Week 4

Question 1

Dementia (also referred to as a major neurocognitive disorder) is a clinical syndrome of disruptions in ___________

Answer 1

cognition.

Question 2

Dementia affects about ___% of individuals aged 65 years and older.

Answer 2

11

Question 3

Dementia Risk factors

1. Advanced _____
2. MCI
3. __________ disease
4. Genetics: family history of dementia, PDD, cardiovascular disease, stroke, presence of ApoE4 allele on chromosome 19
5. Environment: head injury, alcohol abuse

Answer 3

1. Advanced age
2. MCI
3. Cardiovascular disease
4. Genetics: family history of dementia, PDD, cardiovascular disease, stroke, presence of ApoE4 allele on chromosome 19
5. Environment: head injury, alcohol abuse

Question 3

In addition to disruptions in cognition, dementias are commonly associated with
changes in function, ________, __________

Answer 3

mood, and behavior.

Question 4

The most common forms of progressive dementia are ___, VaD, DLB, and FTD; the
pathophysiology for each is poorly understood.

Answer 4

AD

Question 5

Clinicians are advised to be alert for _____________________________ in older adults to detect dementia and dementia-like presentation in early stages

Answer 5

cognitive and functional decline

Question 6

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

Answer 6

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

Question 7

[Dementia] Mini-Cog combines the CDT with the ________________

Answer 7

three-word recall.

Question 8

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.

Answer 8

needs

Question 9

[Dementia] Avoid the use of physical and pharmacological ___________.

Answer 9

restraints

Question 10

[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

Answer 10

functional

Question 11

[Dementia] Assure a therapeutic and safe environment: Provide an environment that is modestly stimulating, avoiding overstimulation, which can cause _________ and increase confusion

Answer 11

agitation

Question 12

[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).

Answer 12

EOL

Question 13

[Dementia] Provide __________ education and support: Respect family systems/dynamics and avoid making judgments

Answer 13

caregiver

Question 14

[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.

Answer 14

independent

Question 15

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

Answer 15

attention

Question 16

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.

Answer 16

increased mortality, hospital length of stay, transfer to long-term care facilities, depression, decreased functional and cognitive status, increased geriatric syndrome complications, and dementia.

Question 16

Delirium - ____ % of ICU patients

Answer 16

31

Question 17

Delirium - 26% to 62% of __________ care patients

Answer 17

palliative

Question 18

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

Answer 18

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

Question 19

Delirium Assess for common and other risk factors

Postoperative status
High-risk medication use (e.g., benzodiazepines)
Urinary catheterization
Physical restraints

Answer 19

Postoperative status
High-risk medication use (e.g., benzodiazepines)
Urinary catheterization
Physical restraints

Question 20

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

Answer 20

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

Question 20

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

Answer 20

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

Question 21

Delirium - Eliminate or minimize risk factors

1. Administer medications judiciously; avoid high-risk medications.
2. Prevent and/or promptly and appropriately treat infections.
3. Prevent and/or promptly treat dehydration and electrolyte disturbances.
4. Provide adequate pain control.
5. Maximize oxygen delivery (supplemental oxygen, blood, and BP support PRN)
6. Use sensory aids as appropriate.
7. Regulate bowel/bladder function.
8. Provide adequate nutrition.

Answer 21

1. Administer medications judiciously; avoid high-risk medications.
2. Prevent and/or promptly and appropriately treat infections.
3. Prevent and/or promptly treat dehydration and electrolyte disturbances.
4. Provide adequate pain control.
5. Maximize oxygen delivery (supplemental oxygen, blood, and BP support PRN)
6. Use sensory aids as appropriate.
7. Regulate bowel/bladder function.
8. Provide adequate nutrition.

Question 22

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

Answer 22

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

Question 23

Delirium is present in 10%-31% of older medical inpatients upon hospital admission and 11%-42% of older adults develop delirium during _____________

Answer 23

Delirium is present in 10%-31% of older medical inpatients upon hospital admission and 11%-42% of older adults develop delirium during hospitalization

Question 24

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.

Answer 24

delirium

Question 25

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.

Answer 25

delirium

Question 26

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.

Answer 26

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.

Question 27

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.

Answer 27

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.

Question 28

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)

Answer 28

multiple

Question 29

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.”

Answer 29

basic needs