Alzheimer`s Disease

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DEMENTIA CARE UPDATE
JOSH ALLEN, RN, C-AL
AGENDA
•
National trends and statistics
•
The brain
•
Disease overview
•
Research update
•
Care trends and best practices
•
Risk Management
Trends and Statistics
42%
of residents living in
assisted living have
Alzheimer’s disease or
another form of dementia
Source: National Survey of Residential Care Facilities
Source: National Survey of Residential Care Facilities
Alzheimer's disease is
the sixth leading
cause of death in the
United States.
More than 5 million
Americans are living
with the disease.
1 in 3 seniors dies
with Alzheimer's or
another dementia.
In 2012, 15.4 million
caregivers provided
more than 17.5 billion
hours of unpaid care
valued at $216 billion.
Nearly 15% of caregivers
for people with
Alzheimer's or another
dementia are longdistance caregivers.
In 2013, Alzheimer's will
cost the nation $203
billion. This number is
expected to rise to $1.2
trillion by 2050.
Source: Alzheimer’s Association, Facts and Figures
www.alz.org
PREVALENCE
•
An estimated 5.2 million Americans have
Alzheimer's disease
•
Approximately 200,000 individuals younger than
age 65 have younger-onset Alzheimer's.
•
By 2025, the number of people age 65 and older
with Alzheimer's disease is estimated to reach 7.1
million
•
By 2050, the number of people age 65 and older
with Alzheimer's disease may nearly triple to a
projected 13.8 million
Source: Alzheimer’s Association, Facts and Figures
MORTALITY
•
6th leading cause of death in the United States overall
•
5th leading cause of death for those aged 65 and older
•
The only cause of death among the top 10 in America
without a way to prevent it, cure it or even slow its
progression
•
Deaths from Alzheimer's increased 68 percent between
2000 and 2010, while deaths from other major
diseases, including the number one cause of death
(heart disease), decreased
Source: Alzheimer’s Association, Facts and Figures
Source: Alzheimer’s Association, Facts and Figures
MORTALITY
•
Ambiguity about the underlying cause of death can
make it difficult to determine how many people die
from Alzheimer's
•
There are no survivors: if you do not die from
Alzheimer's disease, you die with it
•
One in every three seniors dies with Alzheimer's or
another dementia
Source: Alzheimer’s Association, Facts and Figures
IMPACT ON CAREGIVERS
•
In 2012, 15.4 million family and friends provided
17.5 billion hours of unpaid care
•
Care valued at $216.4 billion
•
80% of care provided in the community is provided
by unpaid caregivers.
•
More than 60 percent of Alzheimer's and dementia
caregivers rate the emotional stress of caregiving
as high or very high; more than one-third report
symptoms of depression
Source: Alzheimer’s Association, Facts and Figures
COST TO THE NATION
•
In 2013, the direct costs will total an estimated
$203 billion
•
Including $142 billion in costs to Medicare and
Medicaid
•
Total payments for health care, long-term care and
hospice for people with Alzheimer's and other
dementias are projected to increase from $203
billion in 2013 to $1.2 trillion in 2050 (in current
dollars)
Source: Alzheimer’s Association, Facts and Figures
Source: Alzheimer’s Association, Facts and Figures
The Brain
THE BRAIN
•
•
•
Cerebrum: remembering,
problem solving, thinking,
and feeling, also controls
movement
Cerebellum: controls
coordination and balance
Brain stem: connects the
brain to the spinal cord
and controls automatic
functions such as
breathing, digestion, heart
rate and blood pressure
THE CORTEX
Parietal Lobe
Frontal Lobe
Occipital
Lobe
Temporal Lobe
ALZHEIMER’S DISEASE
ALZHEIMER’S DISEASE
Source: Alzheimer’s Association
NEURONS
HUMANS: 85 BILLION NEURONS
•
Fruit Fly: 100 thousand neurons
•
Cockroach: One million neurons
•
Mouse: 75 million neurons
•
Cat: One billion neurons
•
Chimpanzee: 7 billion neurons
•
Elephant: 23 billion neurons
NEURONS
•
•
•
•
•
•
A nerve cell that is the basic building block of the
nervous system
Specialized to transmit information throughout the body
Communicating information in both chemical and
electrical forms
Sensory neurons carry information from the sensory
receptor cells throughout the body to the brain
Motor neurons transmit information from the brain to
the muscles of the body
Interneurons are responsible for communicating
information between different neurons in the body
CHEMICAL AND ELECTRICAL MESSAGES
Dendrite
Cell body
Axon
SYNAPSE
•
The information must be
transmitted across the
synaptic gap to the next
neuron
•
Neurotransmitters
•
Chemical messengers that
are released from the axon
terminals to cross the
synaptic gap and reach the
receptor sites of other
neurons
NEUROTRANSMITTERS
•
Acetylcholine: Associated with memory, muscle
contractions, and learning. A lack of acetylcholine in the
brain is associated with Alzheimer’s disease.
•
Endorphins: Associated with emotions and pain
perception. The body releases endorphins in response to
fear or trauma. These chemical messengers are similar to
opiate drugs such as morphine, but are significantly
stronger.
•
Dopamine: Associated with thought and pleasurable
feelings. Parkinson’s disease is one illness associated with
deficits in dopamine, while schizophrenia is strongly linked
to excessive amounts of this chemical messenger.
Disease Overview
CHECK FOR UNDERSTANDING:
What is the difference between
dementia and Alzheimer’s disease?
DEMENTIA
•
Not a specific disease
•
A general term that describes a wide range of
symptoms associated with a decline in memory or
other thinking skills severe enough to reduce a
person's ability to perform everyday activities
•
Alzheimer's disease accounts for 60 to 80 percent
of cases
•
Vascular dementia, which occurs after a stroke, is
the second most common dementia type
Source: Alzheimer’s Association
DEMENTIA
Alzheimer’s Disease
Vascular Dementia
Lewy Body
Frontotemporal
Mixed Dementia
Parkinson’s
Disease
SYMPTOMS
•
Symptoms of dementia can vary greatly
•
At least two of the following core mental functions
must be significantly impaired to be considered
dementia:
•
Memory
•
Communication and language
•
Ability to focus and pay attention
•
Reasoning and judgment
•
Visual perception
Source: Alzheimer’s Association
OTHER CAUSES OF COGNITIVE CHANGES
•
Depression
•
Medication side effects
•
Infection
•
Excess use of alcohol
•
Thyroid problems
•
Vitamin deficiencies
Source: Alzheimer’s Association
DIAGNOSIS
•
There is no one test to determine if someone has
dementia.
•
Medical history
•
Physical examination
•
Laboratory tests
•
Characteristic changes in thinking, day-to-day function
and behavior associated with each type
•
Can determine dementia with a high level of certainty
•
Harder to determine the exact type
Source: Alzheimer’s Association
ALZHEIMER’S DISEASE
Symptoms:
•
Difficulty remembering names and recent events
•
Apathy and depression
•
Impaired judgment
•
Disorientation
•
Confusion
•
Behavior changes
•
Difficulty speaking, swallowing and walking
Source: Alzheimer’s Association
ALZHEIMER’S DISEASE
Brain changes:
•
Deposits of the protein
fragment beta-amyloid
(plaques) that build up
between brain cells
•
Twisted strands of the
protein tau (tangles) that
build up inside cells
•
Evidence of nerve cell
damage and death in the
brain
Source: Alzheimer’s Association
STAGES
Stage 1
No impairment
The person does not experience any memory problems. An interview
with a medical professional does not show any evidence of symptoms
of dementia.
