Michelle Peck | Legal Nurse Consultant | Adult & Geriatric Nurse Practitioner | Health Care | Consultant | Professional Speaker | Educator | Researcher
Enjoy your journey through this slide deck!
During your journey through Geriatric Dementia, Delirium and Depression, you will experience how to:
• Differentiate delirium, depression & dementia.
• Describe the etiology & signs and symptoms of delirium, depression, and dementia.
• Identify risk factors for delirium, depression, and dementia.
• Identify types of medications that may cause depression.
• Communicate and care for people experiencing delirium.
• Explain non-pharmacologic interventions for treating dementia.
In order to minimize risk and customize interventions, we have to know where and how our clients are living.
The picture on the first slide is from geriatric simulation lab, where nursing students practice administering geriatric assessment scales to identify areas of risk. What risks and hazards can you see in this picture?
What you can't see is that the V8 Splash bottle is actually whiskey, medications and incontinence briefs are scattered all over the floor and our client is using oxygen via nasal cannula while smoking. Would picking up the trash and organizing the house fix the problem? Fifty percent of the students verbalized wanting to clean up during their assessment visit and some asked if they could tidy up upsetting the client.
Every problem deserves a viable solution. A comprehensive geriatric assessment is in order and interventions need to follow by assembling the geriatric team.
Our client's assessment findings were all high risk.
View the geriatric assessment scales with how to administer articles & videos at http://consultgerirn.org/resources.
What do we do next? We need to assemble the geriatric team to intervene.
View assembling the geriatric team "Assessments and Referrals" at http://www.environmentalgeriatrics.org/cme/extra/noCredit.html.
Hopefully at minimum the discharging physician ordered the home health care services necessary to bridge our client's hospital to home care.
If the geriatric assessment scales were performed prior to hospital discharge the physician should have recognized that with all her high risk findings she should not have been discharged home alone. At minimum she requires 24 hour supervision for safety.
The students all felt our client was confused and attributed it to her whiskey drinking, but after performing her Mini Cog they realized she was screening positive for dementia. How many clients slip through the cracks because of lack of assessment?
Our client confabulated and was quite convincing until the students saw her clock draw. Now they knew environmental observations were much more important than client self-report.
A picture is worth a thousand words. We fail our clients until we learn the assessment skills required to paint an accurate picture.
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
During your journey through this slide deck of the geriatric populations 3 D’s, you will experience: the difference between geriatric dementia, geriatric delirium and geriatric depression; the global impact of dementia and the importance of a quality diagnosis; and the dementia assessment, management and treatment options.
The links in this slide deck lead you to expert geriatric teaching tools and videos that you will value and love.
According to the World Alzheimer Report if dementia care were a country, it would be the world’s 18th largest economy. The worldwide costs of dementia exceeded 1% of global GDP in 2010, at US$604 billion. If dementia were a company, it would be the world’s largest by annual revenue exceeding Wal-Mart (US$414 billion) and Exxon Mobil (US$311 billion). Geriatric populations are increasing and Alzheimer’s in the USA will ALMOST TRIPLE BY 2050. Let’s stay informed!
Learn it-Live it-Love it-Your path for a more informed life!
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
Aging is associated with cognitive decline, and older subjects can have demonstrable cognitive impairment without crossing the threshold for dementia.
This condition has been termed “mild cognitive impairment” (MCI), and these patients have an increased risk of developing dementia, especially Alzheimer disease (AD).
Studies conducted in referral clinics have shown that patients with MCI progress to AD at a rate of 10% to 15% per year, and 80% of these patients have converted to AD after approximately 6 years of follow-up.
The identification and classification of MCI can be a major challenge.
An exploration of the pros and cons of dementia screening/case-finding, in the context of the UK government's dementia strategy in 2013.
Presented to Thames Valley Faculty on 30 April 2013
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
During your journey through this slide deck of the geriatric populations 3 D’s, you will experience: the difference between geriatric dementia, geriatric delirium and geriatric depression; the global impact of dementia and the importance of a quality diagnosis; and the dementia assessment, management and treatment options.
The links in this slide deck lead you to expert geriatric teaching tools and videos that you will value and love.
According to the World Alzheimer Report if dementia care were a country, it would be the world’s 18th largest economy. The worldwide costs of dementia exceeded 1% of global GDP in 2010, at US$604 billion. If dementia were a company, it would be the world’s largest by annual revenue exceeding Wal-Mart (US$414 billion) and Exxon Mobil (US$311 billion). Geriatric populations are increasing and Alzheimer’s in the USA will ALMOST TRIPLE BY 2050. Let’s stay informed!
Learn it-Live it-Love it-Your path for a more informed life!
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
Aging is associated with cognitive decline, and older subjects can have demonstrable cognitive impairment without crossing the threshold for dementia.
This condition has been termed “mild cognitive impairment” (MCI), and these patients have an increased risk of developing dementia, especially Alzheimer disease (AD).
Studies conducted in referral clinics have shown that patients with MCI progress to AD at a rate of 10% to 15% per year, and 80% of these patients have converted to AD after approximately 6 years of follow-up.
The identification and classification of MCI can be a major challenge.
An exploration of the pros and cons of dementia screening/case-finding, in the context of the UK government's dementia strategy in 2013.
Presented to Thames Valley Faculty on 30 April 2013
This is the updated slideshow for the 2011 NFMBR presentation of Geriatrics. We apologize sincerely for the error in the manual, you can both view the slideshow online or download it to your computer and view with PowerPoint.
what is dementia and why it is considered only for old age and how it goes to misdiagnose buy the health care professionals and what is infact. in nepal this issues is given low priority in both hospital and public
Geriatrics is a sub-specialty of medicine that focuses on health care of the elderly. It aims to promote health and to prevent and treat diseases and disabilities in older adults.
Translational Medicine: Patterns of Response to Antidepressant Treatment and ...Joanne Luciano
This is a talk I gave at the IEEE Schenectady Section - 17 MAY Membership Meeting.
The mission of my depression research is to help people figure out what they need to help them get out of a depressed state. That is, finding out what is best for them, not what is best for their doctor, friends, therapist, or anyone else. Depression is now a global problem. In the past 15 years it has gotten worse. Depression is complex; it has a wide range of varying symptoms and degrees of intensity. It can be challenging to determine the best course of action, whether medical treatment is necessary, or which of the many treatments (drug and non-drug) is the best match. Many people who are depressed do not get the help they need, and many people receive medications when they are not necessary. My work aims to bring together tools, technology, scientific and medical data and patient experience to help address depression, both personally and globally.
Geriatric Special Focus, Pain Management and Analgesic Prescribing for Advanc...Michelle Peck
Michelle Peck | Geriatric Nurse Practitioner | Health Care Consultant | Professional Speaker | Nursing Faculty| Legal Nurse Consultant | Mindful Geriatrics
In collaboration with Dr. Linh Nguyen, Supportive Medicine at UTHealth Medical School, we have created this slide deck for Advanced Practice Nurses.
Our mission is to simplify the pharmacologic basics of good pain prescribing. We have not provided very much detail about schedule II controlled substances due to the current limitations on Texas Nurse Practitioner prescribing in primary care.
This lecture is designed to meet our Advanced Practice Nursing audience where they are at and provide tools, knowledge and practical tips. Areas where we detect mastery with our polling questions are briefly touched upon and more time and examples are given are to areas of audience identified needs. Prescribing pain medication for Advanced Practice Nurses is dynamic, complex and ever changing
We have also included a special focus (our passion) for pain prescribing in the geriatric population. Beer’s Criteria medications, to be used with caution or avoid completely in geriatrics are mentioned throughout this presentation.
This presentation starts with the audience writing down their biggest fear about pain prescribing. We then categorize these fears, so that throughout our lecture we can give special focus and alleviate fears with practical tips, guidelines and real life examples.
Our objectives are to discuss:
1. Benefits and side effects of common analgesics
2. The impact of patient-related factors on drug selection & dose based on knowledge of patient related changes
3. Medications to avoid, use with caution, explain why
4. Management of pain based on client care goals
We hope you Learn it-Live it-Love it!
This is the updated slideshow for the 2011 NFMBR presentation of Geriatrics. We apologize sincerely for the error in the manual, you can both view the slideshow online or download it to your computer and view with PowerPoint.
what is dementia and why it is considered only for old age and how it goes to misdiagnose buy the health care professionals and what is infact. in nepal this issues is given low priority in both hospital and public
Geriatrics is a sub-specialty of medicine that focuses on health care of the elderly. It aims to promote health and to prevent and treat diseases and disabilities in older adults.
Translational Medicine: Patterns of Response to Antidepressant Treatment and ...Joanne Luciano
This is a talk I gave at the IEEE Schenectady Section - 17 MAY Membership Meeting.
The mission of my depression research is to help people figure out what they need to help them get out of a depressed state. That is, finding out what is best for them, not what is best for their doctor, friends, therapist, or anyone else. Depression is now a global problem. In the past 15 years it has gotten worse. Depression is complex; it has a wide range of varying symptoms and degrees of intensity. It can be challenging to determine the best course of action, whether medical treatment is necessary, or which of the many treatments (drug and non-drug) is the best match. Many people who are depressed do not get the help they need, and many people receive medications when they are not necessary. My work aims to bring together tools, technology, scientific and medical data and patient experience to help address depression, both personally and globally.
Geriatric Special Focus, Pain Management and Analgesic Prescribing for Advanc...Michelle Peck
Michelle Peck | Geriatric Nurse Practitioner | Health Care Consultant | Professional Speaker | Nursing Faculty| Legal Nurse Consultant | Mindful Geriatrics
In collaboration with Dr. Linh Nguyen, Supportive Medicine at UTHealth Medical School, we have created this slide deck for Advanced Practice Nurses.
Our mission is to simplify the pharmacologic basics of good pain prescribing. We have not provided very much detail about schedule II controlled substances due to the current limitations on Texas Nurse Practitioner prescribing in primary care.
This lecture is designed to meet our Advanced Practice Nursing audience where they are at and provide tools, knowledge and practical tips. Areas where we detect mastery with our polling questions are briefly touched upon and more time and examples are given are to areas of audience identified needs. Prescribing pain medication for Advanced Practice Nurses is dynamic, complex and ever changing
We have also included a special focus (our passion) for pain prescribing in the geriatric population. Beer’s Criteria medications, to be used with caution or avoid completely in geriatrics are mentioned throughout this presentation.
This presentation starts with the audience writing down their biggest fear about pain prescribing. We then categorize these fears, so that throughout our lecture we can give special focus and alleviate fears with practical tips, guidelines and real life examples.
Our objectives are to discuss:
1. Benefits and side effects of common analgesics
2. The impact of patient-related factors on drug selection & dose based on knowledge of patient related changes
3. Medications to avoid, use with caution, explain why
4. Management of pain based on client care goals
We hope you Learn it-Live it-Love it!
ECO 11: Medicines Optimisation Through Precision - Sir Munir PirmohamedInnovation Agency
Munir Pirmohamed discusses the potential impact of medicines optimisation in terms of ensuring the right patients get the right choice if medicine at the right time. He presents a case history of over prescription and introduces three examples of medicines optimisation through use of genetics, big data, and pharmacogenetics profiling.
Providing quality pediatric pain management during end of life carecassidydanielle
Author: Danielle Cassidy, PharmD, BCPS
Audience: continuing education for hospice nurses
Background: describes common developmentally appropriate tools for assessing pain in children, general principles of pediatric pharmacology, common pharmacological interventions, side effects commonly associated with opioid medications & side effect management strategies.
Geriatric Population. Geriatric Clinician Practice. Your Medicare, Long-Term ...Michelle Peck
Michelle Peck | Legal Nurse Consultant | Adult & Geriatric Nurse Practitioner | Health Care | Consultant | Speaker | Educator | Researcher
Enjoy your journey through this slide deck of Geriatric Population. Geriatric Clinician Practice. Your Medicare, Long-Term Care Documentation.
Imagine if writing a progress note was really as simple as the note featured on the title slide. This physician progress note style filled the charts of a 120 bed nursing facility in rural Texas. Walking down the facility hallways I observed many unstable conditions and behaviors. Staff were numb to the yelling. When I questioned about the yelling "we don't medicate behaviors" was the most popular response. I needed to be medicated after a few hours of being there. Collecting data had never been this difficult. Stable and clinical documentation now had a whole new meaning.
This month I am instructing Nurse Practitioner students on Medicare and Long-Term Care Coding and Documentation. Revising this lecture reminds me of all of the clinician types I have met during my long-term care travels.
1. Amazing Clinicians
◾ They know state and federal regulations and practice perfectly.
◾ They don't cross your path very often.
◾ When you meet them you must stop, listen and absorb all their knowledge.
2. So-So Clinicians
◾ They don't know that there are regulations on state and federal levels.
◾ They are pretty common and are doing enough with meaningful practices.
◾ When you meet them you must stop, talk and they absorb your knowledge.
3. Corner Cutters
◾ They are not doing enough and practice out of compliance.
◾ Their colleagues are also clueless, there is guilt by association.
◾ When you meet them, run in the opposite direction.
What types of geriatric clinicians are crossing your path? The documentation is very telling as to the practice type. Are they awesome, so-so, or of the corner cutter breed?
Learn it-Live it-Love it-Your path for a more informed life!
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
A brief presentation on medicines optimisation and the input a clinical pharmacist can make in improving treatment outcomes for patients and help make evidence led cost effective improvements for the wider NHS.
Dementia is a neurodegenerative disorder. Number of patients with dementia is rising in India, as the population will grow older in next few decades. Undergraduate medical students, must therefore know the common presenting symptoms of dementia as well as how to distinguish them from physiological age related cognitive decline.
Ana Claudia DiagnosisOne of the earliest symptoms of dementia .docxjesuslightbody
Ana Claudia
Diagnosis
One of the earliest symptoms of dementia (ICD-10 code F03. 90) is delirium (ICD-10 code F05), which could be the primary warning that an individual is getting sick. Cases of both dementia and acute delirium in the elderly are presented. Especially when it comes to alleged dementia as well as severe delirium, the healthcare practitioner's focus will be on determining the highly likely diagnosis (Lai et al., 2021). In accordance with the case study's findings, a number of factors, including substance withdrawal, stress, inflammation, and direct intoxication may all have a role in the development of acute delirium. If an individual is going through detox from addiction, their neurotransmitter system will go through a time of disruption inside the excitatory and inhibitory pathways.
Anticholinergic medications, dopaminergic drugs, and electrolyte imbalances are some more examples of conditions that can affect neurotransmitter production or release. It might affect the process in a roundabout way. These include, but are not limited to, hypercalcemia, hypoxia, hypoglycemia, and ischemia. All of those are obviously only a small sample of the many examples of inequality. Furthermore, cytokines are a group of molecules that are produced as a result of inflammation (Tieges et al., 2020). As a result, these cytokines commonly interfere with the proper action of neurotransmitters. Comparatively, the stress response is linked to the secretion of neurotoxic glucocorticoids as well as noradrenaline. The information covered so far suggests that while attempting to diagnose acute delirium, it is important to take into account any coexisting clinical disorders. In particular, renal failure or injury; cerebrovascular illness; insomnia; malignancy; heart arrhythmias; seizures; delirium from medicines; and pulmonary pathology are all conditions that can cause hypovolemia.
Additional Testing to Be Considered
Particularly for elderly individuals, there are a variety of options available when treating acute delirium plus dementia situations addressed by healthcare professionals. According to Mattison (2020), depending on the circumstances, it is necessary to first explain how to diagnose delirium signs by analyzing the patient's medical history and doing a comprehensive physical examination. We can then proceed to determine what caused the delirium after that is complete. Supplemental diagnostic tests may be required to determine the highly likely origin of the medical issue. Particular tests that could be performed on the patient include electrolyte levels, complete blood count, creatine, C-reactive protein, liver function tests, thyroid-stimulating hormone, calcium, kidney tests, blood glucose levels, and urinalysis. The potential of acute delirium can be ruled out by performing the aforementioned medical tests and diagnostics. Additional diagnostic techniques, including a computer tomography scan of the head, an electroencephalogram, and a .
Dementia
By Hilda Nyemah
Definition
Dementia is a is a group of symptoms, not an illness lasting more than six months and affecting aspects of mental function. Cognitive dysfunction, psychiatric and behavioral problems, and difficulties with activities of daily living.
People with dementia have significantly impaired intellectual functioning that interferes with normal activities and relationships.
Cognitive dysfunction, resulting in problems with memory, language, attention, thinking, orientation, calculation, and problem solving. Psychiatric and behavioral problems, such as changes in personality, emotional control, social behavior, depression, agitation, hallucinations, and delusions. Difficulties with activities of daily living, such as driving, shopping, eating, and dressing.
2
Common causes of dementia
Vascular dementia, Alzheimer’s disease, Lewy body dementia
Dementia is caused by damage to brain cells. This damage interferes with the ability of brain cells to communicate with each other. When brain cells cannot communicate normally, thinking, behavior and feelings can be affected.
Vascular Dementia is caused by a series of small strokes. Multi-infarct Dementia (MID) is the second most common cause of dementia after Alzheimer disease in people over age 65. MID usually affects people between ages 55 and 75. More men than women have MID.
Alzheimer's disease (AD) is the most common form of Dementia. AD begins slowly. It first involves the parts of the brain that control thought, memory and language. People with AD may have trouble remembering things that happened recently or names of people they know. Usually begins after age 60.
Lewy body dementia (LBD) is a type of progressive dementia that leads to a decline in thinking, reasoning and independent function because of abnormal microscopic deposits that damage brain cells over time. Most experts estimate that Lewy body dementia is the third most common cause of dementia after Alzheimer’s disease and Vascular dementia accounting for 5 to 10 percent of cases. (Alzheimer Association)
Lewy Body Dementia. (n.d.). Retrieved December 13, 2020, from https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/lewy-body-dementia?utm_source=google
3
Risk Factors
Age
Genetics
Smoker
atherosclerosis
Diabetes
Some risk factors for dementia, such as age and genetics cannot be changed.
Alzheimer’s Association suggests that adopting multiple healthy lifestyle choices, including healthy diet, not smoking, regular exercise and cognitive stimulation, may decrease the risk of cognitive decline and dementia.
Age the risk of Alzheimer's disease, vascular dementia, and several other dementias goes up significantly with advancing age.
Genetics/family history Although people with a family history of Alzheimer's disease are generally considered to be at a heightened risk of developing the disease themselves, many people who have relatives wi ...
Difficulties in Treating Patients with Traumatic Brain injuryjamesyoungmd
Traumatic Brain Injury occurs every 15 seconds with 500,000 requiring hospitalization. It is the leading killer and cause of disability in children and young adults. Motor vehicle crashes are a leading cause of death in the U.S. More than 2.5 million drivers and passengers were treated in emergency departments as the result of being injured in motor vehicle crashes in 2012. The economic impact is also notable: in a one-year period, the cost of medical care and productivity losses associated with injuries from motor vehicle crashes exceeded $80 billion. http://www.cdc.gov/injury/wisqars, 2010
An estimated 2.4 million children and adults in the U.S. sustain a traumatic brain injury (TBI) and another 795,000 individuals sustain an acquired brain injury (ABI) from non-traumatic causes each year.
Currently more than 5.3 million children and adults in the U.S. live with a lifelong disability as a result of TBI and an estimated 1.1 million have a disability due to stroke.
(Statistics courtesy of the Centers for Disease Control and the Stroke Fact Sheet
Holding Hands With The Hopeless Edps Project Finalcmadison
This was initially completed as a project in one of my courses. However, understanding substance abuse as a disease and not a moral issue or lack of willpower is vitaly important to continue to make advancements in treatments and reimbursement issues, which are a huge threat.
A critical discussion of the focus on the biomedical perspective in the preve...GERATEC
The biomedical focus on dementia brought the phenomena of what was considered a normal part of ageing into the medical and scientific field of interest (Bartlett, R and O’Connor, D. 2010). This perspective comes with a strong focus on neurodegenerative decline and deficits. Even though Alzheimer’s disease was around for more than 70 years since noted by Alois Alzheimer, it was only in the 1980’s that the “disease emerged as an illness category and policy issue” (Lyman, A. 1989). The Nun Study of David A. Snowdon, PhD, which started in 1991, brought a new perspective to the research into dementia. It was discovered during autopsies that people who have lived their lives without any signs of dementia, actually had amyloid plaques and tangles in their brains congruent to people living with dementia (Snowdon, D.A. 2003). Biomedical research is at this stage the primary focus of research into dementia, receiving most of the funding budget. According to an article in Therapy Today (July 2012) in the UK alone, £66 million will be allocated to dementia research by 2015, of which only £13 million is earmarked for social science research. In the WHO report on Dementia, Daviglus M.L. et al of the US National Institutes of Health state that “firm conclusions cannot be drawn about the association of any modifiable risk factor with cognitive decline of Alzheimer disease”.
The importance of the research findings of the biomedical model cannot be underestimated. However, considering the facts that t this point there seems to be nothing that can prevent nor cure Dementia, I am of the opinion that more research and funding should focused on creating a life worth living for people who live with dementia.
The Effects of Alzheimer on AmericaBackgroundAlzheimer’s dis.docxmehek4
The Effects of Alzheimer on America
Background
Alzheimer’s disease is known to affect the brain, cells, and nerves, nervous and psychic-emotional system. Alzheimer’s is the progressive disorder which results in the loss of cognitive abilities. It is the most concerned structure of dementia. As of today, there is still no clue to why or what causes this disorder, but there are ample ideas and suggestions for this disorder.
One of the most relevant symptoms of Alzheimer’s disease is the reduction of the ability to interpret your sensory perceptions and to understand the meaning of things. There is no current treatment, but there are drugs that are been used to slow down its progression.
In 1906, Alexander Alois described this disorder as a pathological presenile of dementia. It is believed that by the 2015, there will be a diagnosis of 5.3 million with Alzheimer’s disease which will eventually cause death.
Alzheimer’s disease is a progressive neurodegenerative disorder leading to sever cognitive, memory and behavioral impairment.
Significance
This proposal is to show how and why there are research done on Alzheimer’s disease. This disease affects 500 million people in the U.S. This is known as the aging disease.
The testing of Alzheimer’s is important because it is a way to find the cause of it and ways to prevent it or either slows down the progression rate in AD.
The diagnosis of Alzheimer’s disease is an important research because it contributes to helping our aging America and onset of Dementia. Alzheimer’s could be cause by other significant disease that may be at bay in our mind and body.
