An Evaluation of a Training Program in Restraint-Free Care for Individuals with Dementia Christina Garrison-Diehn, Clair Rummel, & Jane E.
|
|
- Jacob Newton
- 5 years ago
- Views:
Transcription
1 An Evaluation of a Training Program in Restraint-Free Care for Individuals with Dementia Christina Garrison-Diehn, Clair Rummel, & Jane E. Fisher
2 Background Disease. (Xu, Kochanek & Tejada-Vera, 2009) Dementia is the leading cause of nursing home admission (Eaker, Vierkant, & Mickel, 2002). 70% of individuals with dementia are living in a nursing home at the end of their life (Mitchell, Kiely & Hamel, 2005) Top reasons for nursing home placement: (Buhr, Kuchibhatla & Clipp, 2006) Need for more skilled care Dementia related behaviors
3 Background Behavioral challenges: Agitation Aggression Delusional speech Hallucinations Repetitive vocalizations Wandering Depressed affect Social withdrawal Prevalence rates = over 60% (Lyketsos, et al. 2002).
4 Traditional Model of Dementia Behavioral challenges = symptoms of neuropathology Attribution of behavioral disturbances as a symptoms of dementia increases the risk of excess disability Impairment in function beyond that which can be accounted for by the disease. (Dawson, Wells & Kline, 1993) Frequency of adaptive behavior is diminished prematurely. (Fisher et al.,2007) First line of treatment: antipsychotic medications
5 Antipsychotics Most common treatment = antipsychotic medications Prescribed off-label 32-58% of nursing home residents are prescribed antipsychotics (Ronchon et al., 2007; Margallo-Lana et al., 2001; Kamble et al., 2009) Typical: haloperidol, thorazine Atypical: risperidone, olanzapine Moderate evidence of efficacy (Agency of Healthcare Research and Quality, 2007)
6 Antipsychotics Adverse effects offset the advantages (Ballard et al., 2009; Schneider et al., 2006; Ballard & Waite, 2006). Increased risk of: Mortality Cerebrovascular adverse events Extrapyramidal symptoms Upper respiratory infections Sedation & confusion Premature reduction of adaptive functioning Decreased quality of life (Ballard & Margallo-Lana, 2004)
7 Contextual Model of Dementia Behavioral challenges = inability to report private events & have needs met (Fisher et al., 2007) Behavior communicates what words cannot Intervention = medical assessment + environmental assessment Evidence for contextual model: modification of the social and physical environment results in a reduction of these problems and a reduction in excess disability (Yury & Fisher, 2007; Burgio & Stevens, 1999; Buchanan & Fisher, 2002; Cohen-Mansfield & Werner, 1998).
8 Restraint Free Care Training Program Development Quality and Compliance Goals: 1. Increase staff knowledge of evidence-based practices for dementia care. 2. Reduce the use of psychotropic medications to manage behavioral challenges in residents with dementia. 3. Increase facilities ability to keep challenging residents. 4. Improve quality of life for residents with dementia by reducing excess disability and preserving adaptive functioning.
9 Restraint Free Care Training Program Development Program characteristics Available to long-term care facilities on a voluntary basis No cost to the facility Needs assessment conducted pre-training Train-the-trainer model 10 hours of training Consultation services post-training Aid in providing trainings to full staff Behavioral consultation for challenging cases Satisfied state requirement for dementia training
10 Restraint Free Care Training Program Overview Topics Covered: Stress of Dementia Care Communication Techniques Excess Disability Assessing Pain Delirium Depression Promoting Choice Delusions and Hallucinations Sexuality Behavioral Interventions Structured trainings designed to include idiographic examples from each specific facility throughout the trainings
11 Program Timeline Development & Recruitment Trainings Conducted January 2010 April 2010 May 2010 November 2010 Data Collection Through April 2011
12 Facility Characteristics Facility Type Skilled Nursing Group Home N Residents on Antipsychotic Medication Pre Training Residents on Antianxiety medication Pre Training 8 <10% - 60% 10% - 50% 12 <10% - 100% <10% - 80%
13 Participant Demographics N = 64 Gender: 85% Female Education: High School: 5% 9% 30% Asian African American Hispanic Some College: 17% AA: 17% BA: 38% Masters/Professional: 15% 47% 5% 3% 6% Native Islander Caucasian Unreported
14 Outcome Measures: Trainers Pre & Post- Training Measures - Modified (ADKS; Carpenter et al., 2009) Approaches to Dementia Questionnaire (ADQ; Lintern et al., 2000 ) Vignette 79-year-old woman Facility resident: 2 years. Recently Mrs. Hansen has been less talkative to her fellow residents and less more frequently and she is refusing to let staff give her a shower.