Stage 2
Very mild cognitive decline
The person may feel as if he or she is having memory lapses —
forgetting familiar words or the location of everyday objects. But no
symptoms of dementia can be detected during a medical examination
or by friends, family or co-workers.
Stage 3
Mild cognitive decline
Friends, family or co-workers begin to notice difficulties. During a
detailed medical interview, doctors may be able to detect problems in
memory or concentration.
Source: Alzheimer’s Association
STAGES
Stage 4
Moderate cognitive decline
At this point, a careful medical interview should be able to detect
clear-cut symptoms in several areas: forgetfulness of recent events,
greater difficulty performing complex tasks, such as planning dinner.
Stage 5
Moderately severe cognitive decline
Gaps in memory and thinking are noticeable, and individuals begin to
need help with day-to-day activities.
Stage 6
Severe cognitive decline
Memory continues to worsen, personality changes may take place
and individuals need extensive help with daily activities.
Source: Alzheimer’s Association
STAGES
Stage 7
Very severe cognitive decline
In the final stage of this disease, individuals lose the ability to respond
to their environment, to carry on a conversation and, eventually, to
control movement.
Source: Alzheimer’s Association
VASCULAR DEMENTIA
Symptoms:
•
Impaired judgment or ability to plan steps needed
to complete a task is more likely to be the initial
symptom, as opposed to the memory loss often
associated with the initial symptoms of Alzheimer's
•
Occurs because of brain injuries such as
microscopic bleeding and blood vessel blockage
•
The location of the brain injury determines how the
individual's thinking and physical functioning are
affected
Source: Alzheimer’s Association
VASCULAR DEMENTIA
Brain changes:
•
Brain imaging can often detect blood vessel
problems implicated in vascular dementia
•
In the past, evidence for vascular dementia was
used to exclude a diagnosis of Alzheimer's disease
(and vice versa)
•
That practice is no longer considered consistent
with pathologic evidence, which shows that the
brain changes of several types of dementia can be
present simultaneously
Source: Alzheimer’s Association
DEMENTIA WITH LEWY BODIES
Symptoms:
•
Often have memory loss and thinking problems
common in Alzheimer's
•
More likely than people with Alzheimer's to have
initial or early symptoms such as sleep
disturbances, well-formed visual hallucinations,
and muscle rigidity or other parkinsonian
movement features
Source: Alzheimer’s Association
DEMENTIA WITH LEWY BODIES
Brain changes:
•
Lewy bodies are abnormal aggregations (or
clumps) of the protein alpha-synuclein
•
Alpha-synuclein also aggregates in the brains of
people with Parkinson's disease, but the
aggregates may appear in a pattern that is different
from dementia with Lewy bodies
Source: Alzheimer’s Association
PARKINSON’S DISEASE
Symptoms:
•
As Parkinson's disease progresses, it often results
in a progressive dementia similar to dementia with
Lewy bodies or Alzheimer's
•
Problems with movement are a common symptom
early in the disease
•
If dementia develops, symptoms are often similar
to dementia with Lewy bodies.
Source: Alzheimer’s Association
FRONTOTEMPORAL DEMENTIA
Symptoms:
•
Typical symptoms include changes in personality
and behavior and difficulty with language
•
Nerve cells in the front and side regions of the
brain are especially affected.
•
Generally develop symptoms at a younger age (at
about age 60) and survive for fewer years than
those with Alzheimer's
Source: Alzheimer’s Association
OTHER DEMENTIAS
•
Creutzfeldt-Jakob disease
•
Normal pressure hydrocephalus
•
Huntington's Disease
•
Wernicke-Korsakoff Syndrome
Depression, Delirium or
Dementia?
DELIRIUM
•
An acute confusional state
•
Medical condition that results in confusion and
other disruptions in thinking and behavior, including
changes in perception, attention, mood and activity
level
•
Individuals living with dementia are highly
susceptible to delirium
•
Can easily go unrecognized
ONSET, COURSE, MOOD
Depression
Delirium
Dementia
Onset
Weeks to months
Hours to days
Months to years
Mood
Low/apathetic
Fluctuates
Fluctuates
Course
Chronic; responds
to treatment.