The significance of this proposal is to give insight on ways to prevent AD. It may also be a cure for it as well as what causes it. It also details where in the brain Alzheimer’s may begin in its early stages.
Literature Review
Alzheimer’s is the most common form of dementia. It is assumed to grow as the population of the aging grows. So far there is no treatment to stop the growth of AD. The growth of AD gets worsen due to the cognitive ability, functional ability and behavioral and mood changes. Alzheimer’s has signs of mood changes, depression, anger and confusion when changes happen. Someone of normal aging process will exhibit decrease in coordinator and movement whereas AD recipient will exhibit halting in movement or coordination and loss of balance.
The criterion for diagnosis of AD is definite, probable, and possible. Definite syndrome is histopathological confirmed. Probable has two cognitive deficits and severity of deficits. Possible has atypical awareness. There will be more updates to include brain imaging and peripheral biomarkers. These interventions may have some evidence to reduce or delay the onset of Alzheimer disease and dementia. It could possibly change the effect of normal aging on the brain activity. Physical exercise has been suggested to reduce the risk of dementia by lessen deterioration and cognitive deficit by reversal. It ...
2018 geriatric pain palliative and hospice careMichelle Peck
I hope you enjoy using this presentation on geriatric pain assessment, management, best practice interventions, caregiving, and palliative & hospice care.
Peck trends in geriatric best practice for nursing careMichelle Peck
I Hope you find this information helpful for providing best practice care to the geriatric population.
Peck, M. (2017). Trends in Geriatric Best Practice for Nursing Care. Podium presentation for Indian
American Nurses Association.
Current Trends in Nursing Practice and
Pharmacology Conference; Houston, Texas.
Geriatric Population. Geriatric Palliative and End-of-Life Care.Michelle Peck
During your journey through this slide deck Geriatric Population. Geriatric Palliative and End-of-Life Care you will experience what it means to die badly.
After practicing as a Geriatric Clinician for over a decade what I know for sure is: Life is a tremendous gift. 100% of us are going to die. If you don't communicate your end-of-life plan, then you should plan on dying badly.
In The Cost of Dying: End-of-Life Care on CBS 60 minutes Steve Kroft interviews Doctor Ira R. Byock. “Families cannot imagine that there could be anything worse than their loved one dying, but in fact there are things worse, generally it’s having someone you love die badly.” ~Doctor Ira Byock
“Dr. Byock what do you mean dying badly?” ~Mr. Kroft
“Dying suffering, dying connected to machines, denial of death at some point becomes a delusion and we start acting in ways that make no sense whatsoever.” ~Doctor Ira Byock
A majority of Americans say they want to die at home. Why is this not happening?
Place of death should be regarded as an essential goal in end-of-life care.
Let’s explore how the end-of-life decision occurs?
For Doctors
Bernacki & Block (2014) found in their review and synthesis of best practices that physician attitudes, training, and perceptions of feeling inadequate in managing the emotional and behavioral reactions of patients all play a role. A majority of trainees were not taught how to communicate and they express strong desires to learn more. Physician barriers also include not addressing psychosocial concerns, placing focus on diagnoses, treatments, and procedures during discussions about the medical care at the end-of-life.
For Patients
Bernacki & Block (2014) found that patients who do bring up dying concerns with their physicians often meet barriers and often are not aware that they are at the end-of-life. Patients that have not set goals based on meaningful conversations about their desires may overuse life-prolonging treatment and underuse services that support quality of life.
Conclusion
Bernacki & Block (2014) found that there is a large body of evidence demonstrating that early discussions of serious illness care goals are associated with:
♛ beneficial outcomes for patients,
♛ no harmful adverse effects, and
♛ potential cost savings.
Apply & Do
To prevent dying badly start early conversations, enhance your knowledge and establish goals. Dreams are only dreams until you write them down. When you write dreams down then they become goals.
Do ♛ The Conversation Project a collaboration with the Institute for Healthcare Improvement. http://theconversationproject.org/starter-kit/intro/
Do your conversation kit now and make your loved ones aware of your wishes.
Wishing you the very best, Michelle
Bernacki RE, Block SD, for the American College of Physicians High Value Care Task Force. Communication About Serious Illness Care Goals: A Review and Synthesis of Best Practices. JAMA Intern Med. 2014;174(12):1994-2003.
Geriatric Population. Pain and Palliative Care for the Older (Geriatric) AdultMichelle Peck
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
During your journey through this slide deck of Geriatric Populations, Pain and Palliative Care for the Older (Geriatric) Adult, you will experience: the assessment of pain; pain management strategies; and learn more about Palliative Care services.
As a health care consumer it is important to recognize and be aware of the quality of life benefits of good pain and symptom control. This begins with a good assessment of the factors contributing to the pain. Pain is a multifaceted experience. There are many barriers to achieving effective pain control in the elderly (geriatric population). Health care providers need to be aware of personal biases surrounding pain for proper pain management. There are also many health care provider misconceptions regarding Palliative Care especially in the geriatric population.
To enrich your geriatric understanding, at the end of this slide deck we discuss Palliative Care: the relief you need when you are experiencing serious medical illness.
Learn it-Live it-Love it-Your path for a more informed life!
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
Geriatric Inter-Professional Team Dynamics. Geriatric leadership.Michelle Peck
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
During your journey through this slide deck of Inter-professional Team Dynamics (with a focus on the geriatric inter-professional team), you will experience: Inter-Professional teams, collaboration, and the benefits to the health care system; Team Dynamics according to psychologist Bruce Tuckman; Five Dysfunctions of a Team according to Patrick Lencioni; and the challenges facing inter-professional teams.
