Safety and societal issues related to dementia
- Daniel Press, MD
Daniel Press, MD
- Assistant Professor in Neurology
- Harvard Medical School
- Michael Alexander, MD
Michael Alexander, MD
- Professor of Neurology
- Harvard Medical School
- Section Editors
- Steven T DeKosky, MD, FAAN, FACP, FANA
Steven T DeKosky, MD, FAAN, FACP, FANA
- Section Editor — Dementia
- Professor of Neurology
- Interim Executive Director
- McKnight Brain Institute
- University of Florida College of Medicine
- Kenneth E Schmader, MD
Kenneth E Schmader, MD
- Editor in Chief — Geriatric Medicine
- Section Editor — Geriatrics
- Chief, Division of Geriatrics
- Duke University
- Director, Geriatric Research Education and Clinical Center
- Durham VA Medical Centers
Patients with dementia have a decreased ability to make decisions. Safety issues are therefore important aspects of the care of patients with dementia. Different safety concerns arise in a relatively predictable manner as dementia progresses. Addressing these issues proactively can prevent serious incidents.
This topic review will discuss the recognition and management of safety and societal issues related to dementia, including decision-making capacity, driving, financial capacity, cooking, wandering and becoming lost, falls, living alone, and voting. The management of neuropsychiatric symptoms of dementia and palliative care of patients with advanced dementia are discussed separately. (See "Management of neuropsychiatric symptoms of dementia" and "Palliative care of patients with advanced dementia".)
The pharmacologic treatment of memory and behavioral problems related to dementia is also discussed separately. (See "Treatment of dementia".)
Any illness or treatment that compromises cognition may be associated with reduced capacity. The likelihood of diminished capacity is related to the severity of cognitive impairment, although brief measures of overall cognition such as the Mini-Mental State Exam (MMSE) are not a substitute for an assessment of capacity. While low scores (eg, <16 out of 30 points) in patients with dementia due to Alzheimer disease are highly correlated with impaired capacity, higher scores may or may not correlate with full capacity to make decisions.
Among patients with mild to moderate stage dementia, verbal reasoning and verbal memory are the two cognitive domains that explain most of the performance on measures of capacity to consent. Measures of an individual’s insight into his or her memory problems also correlate with decision-making capacity.
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- DECISION-MAKING CAPACITY
- FINANCIAL CAPACITY
- WANDERING AND BECOMING LOST
- Who is at risk
- Situations involving risk
- Risk of death
- Factors impeding the search
- Effective search strategies
- - Safe Return
- AGGRESSIVE BEHAVIOR
- LIVING ALONE
- END OF LIFE ISSUES
- SUPPORT FOR CAREGIVERS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS