J Donna Sullivan, LCSW, C-ASWCM. AgeWiseConnections

Transcription

1 J Donna Sullivan, LCSW, C-ASWCM AgeWiseConnections

2 Medical terminology Assessment procedures Medication & Medication Mismanagement Caregiver Stress Family Health Care Decision Act Resources

3 Dementia vs. Delirium Types of Mental Illness Developmental Disabilities Substance Abuse/Misuse

4 Delirium Dementia abrupt gradual acute chronic over years usually reversible generally irreversible disoriented early disoriented late short attention span attention span normal hallucinations some hallucinations late onset disturbed sleep day/night reversal

5 Alzheimer's- affecting more than 5.4million people in the US alone Vascular sometimes referred to a multi-infarct dementia. Stems from small strokes often undetected that ultimately leads to a dementia diagnosis Korsakoff or Wernickel Syndrome- directly related to alcohol consumption/abuse HIV Dementia Parkinson Dementia Huntington's MS Creutzfeldt-Jakob Disease- very rare. Transmitted by way of a virus Pick s disease Head trauma

6 Major Depression PTSD Psychotic disorder Schizophrenia Schizo-affective disorder Bi-Polar

7 MR/DD Aspergers Autism Traumatic Brain Injury

8 Assessment procedures: History & Physical- blood work, functional assessment, CT scan, MRI, PET scan Psycho-social assessment- Mental Status Exam, * ADL s, IADL s environmental stressors Psychopharmacology & Psychiatric disorders (ECT?) DSM 5 (2013)- used to codify mental disorders and symptoms *ADL= Activities of Daily Living Eating Mobility Transfer Toileting

9 MEDICAL EVALUAT ION: lab/blood works, Thyroid, Blood Sugar, electrolytes, liver function, urine also, HIV and syphilis. MRI or CT scan may also be ordered. PSYCHO-SOCIAL ASSESSMENT: family history, including family health history, education, occupation, living situation, history of substance abuse. Mini-mental exam ACTIVITIES OF DAILY LIVING (ADL s): eating, sleeping,toileting and ambulation. How is the person managing (or not) at home. Also include how the person is getting his food, his/her ability to visit the doctor and (the most troubling.) are they driving!!! OBSERVATION: How do they look. Grooming, odor? appear agitated, eye contact, speech, psychotic symptoms. Environment, Hoarder???

10 Prescribing of medications from non-specialists physicians A) Multiple medications for numerous conditions B) Dosage management ( Start low. Go slow ) C) Confusion/Misuse A) Addiction B) Well meaning prescription practice

11 1. Most research on medication involves few older people. Individuals over 74 are usually excluded from clinical trials. 2. Doses of medication need to be adjusted to older adults, (OA) small body frame and reduced kidney and liver function. 3. Some medications should be avoided at all costs because they may increase the risk of falls or delirium. 4. Because OA often have multiple medications, drug interaction and adverse drug reactions (ADR s) are very common. 5. ADR s are responsible for an estimated 350,000 medication errors in nursing homes and another study showed that 10.7% of OA hospital admissions were due to ADR s 6. The American Geriatric Society (www. americangeriatrics.org ) has a listing of potentially inappropriate medications for older adults called the Beers Criteria *information from GENERATIONS, Journal of the American Society on Aging: vol:36,volumn 4 (2011)

12 Anger Denial Social Withdrawal Anxiety Depression Exhaustion Sleeplessness Irritability Lack of concentration Health problems

13 What does it provide? This law allows a patient s family member or close friend to make health care decisions for them if they lack decisional capacity and have left no prior instructions or Health Care Proxy. The law ONLY applies to patients in hospitals and nursing homes. How is lack of capacity determined? Unless previously determined by the Court; physicians (2) are involved in this decision. Laws are different for minors, for those with documented mental illness and developmental disabilities. Who can be a surrogate? The Court has stipulated a hierarchy list of surrogates: 1. Legal Guardian appointed under Article Spouse or domestic partner 3. Adult child 4. Parent 5. Brother or sister 6. Close friend- over age 18, or a relative other than those listed

14 Westchester County Department of Senior Programs and Services (914) Long Term Care Ombudsman Program (914) (Westchester County) Alzheimer's Foundations or National Association of Private Geriatric Care Managers PERS and additional home safety products: Lifeline: Voicecare: Ramps:

15 LISTEN CAREFULLY TO THE PERSON Study his/her words and actions; many confused people can express their feelings and needs but not as easily as before. GIVE SIMPLE DIRECTIONS WHEN YOU ASK THEM TO DO SOMETHING COMMUNICATE CLEARLY AND SIMPLY Use a soft, calm tone of voice, a pleasant manner to express yourself. ASK SIMPLE, CLEAR QUESTIONS The person may have a reason for not cooperating, something which he/she cannot express. Perhaps the person doesn t hear you and misunderstands. Perhaps the person doesn t feel well, or has pain. DISTRACT THE PERSON Sometimes shifting attention gets better results than trying to reason with the person. USE HUMOR WHEN POSSIBLE. SMILES AND LAUGHTER CAN HELP COMMUNICATION

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