As a health care consumer it is important to recognize and be aware of the benefit of inter-professional teams, and the geriatric inter-professional team to the health care system.
Most importantly, team dysfunction can compromise outcomes, especially when leadership lets the team down.
Building great teams takes good leadership. The leader is most important for building trust, which sets the foundation for the team. For a high performing team to operate members must share successes, failures, strengths and weaknesses in a trustworthy environment. When teams build trust and engage in constructive conflict then there is the potential for building commitment and accountability. Then the team can focus on meeting and exceeding the goals and mission. Lencioni, P. (2002).
Learn it-Live it-Love it-Your path for a more informed life!
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
Geriatric Population. Injury in Aging (Geriatrics) : How to Handle Older (Ger...Michelle Peck
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
During your journey through this slide deck of Injury in Geriatric populations, you will experience: the measurement of injury; how old age (geriatrics) modifies clinical features & management (i.e. fractures, infection, confusion, host response); and how geriatric trauma victims differ from their younger counterparts.
The links in this slide deck lead you to expert geriatric teaching resources that you will value and love.
You will learn why trauma is so much more “traumatic” for geriatric populations.
Existing assessment and management standards have not been evaluated for efficacy in geriatric trauma patients, only one third of Baccalaureate nursing programs require a course in geriatrics, and less than 1% of registered nurses are certified in geriatrics. Cutungo, C. (2011).
With aging the body undergoes a progressive loss of function and vital organs lose their ability to compensate in times of physical and metabolic stress. Bartley, M. K. (2010). The “fight or flight” response in geriatric people is less robust. Cutungo, C. (2011).
As a health care consumer it is important to recognize and be aware of how being geriatric modifies clinical features and increases the risk for complications and mortality.
Learn it-Live it-Love it-Your path for a more informed life!
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
Geriatric Population. What you need to know about medication and supplement s...Michelle Peck
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
Do you know the common Beer’s Criteria Medications, these are medications to watch out for and avoid in geriatric populations?
You would be surprised at all the changes we experience with the aging process. What we may consider a safe medication when we are younger can become quite dangerous to our body as we age.
What vitamin deficiency in the geriatric population can lead to memory impairment, fatigue, irritability, mood changes? Let’s find out!
Begin your journey and become a very informed consumer. This short slide deck is your passageway to obtaining medication and supplement safety super geriatric knowledge.
Special focus on geriatric populations.
Learn it-Live it-Love it-Take control of your health!
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Geriatric Population the 3 D's Geriatric Dementia, Delirium and Depression 2015
1.
2. LET’S DISCUSS HOW TO
Differentiate delirium, depression &
dementia.
Describe the etiology and signs and
symptoms of delirium, depression, and
dementia.
Identify risk factors for delirium,
depression, and dementia.
3. LET’S DISCUSS HOW TO
Identify types of medications that may
cause depression.
Communicate and care for people
experiencing delirium.
Explain non-pharmacologic interventions
for treating dementia.
4. DELIRIUM
Cholinergic/dopaminergic excess
Cascade of events
Complicates hospitalizations
Is a medical emergency
Durso, S. C. & et al. (2010).
Sometimes preventable by minimizing
medication use and adequate hydration
7. COMMUNICATION IN
DELIRIUM
Know the person’s
patterns
Look at nonverbal
signs
Speak slowly
Explain all actions
Be calm
Face the person
keep eye contact
Get to the level of
the person, don’t
stand over them
Touhy, T. & Jett, K. (2012).
8. COMMUNICATION IN
DELIRIUM
Smile
Use simple familiar
words
Allow adequate time
for response
Repeat if needed
BE Consistent
Tell the person what
you want them to do
One-step directions
Reassure safety
Do not assume they
cannot understand
Touhy, T. & Jett, K. (2012).
11. DEPRESSION
Not a normal part of aging
Most common mental health problem of late life
Among the most treatable
Often co-occurs illness “unwanted cotraveler”
Up to 1 in 4 primary care clients suffer from
depression
Touhy, T. & Jett, K. (2012).
12. MEDICATIONS MAY
RESULT IN DEPRESSIVE
SYMPTOMS
Antihypertensives
Angiotensin-
Converting Enzyme
Inhibitors
Antidysrhythmics
Anticholesteremics
Antibiotics
Analgesics
Corticosteroids
Touhy, T. & Jett, K. (2012).
13. DEPRESSION
Two simple questions effectively
screen:
Over the past 2 weeks, have you felt
down, depressed or hopeless?
Have you experienced a loss of
interest or pleasure in most things?
Durso, S. C. & et al. (2010).
14. DEPRESSION
Supportive treatment
Counseling, relief of loneliness
Treat physical symptoms and pain
Address anxiety, financial, dependency
Consider stopping contributory drugs
Psychotherapy effective as antidepressants
Cognitive-behavioral therapy
15. comprehension
DEMENTIA
The term dementia describes a syndrome
Chronic and progressive brain disease
Affects higher cortical functions
memory
language
judgment
learning
capacity
thinking orientation
calculation
Bereczki, D. & Szatmári, S. (2009).
16.
17. IMPACT
35.6 million with dementia
Nearly doubles every 20 years
Alzheimer’s in the USA will
ALMOST TRIPLE BY 2050
World Alzheimer Report 2011.
18. 28 million of
the world’s
35.6 million
people with
dementia have
yet to receive a
diagnosis…
World Alzheimer Report 2011.
20. Annual dementia
care costs
$32,865
per person
With a quality
dementia diagnosis
annual dementia cost
decreases to $5,000
per person
Improved health
& quality of life
even more
cost-effective
Impact of a Quality
Dementia Diagnosis
World Alzheimer Report 2011.
