Week 4 Flashcards
Dementia (also referred to as a major neurocognitive disorder) is a clinical syndrome of disruptions in ___________
cognition.
Dementia affects about ___% of individuals aged 65 years and older.
11
Dementia Risk factors
- Advanced _____
- MCI
- __________ disease
- Genetics: family history of dementia, PDD, cardiovascular disease, stroke, presence of ApoE4 allele on chromosome 19
- Environment: head injury, alcohol abuse
- Advanced age
- MCI
- Cardiovascular disease
- Genetics: family history of dementia, PDD, cardiovascular disease, stroke, presence of ApoE4 allele on chromosome 19
- Environment: head injury, alcohol abuse
In addition to disruptions in cognition, dementias are commonly associated with
changes in function, ________, __________
mood, and behavior.
The most common forms of progressive dementia are ___, VaD, DLB, and FTD; the
pathophysiology for each is poorly understood.
AD
Clinicians are advised to be alert for _____________________________ in older adults to detect dementia and dementia-like presentation in early stages
cognitive and functional decline
Dementia assessment
Cognitive parameters
1. __________ : person, place, time
2. _________ : ability to register, retain, recall information
3. _________ : ability to attend and concentrate on stimuli
4. Thinking: ability to organize and communicate ideas
5. Language: ability to receive and express a message
6. Praxis: ability to direct and coordinate movements
7. Executive function: ability to abstract, plan, sequence, and use feedback to guide
performance
Cognitive parameters
1. Orientation: person, place, time
2. Memory: ability to register, retain, recall information
3. Attention: ability to attend and concentrate on stimuli
4. Thinking: ability to organize and communicate ideas
5. Language: ability to receive and express a message
6. Praxis: ability to direct and coordinate movements
7. Executive function: ability to abstract, plan, sequence, and use feedback to guide
performance
[Dementia] Mini-Cog combines the CDT with the ________________
three-word recall.
The caregiver of the patient with dementia often has as many _______ as the patient with dementia, so a detailed assessment of the caregiver and the caregiving environment is essential.
needs
[Dementia] Avoid the use of physical and pharmacological ___________.
restraints
[Dementia] Maximize __________ capacity: Maintain mobility and encourage independence as long as possible, provide graded assistance as needed with ADL and IADL, provide scheduled toileting and prompted voiding to reduce urinary incontinence, encourage an exercise routine that expends energy and promotes fatigue at bedtime, and establish bedtime routine and rituals
functional
[Dementia] Assure a therapeutic and safe environment: Provide an environment that is modestly stimulating, avoiding overstimulation, which can cause _________ and increase confusion
agitation
[Dementia] Provide appropriate _____ care in the terminal phase: provide comfort measures, including adequate pain management; weigh the benefits/risks of the use of aggressive treatment (tube feeding, antibiotic therapy).
EOL
[Dementia] Provide __________ education and support: Respect family systems/dynamics and avoid making judgments
caregiver
[Dementia] Patient outcomes: The patient remains ___________ and functional in the environment of choice for as long as possible, the comorbid conditions the patient may experience are well managed, and the distressing symptoms that may occur at EOL are minimized or controlled adequately.
independent
Delirium is a neurocognitive disorder that develops over a short period of time (hours to days), fluctuates in severity throughout the day, and is primarily a disturbance of __________ .
Delirium is a physiological consequence of another underlying disorder
attention
Delirium Outcomes: in hospitalized older adults
increased mortality, hospital length of stay, transfer to long-term care facilities, depression, decreased functional and cognitive status, increased geriatric syndrome complications, and dementia.
increased mortality, hospital length of stay, transfer to long-term care facilities, depression, decreased functional and cognitive status, increased geriatric syndrome complications, and dementia.
Delirium - ____ % of ICU patients
31
Delirium - 26% to 62% of __________ care patients
palliative
Delirium - Risk factors: in acute hospital units
dementia, older age, comorbid illness, severity of medical illness, infection, “high-risk”
medication use, postoperative status, diminished activities of daily living, immobility, sensory impairment, urinary catheterization, urea and electrolyte imbalance, metabolic acidosis, and malnutrition
Other possible risk factors include sleep deprivation, polypharmacy, physical restraints, and anemia
dementia, older age, comorbid illness, severity of medical illness, infection, “high-risk”
medication use, postoperative status, diminished activities of daily living, immobility, sensory impairment, urinary catheterization, urea and electrolyte imbalance, metabolic acidosis, and malnutrition
Other possible risk factors include sleep deprivation, polypharmacy, physical restraints, and anemia
Delirium Assess for common and other risk factors
Postoperative status
High-risk medication use (e.g., benzodiazepines)
Urinary catheterization
Physical restraints
Postoperative status
High-risk medication use (e.g., benzodiazepines)
Urinary catheterization
Physical restraints
Assess for delirium
Key features of delirium (CAM, CAM-ICU, bCAM)
* Acute onset and fluctuating course
* Inattention
* Disorganized thinking
* Altered level of consciousness
Delirium symptoms (Nu-DESC)
* Disorientation
* Inappropriate behavior
* Inappropriate communication
* Illusions or hallucinations
* Psychomotor hypoactivity
Key features of delirium (CAM, CAM-ICU, bCAM)
* Acute onset and fluctuating course
* Inattention
* Disorganized thinking
* Altered level of consciousness
Delirium symptoms (Nu-DESC)
* Disorientation
* Inappropriate behavior
* Inappropriate communication
* Illusions or hallucinations
* Psychomotor hypoactivity
Delirium - therapeutic environment
Foster orientation: Frequently reassure and reorient patient
Provide appropriate sensory stimulation: quiet room, adequate light, pursue one task at a time, use noise-reduction strategies.