Acute; responds to Chronic, with
treatment
deterioration over
time
Source: American Medical Association
SELF-AWARENESS, ADLS, IADLS
Depression
Delirium
Dementia
SelfAwareness
Likely to be
May be aware of
Likely to hide or be
concerned about
changes in cognition; unaware of cognitive
memory impairment fluctuates
deficits
ADLs
May neglect basic
self-care
May be intact or
impaired
May be intact early,
impaired as disease
progresses
IADLs
May be intact or
impaired
May be intact or
impaired
May be intact early,
impaired before ADLs
as disease
progresses
Source: American Medical Association
Research Updates
GREAT INFO AT WWW.ALZ.ORG
CAUSES
•
Scientists know Alzheimer's disease involves
progressive brain cell failure
•
The reason cells fail isn't clear
•
Experts believe that Alzheimer's develops as a
complex result of multiple factors rather than any
one overriding cause
Source: Alzheimer’s Association
CAUSES
Age and Alzheimer’s:
•
Although Alzheimer's is not a normal part of
growing older, the greatest risk factor for the
disease is increasing age
•
After age 65, the risk of Alzheimer's doubles every
five years
•
After age 85, the risk reaches nearly 50 percent
Source: Alzheimer’s Association
CAUSES
Family History and Alzheimer’s:
•
Research has shown that those who have a parent,
brother, sister or child with Alzheimer's are more
likely to develop the disease
•
The risk increases if more than one family member
has the illness
•
Either heredity (genetics) or environmental factors
or both may play a role
Source: Alzheimer’s Association
WATCH THIS VIDEO
VIDEO:
THE ROLE OF GENETICS IN
ALZHEIMER’S
Instructors: Click on the link to the movie to begin.
The movie will open in Media player. Double click on the playing video to make it full-screen.
When movie is complete, hit escape. Then, close Media player to return to PowerPoint.
Source: Alzheimer’s Association
GENES LINKED TO ALZHEIMER’S
•
Amyloid precursor protein (APP), discovered in
1987, is the first gene with mutations found to cause an
inherited form of Alzheimer's.
•
Presenilin-1 (PS-1), identified in 1992, is the second
gene with mutations found to cause inherited
Alzheimer's. Variations in this gene are the most
common cause of inherited Alzheimer's.
•
Presenilin-2 ( PS-2), discovered 1993, is the third
gene with mutations found to cause inherited
Alzheimer's.
•
Apolipoprotein E-e4 (APOE4), discovered in 1993, is
the first gene variation found to increase risk of
Alzheimer's and remains the risk gene with the greatest
known impact. Having this mutation, however, does not
mean that a person will develop the disease.
Source: Alzheimer’s Association
TREATMENTS
Drug Name
Brand Name
Approved For
FDA Approved
donepezil
Aricept
All stages
1996
galantamine
Razadyne
Mild to moderate
2001
memantine
Namenda
Moderate to
severe
2003
rivastigmine
Exelon
Mild to moderate
2000
tacrine
Cognex
Mild to moderate
1993
Source: Alzheimer’s Association
HOW ALZHEIMER’S DRUGS WORK
Source: Alzheimer’s Association
HOW ALZHEIMER’S DRUGS WORK
Cholinesterase inhibitors
•
Slowing down the disease activity that breaks down
a key neurotransmitter
•
Donepezil, galantamine, rivastigmine and tacrine
are cholinesterase inhibitors
Source: Alzheimer’s Association
HOW ALZHEIMER’S DRUGS WORK
Memantine
•
NMDA (N-methyl-D-aspartate) receptor antagonist
•
Works by regulating the activity of glutamate, a
chemical messenger involved in learning and
memory
•
Protects brain cells against excess glutamate, a
chemical messenger released in large amounts by
cells damaged by Alzheimer's disease and other
neurological disorders
Source: Alzheimer’s Association
DIAGNOSIS
VIDEO:
ADVANCES IN BRAIN
DAMAGE
Instructors: Click on the link to the movie to begin.