15 Outcome Measures Observational Data Collection Two skilled-nursing facilities in Reno, NV Resident criteria Dementia diagnosis Staff report of challenging behaviors Systematic observation of residents Staff behavior and affect when interacting with observed residents Pre- and post-training & post-facility wide training Chart review PRN administration, behavioral incidents, assessments, consults, illness, hospitalizations Medication Administration Records, nursing notes, behavioral reports, incident reports
16 Outcome Measures 3- Month Follow Up Facility characteristics Antipsychotic medication use Staff turnover Evaluation and feedback form Rate specific training objectives Room for comments Status of facility wide trainings
17 Pre & Post Results Measure N Pre Post P-value ADKS * ADKS - Contextual * ADQ Vignette Vignette - Communication Strategies * Vignette Assessment * Vignette - Consultation Vignette Environmental Strategies
18 Data Analysis underway Resident behavior + Chart review (staff behavior) Systematic review of impact of training on staff behavior Examining observed changes in adaptive behavior and Versus staff charted behavior Pain assessment Medical assessment Medication administration
19 Aggregate Observational Data of Staff Facility I IRR trials = 15% Trials Positive Staff Behavior Negative Staff Behavior Positive Affect Negative Affect Neutral Affect Pre 38 84% 12% 87% 5% 16% Post 63 86% 6% 68% 1% 7% 3 month follow-up 48 72% 13% 48% 10% 69% Facility II IRR trials = 45% Trials Positive Staff Behavior Negative Staff Behavior Positive Affect Negative Affect Neutral Affect Pre 84 81% 4% 50% 4% 74% Post % 16% 49% 3% 49% 3 month follow-up 83 87% 11% 43% 4% 69%
20 Agreement Facility I Mean Range % agreement Facility II Mean Range % agreement
21 Modules given to full staff Status of Trainings at 3 month follow-up (9 forms received) Managing the stress of dementia care 5 Knowing the facts about dementia 5 Communicating the facts about dementia 5 Knowing about excess disability 5 Assessing pain 4 Promoting choice 4 Making sense of delusions and hallucinations 3 Sexuality in long-term care 3 Ruling out excess disability 3 Ruling out delirium and depression 3 The contextual ABCs of dementia care 2 Searching for clues Part 1: Antecedent interventions 3 Searching for clues Part 2: Consequent Interventions 2
22 3-Month Follow-up Feedback (9 respondents) Criteria Articulation of training program objectives Meeting of training program objectives Effectiveness of teaching methods Flow and style of presentation Relevance of information to your situation Usefulness of handouts &/or training material Usefulness of examples Excellent Ratings Very Good Ratings Good Ratings Average Ratings Poor Ratings
23 3-Month Follow-up Feedback Reported psychotropic medication use No significant changes Anti-psychotic Anti-anxiety Responders comments Helpfulness of the training program Suggested improvements Trainings impact on staff ability to manage challenging behaviors manage challenging behaviors
24 Discussion Observational data does not indicate that the training program had an impact on staff interactions with residents Chart review data will indicate if there was an impact on other staff behavior Staff reported enjoying content and delivery of the training Especially the use of in-facility examples
25 Discussion Model based on identifying idiosyncratic barriers to effective caregiving and guided practice More intense intervention may be needed Limited use of follow-up consultation Buy-in from administration
26 Contact:
27 References Agency of Healthcare Research and Quality (2007). Efficacy and comparative effectiveness of off-label use of atypical anti-psychotics [publication no. 07-EHC003-EF]. Rockville (MD): Agency of Healthcare Research and Quality. Ballard C. & Waite J. (2006). The effectiveness of atypical antipsychotics for the treatment of aggression Ballard, C., Hanney, M.L., Douglas, S., McShane, R., Kossakowski, K., et al. (2009). The dementia antipsychotic withdrawal trial (DART-AD): Long-term follow-up of a randomized placebo-controlled trial. The Lancet Neurology, 8, Ballard, C.G. & Margallo-Lana, M.L. (2004). The relationship between antipsychotic treatment and quality of life for patients with dementia living in residential and nursing home care facilities. Journal of Clinical Psychiatry, 65(11), Buchanan, J.A., & Fisher, J.E. (2002). Functional assessment and noncontingent reinforcement in the treatment of disruptive vocalization in elderly dementia patients. Journal of Applied Behavior Analysis, 35, for improving discussions with families prior to the transition. The Gerontologist, 46, Burgio, L.D., & Stevens, A.B. (1999). Behavioral interventions and motivational systems in the nursing home. In R. Schulz, G. Maddox, & M.P. Lawton (Eds.), Annual review of gerontology and geriatrics: Vol. 18. Focus on interventions research with older adults (pp ). New York: Springer Cohen-Mansfield J, & Werner, P. (1998). The effects of an enhanced environment on nursing home residents who pace. Gerontologist 38(2), Dawson, P., Wells, D.L., & Kline, K. (1993). related dementias. New York: Springer.