21. Earlier diagnosis allows
people with dementia to…
plan ahead while
they still have the
capacity, receive
timely practical
information, advice
and support
get access to available
drug and non-drug
therapies
participate in
research for the
benefit of future
generations
World Alzheimer Report 2011.
22. 7.7 million new cases yearly.
New case of dementia every?
A. 18 minutes
B. 23 hours
C. 4 seconds
D. 23 minutes
E. 30 seconds
C. 4 seconds
24. 0 1 2 3 4 5 6
DEMENTIA
WAL-MART
EXXON MOBIL
100 BILLION US DOLLARS
Dementia Costs More Than
1% Gross Domestic Product
Borson, S. & et al. (2013).
If dementia were a company, it would be the
world’s largest by annual revenue.
25. RISK
Age
Family history and genetics
Psychiatric disorders
Cardiovascular disease – related factors
Head trauma
Alcohol, drugs & toxins
Vasculitis, Endocrine & Infectious disorders
Neoplastic & Respiratory disorders
Brain lesions, normal pressure hydrocephalus
Fillit, H. M. & et al. (2010) & Patterson, C. & et al. (2007).
26. MILD COGNITIVE
IMPAIRMENT
NOT the result of normal aging
Forgetfulness is hallmark symptom
Sometimes called a transitional phase
Conversion rate 2 - 15% per year
Up to 80% conversion at 6 years
Fillit, H. M. & et al. (2010).
27. MAJOR DEMENTIA TYPES
AD Alzheimer’s disease
VaD Vascular dementia
FTD Frontotemporal dementia
PDD Parkinson’s disease dementia
DLB Dementia with Lewy bodies
Others: SD Semantic dementia, Progressive
nonfluent aphasia, etc.
28. NEUROPSYCHOLOGICAL
DOMAINS
Premorbid ability: review of
educational, occupation
Verbal memory: verbal and
memory learning tests
Visual memory: visual
reproduction, figure drawing
Simple attention: digit span
Language: animal naming, oral
word association test
Executive function: card
sort test, similarities
Visuospatial: digit symbol
test, clock drawing
Motor: finger tapping
Cognitive screening:
MMSE, SLUMS, MoCA, etc.
Fillit, H. M. & et al. (2010).
29. OTHER DOMAINS
Function
Katz Index of Activities of Daily Living ADL
Lawton Instrumental Activities of Daily Living Scale IADL
Get-up and go
Caregiver Input
Depression
Hamilton Depression Rating Scale HDRS
Geriatric Depression Scale GDS
Fillit, H. M. & et al. (2010).
30. DIAGNOSTIC
LABORATORY
CBC, CMP, Thyroid, B12, Folate, CRP,
RPR, Lipids, HIV, SED rate, etc.
May need to rule out delirium urine
sample, blood cultures, chest x-ray, CSF
Neuroimaging
MRI or CT - Choice depends on
availability, cost, patient acceptability,
contraindication
MRI is preferred. SPECT & PET
scanning, Pittsburgh Compound-B
ligand for PET
Fillit, H. M. & et al. (2010).
31. Reports of progressive
change in cognition or ADL
Clinical assessment
Is cognitive impairment
confirmed on formal testing?
Is ADL impaired
Is onset relatively sudden
with disturbed attention?
Investigations, including
neuroimaging
Is a non-vascular etiology for
dementia identified?
Is a vascular etiology for
dementia identified?
Is parkinsonism, visual hallucinations
or fluctuating cognition present?
Is presentation with isolated
language and/or executive deficits?
Is episodic memory deficit prominent?
Consider depression,
anxiety, normal agingNO
NO
Mild Cognitive
Impairment
YES Delirium
Is cognitive impairment
persistent despite
appropriate treatment
YES
YES
Toxic, NPH, tumor, Huntington, head
injury, MS, HIV, Neurosyphilis, CJD,
metabolic – thyroid, B12 deficiency
YES
Vascular dementia,
SDH, vasculitis
YES
Dementia with Lewy bodies,
Parkinson’s disease dementia
YES Frontotemporal dementia
YES Alzheimer’s disease
DIAGNOSTIC PROCESSFillit,H.M.&etal.(2010).
32.
33. ALZHEIMER’S DISEASE
Impairment in memory
Functional impairment social
or vocational
And impairment in one other
cognitive area
Agnosia - impaired ability recognize objects
Aphasia - language disturbances in expressing,
understanding
Apraxia - inability to carry out motor activities
Attention
Executive function
Visuospatial ability
Other criteria:
Progression is
insidious and
other diseases that
could cause
cognitive decline
have been ruled
out, diagnosis is
primarily based on
clinical judgment.
Fillit, H. M. & et al. (2010).
34. AD - Damage to plaque and
neurofibrillary tangles, synapse
loss, atrophy starts medial
temporal lobe
SIGNS AND SYMPTOMS
Understanding Language
Processing Auditory
Information
Organizing Information
Memory
Learning
35. JILL, 86 YO CAUCASIAN FEMALE,
COMPLETED SOME COLLEGE
CAM: negative
ADLs: Independent in eating & transfer
IADLs: Dependent in ALL
GDS: 4/15, negative
Labs: not remarkable
Brain Imaging: Diffuse atrophy
PMH: HTN, DM II, CAD
Physical Exam: Confabulates
Increasingly more forgetful for the past 6
months…
36. CAM - negative
No Feature 1: Acute Onset or Fluctuating Course
No Feature 2: Inattention
No Feature 3: Disorganized thinking
No Feature 4: Altered Level of consciousness
The diagnosis of delirium by CAM requires the
presence of features 1 and 2 and either 3 or 4.
Inouye, S. & et al. (1990).
