Helping Your Parents AGE IN PLACE Start with the Basics

Connie Lambert, PT, CCM, PhD

"Life is no brief candle to me. It

is a sort of splendid torch which I have hold of for the moment, and I want to make it burn as brightly as possible before handing it on to future generations."
George Bernard Shaw 1856-1950, Irish-Born Writer

FACTS
25% 20% 15% 10% 5% 0% 65 or over

1985 2000 2015

WHO WILL FILL THE GAP?

The age at time of admission to nursing home is 5 years older than just 3 years ago 50% motimedmission Acuity level has risen dramatically
82 81 80 79 78 77 76 75 74 1st Qtr 1998 2001

THE NATURAL AGING PROCESS

We do NOT age from the top down Up to 15% slowing in cognitive process Process remains intact and accurate

DEMENTIA IS NOT GLOBAL Mental Assets Remain !

ASPECTS OF DEMENTIA
Cognitive
Loss of cognitive function or intellectual abilities

Behavioral
Behavioral or social dysfunction

COMMON DEMENTIAS
Alzheimers Disease (40% of total cases) Vascular Dementia Small Vessel Dementia Frontal Lobe Dementia Dementia with Lewy bodies Parkinsons Disease with Dementia Mixed Dementia

ALZHEIMERS DISEASE

Memory loss (85%) Denial of problem Behaviors late stage Variable speed of progression

VASCULAR DEMENTIA
CVA Emotional lability Personality changes Stepwise progression Multi-infarct dementia

FRONTAL LOBE DEMENTIA

2nd most common Social Inadequacy Inertia Progressive loss of speech Frontal release View of Human Brain, Right

SMALL VESSEL DEMENTIA

Circulatory and Vascular disease Diabetes Diffuse damage Orthostasis

DEMENTIA WITH LEWY BODIES

Cerebellum, Midbrain, Brainstem

Delusions Hallucinations, Severe muscle rigidity

PARKINSONS DISEASE
25% develop dementia Stooped Posture Rigid Muscle Tone Festinating gait Facial masking

RISKS OF UNRECOGNIZED DEMENTIA

PROBLEM
1. Medication errors
2. Mismanaged, fragmented medical care 3. Delirium (acute confusion) 4. Mismanagement of personal finances

RISKS
1. Misuse of prescription medications& OTC medication. 2. Inappropriate and risky tests and procedures. 3. Susceptibility to complication from medication, illnesses & stressors 4. Loss of significant resources

RISKS OF UNRECOGNIZED DEMENTIA Cont.

PROBLEMS
5. Mistakes 6. Interpersonal conflicts 7. Poor planning 8. Lower quality of life

RISKS
5. Embarrassment
6. Alienation from family and others (irritability, paranoia, belligerence) 7. Future needs go unmet 8. Failure to receive treatment to reduce and manage symptoms

MANAGING THE PROBLEM The 7 Rs

The Right Diagnosis The Right Environment The Right Intervention The Right Medication In the Right Amount All at the Right Time As part of the Right Plan

DIFFERENTIAL DIAGNOSIS
Comprehensive Evaluation (2 -4 hours) Use of standardized testing tools Social and Interpersonal Assessment Support Systems Assessment Financial Planning and Concerns Legal Concerns

THE RIGHT ENVIRONMENT

Assessment of personal skills i.e. banking, driving, grooming, cooking, socialization. Assessment of gaps between skills and requirements of current setting. A PLAN for progressing from one setting to another.

BEHAVIORS OF DEMENTIA
Depression & Apathy Anxiety & Fear Agitation Aggression Wandering Sundowning Repetitive Questioning Poor Verbal Abilities Paranoia Delusions Hallucinations Hypersexuality Excessive Disability and Neediness Shadowing

THE CHALLENGE OF BEHAVIOR

Behavior is communication ! Environmental issues cause 90% of behavioral problems.er what, why when. Focus! Use medications only in very moderate amounts and in very specific situations. Track behavioral and physical responses.

MEDICATION - examples
Atypical Antipsychotics seroquel, risperidal, zyprexa, abilify Antidepressants celexa, lexapro, paxil, zoloft, cymbalta Novel Antidepressants effexor, remeron Antiepileptics (mood stabilizers) depakote, tegretal Antianxiolytics ativan, buspar. xanax Neurotransmiter Manipulatives aricept, exelon, reminyl, namenda

THE RIGHT INTERVENTION

Determine in advance the conditions under which you will assume control. Agree in advance that you will be the only decision-maker but with input of others. Consult with eldercare attorney and accountant Take charge when the time comes. Use all available resources. NEVER accept faulty or inadequate care.

GET STARTED
Leave Apprehension at the Doorway Be Proactive ! Advocate
Seek Out Qualified Professionals to Help

Empower Yourself with Knowledge Trust Your Instincts

STRESS INDICATORS FOR CAREGIVER

Sadness Withdrawn Tired Trouble Sleeping Health Problems

Irritability Isolation Depression Anxiety