the aging brain: maturity & making health transitions
DESCRIPTION
This presentation by Alicia I. Arbaje, M.D. was given at the 2010 RWJF Local Funding Partnerships Annual Meeting in St. Paul, MN. Aging is a time of physical, emotional, cognitive, psychosocial and health care transitions that vary in rate and severity from one individual to another. We are actively learning about the way the human brain changes in the later years of our lives. What can older individuals, their families, and our human service organizations do to maintain or improve quality of life as older adults navigate these transitions? This presentation looks at how decisions at times of transition can make the difference between independence and isolation, socialization and loneliness, maintaining vigor and declining health. It will focus on how best practices may be influenced by rural or urban locations, economic status and nonprofit versus commercial interests. We will also look at issues related to housing, physical activity, recovery from loss or illness and intergenerational relationships.forthTRANSCRIPT
The Aging Brain: Maturity & Making Health Transitions
Alicia I. Arbaje, MD, MPHAssistant Professor of MedicineAssociate Director of Transitional Care ResearchDivision of Geriatric Medicine and Gerontology
Learning Objectives• Understand demographics and special
needs of older adults
• Discuss the 3 “D’s” of the aging brain—Dementia, Depression, Delirium
• Discuss experiences from graduating programs
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Mary• 81 years old
• Completed 8th grade
• Cares for husband with dementia
• Daughter lives 20 miles away
• Six chronic conditions
• Four physicians
• Nine medications
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During the past 6 months…
Multiple settings
• 3 hospitalizations• 2 rehabilitation
stays
Several providers
• 8 physicians• 25 nurses• 7 therapists
Changes to plan of
care
• 4 medication lists• 3 new
prescriptions
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Increasing Number of Older Adults 5
Where Older Adults Live 6
How Older Adults Live 7
Sensory Impairments and Oral Health 8
How Do Older Adults Spend Their Time? 9
Residential Services 10
Residential Services 11
Older Adults Are Different• More chronic conditions• More medications• More healthcare providers• More hospitalizations• More susceptible to diseases• More difficult to diagnose• More sensitive to medications• More sensitive to changes in their environment
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CHF
Stroke
DM
Functional decline
COPD
Stroke
Older Adults are Heterogeneous
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Common Geriatric Syndromes
• Confusion
• Constipation
• Delirium / hallucinations
• Depression
• Dizziness
• Drowsiness / fatigue
• Falls and fractures
• Incontinence
• Insomnia
• Loss of coordination
• Malnutrition/dehydration
• Memory loss
• Pain
• Vision/hearing problems
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Common Consequences• Decreased quality of life• Emergency room visits• Hip fractures and other physical disabilities• Hospitalization• Loss of functional ability• Loss of independence• Nursing facility placement• Death
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Where Do They Receive Care?• Across all aspects of the care continuum▫ Emergency department▫ Hospital▫ Rehabilitation facility▫ Nursing home▫ Ambulatory care clinic▫ Hospice▫ Home
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Transitional Care
• A set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care within the same location.▫ Logistical arrangements▫ Patient/caregiver education▫ Coordination among the health professionals
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Brought to you by the letter D.
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The 3 D’s in Older Adults
• Common
• Difficult to seek help due to social stigma
• Difficult to diagnose
▫ Symptoms similar to other conditions
• Difficult to treat
▫ Take longer before seeking treatment
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What Can You Do to Impact the Brain?
• Connect older adult to the social environment
• Help deal with “retirement blues”, especiallymen
▫ Activities, hobbies, senior center
▫ Counseling
• Exercise! Just as good as medication.
• Volunteer! Can actually remodel the brain.
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What Can You Do to Impact the Brain?
• Treatment of underlying medical conditions
▫ Caveat: not too little, not too much (HTN, DM)
▫ Prevention of delirium
• Adequate nutrition
▫ Hydration
▫ Vitamin D
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Summary• Older adults have special needs from the
community
• The 3 D’s are common and can impact the success of your program
• There are several targets for intervention
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Questions for Group• How did you deal with transitions in leadership?
• How has the economy impacted your program?
• How are you reaching out to the “younger” old?
• What is the importance of data?
• What are your plans for sustainability?
• How do you help older adults feel like there are
still in control over their lives?
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