Facilitate sleep
Foster familiarity
Maximize mobility
Reassure and educate family
Consult with a geriatric specialist.
Consider psychotropic medication as a last resort for agitation
Foster orientation: Frequently reassure and reorient patient
Provide appropriate sensory stimulation: quiet room, adequate light, pursue one task at a time, use noise-reduction strategies.
Facilitate sleep
Foster familiarity
Maximize mobility
Reassure and educate family
Consult with a geriatric specialist.
Consider psychotropic medication as a last resort for agitation
Delirium - Eliminate or minimize risk factors
- Administer medications judiciously; avoid high-risk medications.
- Prevent and/or promptly and appropriately treat infections.
- Prevent and/or promptly treat dehydration and electrolyte disturbances.
- Provide adequate pain control.
- Maximize oxygen delivery (supplemental oxygen, blood, and BP support PRN)
- Use sensory aids as appropriate.
- Regulate bowel/bladder function.
- Provide adequate nutrition.
- Administer medications judiciously; avoid high-risk medications.
- Prevent and/or promptly and appropriately treat infections.
- Prevent and/or promptly treat dehydration and electrolyte disturbances.
- Provide adequate pain control.
- Maximize oxygen delivery (supplemental oxygen, blood, and BP support PRN)
- Use sensory aids as appropriate.
- Regulate bowel/bladder function.
- Provide adequate nutrition.
Delirium EVALUATION/EXPECTED OUTCOMES
Patient
1. Absence of delirium
2. Cognitive status returned to baseline (before delirium)
3. Functional status returned to baseline (before delirium)
4. Discharged to same destination as prehospitalization
Healthcare provider
1. Regular use of delirium screening tool
2. Increased detection of delirium
3. Implementation of appropriate interventions to prevent/treat delirium from
standardized protocol
Patient
1. Absence of delirium
2. Cognitive status returned to baseline (before delirium)
3. Functional status returned to baseline (before delirium)
4. Discharged to same destination as prehospitalization
Healthcare provider
1. Regular use of delirium screening tool
2. Increased detection of delirium
3. Implementation of appropriate interventions to prevent/treat delirium from
standardized protocol
Delirium is present in 10%-31% of older medical inpatients upon hospital admission and 11%-42% of older adults develop delirium during _____________
Delirium is present in 10%-31% of older medical inpatients upon hospital admission and 11%-42% of older adults develop delirium during hospitalization
The Confusion Assessment Method (CAM) is a standardized evidence-based tool that enables non-psychiatrically trained clinicians to identify and recognize _________ quickly and accurately in both clinical and research settings.
The CAM includes four features found to have the greatest ability to distinguish delirium from other types of cognitive impairment.
delirium
The presence of ________ warrants prompt intervention to identify and treat underlying causes and provide supportive care. Vigilant efforts need to continue across the healthcare continuum to preserve and restore baseline mental status.
delirium
The Confusion Assessment Method (CAM) Diagnostic Algorithm
Feature 1: Acute Onset or Fluctuating Course
Feature 2: Inattention
Feature 3: Disorganized thinking
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.
Feature 1: Acute Onset or Fluctuating Course
Feature 2: Inattention
Feature 3: Disorganized thinking
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.
When looking at caregivers for adults only, the prevalence of caregiving has risen from 16.6 percent in 2015 to 19.2 percent in 2020—an increase of over 8 million adults providing care to a family member or friend age 18 or older, primarily driven by a significant increase in the prevalence of caring for a family member or friend who is age 50 or older.
When looking at caregivers for adults only, the prevalence of caregiving has risen from 16.6 percent in 2015 to 19.2 percent in 2020—an increase of over 8 million adults providing care to a family member or friend age 18 or older, primarily driven by a significant increase in the prevalence of caring for a family member or friend who is age 50 or older.
Compared to 2015, a greater proportion of caregivers of adults are providing care to _________ people now, with 24 percent caring for two or more recipients (up from 18 percent in 2015)
multiple
Elder abuse is defined as: “(a) intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trust relationship, or (b) failure by a caregiver to satisfy the elder’s _____________ or to protect the elder from harm.”
basic needs
Risk Factors for Dementia:
Advanced _____
____________ History,
_____________ (ie head injury, alcoholism)
Advanced Age
Family History,
Enviornment (ie head injury, alcoholism)
DEMENTIA Cognitive Parameters:
orientation, memory, attention, thinking, language, praxis, executive function
orientation, memory, attention, thinking, language, praxis, executive function
DELIRIUM: ____________ disorder that develops over a short period of time
(hours to days).
