Reply separately to two of your classmates posts (See attached classmates posts, post#1 and post#2). INSTRUCTIONS: Respond to two of your peers, and discuss two separate resources they did not mention

POST # 1 LEANNE

Dementia is an umbrella term for a group of disorders that affect cognition and behavior. Various types of dementia include Alzheimer’s disease, dementia with Lewy bodies (DLB), Parkinsonian dementia (PDD), and frontotemporal dementia (FTD). According to the World Health Organization (WHO) (2019) approximately 50 million people have some form of dementia worldwide, and it is a major cause for disability and dependency for older adults. The purpose of this discussion is to explore ways to reduce costs related to dementia while still maintaining a person’s quality of life (QOL). 

     Healthcare costs are known to be elevated in the United States (US), and the costs associated with dementia are significant. In 2015, it was estimated that the US spent $818 billion on dementia care (WHO, 2019), and that cost is expected to increase to $2 trillion by the year 2030 (Ijssel et al., 2019). The goal for Healthy People (2020) is to not only reduce the morbidity of dementia but also the costs associated with it while preserving or even improving QOL. Dementia is progressive and usually develops in stages, often overlooked in the beginning due to the gradual onset and mild symptoms including forgetfulness and losing track of time (WHO, 2019). 

     Early diagnosis could be a key factor in reducing costs associated with dementia. Different types of dementia can have varying effects on individuals as well as differing life expectancy. People suffering from Creutzfeldt-Jakob disease could have a life expectancy as short as three weeks, whereas someone with Alzheimer’s or FTD could live up to 20 years after diagnosis (Mulkey et al., 2019). Mulkey et al. (2019) explain that FTD is the second most common form of dementia with early onset, having symptoms that begin between age 50-60 and usually appear mor as personality and behavioral changes including depression, lack of interest, and being socially inappropriate. Given that one does not usually associate dementia with a person in this age group providers must be aware of changes such as these in a person that could indicate a serious issue. Although there was insufficient evidence found for recommendations on screening for cognitive impairment, the United States Preventive Services Task Force (USPSTF) (2020) agrees that detecting cognitive impairment early may allow for identification and treatment of reversible causes, allow for providers to anticipate problems patients may have following treatment plans, and educate the patient and their family on the implications of dementia so that advanced care planning may be done. 

     Given that dementia primarily affects older adults, many who suffer from the disorder also have other chronic illnesses. One of the objectives of Healthy People (2020) is to reduce the number of preventable hospitalizations to reduce cost. Many of these hospitalizations are attributed to unmanaged symptoms related to the dementia or symptoms from other chronic illnesses that are not being managed because of the dementia. Palliative care is a great resource that could be used to help manage dementia and its impact on other chronic conditions. Although traditionally palliative care focused on cancer patients, there has been an increased demand to extend palliative care services to all people with life-limiting illness including dementia (Murphy et al., 2016). Symptoms that occur with dementia including agitation, hallucinations, and aggression can be managed by palliative care, and support, education, and ongoing discussions regarding goals of care can be provided to family or caregivers. More providers need to be made aware of and consider palliative care services for their patients with dementia, regardless of the type. 
References

HealthyPeople.gov. (2020). Dementias, including Alzheimer’s disease. Retrieved July 5, 2020 from https://www.healthypeople.gov/2020/topics-objectives/topic/dementias-including-alzheimers-disease

Ijssel, J. C. D. V. D., Bakker, C., Smalbrugge, M., Zwijsen, S. A., Adang, E., Appelhof, B., … Koopmans, R. T. (2019). Cost‐consequence analysis of an intervention for the management of neuropsychiatric symptoms in young‐onset dementia: Results from the BEYOND‐II study. International Journal of Geriatric Psychiatry, 35(1), 131–137. https://doi.org/10.1002/gps.5229

Mulkey, M. A., Everhart, D. E., & Hardin, S. R. (2019). Fronto-temporal dementia: A case study and strategies and support for caregivers. British Journal of Community Nursing, 24(11), 544–549. https://doi.org/10.12968/bjcn.2019.24.11.544

Murphy, E., Froggatt, K., Connolly, S., O'shea, E., Sampson, E. L., Casey, D., & Devane, D. (2016). Palliative care interventions in advanced dementia. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd011513.pub2

United States Preventive Services Task Force. (2020, February 25). Cognitive impairment in older adults: Screening. Retrieved July 6, 2020 from https://uspreventiveservicestaskforce.org/uspstf/recommendation/cognitive-impairment-in-older-adults-screening

World Health Organization. (2019, September 19). Dementia. Retrieved July 5, 2020 from https://www.who.int/news-room/fact-sheets/detail/dementia