28 References Eaker, E.D., Vierkant, R.A., & Mickel S.F. (2002). Predictors of nursing home admission and/or death in -based study. Journal of Clinical Epidemiology, 55: Lyketsos, C. G.,Lopez, O., Jones, B., Fitzpatrick, A.L., Breitner, J., Dekosy, S. (2002). Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: Results from the cardiovascular health study. Journal of the American Medical Association, 288, Margallo- pharmacological management of behavioural and psychological symptoms amongst dementia sufferers living in care environments. International Journal of Geriatric Psychiatry, 16, Mitchell, S.L., Kiely, D.K., Hamel, M.B. (2004). Dying with advanced dementia in the nursing home. Archives of Internal Medicine, 164, Ronchon, P.A., Stukel, T.A., Bronskill, S.E., Gomes, T., Sykora, K. et al. (2008). Variation in nursing home antipsychotic prescribing rates. Archives of Internal Medicine, 167(7), Schneider, L.S., Tariot, P.N., Dagerman, K.S., Davis, S.M., Hsiao, J.K., et al. (2006). Effectiveness of The New England Journal of Medicine, 355, Xu, J., Kochanek, K.D. & Tejada-Vera, B. (2009). Deaths: Preliminary Data for National Vital Statistics Reports 58(1). Hyattsville, Md.: National Center for Health Statistics. Yury, C., & Fisher, J.E. (2007). Meta-analysis of the effectiveness of atypical antipsychotics for the treatment of behavioral problems in persons with dementia. Psychotherapy and Psychosomatics, 76,
Management of the Acutely Agitated Long Term Care Patient
Management of the Acutely Agitated Long Term Care Patient 80 60 Graying of the Population US Population Over Age 65 Millions of Persons 40 20 0 1900 1920 1940 1960 1980 1990 2010 2030 Year Defining Dementia
More informationDescribe the University of Nevada, Reno Nevada
Preventing Excess Disability and Promoting Quality of Life University of Nevada, Reno Overview Describe the Nevada Caregiver Support Center contextual model of dementia care Describe the concept of excess
More informationWhere PASRR and Dementia Meet
Where PASRR and Dementia Meet Department of Psychology University of Nevada, Reno Overview What are the challenges in detecting and effectively responding to dementia & psychiatric related symptoms in
More informationPsychiatric and Behavioral Symptoms in Alzheimer s and Other Dementias. Aaron H. Kaufman, MD
Psychiatric and Behavioral Symptoms in Alzheimer s and Other Dementias Aaron H. Kaufman, MD Psychiatric and Behavioral Symptoms in Alzheimer s and Other Dementias Aaron H. Kaufman, M.D. Health Sciences
More informationAntipsychotic Medications
TRAIL: Team Review of EVIDENCE REVIEW & RECOMMENDATIONS FOR LTC Behavioural and psychological symptoms of dementia (BPSD) refer to the non-cognitive symptoms of disturbed perception, thought content, mood
More informationGuidelines for the Management of Behavioural and Psychological Symptoms of Dementia (BPSD) Summary document for Primary Care
Guidelines for the Management of Behavioural and Psychological Symptoms of Dementia (BPSD) Summary document for Primary Care Guidelines for the Management of Behavioural and Psychological Symptoms of Dementia
More informationThe place for treatments of associated neuropsychiatric and other symptoms
The place for treatments of associated neuropsychiatric and other symptoms Luca Pani dg@aifa.gov.it London, 25 th November 2014 Workshop on Alzheimer s Disease European Medicines Agency London, UK Public
More informationDisclosure. Speaker Bureaus. Grant Support. Pfizer Forest Norvartis. Pan American Health Organization/WHO NIA HRSA
Disclosure Speaker Bureaus Pfizer Forest Norvartis Grant Support Pan American Health Organization/WHO NIA HRSA How Common is Psychosis in Alzheimer s Disease? Review of 55 studies 41% of those with Alzheimer
More informationOrganization: Sheppard Pratt Health System Solution Title: Lean Methodology: Appropriate Antipsychotic Use on an Inpatient Dementia Unit
Organization: Sheppard Pratt Health System Solution Title: Lean Methodology: Appropriate Antipsychotic Use on an Inpatient Dementia Unit Problem: For dementia patients, antipsychotic medications are prescribed
More informationHow I Treat Aggression in Outpatients With Dementia. C. Omelan MD, FRCP(C)
How I Treat Aggression in Outpatients With Dementia C. Omelan MD, FRCP(C) Conflict of Interest I have no potential conflicts of interest to declare Overview Outline the prevalence of aggression Review
More informationPsychosis and Agitation in Dementia
Psychosis and Agitation in Dementia Dilip V. Jeste, MD Estelle & Edgar Levi Chair in Aging, Director, Stein Institute for Research on Aging, Distinguished Professor of Psychiatry & Neurosciences, University
More informationNKR 55 demens og medicin PICO 2 seponering af antipsykotisk medicin versus forsat behandling Review information
NKR 55 demens og medicin PICO 2 seponering af antipsykotisk medicin versus forsat behandling Review information Authors Sundhedsstyrelsen 1 1 [Empty affiliation] Citation example: S. NKR 55 demens og medicin
More informationBehavioral and Psychological Symptoms of dementia (BPSD)
Behavioral and Psychological Symptoms of dementia (BPSD) Chris Collins - Old Age Psychiatrist, Christchurch chris.collins@cdhb.health.nz Approaching BPSD: the right mindset Assessment Non-drug management
More informationThe burden of psychotropic drug prescribing in people with dementia: a population database study
Age and Ageing 2010; 39: 637 642 doi: 10.1093/ageing/afq090 Published electronically 12 July 2010 The Author 2010. Published by Oxford University Press on behalf of the British Geriatrics Society. All
More informationOptimal Management of Challenging Behaviours in Dementia: An Update on Pharmacologic and Non-Pharmacologic Approaches
Optimal Management of Challenging Behaviours in Dementia: An Update on Pharmacologic and Non-Pharmacologic Approaches Andrea Iaboni, MD, DPhil, FRCPC Toronto Rehab Institute, UHN Learning objectives Recognize
More informationCondensed Clinical Practice Guideline Treatment Of Patients With Schizophrenia
Condensed Clinical Practice Guideline Treatment Of Patients With Schizophrenia I. Key Points a. Schizophrenia is a chronic illness affecting all aspects of person s life i. Treatment Planning Goals 1.
