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Apathetic Residents Should Be Encouraged to Engage in Social Activities and Exercise

A critical issue that has long been a challenge to manage is apathy among older adult residents in long-term care settings, such as assisted living and nursing home facilities.  Apathy is commonly seen in residents with neurodegenerative disorders.  For those with Alzheimer’s disease, apathy is the primary behavioral syndrome. It also may occur in the early of stages of mild cognitive impairment (MCI) and could act as an indicator for future development of dementia, especially in older adults with apolipoprotein E ε4.  The progression of dementia exacerbates the severity of apathy, and apathy may represent a behavioral marker of a more serious form of dementia, indicated by a faster development of mental, functional, and emotional deterioration.  Older adults with Lewy bodies and Parkinson’s disease also express apathy, even if they do not have dementia.  It is also a prominent syndrome in dementia related to alcohol.

Apathy is often misunderstood as depression, but it is not well known that apathy is actually a different syndrome from depression, although these two conditions commonly occur at the same time.  Depression could result in loss of interest and lower activity but is thought to be negative affective experience. On the other hand, apathetic people have a neutral experience due to it being an emotional deficit state. Apathy significantly affects daily functioning more than depression and could, thus, call for more assistance from care providers.  Along with the different symptomatology and their independent influences on quality of life, neuropathological research also shows that apathy is related to brain small blood vessel disease, whereas depression has no such relationship with this condition.

Apathy is not only prevalent, but also an ongoing syndrome. It is strongly related to mortality, increases risk of disability, makes the management of other diseases more challenging, and could increase weight loss.  Apathy could act as a barrier to effective involvement in rehabilitative activities and could increase health care expenses and dependence on care. No medications exist that specifically target treatment of apathy, although some researchers propose that anti-dementia medications could be beneficial.  Substantial research shows that taking a nonpharmacological route in treating apathy is best.  A recent article published in The Journal of Post-Acute and Long-Term Care Medicine reported on the latest study exploring the effectiveness of nonpharmacological methods for treatment of apathy.

The study tested three methods: antipsychotic review, physical exercise, and social engagement with pleasant activities.  The results of the study showed that apathy increased as a result of antipsychotic review and this worsening was improved by both nonpharmacological methods—physical exercise and social engagement.

Staff in long-term care facilities should strive to eliminate apathy in their residents.  They should perform regular assessments of their residents to detect the presence of apathy.  Apathy commonly goes unrecognized due to the fact that apathetic elderly residents do not complain and do not believe their apathy is an issue.  Providers of care may not be aware that apathy is a problem because they could perceive it as a result of illness.

If you or someone you love has been a victim of elder abuse or neglect in a long-term care facility such as one in Avalon or Azusa, California, due to inattentive or untrained staff, please contact The Law Offices of Ben Yeroushalmi. We are experts in elder law and are passionate about fighting for the rights of older adults.