helping your parents age in place
TRANSCRIPT
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Helping Your Parents
AGE IN PLACEStart with the Basics
Connie Lambert, PT, CCM, PhD
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"Life is no brief candle to me. Itis a sort of splendid torch
which I
have hold of for the moment,
and I want to make it burn as
brightlyas possible before handing it
on to future generations."
George Bernard Shaw
1856-1950, Irish-Born Writer
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FACTS
0%
5%
10%
15%
20%
25%
65 or over
1985
2000
2015
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WHOWILL FILL THE GAP?
The age at time of
admission to nursing
home is 5 years older
than just 3 years ago
50% motimedmission
Acuity level has risen
dramatically
74
75
76
77
78
79
80
81
82
1st Qtr
1998
2001
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THE NATURAL AGING
PROCESS
We do NOT age from the top down Up to 15% slowing in cognitive process
Process remains intact and accurate
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DEMENTIA IS NOT GLOBAL
Mental Assets Remain !
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ASPECTS OFDEMENTIA
Cognitive
Loss ofcognitivefunction or
intellectual
abilities
Behavioral
Behavioral or socialdysfunction
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COMMONDEMENTIAS
Alzheimers Disease (40% of total
cases)
Vascular Dementia Small Vessel Dementia
Frontal Lobe Dementia
Dementia with Lewy bodies Parkinsons Disease with Dementia
Mixed Dementia
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ALZHEIMERSDISEASE
Memory loss
(85%) Denial of problem
Behaviors latestage
Variable speed ofprogression
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VASCULAR DEMENTIA
CVA
Emotional lability
Personalitychanges
Stepwise
progression
Multi-infarct
dementia
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FRONTAL LOBEDEMENTIA
2nd most common
Social Inadequacy
Inertia
Progressive loss
of speech
Frontal release
View of Human
Brain,Right
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SMALL VESSEL DEMENTIA
Circulatory and
Vascular
disease
Diabetes
Diffuse damage
Orthostasis
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DEMENTIA WITH LEWY BODIES
Delusions Hallucinations,
Severe muscle rigidity
Cerebellum, Midbrain,
Brainstem
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PARKINSONSDISEASE
25% develop dementia
Stooped Posture Rigid Muscle Tone
Festinating gait
Facial masking
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RISKS OFUNRECOGNIZED
DEMENTIA
PROBLEM
1. Medication errors
2. Mismanaged, fragmented
medical care
3. Delirium (acute confusion)
4. Mismanagement of personal
finances
RISKS1. Misuse of prescription
medications& OTC medication.
2. Inappropriate and risky tests and
procedures.
3. Susceptibility to complication
from medication, illnesses &
stressors
4. Loss of significant resources
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RISKS OFUNRECOGNIZED
DEMENTIA Cont.
PROBLEMS
5. Mistakes
6. Interpersonal conflicts
7. Poor planning
8. Lower quality of life
RISKS
5. Embarrassment
6. Alienation from family and
others (irritability, paranoia,
belligerence)
7.F
uture needs go unmet
8. Failure to receive treatment
to reduce and manage
symptoms
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MANAGING THE PROBLEM -
The 7 R s
The Right Diagnosis
The Right Environment The Right Intervention
The Right Medication
In the Right Amount All at the Right Time
As part of the Right Plan
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DIFFERENTIAL DIAGNOSIS
Comprehensive Evaluation (2 -4 hours)
Use of standardized testing tools
Social and Interpersonal Assessment Support Systems Assessment
Financial Planning and Concerns
Legal Concerns
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THE RIGHT ENVIRONMENT
Assessment of personal skills i.e. banking,
driving, grooming, cooking, socialization.
Assessment of gaps between skills andrequirements ofcurrent setting.
APLAN for progressing from one setting
to another.
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BEHAVIORS OF DEMENTIA
Depression & Apathy
Anxiety & Fear
Agitation
Aggression
Wandering
Sundowning
Repetitive
Questioning
PoorVerbal Abilities
Paranoia
Delusions
Hallucinations
Hypersexuality
Excessive Disability
and Neediness
Shadowing
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THE CHALLENGE OF
BEHAVIOR
Behavior is communication !
Environmental issues cause 90% of
behavioral problems.er what, why when. Focus! Use medications only in very
moderate amounts and in very specific
situations. Track behavioral and physical
responses.
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MEDICATION- examples
Atypical Antipsychotics
seroquel, risperidal, zyprexa, abilify
Antidepressants
celexa, lexapro, paxil, zoloft, cymbalta
Novel Antidepressantseffexor, remeron
Antiepileptics (mood stabilizers)
depakote, tegretal
Antianxiolyticsativan, buspar. xanax
NeurotransmiterManipulatives
aricept, exelon, reminyl, namenda
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THE RIGHT INTERVENTION
Determine in advance the conditions underwhich you will assume control.
Agree in advance that you will be the only
decision-maker but with input of others.
Consult with eldercare attorney and
accountant
Take charge when the time comes.
Use all available resources. NEVER accept faulty or inadequate care.
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GET STARTED
Leave Apprehension at the Doorway
Be Proactive !
Advocate Seek Out Qualified Professionals to Help
Empower Yourself with Knowledge
Trust Your Instincts
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STRESS INDICATORS FOR
CAREGIVER
Sadness
Withdrawn Tired
Trouble Sleeping
Health Problems
Irritability
Isolation
Depression
Anxiety