More informationNeuroPharmac Journal ISSN: Alzheimer s Disease: Pharmacotherapy of noncognitive symptoms Aslam Pathan; Abdulrahman M.
ISSNISSN ISSN: 2456-3927 NeuroPharmac Journal Alzheimer s Disease: Pharmacotherapy of noncognitive symptoms Aslam Pathan; Abdulrahman M. Alshahrani www. neuropharmac.com Jan-April 2018, Volume 3, Issue
More informationManagement of Agitation in Dementia. Kimberly Triplett Ferguson, MS4
Management of Agitation in Dementia Kimberly Triplett Ferguson, MS4 Objectives 1. Review recommended evaluation of agitated patients with dementia. 2. Discuss evidence concerning nonpharmacologic management.
More informationBehavior Problems: in Long Term Care and Assisted Living
Behavior Problems: Dementia and Mental Illness in Long Term Care and Assisted Living Module I Dr. David A. Smith, M.D., FAAFP, CMD mmlearn.org is a program of Morningside Ministries Cell Phones and Pagers
More informationManagement of Behavioral Problems in Dementia
Management of Behavioral Problems in Dementia Ghulam M. Surti, MD Clinical Assistant Professor Department of Psychiatry and Human Behavior Warren Alpert Medical School of Brown University Definition of
More informationBest Practice Guideline for Accommodating and Managing Behavioural and Psychological Symptoms of Dementia in Residential Care
Best Practice Guideline for Accommodating and Managing Behavioural and Psychological Symptoms of Dementia in Residential Care A Person-Centered Interdisciplinary Approach October 25, 2012 Acknowledgements
More informationANTIPSYCHOTICS IN LONG TERM CARE: Are We Doing More Harm than Good?
ANTIPSYCHOTICS IN LONG TERM CARE: Are We Doing More Harm than Good? STEPHANIE M. OZALAS, PHARMD, BCPS, BCGP VA MARYLAND HEALTH CARE SYSTEM BALTIMORE, MD DISCLOSURES Off-label use of medications will be
More informationRe: Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities
Public Policy Division 202.393.7737 p 1212 New York Ave NW 866.865.0270 f Suite 800 www.alz.org Washington, DC 20005 Andy Slavitt Acting Administrator Centers for Medicare & Medicaid Services Department
More informationDelirium. A Plan to Reduce Use of Restraints. David Wensel DO, FAAHPM Medical Director Midland Care
Delirium A Plan to Reduce Use of Restraints David Wensel DO, FAAHPM Medical Director Midland Care Objectives Define delirium Describe pathophysiology of delirium Understand most common etiologies Define
More informationBehavioural and Psychological Symptoms and Medications Presentation
1 2 Vover s research indicated that antipsychotic med are frequently used for individual presenting with disruptive behaviours. This often combined with physical restraints Efficacy of use not justify
More informationVanderbilt & Qsource Webinar Series
Vanderbilt & Qsource Webinar Series Vanderbilt Medical Center Vanderbilt University Center for Quality Aging Qsource Session #1: Introduction to Dementia Care & QAPI Session #2: Dementia & Behavioral Disturbances
More informationAntipsychotics for Dementia Under Control or Over-Prescribed?
Antipsychotics for Dementia Under Control or Over-Prescribed? Nathaniel Hedrick, PharmD ProCare HospiceCare, Manager of Clinical Services Learning Objectives Summarize the disease progression and most
More informationUse of Anti-Psychotic Agents in Irish Long Term Care Residents with Dementia
Use of Anti-Psychotic Agents in Irish Long Term Care Residents with Dementia Aine Leen, Kieran Walsh, David O Sullivan, Denis O Mahony, Stephen Byrne, Margaret Bermingham Pharmaceutical Care Research Group,
More informationDebra Brown, PharmD, FASCP Pharmaceutical Consultant II Specialist. HMS Training Webinar January 27, 2017
Debra Brown, PharmD, FASCP Pharmaceutical Consultant II Specialist HMS Training Webinar January 27, 2017 1 Describe nationwide prevalence and types of elderly dementia + define BPSD Define psychotropic
More informationAmerican Board of Psychiatry and Neurology, Inc. Geriatric Psychiatry Core Competencies Outline
American Board of Psychiatry and Neurology, Inc. Geriatric Psychiatry Core Competencies Outline I. Geriatric Psychiatry Patient Care and Procedural Skills Core Competencies A. Geriatric psychiatrists shall
More informationSilvia Duong, 1,2 Kam-Tong Yeung, 1 and Feng Chang 1,3. 1. Introduction
Aging Research Volume 2015, Article ID 570410, 6 pages http://dx.doi.org/10.1155/2015/570410 Research Article Intramuscular Olanzapine in the Management of Behavioral and Psychological Symptoms in Hospitalized
