Working with the Cognitively Challenged

Transcription

1 Working with the Cognitively Challenged Joanne M. Hamilton, PhD Neuropsychologist, CA PSY (760)

2 Education 1993 B.A., Human Biology, Stanford University 2000 PhD, Clinical Psychology, SDSU/UCSD Joint Doctoral Program in Clinical Psychology 2002 Post-Doctoral Fellowship, UCSD Alzheimer s Disease Research Center 2002 Research Neuroscientist, UCSD Dept. of Neurosciences 2006 Assistant Professor, Psychology, San Diego Mesa College

3 Objectives To recognize reduced decisional capacity in your clients To understand how a neuropsychologist assesses decisional capacity To learn compensation strategies for effective communication

4 Outline What is decisional capacity? What should you be looking for to gain insight into a client s capacity? What is clinical neuropsychology? What can you do to compensate for loss?

5 What is decisional capacity? Do not reproduce without permission: Joanne Hamilton, PhD

6 Decisional Capacity Possession of a set of values and goals The ability to communicate and to understand information The ability to reason and to deliberate about one s choices Appreciate foreseeable consequences of the decisions Jonsen, Veatch, & Walters, 1998

7 Competency v. Capacity Competency a legal term signifying the allor-none capability to care for oneself. Capacity Situation-specific determination of the ability to make decisions about one s welfare.

8 Capacity for what? Capacity is specific to a given situation A client might have the capacity to make some decisions but not others Capacity is changeable A client may lack decisional capacity due to delirium today but regain capacity when delirium resolves

9 Decisional capacity is not determined by the degree of agreement with healthcare providers or family Do not reproduce without permission: Joanne Hamilton, PhD

10 Delirium v. Dementia Delirium is a reversible condition caused by acute changes affecting the brain (e.g., intoxication, psychosis, infection, medication) Dementia is a progressive, irreversible condition characterized by decline in cognitive ability Both will cause changes in functional ability Not mutually exclusive

11 Gaining insight into your client s functional status Do not reproduce without permission: Joanne Hamilton, PhD

12 Mental Status Examination Appearance Alertness Speech Behavior Orientation Thought process Thought content Memory Calculations Reasoning Mood Affect Do not reproduce without permission: Joanne Hamilton, PhD

13 Decision-making Can client explain issue? Can client explain pros and cons of issue? Can client voice opinion and provide rationale?

14 Overview of clinical neuropsychology Do not reproduce without permission: Joanne Hamilton, PhD

15 What is neuropsychology? The study of cognitive and behavioral changes in people with brain disorders

16 What is a neuropsychological evaluation? A comprehensive assessment of cognitive and behavioral functions using a set of standardized tests and procedures.

17 Why clinical neuropsychology? Localize brain injury Clarify the etiology of the changes Assess severity of illness and document progression Identify strengths and weaknesses Provide recommendations to promote the functioning and well-being of the client

18 Neuropsychological Assessment of Capacity Mental Status Examination Memory Language Executive Functions Psychiatric Status Functional Status

19 Strategies for working with people who are cognitively impaired Do not reproduce without permission: Joanne Hamilton, PhD

20 Communication Do NOT speak to individual like a child Do speak in short, simple sentences Organize instructions without providing unnecessary detail Allow enough time for individual to respond

21 Memory Reduce distractions and noise Make sure that you have the client s attention Ask for a family member to attend meetings Put it in writing Provide only necessary information

22 Appointments Schedule appointments during the client s best time of day Wait until the day of to tell client about the appointment Break complex activities into smaller steps Watch for frustration and then distract

23 Decision-Making Ask yes/no questions rather than openended questions Limit the number of options Do NOT rush or pressure individual Allow the client ample time to consult with trusted advisors If possible, skip decisions that worry client

24 Summary Decisional capacity is a fluid concept Reduced decisional capacity is not always obvious Formal assessment can identify limitations in decisional capacity to help plan for and manage the client s well-being

25 For more information contact Joanne M. Hamilton, PhD (760)