Deprescribing. Living with Dementia: Staying at Home. Webinar #5 Webinar #1. Jessica Visco, PharmD, CGP. SeniorPharmAssist.

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1 Webinar #5 Webinar #1 Living with Dementia: Safety, Security Deprescribing and Staying at Home Mitchell Heflin, MD, MHS Cornelia Poer, MSW, LCSW Lisa Gwyther, MSW, LCSW Jessica Visco, PharmD, CGP SeniorPharmAssist Deprescribing Jessica Visco, PharmD, CGP SeniorPharmAssist August 24, 2016

2 Disclosures Verification of participation will be noted by signing in via the chat box. No influential financial relationships have been disclosed by planners or presenters which would influence the planning of the activity. If any arise, an announcement will be made at the beginning of the session. No commercial support has influenced the planning of the educational objectives and content of the activity. Any commercial support will be used for events that are not CE related.

3 Objectives Describe the balance between autonomy and safety in caring for people with dementia List methods for improving safe management of finances and medications Develop a plan for maintaining home safety Implement measures to reduce falls among people with dementia

4 The Boss Mrs. W: 85 year old retired owner of a family insurance business Developed problems with memory 3 years ago Progressive worsening Repeats herself often, trouble recalling names Increasing difficulty managing the business Recently had to pass on control of business to her son

5 More irritable recently The Boss Lives alone and still managing medications and finances at home Trouble preparing recipes Stopped driving 1 year ago Less active and unsteady on her feet

6 The Boss Medical history: Hypertension Knee osteoarthritis Hysterectomy Medications HCTZ 25 mg po qd Amlodipine 5 mg po qd Potassium Cl 10 meq po daily ASA 81 mg po daily Naproxen 220 mg 2-3 times per day as needed Exam: BP 157/84 HR 84 No orthostatic change Heart sounds regular, no murmur Lungs clear No edema, + OA in knees Neuro exam: MOCA 14/30 Deficits: Trails 0/1, cube 0/1, clock 0/3, naming 2/3, serial 7 0/3, verbal fluency 0/1 (4!), 0/5 recall (0 with prompting), 5/6 orientation CN normal except hearing loss Strength normal, Sensation in tact FTN normal, no cogwheeling No frontal signs Gait: Slowed and unsteady related to bilateral knee pain/varus deformity Koenig Scale: 4/11

7 The Boss Her son says: She is a strong willed person but I think she is getting depressed because we are taking away her independence. Can she continue to live alone? How can we help her? What safety issues concern you? Can she live alone or is it time for her to move? How can her family members help her?

8 Balancing safety and autonomy Balancing act between respecting family member s autonomy and keeping them safe. Duke Family Support Program, February 2017

9 Safety Basics Financial protections, Internet Safety Medication Management, OTCs, Toxins Safe Return/Medic Alert/ NC Silver Alert Guns, power tools, kitchen Monitoring: Low and high tech Duke Family Support Program, 2015

10 Money woes Photo: Ryan Collerd for The New York Times Money Woes Can Be Early Clue to Alzheimer s, New York Times Duke Family Support Program, February 2017

11 Money Matters She didn t want me to take over. - Daughter Duke Family Support Program, 2015

12 Managing money Money Difficulty managing finances is often one of the earliest signs of dementia People with dementia are at risk of being taken advantage of financially At some point care partners need to take over managing money Duke Family Support Program, February 2017

13 Medication issues Get rid of old medicine Put over-the-counter meds out of sight Over-taking non-recommended favorites Resistance to taking meds May need assistance with organizing and dispensing medication medication reminders Duke Family Support Program, February 2017

14 Weapons Guns and Alzheimer s don t go together The safest action is to get rid of guns Store them at a neighbor s house Sell them Take them to the police Firearms & Dementia, Department of Veterans Affairs Duke Family Support Program, February 2017

15 Home Alone But she fired all the help! Duke Family Support Program, 2015

16 Home alone? Leaving stove on Smoking Responding to emergencies Wandering University of Michigan Geriatrics Center Duke Family Support Program, February 2017

17 Home alone? Giving money away Falling often Calling frequently Opening the door to strangers University of Michigan Geriatrics Center Duke Family Support Program, February 2017

18 Is She OK Living Alone? Telephone? Mail? Internet? Med management? Day/Night? Travel outside home? Bathroom/continence? Falls/ injuries? Kitchen risks water running? Weight loss/food management Available discreet surveillance? Duke Family Support Program, 2015

19 Falls Over 65, 1 in 4 falls each year 20% have serious injury Falls are a combination of risk factors risk factors, chances of falling. Centers for Disease Control and Prevention

20 Risk of falling is high if: Falls History of falls Weakness, dizziness, balance issues Medications - high blood pressure, anxiety, sleep or depression Impaired vision Muscle coordination Sensory impairment Sleepy Disoriented Fear of falling

21 Falls Aging affects: Vision changes light/dark transition, glare, field of vision, perception Walking requires: Precise coordination of muscles Brain coordination of incoming and outgoing signals/messages Pain in joints Reflexes change Muscle strength any breakdown in the process and the person loses balance

22 Falls Dementia risk of falling Brain is having trouble telling body what to do and how to move Brain is having trouble perceiving or understanding things in environment Risk as disease progresses getting in and out of bed trying to move from bed to chair walking

23 Falls Falls happen due to combination of: Environment Physical changes Changes in ability

24 Falls Can change environment Flooring/Carpeting Lighting/Nightlights Distance to telephones Clutter Bathrooms Furniture/cord placement Storage Stairways Footwear/clothing

25 Falls Sometimes can change the person with dementia s physical ability Proper use of assistive devices Address sensory changes- vision/hearing Physical therapy Exercise (30 minutes per day) Tai Chi Walking Gardening Yoga Cannot change person with dementia s thinking ability

26 Summary Routinely assess for safety issues in people with dementia including ability to manage: Finances Medications Appliances, tools, weapons Balance decisions regarding autonomy and home safety in making decisions regarding living independently Anticipate fall hazards and means of reducing risk by physical and environmental interventions

27 Continuing Education Credits 1 hour of CE credit is being offered for this webinar. For the live webinar, to obtain the credit you must: Add your name to the chat box (to verify attendance) Complete the survey. The survey will open automatically at the end of the webinar and the link will be sent in a follow-up . If you did not register for this webinar and would like CE credit, contact julie.counts@duke.edu