More informationIntegrating INTERACT into Interim Pharmacist Reviews
Integrating INTERACT into Interim Pharmacist Reviews Chad R. Worz, Pharm.D. President, Medication Managers, LLC Adjunct Assistant Professor of Pharmacy Practice, University of Cincinnati, College of Pharmacy
More informationReducing Antipsychotic Drug Use in Long Term Care
Reducing Antipsychotic Drug Use in Long Term Care Janice S. Ceriotti, RPh, CGP Director of Clinical Services Omnicare Pharmacies / Eastern MO Goals and Objectives Understand the history of Antipsychotics
More informationThe efficacy of Rivastigmine in the management of the behavioral and psychological symptoms of lewy body dementia- a review of literature
Review article: The efficacy of Rivastigmine in the management of the behavioral and psychological symptoms of lewy body dementia- a review of literature Dr. Ivan Netto 1, Aditya Iyer 2, Dr. Prathamesh
More informationRisks of Antipsychotics use In Dementia
AHCA/NCAL Quality Initiative for Assisted Living Webinar Series: Safely Reducing the Off-Label Use of Antipsychotics Risks of Antipsychotics use In Dementia Sanjay P. Singh, MD Chairman & Professor, Department
More informationDelirium. Assessment and Management
Delirium Assessment and Management Goals and Objectives Participants will: 1. be able to recognize and diagnose the syndrome of delirium. 2. understand the causes of delirium. 3. become knowledgeable about
More informationCaregiver Mediated Intervention. Trumps Pharmacotherapy for BPSD
Caregiver Mediated Intervention DEMENTIA RESEARCH Trumps Pharmacotherapy for BPSD Henry Brodaty and Caroline Arasaratnam Dementia Collaborative Research Centre Assessment and Better Care Collaborative
More informationRecognition and Management of Behavioral Disturbances in Dementia
Recognition and Management of Behavioral Disturbances in Dementia Danielle Hansen, DO, MS (Med Ed), MHSA INTRODUCTION 80% 90% of patients with dementia develop at least one behavioral disturbances or psychotic
More informationScreening and Management of Behavioral and Psychiatric Symptoms Associated with Dementia
Screening and Management of Behavioral and Psychiatric Symptoms Associated with Dementia Measure Description Percentage of patients with dementia for whom there was a documented screening* for behavioral
More informationCritical Care Pharmacological Management of Delirium
Critical Care Pharmacological Management of Delirium Policy Title: in the Critical Care Unit Executive Summary: This policy provides guidance Pharmacological Management of delirium in the Critical Care
More informationAntipsychotic use in dementia: a systematic review of benefits and risks from metaanalyses
658463TAJ0010.1177/2040622316658463Therapeutic Advances in Chronic DiseaseRR Tampi, DJ Tampi research-article2016 Therapeutic Advances in Chronic Disease Original Research Antipsychotic use in dementia:
More informationClinical Trial Designs for RCTs focussing on the Treatment of Agitation in people with Alzheimer s disease
Clinical Trial Designs for RCTs focussing on the Treatment of Agitation in people with Alzheimer s disease Professor Clive Ballard Dr Byron Creese University of Exeter, UK Guardian guide for 2018: Top
More informationPharmacological Treatment of Aggression in the Elderly
Pharmacological Treatment of Aggression in the Elderly Howard Fenn, MD Adjunct Clinical Associate Professor Department of Psychiatry and Behavioral Sciences Stanford University Self-Assessment Question
More informationGERIATRIC ADULT MENTAL HEALTH SPECIALTY TEAM TRAINING MODULES
GERIATRIC ADULT MENTAL HEALTH SPECIALTY TEAM TRAINING MODULES Title of Presentation Length Description ACCEPTING THE CHALLENGE DVD created by Alzheimer s NC. ALTERNATIVES TO RESTRAINTS 1 hour Overview
More informationEvidence-Based Interventions to Improve Caregiver and Patient Outcomes in Dementia
Evidence-Based Interventions to Improve Caregiver and Patient Outcomes in Dementia Alan B. Stevens, PhD Professor, Department of Medicine Vernon D. Holleman-Lewis M. Rampy Centennial Chair in Gerontology
More informationDelirium. Geriatric Giants Lecture Series Divisions of Geriatric Medicine and Care of the Elderly University of Alberta
Delirium Geriatric Giants Lecture Series Divisions of Geriatric Medicine and Care of the Elderly University of Alberta Overview A. Delirium - the nature of the beast B. Significance of delirium C. An approach
More informationDEMENTIA and BPSD in PARKINSON'S DISEASE. DR. T. JOHNSON. NOVEMBER 2017.
