Evaluations www.careandcompliance.com/eval We deeply value your feedback, and will utilize it in the ongoing development of our courses and services. 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. 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 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 www.careandcompliance.com/eval If you have not completed your evaluation please take time to complete when time permits, your feedback is greatly appreciated.