Diagnosis and management of dementia in long-term care

Dementia is a complex medical illness that primarily affects older adults. The prevalence of dementia can exceed 60% in U.S. long-term care facilities, and management of the disease can represent a challenge to clinicians. Diagnosis of dementia relies mostly on ascertainment of the resident's history, and the evaluation should include an interview with a family member or close friend. Treatment of cognitive impairment due to Alzheimer's disease, the most common cause of dementia, may include cholinesterase inhibitors and/or memantine. Behavioral symptoms are common among residents with dementia. Treatment should include nonpharmacologic strategies, but may require cholinesterase inhibitors, antidepressants, or antipsychotics. Residents with advanced dementia are also at risk for falls and fractures, pressure sores, and weight loss. Use of preventive strategies to reduce risk and enable early recognition of these common conditions is essential. Early identification of end-of-life wishes is extremely important.