Poor Care plus Dementia Equals Violence: Experts

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Poor Care plus Dementia Equals Violence: Experts

By Maggie Fox, Reuters Health

March 22, 2004

WASHINGTON - Demented Americans are not being diagnosed because health care workers who care for them are untrained and often underpaid--and the result, increasingly, is violence, a Senate committee was told on Monday.

Dr. Constantine Lyketsos, a geriatric psychiatrist at Johns Hopkins University and Hospital in Baltimore , said only about 30 percent of patients with dementia are diagnosed by their primary care doctors.

"Part of the problem is that the costs associated with treating these symptoms are high, and Medicare fee and reimbursement structures are not conducive to clinicians getting paid for managing these symptoms," Lyketsos said in remarks prepared for delivery.

Lyketsos was one of several experts slated to testify before the Senate Special Committee on Aging who warned the problem could worsen as the U.S. population ages unless something is done to better train health care providers and to improve the organization and funding of health care, including Medicare.

Donna Cohen, a professor of aging and mental health at the University of South Florida and a co-founder of the Alzheimer's Association, cited several examples of recent violence by confused or upset dementia patients who killed others, including a man who beat his wife to death and another who shot his wife, a fellow nursing home resident and finally himself.

"Although lethal violence is relatively uncommon at the moment, it is possible that homicide and severe violence may increase as the population ages, accompanied by increasing numbers of individuals with Alzheimer's disease and related dementias," Cohen said in prepared testimony.

She said in 2000 there were at least 4 million people with Alzheimer's disease and related dementias in the United States , and the number is estimated to increase to between 11.3 million to 16 million Americans by 2050.

Last month's shooting death of sheriff's deputy Brian Litz in Ocala , Florida , was also cited; Litz was killed by a person with undiagnosed Alzheimer's disease, Ivan Gotham, 74.

"Cases of severe violence by seniors with dementia continue to grow," said U.S. Sen. John Breaux of Louisiana , a ranking Democrat on the committee.

"By training family members, health care providers, law enforcement officials and the court system to better understand and treat those with dementia, we can prevent many of these incidents," Breaux said in a statement.

Lyketsos said up to 90 percent of Alzheimer's disease patients may develop symptoms other than memory loss.

"Among the most troubling to patients and caregivers are depression, delusions, hallucinations and otherwise unexplained agitation," Lyketsos said. "Physical violence is not uncommon, being exhibited by about 15 percent to 18 percent of patients per year."

Doctors, nurses and other health care workers are not trained to detect these symptoms early on, he added.

"This is a major missed opportunity on the part of our health care system to intervene early to prevent severe behavior problems among Alzheimer sufferers," Lyketsos said.