arden l aylor, md geriatrics. health maintenance quick office screening tools advance directives ...
TRANSCRIPT
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LONG-TERM CARE DECISION MAKING
Arden L Aylor, MDGeriatrics
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Objectives: Primary Care
Health Maintenance Quick office screening tools Advance Directives
Driving issues Care types Placement
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Health Maintenance
Primary and secondary disease prevention screening
Control chronic medical problems Bi-annual medication review Optimize function: cognitive, auditory, vision,
fall screening Assess for adequate support system Discuss and document Advanced Directives
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Optimize Function
Auditory - annual Vision - annual Fall risk Cognitive screen
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Fall Risk
Vital Signs/ Orthostatic Neurologic assessment Musculoskeletal assessment Medications Footwear Cognitive assessment Functional Reach Test
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Falls in past year?
No falls No Intervention
Recurrent falls
Single fall
Fall Evaluation
Gait & balance problem
Yes No
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Functional Reach Test
Single item test: quick screen for balance problems in older adults
Interpretation:Score of 6 or less indicates a significant increased risk for falls
>70% fall in 3 monthsScore between 6-10 inches indicates a moderate risk for falls
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Cognitive screen
MMSE MoCA (Montreal Cognitive Assessment) Clock
Score (4-1)
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Clock
4 3
21
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Driving Myths
Specific rules for older driversRenewal is every 2 years for those 85 and older Mail, phone, and electronic renewal are not available for those 79 and older
Renewal conditions: In person
Vision test: At in-person renewals
Written test: No
Road test: No, unless there is a concern (mental or physical) regarding the driver's ability to safely operate a motor vehicle TxDOT
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Quick Test
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Support & Advance Directives
Adequate support system Legal Directives
Wills Financial
Medical Directive DNR/DNI
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Home Health
Home Health Care is skilled nursing need All Medicare beneficiaries can receive home
health Physical Therapy Skilled Nursing Respiratory Care Medical Equipment Infusion Therapy Nursing aid - ADLs
No 24/7 care coverage
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Assisted Living
Level A: Resident may require minimal assistance with ADL, must be mobile, may receive home health services
Level B: Resident may receive full assistance with ADL Resident may be semi-independent and may
require the assistance for transfers or to evacuate the facility
Resident may receive assistance with medication Level C: Resident receive full assistance with ADL
Caregiver 24hrs on sight
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Nursing Home Myth
Patients need to go to hospital for nursing home placement
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Placement: Nursing Home Types
Skilled Nursing Facility (short-stay): 1-6 months Terminally ill Short term rehabilitation Debilitated post-acute care hospitalization
Nursing Home (long-stay): 6 months to years Primarily cognitively impaired Significant impairments of both cognitive and
physical functioning Primarily physically impaired
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Palliative Care
Focuses on improving the quality of life of people facing serious illness
Emphasis is placed on pain and symptom management
Goal is to improve the patients ability to tolerate medical treatments
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Hospice
Hospice care is end-of-life care Terminal diagnosis with life expectancy <6 months Offering medical, psychological and spiritual
support No invasive treatment or PT/OT Goal to help people who are dying have peace,
comfort and dignity Where: Home, Nursing Home, Hospital, Hospice
respite center
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Key Points
Advance Directive should be assessed and updated annually
Quick screen tools and be helpful in evaluating function
Patients need not go to hospital for nursing home placement
Palliative offers some degree of therapy Hospice comfort care
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References
• Texas Department of Aging and Disability Services Revision: 08-5.07• American Geriatric Society, 2011
americangeriatrics.org• Center for Medicaid and Medicare Services, 2011
cms.gov• Trailblazers CMS Texas, 2010
trailblazerhealth.com• Federal Government Publication and statistics, 2010
gov/employees/govpubs/Pages/FederalGovernmentPublications.aspx• TxDOT, 2011
txdot.gov
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Thank You!