Compulsive hoarding disorder consists of three components: acquiring a large number of possessions, storing of items and not discarding unused objects, and keeping or storing them in such a way that it interferes with daily living, with possible severe neglect of living space. This behavior was first described in 1975 in a sample of 30 individuals, all of whom were elderly and demonstrated extreme neglect of their home, appearance, and health, and was termed Diogenes syndrome. (more…)

The current standard of clinical care for mild to moderate Alzheimer’s Disease is treatment with cholinesterase inhibitors. Four are currently available: donepezil, tacrine, rivastigmine, and galantamine. These treatments may slow cognitive decline or may reduce the emergence of new behavioral manifestations of the disease but are not considered a cure for the disease. Nevertheless, the prevalence and importance of understanding the physiological effects of these drugs in the treatment of Alzheimer’s Disease is not to be underestimated. (more…)

There are a number of issues that must be considered in geriatric pain assessment. The major issues that merit attention are presence of comorbidities, mental status, depression in late life, limitations in ADLs, medications, and the importance of family and other support systems (see Depression; Social Networks, Support, and Integration). (more…)

The treatment of any person of any age with any degree of cognitive impairment must be individualized. Clearly, if there are underlying causes and risk factors for deterioration, they must be addressed.

Dementia treatment based on non-pharmacological approaches include providing educational material, suggesting counseling, and recommending environmental modifications in the patient’s home or other residential care environment. (more…)

It is always important in the treatment of dementia to have clear therapeutic goals established in partnership with the patient and family. Often, the concept of quality of life is an important guide to therapy, as this reflects the values of the individual and his or her family. This section discusses both non-pharmacological and pharmacological treatments of dementia. Remember that non-pharmacological approaches are always appropriate. (more…)

It is now almost axiomatic that late-life depression is under detected, under diagnosed, and under treated. Although this basic fact has not changed, there has been tremendous progress over the past 10 years in ensuring that older adults with depressive disorders are in fact appropriately assessed, triaged, and provided adequate treatment for their symptoms. (more…)