascular disease is the leading cause of death among the older adults suffering
from dementia for a prolong period of time. Abdominal obesity, hypertension and lack of
physical activity are the main contributing factors behind the development of the
cardiovascular complications (Prince et al., 2013). The long-term usage of the antipsychotic
medication like the thioridazine and chlorpromazine, the low-potency first generation
antipsychotic medications pose a substantial risk of weight gain. The similar threats are also
impacted by the second generation antipsychotic medications like clozapine and olanzapine
(Maust et al., 2015). Moreover, the older adults who are suffering the dementia for a prolong
period of time mainly leads to sedentary life. The unhealthy life style habits along with the
side-effects of the drugs increases the vulnerability of gaining body weight and thereby
increasing the risk factor of cardiovascular disease. Hypertension is another determining
factor behind the development of the cardiovascular disease among the older adults (Prince et
al., 2013). Neurodegenerative diseases like dementia increase the risk of developing high
blood pressure and this further aggravated by the long-term intake of the antipsychotic
medications. Having high blood pressure and high body weight among the dementia patients
cumulates in the development of the cardiovascular disease (Iadecola, 2014).
Literature Review
According to the research conducted by Damen et al. (2016), cardiovascular disease
(CVD) is one of the leading cause of the increase rate of mortality and morbidity worldwide
and it accounts for nearly one third of all the deaths. Halter et al. (2014) stated that
prevalence of the cardiovascular disease and diabetes mellitus increases with age and is
mainly driven in part by an absolute increase in the rate of incidence among the older adults
who are above 65 years of age. The study also highlighted that older adults are more prone
towards developing type 2 diabetes mellitus (T2DM) and development of the T2DM

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increases the risk of developing cardiovascular complications. Inflammatory stress,
generation of the oxidative stress also plays a significant role behind increasing the
vulnerability of developing cardiovascular disease among the older adults (Halter et al.,
2014). The systematic review and meta-analysis conducted by Vancampfort et al. (2014)
highlighted that older adults, who are suffering from the complex mental health condition like
dementia, schizophrenia and bipolar disorders and more prone in developing T2DM. The
patients who are exposed to antipsychotic medication expect aripriprazole and amisulpride
are more prone in getting affected with the T2DM and this eventually increase the risk of
developing cardiovascular complications. Mota et al. (2015) highlighted that initially
medication of the anti-psychotic medication used to cure dementia among the older adults
increase the level of oxidative stress by increasing the release of the reactive oxygen species
(ROS) from the endoplasmic reticulum. Sarandol et al. (2015) further highlighted that
oxidative stress and antioxidant markers are the main markers behind the mechanism of
action of the first episode of the anti-psychotic medication. The increase in the level of the
oxidative stress and high release of the reactive oxygen species in the blood leads to damage
in the capillary tissues and the arteries. The damage in the arteries and capillaries hamper the
flow of the blood and thereby increasing the chance of developing cardiovascular disease in
the older adults with dementia. Parsons (2017) highlighted a completely different aspect
behind the development of the cardiovascular disease among the older adults with dementia.
The research highlighted that older adults who are suffering from dementia for a prolong
period of time at times become victim of the polypharmacy or over use of the antipsychotic
medication and thereby increasing the vulnerability of developing cardiovascular disease.