Essay on Dementia and Physical Co-morbidities, HNB3224

This essay delves into the significant issue of physical co-morbidities in patients with dementia. It begins by defining dementia and its impact, followed by an analysis of common physical co-morbidities like diabetes, COPD, and cardiovascular issues. The essay highlights the roles of healthcare access, family support, and antipsychotic medications in the development of these co-morbidities. It then explores best practices, including early diagnosis, diet management, and non-pharmacological interventions, while emphasizing the role of mental health nurses in managing these conditions. The essay also addresses barriers to accessing interventions, such as healthcare access in rural areas and the perceptions of family carers, concluding with the importance of early detection and comprehensive care to improve the quality of life for individuals with dementia.

Running head: DEMENTIA AND PHYSICAL CO-MORBIDITIES
Dementia and Physical Co-morbidities
Name of the Student
Name of University
Author’s note

1
DEMENTIA AND PHYSICAL CO-MORBIDITIES
Introduction
Dementia is a debilitating condition that is characterized by loss of intellectual and
cognitive functioning of the body that slowly interferes with the occupational and social
performance. It is a global concern and at present nearly 36 million people is suffering from
dementia (Fox et al., 2014). The physical co-morbidities are defined as conditions or diseases
that co-exist with other disease. Till now, the physical health needs associated with the people
suffering from dementia is not explored properly (Jørgensen et al., 2018). The physical health
needs can be explored only when the physical co-morbidities associated with dementia is
identified distinctively. The following essay aims to analyse the physical co-morbidities
associated with the mental health complication, dementia. The essay will initiate by throwing
light over the common physical comorbidities associated with dementia. The essay will highlight
the role of the proper healthcare access and family members behind the development of the
physical comorbidities among the dementia care patients. The essay will also focus on the role of
antipsychotic medications used in dementia in development of the physical comorbidities. At the
end the essay will highlight the role of the mental health nurses in managing the conditions and
barriers to access those interventions
Dementia and physical co-morbidities
Dementia is common among the older adults who are frequently presented with several
other medical complications known as co-morbidities. The common co-morbidities associated
with the development of dementia in 61% of the cases include diabetes, chronic obstructive
pulmonary disease (COPD), musculoskeletal disorder and heat failure (Jørgensen et al., 2018).
Clagueet al. (2016)are of the opinion that musculoskeletal complications, genitourinary disorder,

2
DEMENTIA AND PHYSICAL CO-MORBIDITIES
nose, ear and throat disorders are frequently reported comorbidities among dementia patient and
it affects nearly 50% of the people suffering from dementia. Pricket al. (2016) argued that
physical comorbidities are treatable and few of the co-morbidities are reversible. Delirium, oral
disease, epilepsy, malnutrition, incontinence, visual dysfunction, frailty and sleep disorders are
found to occur more among the dementia patient and if left untreated can lead to the
development of more severe health care complications like increase in the level of pain and
distress and thereby hampering the overall quality of life. As the severity of dementia increases,
the number of physical co-morbidities also increases and thus worsening the symptoms of
dementia further like complication in the genitourinary tract, development of pneumonia,
congestive heart failure increases the fatal risk in dementia (Pricket al., (2016). Jørgensen et al.
(2018) reported that duodenal ulcer is also an important physical co-morbidity associated with
dementia patients. The study conducted by Bunn et al. (2014) highlighted that presence of certain
physical co-morbid condition like type 2 dementia exacerbate the progression of dementia like
increasing the rate of cognitive decline.
There are certain physical comorbidities that are associated with the people suffering
from dementia in comparison to the older adults who are not suffering from dementia. First
physical co-morbidity include epileptic seizures that is defined as unprovoked yet brief san of
disturbance in conscious state of mind hampering the motor function fractionally. Delirium is
another unique physical co-morbidity among older adults with dementia it is defined as a
condition of confused state of mind (NSW Government, 2018). The body balance of the people
also gets hampered among the dementia patient due to neuro-degenration in the parasympathetic
nervous system. The difficulty in maintaining body balance and visual disturbance increase the
risk factor of physical co-morbidties like musculo-skeletal disorders arising from the accidental

