week 9- depression, dementia and delerium Flashcards
normal changes with aging- cognitive function
- memories are stored in the hippocampus but are harder/slower to retrieve
- multitasking or distractions are less easily tolerated
risk factors for dementia- early life
less education
risk factors for dementia- mid life
hearing loss, traumatic brain injury, HT, increased alcohol consumption, obesity
risk factors for dementia- later life
smoking, depression, social isolation, physical inactivity, air pollution, diabetes
forms of dementia
alzheimer’s, lewy body dementia, vascular dementia, frontotemporal dementia, parkinson’s/huntington’s dementia
severity of dementia (in home vs LTC)
mild dementia is more prominent in home care, severe dementia is more prominent in LTC homes
prevalence of dementia
- 20,000 canadians diagnosed every month
- 1 in 4 require extensive help with ADLs, have behavioural changes and exhibit signs of depression
- 1 in 4 were admitted to hospital once in last 3 months
- 1 in 5 have been to an emergency room in the last 3 months
development of alzheimer’s
- prior to developing dementia, there is years of amyloid plaque buildup and tau tangles (10-20)
- these plaques eventually lead to cell loss and the patient displays mild cognitive impairment
- as cell loss continues, the MCI progresses to dementia within 3-5 years
testing cognition
- mini mental state examination
- has questions that test memory, executive planning, word finding, visual spatial and attention skills
role of frontal lobe
executive function, motivation, behaviour
role of temporal lobe
emotional responses, memory
role of parietal lobe
visuospatial function, praxis
role of occipital lobe
perception of visual information
stages of dementia
- MCI: poor STM, no functional impacts
- mild dementia: impacts IADLs, impacts functioning
- moderate dementia: impacts ADLs, need reminders/cues
- severe dementia: impacts ADLs, need hands on help
- very severe dementia: non-verbal, non-mobile
ability based approach to care
- people with dementia/alzheimer’s live in the moment
- break down the activity into one instruction at a time
- this will encourage participation and cooperation
symptoms of depression
feeling sad/hopeless, not participating in activities you enjoy, loss of appetite/weight loss, trouble sleeping, indecisiveness, difficulty concentrating
geriatric depression scale
- a score of 5 or more indicates depression
- used as a screening instrument
outcomes of responsive behaviours
- increased risk of secondary complications (falls, fractures, ER visits, earlier institutionalization)
- poor nutrition, higher risk of death and delirium
relational care
ongoing process of building a person’s capacity, supporting a person in their growth and well-being
management of responsive behaviours
- strong evidence for non-pharm management (music, massage, touch therapy, recreation therapy, pets)
- limited evidence for symptomatic pharmacological treatment
CGA competency framework
describes detailed practice expectations of health professionals, while preparing them to deliver comprehensive geriatric assessments and interventions
goals of CGA framework
- improve quality of assessments
- improved goal-based care planning
- better tailoring of appropriate interventions
- appropriate follow-ups
- improved consistency in assessment practices
cohen-mansfield agitation inventory
- agitation related to cognitive impairment (29 item scale)
- rated by primary caregiver, frequency over the past two weeks
community supports for OA with dementia
BSO nurses, community care peterborough, alzheimer’s society, adult day programs (VON)
comprehensive geriatric assessment
- gold standard in best practice for managing frailty
- interprofessional diagnostic intervention process that involves systematic evaluation across multiple domains, in order to identify treatable health issues and develop a care plan to maximize health
demographic of GAIN patients
majority of patients are female, in rural areas, receiving in-home care with additional paid supports
