The Increasing Difficulty of Treating Assisted Living Facility Residents with Overlapping Diseases

According to a recent government study reported in The New York Times, 82% of residents who live in assisted living facilities suffer from at least one of the three most common chronic conditions: Alzheimer’s disease, high blood pressure and heart disease. The alarming way in which these ailments overlap has triggered an important new field of study.
Over 733,000 people reside in American assisted living facilities. These facilities provide care for people who need help performing their daily activities, such as dressing, but do not require the more intensive services of a nursing home.
Not only did the study find that more than half the residents are ages 85 and older, researchers were shocked that so many were in need of medical care. In a data brief, the researchers reported, “These findings suggest a vulnerable population with a high burden of functional and cognitive impairment.”
42% of assisted living residents have dementia. An estimated 9% had dementia, high blood pressure and some type of heart disease, such as atherosclerosis.
Numerous studies have shown an association between vascular disease and dementia, particularly Alzheimer’s, and researchers are exploring possible interconnections. Dr. P. Murali Doraiswamy, a psychiatry professor at Duke University, presumes that vascular problems may have to be treated in order to treat dementia.
Unfortunately, treating patients with multiple conditions can be very challenging. “We don’t universally do a great job of how we treat conditions that overlap, for example Alzheimer’s and high blood pressure,” says Dr. Cynthia Boyd, a geriatric medicine professor at Johns Hopkins University.
For example, diuretics to treat high blood pressure often increase the need to urinate, yes many patients with dementia are already incontinent. Some studies have shown that on rare occasions statins used to treat high cholesterol and prevent heart attacks could also affect cognitive functioning, which can make care more difficult for dementia patients.
“Much of the way we practice medicine is looking at disease by disease,” says Dr. Boyd. “We aren’t doing enough thinking about how to add them together and really integrate care.”
The number of older adults with at least one of these three diseases is on a continuous rise, augmenting the need to study on their overlaps. “It’s time for the best minds in vascular research to unite with the best minds in amyloid and tau protein research,” writes Dr. Doraiswamy on the proteins associated with Alzheimer’s disease. “Why don’t we start today?”