DEMENTIA and BPSD in PARKINSON'S DISEASE. DR. T. JOHNSON. NOVEMBER 2017. Introduction. Parkinson's disease (PD) has been considered largely as a motor disorder. It has been increasingly recognized that
More informationTHE BEHAVIOURAL VITAL SIGNS (BVS) TOOL
DID YOU KNOW THE BEHAVIOURAL VITAL SIGNS (BVS) TOOL. Did you know that it is essential to know the target cluster(s)/symptom(s) one is treating to guide and monitor non-pharmacological approaches and pharmacological
More informationPSYCHOTROPIC SOLUTIONS
PSYCHOTROPIC SOLUTIONS A proactive approach to antipsychotic medication management A Quality Use of Medicines initiative by Choice Aged Care Copyright 2018 Key Senate Committee Recommendations: All RACF
More informationCambridge University Press Effective Treatments in Psychiatry Peter Tyrer and Kenneth R. Silk Excerpt More information
Organic disorders 1 Delirium Based on Delirium by Laura Gage and David K. Conn in Effective Treatments in Psychiatry, Cambridge University Press, 2008 Introduction Delirium needs treatment for both its
More informationPSYCHOTROPIC MEDICATIONS IN LTC CHALLENGES AND OPPORTUNITIES FOR BEST PRACTICES
PSYCHOTROPIC MEDICATIONS IN LTC CHALLENGES AND OPPORTUNITIES FOR BEST PRACTICES Coleen Kayden, RPh Medication Information Services Division of Williams Apothecary Conflicts of Interest None to report PANAC
More informationMORTALITY ASSOCIATED WITH USE OF ANTIPSYCHOTICS IN DEMENTIA: REVIEWING THE EVIDENCE
MORTALITY ASSOCIATED WITH USE OF ANTIPSYCHOTICS IN DEMENTIA: REVIEWING THE EVIDENCE KRISTA L. LANCTÔT, PHD PROFESSOR OF PSYCHIATRY AND PHARMACOLOGY, UNIVERSITY OF TORONTO; SENIOR SCIENTIST, HURVITZ BRAIN
More informationCritical Care Pharmacological Management of Delirium
Critical Care Pharmacological Management of Delirium Policy Title: in the Critical Care Unit Executive Summary: This policy provides guidance Pharmacological Management of delirium in the Critical Care
More informationChallenging ASD Cases November 11, Melanie Penner, MD, MSc, Mohammad Zubairi, MD, MEd,
Challenging ASD Cases November 11, 2017 Melanie Penner, MD, MSc, FRCPC @drmelpenner Mohammad Zubairi, MD, MEd, FRCPC @md_mszubairi Learning Objectives By the end of this workshop, participants will: 1)
More information9/11/2012. Clare I. Hays, MD, CMD
Clare I. Hays, MD, CMD Review regulatory background for current CMS emphasis on antipsychotics Understand the risks and (limited) benefits of antipsychotic medications Review non-pharmacologic management
More informationDementia: Rethinking our approach to behaviour
Dementia: Rethinking our approach to behaviour Dr Kathryn Lord Research Fellow 1 A bit about me: The 3 P s! Psychology Psychiatry Person centredcare 2 Challenging behaviours in Challenging behaviours dementia
More informationAmanda Adams-Fryatt RN MN Nurse Practitioner WRHA
Amanda Adams-Fryatt RN MN Nurse Practitioner WRHA Discuss the prevalence of BPSD Discuss the etiology of Disruptive Vocalizing Discuss memory and communication Discuss the Needs-Based Models Discuss the
More informationAtypical Antipsychotics and the Risk of Diabetes in an Elderly Population in Long-Term Care: A Retrospective Nursing Home Chart Review Study
Atypical Antipsychotics and the Risk of Diabetes in an Elderly Population in Long-Term Care: A Retrospective Nursing Home Chart Review Study Stewart G. Albert, MD, George T. Grossberg, MD, Papan J. Thaipisuttikul,
More informationPresented by Rengena Chan-Ting, DO, CMD, FACOI Jenna D. Toniatti, PharmD
Presented by Rengena Chan-Ting, DO, CMD, FACOI Jenna D. Toniatti, PharmD Define BPSD and review the spectrum of associated symptoms Review pharmacologic and non-pharmacologic treatments for BPSD Evaluate
More informationLearning Objectives. Delirium. Delirium. Delirium. Terminal Restlessness 3/28/2016
Terminal Restlessness Dr. Christopher Churchill St. Cloud VA Health Care System EC&R Service Line Director & Medical Director Hospice & Palliative Care March 31, 2016 Learning Objectives Different Terminology
More informationPsychotropic Medication. Including Role of Gradual Dose Reductions
Psychotropic Medication Including Role of Gradual Dose Reductions What are they? The phrase psychotropic drugs is a technical term for psychiatric medicines that alter chemical levels in the brain which
More informationImproving Meaningful Engagement (ME) in LTC Residents with Dementia: Applying the MemPics Program
Improving Meaningful Engagement (ME) in LTC Residents with Dementia: Applying the MemPics Program Presented by Dr. William Mansbach Founder & CEO, Mansbach Health Tools, LLC Home of the BCAT at www.thebcat.com
More informationNATIONAL INSTITUTE FOR CLINICAL EXCELLENCE SCOPE. Dementia: the management of dementia, including the use of antipsychotic medication in older people
NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE 1 Guideline title SCOPE Dementia: the management of dementia, including the use of antipsychotic medication in older people 1.1 Short title Dementia 2 Background
More informationDELIRIUM IN ICU: Prevention and Management. Milind Baldi
DELIRIUM IN ICU: Prevention and Management Milind Baldi Contents Introduction Risk factors Assessment Prevention Management Introduction Delirium is a syndrome characterized by acute cerebral dysfunction
More informationMedications for treating people with dementia: summary of evidence on cost-effectiveness
Medications for treating people with dementia: summary of evidence on cost-effectiveness Martin Knapp, A-La Park and Alistair Burns PSSRU, London School of Economics and Political Science v4 23 July 2017
More informationWhy is training not enough to make a difference in dementia care? Acknowledgements. Staff attitudes need to encourage:
Why is training not enough to make a difference in dementia care? Bob Woods Professor of Clinical Psychology of Older People University of Wales Bangor b.woods@bangor.ac.uk Acknowledgements Tracey Lintern
More informationDRAFT. Consultees are asked to consider and comment on the CEPP National Audit: Antipsychotics in Dementia document.