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When movie is complete, hit escape. Then, close Media player to return to PowerPoint.
Source: Alzheimer’s Association
LATEST NEWS
•
Brain Atrophy Linked With Cognitive Decline in
Diabetes
•
Mediterranean Diet Is Good for the Mind, Research
Confirms
•
Alzheimer’s risk raised by high blood sugar, even
for those without diabetes
•
Exercise May Be the Best Medicine for Alzheimer‘s
Disease
DIET AND EXERCISE
VIDEO:
THE BENEFIT OF DIET AND
EXERCISE IN ALZHEIMER’S
Instructors: Click on the link to the movie to begin.
The movie will open in Media player. Double click on the playing video to make it full-screen.
When movie is complete, hit escape. Then, close Media player to return to PowerPoint.
Source: Alzheimer’s Association
Care Trends and Best Practices
CARE TRENDS AND BEST PRACTICES
•
Behavior management
•
Communication
•
Wandering and elopement
•
Co-morbidities
•
Changes in condition
•
Tips and tricks…
Behavior Management
BEHAVIOR MANAGEMENT
•
Can be one of the most challenging aspects of
caring for residents with dementia
•
The key is to have an established management
technique
•
Behaviors are not resolved, they are managed.
•
Caregivers will find caring for residents with
dementia less stressful if they accept that difficult,
and even bizarre behaviors are a normal part of the
illness
TOP 5 TIPS…
1.
Try not to take behaviors personally
2.
Remain patient and calm
3.
Explore pain as a trigger
4.
Don't argue or try to convince
5.
Accept behaviors as a reality of the disease and
try to work through it
•
Source: Alzheimer’s Association
BEHAVIOR MANAGEMENT
•
Step 1: Is the behavior a problem?
•
Step 2: What is the problem?
•
Step 3: Who, when and where?
•
Step 4: Why?
•
Step 5: How will you manage the behavior?
•
Step 6: Reassessment
STEP 1: IS THE BEHAVIOR A PROBLEM?
•
A behavior is not a problem unless it negatively
affects the resident with the behavior or other
residents
•
If a behavior does not negatively affect the resident
or other residents, management of the behavior is
not necessary
STEP 2: WHAT IS THE PROBLEM?
•
Specifically identify what the problem behavior is
STEP 3: WHO, WHEN, AND WHERE?
•
Identify with whom the problem behavior occurs,
when it occurs, and where it occurs
•
This can identify specific triggers that may be
causing the problem behaviors
•
Such as specific times of day, specific residents or
staff, or specific places or situations
STEP 4: WHY?
•
This step can be difficult but attempt to identify why
the problem behavior occurs
•
If a specific reason for the behavior cannot be
identified, it can be related to a symptom of
dementia
STEP 5: HOW WILL YOU MANAGE THE BEHAVIOR?
•
This step must be done as a team effort
•
All members of the staff and caregivers in your
community can contribute
•
Remember, problem behaviors in dementia are
managed, not resolved
STEP 6: REASSESSMENT
•
It is vital that the problem behavior is regularly
reassessed
•
Is it getting better?
•
Has it become worse?
•
Should your management solution be changed or
updated?
•
Establish a regular time frame for reassessments,
such as; every day, every week, etc.