3
DEMENTIA AND PHYSICAL CO-MORBIDITIES
fall (NSW Government, 2018). Thus the clinical practice guidelines for the dementia
management include effective management of the accidental fall by taking help from the
occupational therapists (Dementia Australia, 2019).
Treatment for dementia: Antipsychotic medications
Morrison, Meehan and Stomski (2015) stated that pharmacological management of
dementia includes the use of the mood stabilizers or the other medications to reduce the neuro-
degeneration at an exponential rate. Common medication used for the treatment of dementia
include: cholinesterase inhibitors and memantine (Namenda). However, usage of antipsychotic
medication for a prolong period of time lead to the generation of cardiovascular syndromes like
chest-pain along with an increased tendency of developing type 2 diabetes mellitus. Correll et al.
(2015) medication like donepezil, rivastigmine and galantamine (Razadyne) are use for dementia
management. These medications work by boosting levels chemical messenger involved in
memory and cognition. However, use of this medications increase the risk of developing obesity,
diabetes mellitus, hematological complications, dyslipidemia, thyroid, cardiovascular disease,
respiratory tract infection and other gastro-intestinal, musculoskeletal and renal diseases.
Jørgensen et al. (2018) stated that people who lead unhealthy lifestyles during their young adult
stage are more likely to development more severe physical comorbidities during their older adult
stage when they are suffering from dementia.
Role of the mental health nurse
As per the NICE guidelines in the UK for the treatment of dementia, proper promotion
and maintenance of independence and increase observance of healthy lifestyle habits is the

4
DEMENTIA AND PHYSICAL CO-MORBIDITIES
principal measures for recovery for the patients with dementia and associated physical co-
morbidities.
Early diagnosis of the physical co-morbidities
Sepulveda et al. (2017) stated that cardiovascular complication, pulmonary problems and
urinary incontinence is preventable in two third of the cases following early diagnosis. Thus it
would be the duty of the mental health nursing professional to promote early diagnosis of the
physical symptoms among the dementia patient. Early diagnosis helps in reducing the chances of
hospitalization and thereby helping to reduce the cost of care and increase in the overall health
and well-being (Fox et al., 2014). A detailed physical assessment like central nervous system,
cardiovascular system, renal system and gastro-intestinal system will help in highlighting the
vulnerability of developing physical co morbidities.
Diet management
According to the Clinical Practice Guidelines for dementia management, diet plays an
important role in reducing the physical co-morbidities associated with dementia. Like proper diet
adherence helps to reduce the chances of developing cardio-vascular disease and diabetes in
dementia patients. Thus it s the duty of the nursing professionals to take help of professional
dietician in order to make proper patient-centred diet plan for the dementia affected older adults
(Dementia Australia, 2019).
Applying non-pharmacological interventions
Reducing the use of the anti-psychotic medication can help to reduce the chances of
developing physical co-morbidites among the older adults with dementia. It would be the duty of
the nursing professionals to make use of the mindfulness-based therapy and music therapy for

5
DEMENTIA AND PHYSICAL CO-MORBIDITIES
the effective management of the mood of the dementia patients and thus improving the condition
of mental health and reducing the harmful effect of antipsychotic medication (Dementia
Australia, 2019).
Barriers to access health interventions
Lack of healthcare access in rural areas
Fox et al. (2014) are of the opinion that diagnosis and effective management of the
physical co-morbidities associated with dementia is poor. The reason behind this is, dementia
dominates several clinical encounters and distract the attention far away from the physical co-
morbidities and thus leading to increase in the rate of mortality and morbidity. Nearly in 18% of
the cases with dementia, there occurs unplanned admission to the acute emergency ward and this
adds to 1.66% of the unadjusted risk of mortality. Stephan et al. (2018) are of the opinion that the
people who are residing in the rural areas and are suffering from dementia have poor access to
health care social care services. For example, Aboriginals and Torres Strait Islanders in Australia
residing in rural areas have limited access to healthcare such that they are not get access to the
nursing support for the effective management of their mental health condition and the associated
physical co-morbidties.
Poor perception of the family of carers
Ball et al. (2015) highlighted in their study that the perception of the family of carers for
the patients who are suffering from dementia are poor. Under these circumstances, the physical
co-morbidities remain unnoticed during the initial stage of the disease. This lack of reporting
hampers the comprehensive access to the nursing interventions. The co-occurrence of one
physical co-morbidities with dementia increases the chance of developing other physical