41. Feature Delirium Dementia Depression
Onset Sudden Insidious Recent
Course over 24
Hours
Fluctuates, often
worse at night
Fairly stable Fairly stable,
may be worse in
the morning
Consciousness Reduced Clear Clear
Alertness Variable Normal Normal
Psychomotor
Activity
Variable, mixed Normal Variable, mixed
Attention
Concentration
Disordered Normal Little
Impairment
Orientation Impaired,
fluctuates
Impaired, tries
to answer,
confabulates
Usually normal,
“I don’t know”
may try not to
answer
Speech Often
incoherent, slow
or raid
Word finding,
perseveration
May be slow
Touhy, T. & Jett, K. (2012).
42. VASCULAR DEMENTIA
Second most prevalent
dementia 1/3
Also know as multi-
infarct dementia
The brain has multiple
vascular lesions in the
cortex and subcortical
areas, sometimes called
“small strokes”
Memory loss most
common complaint
The cognitive changes
that occur are directly
related to the location of
the lesions
Working memory more
likely to be impaired
more than delayed recall
Fillit, H. M. & et al. (2010).
44. JOHN, 70 YO CAUCASIAN MALE,
RETIRED PHARMACIST
CAM: negative
ADLs: Independent in ALL
IADLs: Dependent in ALL
GDS: 3/15, negative
Labs: ESRD
PMH: Insulin dependent diabetic
Physical Exam: gait imbalance, due
worsening vision/peripheral neuropathy
Reports he trusts his wife to make all his
decisions as he no longer can, “I do whatever
she wants…”
45. JOHN’S MRI
MRI Brain:
Small punctate acute ischemic lesion
in the right hippocampus, diffuse
extensive chronic white matter
microvascular ischemic changes and
volume loss advanced for age.
46.
47. Functional Assessment
Staging (FAST)
Stage 1 Normal adult.
No functional decline.
Stage 2 Normal older adult.
Personal awareness of some functional
decline.
Stage 3 Early AD. Noticeable deficits
in demanding job situations.
Stage 4 Mild AD. Requires assistance
in complicated tasks such as handling
finances, planning parties, etc.
Stage 5 Moderate AD.
Requires assistance in choosing proper
attire.
Stage 6 Moderately Severe AD.
Requires assistance dressing, bathing,
and toileting. Experiences urinary and
fecal incontinence.
Stage 7 Severe AD.
Speech ability declines to about a half-
dozen intelligible words. Progressive
loss of the ability to walk, sit-up, smile,
and hold head up.
48. maintaining
reestablishing
independence
Improving and
stabilizing cognitive
ability and mood
TREATMENT GOALS
effective future
planning
symptom
management
orientating
redirecting
pharmacologic
therapies
daily care
safety as
needed
Fillit, H. M. & et al. (2010) & Bereczki, D. & Szatmári, S. (2009).
caregiver
interventions
nonpharmacologic
promoting
autonomy
49. NON-PHARMACOLOGIC
INTERVENTIONS
DEMENTIA
Person-Centered Care
Structure the environment and relationships to
maintain stability – Stable & Predictable
Establish a caring relationship
Provide unconditional positive regard
Find causes of behavior, identify triggers
Provide as much control as possible
Touhy, T. & Jett, K. (2012).
52. DEMENTIA KEY FINDINGS
Most people wish to be told of their diagnosis
Improving the likelihood of earlier diagnosis:
medical practice-based educational programs,
introduction of accessible dementia care services,
promoting effective interaction in the health system
Early therapeutic interventions:
improving cognitive function, treating depression,
improving caregiver mood, delaying
institutionalization
World Alzheimer Report 2011
53. What’s Your Story?
"ElderlyWomanInGlasses". Licensed under CC BY-SA 3.0 via Wikimedia Commons -
http://commons.wikimedia.org/wiki/File:ElderlyWomanInGlasses.jpg#mediaviewer
/File:ElderlyWomanInGlasses.jpg
54.
55. Bereczki D, Szatmári S. Treatment of dementia and cognitive impairment:
What can we learn from the Cochrane library. J Neurol Sci [Internet]. 2009
8/15;283(1–2):207-10.
Borson S, Frank L, Bayley PJ, Boustani M, Dean M, Lin P, McCarten JR,
Morris JC, Salmon DP, Schmitt FA, Stefanacci RG, Mendiondo MS, Peschin S,
Hall EJ, Fillit H, Ashford JW. Improving dementia care: The role of screening
and detection of cognitive impairment. Alzheimer's & Dementia [Internet].
2013 3;9(2):151-9.
de Vugt ME, Verhey FRJ. The impact of early dementia diagnosis and
intervention on informal caregivers. Prog Neurobiol [Internet]. 2013 In Press.
Durso, S. C., Bowker, L. K., Price, J. D., & Smith, S. C. (Eds.). (2010). Oxford
American handbook of geriatric medicine (First ed.). New York, New York:
Oxford University Press Inc.
REFERENCES
56. Fillit HM, Rockwood K, Woodhouse K. The nervous system In:
Brocklehurst's textbook of geriatric medicine and gerontology. 7th ed.
Philadelphia: Elsevier; 2010; p. 385-432.
Inouye, S., van Dyck, C., Alessi, C., Balkin, S., Siegal, A. & Horwitz, R. (1990).
Clarifying confusion: The confusion assessment method. Annals of
Internal Medicine, 113(12), 941-948.
Patterson C, Feightner J, Garcia A, MacKnight C. General risk factors for
dementia: A systematic evidence review. Alzheimer's & Dementia [Internet].
2007 10;3(4):341-7.
Touhy, T. & Jett, K. (2012). Ebersole & Hess’ Toward healthy aging: Human
needs and nursing response, 8th edition. St. Louis: Elsevier Mosby.
Special Thank You: Department of Veterans Affairs, Saint Louis
University, SLUMS Examination. World Alzheimer Report 2009 & 2011.
REFERENCES