COMMON TRIGGERS
•
Pain
•
Frustration
•
Demoralizing or infantilizing
approach
•
Misunderstanding a request
•
Fatigue
•
Communication barriers
•
Inability to perform a task
•
Inability to express needs
•
Rapid change in the environment
Communication
COMMUNICATION
•
Be patient and supportive
•
Offer comfort and reassurance
•
Avoid criticizing or correcting
•
Avoid arguing
•
Offer a guess
•
Encourage unspoken communication
•
Limit distractions
•
Focus on feelings, not facts
•
Source: Alzheimer’s Association
Behavior Tips…
AGGRESSION AND ANGER
•
•
•
•
•
•
•
•
•
Try to identify the immediate
cause
Rule out pain as a source of
stress
Focus on feelings, not the facts
Don't get upset
Limit distractions
Try a relaxing activity
Shift the focus to another activity
Decrease level of danger
Avoid using restraint or force
•
Source: Alzheimer’s Association
SLEEP ISSUES AND SUNDOWNING
•
Keep the home well lit in
the evening
•
Make a comfortable and
safe sleep environment
•
Maintain a schedule
•
Avoid stimulants and big
dinners
•
Plan more active days
•
Try to identify triggers
•
Source: Alzheimer’s Association
WANDERING
•
Carry out daily activities
•
Identify the most likely times of day that wandering may occur
•
Reassure the person if he or he feels lost, abandoned or
disoriented
•
Ensure all basic needs are met
•
Avoid busy places that are confusing and can cause
disorientation
•
Place locks out of the line of sight
•
Camouflage doors and door knobs
•
Use devices that signal when a door or window is opened
•
Provide supervision
•
Keep car keys out of sight
•
Source: Alzheimer’s Association
SEXUAL BEHAVIOR CHALLENGES
•
Ensure safety of residents and staff
•
Resident rights
•
Ability to consent
•
Communicate with family
•
Relocate if needed
Co-Morbidities
Swallowing Disorders
SWALLOWING DISORDERS
•
Dysphagia: Occurs when there is a problem with
any part of the swallowing process.
•
Aspiration: Occurs when liquids or solids are
breathed into the respiratory system instead of
properly being swallowed into the stomach.
MONITORING FOR ASPIRATION
•
Choking on foods, liquids or medication
•
Coughing during or after eating
•
Wet sounding voice
•
Extra effort to chew or swallow
•
“Pocketing” food
INTERVENTIONS
•
Have resident sit upright when eating.
•
Tilt the resident’s head slightly forward when
eating.
•
Ensure the resident remains sitting or standing
upright for at least 15-20 minutes after finishing a
meal.
•
Minimize distractions in dining area.
INTERVENTIONS
•
Do not encourage residents to talk until he/she has
swallowed his/her food.
•
Cut food into small pieces.
•
Encourage swallowing more than once after each
bite or drink.
•
Modified diets if physician ordered.
•
Request a speech therapy evaluation from the
physician to evaluate swallowing.
MODIFIED DIETS
•
Thick liquids
•
Soft foods
•
Pureed
•
Minced, ground and
chopped
Skin Breakdown
RISK FACTORS
•
•
•
•
•
•
•
•
•
•
Poor nutrition
Dehydration
Lack of ability to ambulate or move about easily
Inability to turn in bed or from side to side in chair
Decreased sensation
Poor circulation
Shearing
Loss of bladder and/or bowel control
Decreased activity
Poor cognitive function
KEEPING SKIN HEALTHY
•
Meticulous incontinence care
•
Adequate hydration and nutrition
•
Turn and reposition minimally every 2 hours
•
Hydrate skin with topical application of
lotions/creams
•
Utilization of a barrier cream/ointment for
incontinence
Falls
FALLS
•
More than 1/3 of adults 65 and older fall each year
in the US.
•
Men are more likely to die from a fall. However,
women are 67% more likely than men to have a
nonfatal fall injury.
•
When an older adult falls, the effects go beyond
physical injury.
