REGISTRATION FORM REGISTRATION FEES RETURN REGISTRATION FORM AND PAYMENT TO:

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RETURN REGISTRATION FORM AND PAYMENT TO: UNIVERSITY OF SOUTH FLORIDA OFFICE OF CONTINUING PROFESSIONAL DEVELOPMENT P. O. BOX 917590, ORLANDO, FL 32891-7590 FAX: (813) 974-3217 OR REGISTER ONLINE AT: WWW.CME.HSC.USF.EDU CALL THE OFFICE OF CONTINUING PROFESSIONAL DEVELOPMENT AT (813) 974-4296 OR 1-800-852-5362 FOR MORE INFORMATION OR E-MAIL: HMORETTI@HSC.USF.EDU REGISTRATION FORM NAME TITLE (MD, RN, ETC.) SPECIALTY GENDER: MALE FEMALE ADDRESS COUNTY CITY STATE ZIP DAYTIME PHONE FAX NUMBER EMAIL ADDRESS PHYSICIAN PSYCHOLOGIST PSYCHIATRIST PHARMACIST PA ARNP NURSE LCSW OTHER REGISTRATION FEES ALL HEALTHCARE PROVIDERS AND OTHERS:............$99.00 "BURNING QUESTION" I WOULD LIKE THE FACULTY TO ADDRESS DURING THE PROGRAM: SPACE IS LIMITED, PLEASE REGISTER BY FEBRUARY 10, 2006 THE REGISTRATION FEE INCLUDES THE COURSE SYLLABUS, CERTIFICATE OF ATTENDANCE, RECEPTION, CONTINENTAL BREAKFAST AND REFRESHMENTS PER PARTICIPANT. UPON RECEIPT OF YOUR REGISTRATION, A CONFIRMATION LET- TER WILL BE SENT. REFUNDS WILL BE MADE UPON RECEIPT OF WRITTEN NOTICE OF CANCELLATION POSTMARKED 5 DAYS PRIOR TO THE PROGRAM DATE. THE REFUND IS SUBJECT TO A $35 PROCESSING FEE. NO REFUNDS WILL BE GIVEN IF CANCELLATION IS RECEIVED LESS THAN 10 DAYS PRIOR TO THE PROGRAM DATE. ENCLOSED IS MY CHECK MADE PAYABLE TO: USF MEDICAL SERVICES SUPPORT CORPORATION (USF MSSC) IN THE AMOUNT OF $ CREDIT CARD: VISA MASTERCARD AMEX IN THE AMOUNT OF $ CARD NUMBER EXP. DATE NAME ON CARD (PRINT) SIGNATURE PN2006588/1170

Target Audience This program has been developed to advance the knowledge of any healthcare practitioner involved in the evaluation and treatment of aging individuals, including Primary Care Physicians, Specialty Care Physicians, Psychiatrists, Psychologists, Nurse Practitioners, Physicians Assistants, Pharmacists, Long Term Care Specialists, and Hospice Professionals. Overview According to AARP, "over the next 25 years, as the nation s baby boomers age, the number of aging Americans with late life mental or emotional problems is expected to climb to 15 million-a surge of epidemic proportions". While various practitioners may concomitantly treat a patient for various chronic diseases, episodic illnesses, and injuries, often times, psychologically distressed patients go undetected and untreated. In addition, substance abuse, and polypharmacy play an important role in the diagnosis and treatment of the aging patient. There is real and present demand for the integration of psychiatric evaluation and treatment or referral by primary care and other healthcare professionals when treating the aging patient. Objectives As a result of participation in this CE program, participants will be able to: Describe aging demographics and psychiatric diagnoses in the elderly Compare and contrast distinguishing types of dementia and antidementia medications Effectively screen for early Alzheimer s disease Identify substance abuse in the elderly Screen for polypharmacy interaction risks Recognize and treat depression in late life Evaluate and treat "sundowning" in the elderly Distinguish patient and caregiver strategies for meaningful living and coping at the end of life

University of South Florida Office of Continuing Professional Development 12902 Bruce B. Downs Blvd., MDC#60 Tampa, FL 33612-4799 NON-PROFIT ORG U.S. POSTAGE PAID TAMPA, FL PERMIT NO. 1632

Physician The University of South Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The University of South Florida College of Medicine designates this educational activity for a maximum of 8 category 1 credits towards the AMA Physician s Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity. Nursing The University of South Florida College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation. This activity is for 9.6 contact hours. Pharmacy The University of South Florida College of Medicine is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program has been approved for contact hours. Universal program number is as follows: (program number). To receive continuing education credit, a pharmacist must attend the accredited sessions and must return the program evaluation instrument. In order to receive full credit, registrants must register no later than 10 minutes after the start of the meeting and must attend the entire meeting. Psychologists The University of South Florida College of Medicine is approved by the American Psychological Association to sponsor continuing education for psychologists. The University of South Florida College of Medicine maintains responsibility for this program and its content. Social Work The University of South Florida College of Public Health is an approved provider (BAP#433 Exp. 3/31/06) of continuing education credits for clinical social work, marriage and family therapy, and mental health counseling. This program has been reviewed and approved for up to 9.5, 50-minute contact hours.

