Alzheimer’s disease (AD) and related cortical dementias are a major health problem. Patients with AD and related dementia have more hospital stays, have more skilled nursing home stays, and utilize more home health care visits compared to older adults without dementia. This chapter discusses the role of family caregivers and how they interact with in-home assistance, day care, assisted living, and nursing homes in the care of an individual with dementia. It also discuss important transitions in the trajectory of dementia care, including diagnosis, treatment decision making, home and day care issues, long-term care placement, and death. It highlights the importance of caregiver assessment, education, and intervention as part of the care process. Dementia caregivers are at risk of a variety of negative mental health consequences. Another important moderating variable for dementia caregiver distress is self-efficacy.

This chapter provides brief description on malnutrition and aging, and nutrition and homelessness. It discusses nutritional impact of substance abuse, and nutrition assessment and intervention. The chapter explores the impact that homelessness and food insecurity has on the nutritional status of older adults. Interventions must be tailored to accommodate the patient’s financial resources, medical conditions, and ultimately his or her own personal goals in order to be effective. Patients may be completely disengaged from nutrition education and focused on other priorities, which are essential for survival, that is, shelter and safety, thus making nutrition education the least effective intervention for that patient at that moment in time. Ideally, the homeless geriatric person would be monitored and re-evaluated; however, follow-up may be unrealistic. What does nutrition assessment look like in action? The chapter provides a case study to describe this question.

Old age brings with it unique challenges in diagnosis, treatment, and care; dementia complicates these issues even more. Improving the management and care of persons with dementia has positive implications for patients, caregivers, and physicians alike. Two types of secondary complications can be analyzed in relation to dementia: conditions that arise outside of the dementia and then conditions that appear to develop due to the neurological degeneration inherent in dementia. Examples of psychiatric complications include depression, anxiety, and psychosis. Medical problems consist of issues such as stroke, cardiovascular problems, cancer, infections, orthopedic issues, diabetes, nutritional disorders, vision and hearing problems, as well as general pain. The high comorbidity of dementias with other psychiatric and medical issues can complicate the diagnosis and treatment of patients with dementia. Issues in the central nervous system (CNS) have long been looked at as possible predictors of dementia.