Neurocognitive
DELIRIUM * Key point: a consequence of a different _______________________________________________
underlying disorder.
* Treat underlying cause!!
DELIRIUM * Risk Factors: Dementia, older age, infection.
Dementia, older age, infection.
DELIRIUM * Dx: ______ (confusion assessment Method)
* Looks at acute onset, inattention, disorgaanized thinking and ALOC.
CAM
Many individuals giving care to people over the age of 75 are __________ with one or more health conditions.
also over 75
- ______ caregivers are women
3 in 5
Risk Factors for Abuse (victim):
- Functional Dependence/Disability
- Poor Physical Health
- Cognitive Impairment
- Poor mental health
- Low income/SES
- Functional Dependence/Disability
- Poor Physical Health
- Cognitive Impairment
- Poor mental health
- Low income/SES
Risk Factors for Abuse (Perpetrator):
- Mental illness
- Substance misuse
- Abuser dependency
- Mental illness
- Substance misuse
- Abuser dependency
Types of elder Abuse:
- Physical
- Financial
- Sexual
- Emotional/Psychological
- Neglect
- Physical
- Financial
- Sexual
- Emotional/Psychological
- Neglect
· Dementia is a clinical syndrome characterized by disruptions in _________.
cognition
· An example of a task requiring use of executive function: A task that has __________________ that need to be performed in order.
several different steps
· If a patient with middle stage dementia is becoming agitated, an appropriate intervention may be to avoid attempting to orient them, and instead attempt to ________ the patient to lower their stress level.
redirect
· Be able to list two risk factors for developing dementia (write-in).
- Advanced age
- MCI
- Cardiovascular disease
- Genetics: family history of dementia, PDD, cardiovascular disease, stroke, presence of ApoE4 allele on chromosome 19
- Environment: head injury, alcohol abuse
· The following are individual (victim) factors that put an older adult at risk for abuse or neglect (5):
Functional dependence or _________
Poor __________ health
Dementia
Depression and anxiety
Low _________.
Functional dependence or disability
Poor physical health
Dementia
Depression and anxiety
Low income.
· The number of caregivers has __________ over the past few years, including an increase in caregivers providing care for ______ care recipients.
· The number of caregivers has increased over the past few years, including an increase in caregivers providing care for two care recipients.
· The majority of older adults ___ years old and older, provide care for someone who is of a similar age or older.
75
· A common occurrence seen among caregivers, is that they often ___________________________
neglect their own needs/healthcare.
· New caregivers who also work outside the home, frequently develop at least one work-related _________________
issue or challenge.
· The podcast “A Bus to Nowhere” describes the issue of Alzheimer’s and Dementia patients wandering off and getting lost. The episode explores the novel solution used at Benrath Senior Center in Düsseldorf, Germany (It does ____ describe the experience of an individual patient family, navigating the healthcare system).
not
· Describe one specific practice change you will implement, that comes from content covered during any week of this course, when caring for an older adult patient. Please limit your answer to 3-5 sentences (short essay).
Making sure not to use the same script/ limited language with older adults. It is important to provide personalized care to each older adult. I will also ensure to not assume things about older adults, such as assuming their sexuality. I will also focus not only on their physical health, but emotional well-being as well.
· Delirium is: A disturbance in ___________________________ that develops over a short period of time and tends to fluctuate in severity during the course of a day, combined with a disturbance in cognition that is neither better explained by another neurocognitive disorder, but by one or multiple physiological effects.
attention and awareness
· For patients identified as suffering from delirium (CAM +), you should seek prompt identification and _________________________ while providing supportive care.
treatment of the underlying cause
· Be able to list the 4 features of the CAM:
Fluctuating, Inattention, Disorganized, Altered consciousness.
· Five types of abuse, as described in the article by Pillemer, et al., are (write-in):
Physical, sexual, material, neglect, and financial.
· Be able to List three strategies to eliminate or minimize risk for development of delirium.
- Administer medications judiciously; avoid high-risk medications.
- Prevent and/or promptly and appropriately treat infections.
- Prevent and/or promptly treat dehydration and electrolyte disturbances.
- Provide adequate pain control.
- Maximize oxygen delivery (supplemental oxygen, blood, and BP support PRN)
- Use sensory aids as appropriate.
- Regulate bowel/bladder function.
- Provide adequate nutrition.
· Describe one thing you learned from reading the book Still Alice (short, specific, essay, 3-5 sentences).
This book showed me the emotional toll that Alzhaimers can have both on patients and on their families or caregivers. I also learned how rapidly the disease can progress and change one’s life. Patience and empathy is important when dealing with patients with this condition.