6
DEMENTIA AND PHYSICAL CO-MORBIDITIES
complications. The family carers are uninformed in the domain of nutritional-related care plan
that must be given to the older adults suffering from dementia. This lack of health-literacy
among the care givers of the patients suffering from dementia increase lack of adherence of the
dietary regime proposed by the nursing professionals for the management of the physical co-
morbidities associated with dementia (Charlesworth et al., 2016).
Conclusion
Thus from the above discussion, it can be concluded that common physical comorbidities
detected among the dementia patients include type-2 diabetes, cardiovascular complications,
COPD, urine incontinence, epilepsy, delirium, vision problem, difficulty in maintain body
balance and gastro-intestinal problems. However, most of the condition can be managed if
detected early and proper interventions are being implemented. The increase in the use of the
antipsychotic medications also increases the vulnerability of developing physical comorbidities
like cardiovascular disease. The lack of health literacy among the family members and poor
healthcare access among the indigenous population residing in the rural areas also increase the
creates a barriers in comprehensive access of the nursing interventions

7
DEMENTIA AND PHYSICAL CO-MORBIDITIES
References
Ball, L., Jansen, S., Desbrow, B., Morgan, K., Moyle, W., & Hughes, R. (2015). Experiences and
nutrition support strategies in dementia care: Lessons from family carers. Nutrition &
Dietetics, 72(1), 22-29.
Bunn, F., Burn, A. M., Goodman, C., Rait, G., Norton, S., Robinson, L., ...&Brayne, C. (2014).
Comorbidity and dementia: a scoping review of the literature. BMC medicine, 12(1), 192.
Charlesworth, G., Burnell, K., Crellin, N., Hoare, Z., Hoe, J., Knapp, M., ...&Orrell, M. (2016).
Peer support and reminiscence therapy for people with dementia and their family carers:
a factorial pragmatic randomised trial. J NeurolNeurosurg Psychiatry, 87(11), 1218-
1228.
Clague, F., Mercer, S. W., McLean, G., Reynish, E., & Guthrie, B. (2016). Comorbidity and
polypharmacy in people with dementia: insights from a large, population-based cross-
sectional analysis of primary care data. Age and ageing, 46(1), 33-39.
Correll, C. U., Detraux, J., De Lepeleire, J., & De Hert, M. (2015).Effects of antipsychotics,
antidepressants and mood stabilizers on risk for physical diseases in people with
schizophrenia, depression and bipolar disorder. World psychiatry, 14(2), 119-136.
Dementia Australia. (2019). Clinical practice guidelines for people with dementia. Access date:
11th September 2019. Retrieved from: https://cdpc.sydney.edu.au/research/clinical-
guidelines-for-dementia/

8
DEMENTIA AND PHYSICAL CO-MORBIDITIES
Fox, C., Smith, T., Maidment, I., Hebding, J., Madzima, T., Cheater, F., ...& Young, J. (2014).
The importance of detecting and managing comorbidities in people with dementia?. Age
and ageing, 43(6), 741-743.
Jørgensen, L. B., Thorleifsson, B. M., Selbæk, G., Benth, J. Š.,&Helvik, A. S. (2018). Physical
diagnoses in nursing home residents-is dementia or severity of dementia of
importance?. BMC geriatrics, 18(1), 254.
Morrison, P., Meehan, T., &Stomski, N. J. (2015). Living with antipsychotic medication side‐
effects: The experience of Australian mental health consumers. International Journal of
Mental Health Nursing, 24(3), 253-261.
NSW Government. (2018). The Physical Comorbidities of Dementia. Access date: 15th August
2019. Retrieved from:
https://sydneynorthhealthnetwork.org.au/wp-content/uploads/2018/04/39282-Dementia-
Book_A5.pdf
Prick, A. E., de Lange, J., Scherder, E., Twisk, J., & Pot, A. M. (2016). The effects of a
multicomponent dyadic intervention on the mood, behavior, and physical health of
people with dementia: a randomized controlled trial. Clinical interventions in aging, 11,
383.
Sepulveda, E., Leonard, M., Franco, J. G., Adamis, D., McCarthy, G., Dunne, C., ...& Meagher,
D. J. (2017). Subsyndromal delirium compared with delirium, dementia, and subjects
without delirium or dementia in elderly general hospital admissions and nursing home
residents. Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring, 7, 1-
10.

9
DEMENTIA AND PHYSICAL CO-MORBIDITIES
Stephan, A., Bieber, A., Hopper, L., Joyce, R., Irving, K., Zanetti, O., ...& Wolfs, C. (2018).
Barriers and facilitators to the access to and use of formal dementia care: findings of a
focus group study with people with dementia, informal carers and health and social care
professionals in eight European countries. BMC geriatrics, 18(1), 131.