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� Victoria L. Braund MD, FACP, CMD

� Division of Geriatrics,

NorthShore University HealthSystem

�Medical Director, Mather Lifeways

�Many are “people pleasers”

� They tell you want they think you want to hear

� In early dementia, social skills are well-preserved

� They sound better than they are

� You need to observe and check things out

� But don’t get caught!

� As teens, we learn…

� Finances

� Driving

� (medications)

� Organization, planning, schedules, etc

Watch for these issues

in your parents!!!� Significant changes are not seen with

normal aging…

� Memory is really quite complicated

� Long-term vs. short term

� Visual vs. verbal vs. procedural

� Memory functions in 3 steps

� Registration

� Retention

� Retrieval

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� Forgetting names!!

� Paying attention takes more effort

� Having trouble doing two things at once

� Slower processing; ex. Senior Jeopardy

championship

� Remembering later!

� Trouble with complex tasks� Finances

� Driving

� Medication management

� Learning new things

� Short term memory poor with good remote memory

� Really losing things

� All these cause trouble doing usual activities

� Changes in judgment

� Changes in mood and behavior

� Changes in personality

� Loss of interests or motivation

� Abnormal blood work (TSH, Vitamin B12)

� Medications (The PMs!)

� Physical Problems: Pain, Disease

� Impaired attention: Hearing & Vision Loss

� Sleep problems (e.g. sleep apnea)

� Habits (Alcohol consumption)

� Depression, Anxiety, Stress

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I LOVE TO DIAGNOSE THIS!� Depression higher in women, medically ill, or long term care residents

�Rarely presents with sadness

�Usually presents with poor appetite, sleep, energy level, concentration

� Patients are irritable, argumentative, indecisive

�Very treatable

� Seniors will deny “depression” so focus on

symptoms and their impact on function

� Sleep, energy, appetite

� Screen with Geriatric Depression Scale

�Neuropsychology testing

� esp. if issues with memory as well

� Treatments work best given early

� Info and support are crucial

� Pharmacological

� SSRIs are the cornerstone

� Safe and effective

� Hyponatremia in some

�Nonpharmacological

� Counseling and support

� Bright light

� Exercise

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�Driving seems so

routine, but…

�Complex neurological

activity!

� Alertness

� Coordination

� Judgment

� Orientation

� Quick decisions

�Executive function is the ability to� organize thoughts and activities,

prioritize tasks,

� manage time efficiently

� make decisions

� monitor and change behavior

� abstract thinking

�Executive function can be subtly impaired in many illnesses

�Hard for doctors to evaluate

�Clock drawing test� Were you here this morning???

�Trails A and B

�Neuropsychological testing

may be needed for high

level issues

�To the adult children:

�“Would you allow them to drive the grandchildren around?”

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�Usually patient and/or their family will

agree, although not always happily

�Occasionally, physician has to notify DMV to

revoke driver’s license

� Use the phrase “driving retirement”

� This normalizes the experience

� More positive than “quitting” or “giving up”

� May need the doctor to write a letter or an Rx !

� Refer to a Driver Rehabilitation Specialist (DRS)

� Contact

� your local rehab department

� Alz.org

� www.ADED.net

� AARP’s “55 Alive” class;

� check out aarp.org

� Senior driving classes (A-Adams etc.)

� Physical Therapy

�Optimize hearing and vision

�One third of seniors fall

every year

�Half are “frequent

fallers”

� Risk of falls increases

each decade

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� 1% of falls� hip

fractures

� 6%of falls� any

fractures

� Soft tissue injuries

� Fear of falling

Intrinsic Extrinsic

Age Medications

Vision Assistive devices

Hearing Environment

Medical Issues

� Increase with age, as above

�Hearing and vision issues

� Independent of age

�Medical Issues

� Neurological

� Arthritis

� Dizziness

� Foot issues

Intrinsic Extrinsic

Age Medications

Vision Assistive devices

Hearing Environment

Medical Issues

�Most important: Medications !!

�Why??

� Change in blood pressure

� Dizziness

� Sedation

�Got ‘em??

�Use ‘em!!

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� Check blood pressure

� Lying, standing, standing at 3”

�Medication review—see next slide

� Vision, hearing

� Check feet

� Check gait

�Osteoporosis Evaluation

� Yes, men too!

� DEXA is easy, painless

� Covered under Medicare

every 2 years

� Can direct treatment

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� Companion/”housekeeper”� Part-time vs. live-in

� Agency vs. private

� Geriatrics Care Manager� Esp for long-distance caregiving

� Social Service Agency� Aoa.gov

� Eldercare.gov

� Meals on Wheels

� Adult Day program

� For memory loss

� Driver’s evaluation

� Transportation programs for older adults in

their communities

� Alzheimer’s Association support group and

Safe return program

�Hospice

�Online resources

� Independent living communities

� Assisted living communities

� Look carefully at the services provided!

�Nursing homes

� Medical

� Memory support

� The best website; www. alz.org

� Check out the “Maintain Your Brain” link

� Great info on diagnosis, treatment, caregiving,

and advocacy

� Caregiver.org

� Agingparents.com

� AARP.com

�Medicare.gov

� The 36 Hour Day by Rabins and Mace

� the care-giving bible

� Both by Gary Small M.D., UCLA Center on

Aging:

� The Memory Bible (2002)

� How food, medicines, exercise, alcohol, stress etc.

affect the aging of our brain

� The Memory Prescription (2004)

� Mental activity, physical conditioning, stress

reduction, diet for brain and body health

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� Remember the 98 year old with the

dwindles???

� Family weighed alternatives

� Stay in San Diego with a caregiver??

� Move nearer family??

� Decision: Move to retirement community

with 2 meals a day and activities

� Doing much better!

�Black coffee

� very hot

�White wine

� very cold

�Loads of friends

�Crosswords

�A really good HDL