COURSE DIRECTOR Francisco Fernandez, M.D. Professor and Chair, USF Health-Psychiatry GUEST FACULTY Ned Cassem, S.J, M.D. Professor of Psychiatry, Harvard Medical School USF FACULTY Lisa Brown, Ph.D Assistant Professor USF-Health Psychiatry Marguerite Poreda, MD Assistant Professor USF Department of Psychiatry Adult, Geriatric and Forensic Psychiatry Training Director Geriatric Psychiatry Associate Director Memory Disorders Clinic Jonathan Stewart, M.D. Professor in Psychiatry University of South Florida College of Medicine Chief, Geropsychiatry Section Bay Pines VA Medical Center Martha Brown, M.D. Associate Professor USF Health-Psychiatry H. James Brownlee, MD Chairman, Department of Family Medicine Friday, March 10, 2006 7:00-9:00 PM Registration & Reception Saturday, March 11, 2006 07.30-08.30 am Registration 08.30-08.35 am Welcome Francisco Fernandez, M.D. Professor and Chair, USF Health-Psychiatry

08.35-09.20 am Aging Demographics and Psychiatric Diagnoses in the Elderly Marguerite Poreda, MD 09.20-10.25 am Evaluation of the Demented Patient Jonathan Stewart, M.D. 10.25-10.40 am Break 10.40-11.25 am Screening for Early Alzheimer s Disease: Beyond the Mini-Mental State Examination Lisa Brown, Ph.D 11.25-11.45 pm Panel Discussion 11.45-1.00 pm Lunch Sunday, March 12, 2006 7:30-8:00 am Breakfast 8:00-8.45 am Sundowning and Delirium in the Elderly Francisco Fernandez, MD 8:45-9:30 am Antidementia Medications H. James Brownlee, M.D. 9:30-10:15 am Substance Abuse in the Elderly. Martha Brown, M.D. 10:15-10:30 am Break 10:30-11:15 am Depression in Late Life TBA 11:15-12:00 pm Meaningful Living and Coping at the End of Life Ned Cassem, S.J, M.D. 12:00-12:15 pm Panel Discussion 12:15-12:30 pm Evaluations & Adjourn

6000 Gulf Blvd., St. Pete Beach, FL 33706 Phone: 727.360.5551, Fax: 727.363.2367 Reservations 1.800.808.9833 Removed, quiet and inviting, the Sandpiper Hotel and Suites is the TradeWinds vacation of relaxed, tropical solitude embraced by an uncommon level of genuine hospitality. It's the soft rustling of sea grapes on a balmy gulf breeze, a quiet breakfast of muffins and coffee at your table overlooking the sea, an afternoon of soaking up the sun by the pool, a tranquil respite with that book you've been meaning to read. And of course you're invited to enjoy the many recreational and dining pleasures at both TradeWinds resorts. A block of rooms has been reserved at a special group rate of $198.00 for a standard parlor room and $213.00 for a tropical hotel room per night, plus tax which is currently 12%. Reservations made after Tuesday, January 24, 2006 will be handled on a space and rate available basis. Call reservations at 800-808- 9833 to reserve your room. Please mention the USF Trauma/Critical Care Conference when you call to reserve your room in order to receive the group rate. Directions From Tampa I-275 South to Exit 17, Pinellas Bayway/St. Pete Beach. Proceed through the toll booth and over a series of 3 bridges. At Gulf Blvd, turn right and proceed 1.5 miles. The hotel will be on your left. From Miami- Take I-75 West towards Naples. Take the I-275 North exit towards St. Petersburg, exit #228. Proceed to the SR-682 W/US-19 North which becomes the Pinellas Bayway. Proceed through the toll booth and over a series of 3 bridges. Turn right at Gulf Blvd and proceed 1.5 miles. The hotel will be on your left. If flying into the Tampa International Airport or the Clearwater/St. Petersburg International Airport, you can arrange ground transportation by calling Super Shuttle at 727-572-1111 or 800-282-6817. Taxis are also available. Please notify the CPD Office, 12901 Bruce B. Downs Blvd., MDC Box 60, Tampa, Florida, 33612 or call (813) 974-4296 a minimum of ten working days in advance of the event if a reasonable accommodation for a disability is needed. Events, activities and facilities of the University of South Florida are available without regard to race, color, sex, national origin, disability, age, or Vietnam veteran status as provided by law and in accordance with the University's respect for personal dignity. The CPD Office at the University of South Florida College of Medicine reserves the right to cancel this activity due to unforeseen circumstances. Registration fee...................$99.00 Space is limited, please register by February 10, 2006 The registration fee includes the course syllabus, certificate of attendance, reception, continental breakfast and refreshments per participant. Upon receipt of your registration, a confirmation letter will be sent. Refunds will be made upon receipt of written notice of cancellation postmarked 5 days prior to the program date. The refund is subject to a $35 processing fee. No refunds will be given if cancellation is received less than 10 days prior to the program date.