RISK FACTORS
Resident
Environment
•
Effects of medications
•
Elevated Bed Heights
•
Eyesight problems
•
Low-seated chairs
•
Hip, leg and foot
disorders
•
Poor lighting
•
Slippery floors or nonsecured rugs
•
Clutter
•
Poorly maintained
ambulatory aides
•
Disease and illness
FALL RISK ASSESSMENT
•
Condition of resident
•
Medications
•
History of falls
•
Gait and balance
•
Ambulatory aide assessment
•
Medical history
•
Evaluation by physical therapist
GENERAL STRATEGIES
•
Remind resident to request assistance as needed.
•
Ensure all pathways are free from obstacles.
•
Provide adequate lighting.
•
Provide appropriate chairs with arms that are solid
and secure.
FALL RISK REDUCTION
•
Remind resident to request assistance as needed.
•
Ensure all pathways are free from obstacles.
•
Provide adequate lighting.
•
Provide appropriate chairs with arms that are solid and
secure.
•
Observe environment for potentially unsafe conditions.
•
Identify residents who are “at risk” for falling and
implement specific fall risk reduction strategies for that
resident
RESPONDING TO A FALL
Changes in Condition
STOP AND WATCH
CHANGES IN BEHAVIOR
•
Physical aggression
•
Physical symptoms, non-aggressive
•
Verbal aggression
•
Verbal symptoms, non-aggressive
•
Social withdrawal
•
Depression
•
Source: www.interact2.net
MENTAL STATUS CHANGE
•
New symptoms or signs of increased confusion
(e.g. disorientation, change in speech)
•
Decreased level of consciousness
•
Inability to perform usual activities (due to mental
status change)
•
New or worsened physical and/or verbal agitation
•
New or worsened delusions or hallucinations
•
Source: www.interact2.net
COMMUNICATION IS KEY!
•
Physician
•
Family
•
Licensing agency
•
Your staff
Reducing Off-Label
Use of Antipsychotics
ANTIPSYCHOTICS
•
Indicated for persons with mental illness (e.g.
schizophrenia, bipolar, etc.)
•
Primarily used to manage psychosis
•
Delusions
•
Hallucinations
ANTIPSYCHOTICS
Traditional
Atypical
•
Haldol
•
Zyprexa
•
Thorazine
•
Risperdal
•
Mellaril
•
Seroquel
•
Serentil
•
Geodon
ANTIPSYCHOTICS
Associated with significant side effects
•
Extrapyramidal effects
•
Tardive dykinesia
•
Hypotension
•
Lethargy
ANTIPSYCHOTICS
Risk of Death
•
Increased risk of death when used for residents
with dementia
•
FDA: 1.6 - 1.7 times increase in death rates
•
Specific causes of death showed that most were
due to heart related events or infections (e.g.,
pneumonia)
REDUCING OVERUSE
1) Work with the physician/prescriber
•
Don’t just ask the doctor for a prescription
•
Ask him/her for alternative solutions to manage the
issue
•
Don’t be afraid to advocate for your resident
REDUCING OVERUSE
2) Focus on Resident-Centered Care
•
Use alternative interventions
•
Physical activity
•
Increased engagement
•
Creating calm environments
•
Identifying behavioral triggers
•
Reminiscence therapy
REDUCING OVERUSE
3) Educate your staff
•
Direct care staff, med aides, and nurses
•
Dangers of overuse
•
How to avoid it
•
Address burnout and caregiver stress
REDUCING OVERUSE
4) Track and trend
•
Quality improvement efforts
•
Track and trend usage among your residents
•
Establish realistic goals for reduction
•
NCAL: Reduce off-label use of antipsychotics by
15 percent
NCAL
www.ncal.org
QUALITY GOALS
Incidence
•
% of residents who have an antipsychotic drug
initiated for an off-label use within the first 90 days
in your community
QUALITY GOALS
Incidence
# of residents with antipsychotic
drug use indicated on medical
records over the first 90 days
# of residents who have been at AL
for 90 days or less
QUALITY GOALS
Prevalence
•
% of residents with off-label use of an antipsychotic
drug
QUALITY GOALS
Prevalence
# of residents (over 90 days) with
antipsychotic drug use indicated on
medical records
# of residents (over 90 days)
QUALITY GOALS
Exclusions: FDA Approved Uses
•
Schizophrenia
•
Bipolar disorder
•
Major depressive disorder
•
Tourette’s disorder
•
Irritability associated with autistic disorder
•
Treatment of resistant depression
ANY QUESTIONS?