Enclosure No: Agenda item No: Author: Contact: xx/xxxxx/xxxx0918 xx CEPP National Audit: Antipsychotics in Dementia All Wales Therapeutics and Toxicology Centre Tel: 02920 71 6900 awttc@wales.nhs.uk 1.0
More informationWorkshop cases answers
Workshop cases answers BPSD Workshop: case histories Case 1: Mrs DM Scenario This is an 83 year old lady diagnosed with multi infarct dementia in 2008. Lives with husband and the couple are supported by
More informationMENTAL HEALTH DISEASE CLASSIFICATIONS
MENTAL HEALTH DISEASE CLASSIFICATIONS DIAGNOSIS OF MENTAL DISORDERS DSM-IV-TR Published by APA ( 2000 ) Multiaxial system 5 categories called axes Facilitate holistic assessment for care Is a great resource
More informationAccording to the U.S. Department of Health and Human
Web audio at CurrentPsychiatry.com Dr. Kales: Risks and benefits of antipsychotics and other psychotropics for behavioral and psychological symptoms of dementia THIRD OF 3 PARTS Prescribing antipsychotics
More informationCEPP National Audit Antipsychotics in Dementia
CEPP National Audit Antipsychotics in Dementia December 2018 This document has been prepared by a multiprofessional collaborative group, with support from the All Wales Prescribing Advisory Group (AWPAG)
More informationBasic Standards for Residency/Fellowship Training in Geriatric Psychiatry
Basic Standards for Residency/Fellowship Training in Geriatric Psychiatry American Osteopathic Association and American College of Osteopathic Neurologists and Psychiatrists Approved 2/2005 Revised 2/2008,
More informationDementia Support Across the Care Continuum
Dementia Support Across the Care Continuum Michelle Niedens, L.S.C.S.W. Director of Education, Programs and Public Policy Alzheimer's Association - Heart of America Chapter July 16, 2015 DEMENTIA SUPPORT
More informationTest your Knowledge: Recognizing Delirium
The Ottawa Hospital Name: Unit: Profession: RN RPN PT OT SW Other Note: Each question has only one correct answer. 1. If a patient is identified as being at high risk for developing delirium, his/her mental
More informationNeuropsychiatric Syndromes
Neuropsychiatric Syndromes Susan Czapiewski,MD VAHCS December 10, 2015 Dr. Czapiewski has indicated no potential conflict of interest to this presentation. She does intend to discuss the off-label use
More informationCHCS. Multimorbidity Pattern Analyses and Clinical Opportunities: Dementia. Center for Health Care Strategies, Inc. FACES OF MEDICAID DATA SERIES
CHCS Center for Health Care Strategies, Inc. FACES OF MEDICAID DATA SERIES Multimorbidity Pattern Analyses and Clinical Opportunities: Dementia December 2010 Cynthia Boyd, MD, MPH* Bruce Leff, MD* Carlos
More information12/17/2012. Unnecessary Drugs
Nursing Home Social Work Webinar Series December 19, 2012 Dr. Robin P. Bonifas, PhD, MSW Arizona State University School of Social Work Importance of familiarity with psychotropic medication regulations.
More informationOpinion statement. Introduction. Cognitive Disorders (M Geschwind, Section Editor)
Current Treatment Options in Neurology DOI 10.1007/s11940-012-0166-9 Cognitive Disorders (M Geschwind, Section Editor) Treatment of Behavioral and Psychological Symptoms of Alzheimer s Disease Anne Corbett,
More informationDelirium. Approach. Symptom Update Masterclass:
Symptom Update Masterclass: Delirium Jason Boland Senior Clinical Lecturer and Honorary Consultant in Palliative Medicine Wolfson Centre for Palliative Care Research Hull York Medical School University
More informationPharmacists as a vital part of the mental health of the nation
Pharmacists as a vital part of the mental health of the nation P H I L I P P I N E S P H A R M A C Y A S S O C I A T I O N C O N V E N T I O N A P R I L 2 5, 2 0 1 5 B A C O L O D T R U D I H I L T O N
More informationDelirium in the Elderly
Delirium in the Elderly ELITE 2017 Liza Genao, MD Division of Geriatrics Why should we care about delirium? It is: common associated with high mortality associated with increased morbidity Very much under-recognized
More informationManagement of Behavioral Symptoms in Dementia. Brenda Jordan, MS, ARNP, BC- PCM Dartmouth-Hitchcock Kendal
Management of Behavioral Symptoms in Dementia Brenda Jordan, MS, ARNP, BC- PCM Dartmouth-Hitchcock Kendal Behavioral Symptoms Common & troubling At least one will occur in 61-92% of those with any dementia
More informationDelirium in the Elderly
Delirium in the Elderly ELITE 2015 Mamata Yanamadala M.B.B.S, MS Division of Geriatrics Why should we care about delirium? It is: common associated with high mortality associated with increased morbidity
More informationTreatment of behavioral and psychological symptoms of dementia: a systematic review
Psychiatr. Pol. 2016; 50(4): 679 715 PL ISSN 0033-2674 (PRINT), ISSN 2391-5854 (ONLINE) www.psychiatriapolska.pl DOI: http://dx.doi.org/10.12740/pp/64477 Treatment of behavioral and psychological symptoms
More informationPsychotropic Medication Use in Canadian Long-Term Care Patients Referred for Psychogeriatric Consultation
Original Research Psychotropic Medication Use in Canadian Long-Term Care Patients Referred for Psychogeriatric Consultation Corinne E. Fischer, MD 1,2,3, Carole Cohen, MD 3,4, Lauren Forrest, BSc 3, Tom
More informationDelirium, Depression and Dementia
Delirium, Depression and Dementia Martha Watson, MS, APRN, GCNS Some material included in this presentation is adapted from: NICHE (2009). Geriatric Resource Nurse Core Curriculum [Power Point presentation].
More informationDepression in the Eldery Handout Package
Depression in the Eldery Handout Package Depression in the Elderly 1 Learning Objectives Upon completion of this module, you should be able to: 1. State the prevalence and describe the consequences of
More informationManagement of Behavioral and Psychological Symptoms in People with Dementia Living in Care Homes: A UK Perspective
Management of Behavioral and Psychological Symptoms in People with Dementia Living in Care Homes: A UK Perspective Clive Ballard Professor of Age Related Diseases, King s College London And Director of
More informationAPNA 25th Annual Conference October 21, Session 3014
Clinical Decision Making to Manage Disruptive Behavior in Older Adults: What Psychiatric Nurses Say They Do vs. What They Document Dr. Pam Lindsey Assistant Professor Millikin University School of Nursing
More informationMarita P. McCabe a *,MichaelBird b, Tanya E. Davison c, David Mellor a, Sarah MacPherson d, David Hallford a and Melissa Seedy a
Aging & Mental Health, 2015 Vol. 19, No. 9, 799 807, http://dx.doi.org/10.1080/13607863.2014.967659 An RCT to evaluate the utility of a clinical protocol for staff in the management of behavioral and psychological
More informationJBI Database of Systematic Reviews & Implementation Reports 2014;12(9)
Assessment and non-pharmacological management among adults with a dementia diagnosis in a residential care setting: a best practice implementation project Antonia Hynes RN Dip. Management 1 Sue Beirne
More informationAcross the Spectrum of Dementia. Keys to Understanding Behaviours & Anticipating Needs
Across the Spectrum of Dementia Keys to Understanding Behaviours & Anticipating Needs Outline Review current predictions for dementia prevalence, & the implications for future needs Discuss retrogenesis
More informationPresenter: Dr M. Elizabeth Collerson Health Law Research Program Queensland University of Technology
Presenter: Dr M. Elizabeth Collerson Health Law Research Program Queensland University of Technology Chief Investigators Queensland University of Technology Associate Professor Ben White Professor Lindy
More informationAn#psycho#c Medica#on in People with Demen#a
An#psycho#c Medica#on in People with Demen#a GERARD BYRNE BSc (Med), MBBS (Hons), PhD, FRANZCP, MFPOA School of Medicine, University of Queensland Mental Health Service, Royal Brisbane & Women s Hospital
More informationSupporting people with dementia to live well in London care homes
Supporting people with dementia to live well in London care homes London Dementia Clinical Network Date Dr Daniel Harwood; Clinical Director and Consultant Psychiatrist SLAM (Lewisham Care Home Intervention
More informationOlder People Mental Health - new directorate/new plans. Dr Adrian Treloar Clinical director
Older People Mental Health - new directorate/new plans Dr Adrian Treloar Clinical director Dementia 700,000 people in the UK currently have dementia; this number is set to double by 2038 1/3 of people
More informationGEC Delirium Resource Review Form
Resource Name: GEC Delirium Resource Review Form Delirium or Dementia: Delirium Morbidity and Mortality Case http://www.webmm.ahrq.gov/case.aspx?caseid=200 Reviewer Name: Eleanor S. McConnell, PhD, RN,
More informationResearch Journal of Pharmaceutical, Biological and Chemical Sciences
Research Journal of Pharmaceutical, Biological and Chemical Sciences Prescribing Pattern of Antipsychotics In A Tertiary Care Hospital, Salem: A Retrospective Study. B Arul 1 *, E Manivannan 2, R Kothai
More informationTRANSPARENCY COMMITTEE Opinion 19 February 2014
The legally binding text is the original French version TRANSPARENCY COMMITTEE Opinion 19 February 2014 RISPERDAL 1 mg, scored film-coated tablet B/60 (CIP: 34009 338 948 7 0) RISPERDAL 2 mg, scored film-coated
More informationDelirium. Dr. John Puxty
Delirium Dr. John Puxty Learning Objectives By the end of the workshop participants will be able to: Appreciate the main diagnostic criteria for delirium. Describe common risk factors, causes and main
More information