Quiz
QUESTION #1
Which of the following is a good intervention for a
resident with Dementia?
a)
3-5 medication prescriptions
b)
Atkins diet
c)
Regular exercise
d)
Isolation
QUESTION #1
Which of the following is a good intervention for a
resident with Dementia?
a)
3-5 medication prescriptions
b)
Atkins diet
c)
Regular exercise
d)
Isolation
QUESTION #2
A swallowing disorder is NOT considered a comorbidity when experienced by a person with
Dementia.
a)
True
b)
False
QUESTION #2
A swallowing disorder is NOT considered a comorbidity when experienced by a person with
Dementia.
a)
True
b)
False
QUESTION #3
High blood pressure increases the risk of
Alzheimer’s disease.
a)
True
b)
False
QUESTION #3
High blood pressure increases the risk of
Alzheimer’s disease.
a)
True
b)
False
QUESTION #4
When redirecting a resident who is wandering, you
should never:
a)
Attempt change of face
b)
Argue with or pull the resident
c)
Allow them to wander in a safe area
d)
All of the above
QUESTION #4
When redirecting a resident who is wandering, you
should never:
a)
Attempt change of face
b)
Argue with or pull the resident
c)
Allow them to wander in a safe area
d)
All of the above
QUESTION #5
When conducting a pre-admission appraisal, it is best to:
a.
Not allow the resident to answer questions, as they
are not a reliable source of information
b.
Interview only the resident, as they are the person
you will care for
c.
Interview both the family members and the resident
d.
All of the above
QUESTION #5
When conducting a pre-admission appraisal, it is best to:
a.
Not allow the resident to answer questions, as they
are not a reliable source of information
b.
Interview only the resident, as they are the person
you will care for
c.
Interview both the family members and the
resident
d.
All of the above
QUESTION #6
Studies how that a history of diabetes has no impact
on the likelihood of developing dementia.
a.
True
b.
False
QUESTION #6
Studies how that a history of diabetes has no impact
on the likelihood of developing dementia.
a.
True
b.
False
QUESTION #7
Alzheimer’s disease is the ______ leading cause of
death in the United States
a.
1st
b.
3rd
c.
5th
d.
6th
QUESTION #7
Alzheimer’s disease is the ______ leading cause of
death in the United States
a.
1st
b.
3rd
c.
5th
d.
6th
QUESTION #8
A lack of which of the following neurotransmitters is
associated with Alzheimer’s disease?
a.
Acetylcholine
b.
Endorphins
c.
Dopamine
d.
Serotonin
QUESTION #8
A lack of which of the following neurotransmitters is
associated with Alzheimer’s disease?
a.
Acetylcholine
b.
Endorphins
c.
Dopamine
d.
Serotonin
QUESTION #9
The main difference between delirium and dementia
is that delirium is a chronic problem that develops
slowly over time.
a.
True
b.
False
QUESTION #9
The main difference between delirium and dementia
is that delirium is a chronic problem that develops
slowly over time.
a.
True
b.
False
QUESTION #10
Which of the following are effective methods to
reduce off-label use of antipsychotic medications?
a.
Work with the physician
b.
Educate staff
c.
Track and trend
d.
All of the above
QUESTION #10
Which of the following are effective methods to
reduce off-label use of antipsychotic medications?
a.
Work with the physician
b.
Educate staff
c.
Track and trend
d.
All of the above
Evaluation
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If you have not completed your
evaluation please take time to complete
when time permits, your feedback is
greatly appreciated.

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