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2072 results in Geriatrics

Page 29 of 104

  • Chapter 10 - Evaluation and management of dementia

  • from Section II - Geriatric syndromes
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book:
    Reichel's Care of the Elderly
    Published online:
    05 June 2016
    Print publication:
    23 June 2016, pp 125-147

  • Summary

    Diagnostic criteria for dementia are separated into major and minor neurocognitive disorders. In major neurocognitive disorder, cognitive symptoms show a significant decline from a previous level of functioning in at least one cognitive domain. The prevalence of dementia increases with age, rising from 15% of those 65-74 years to more than 38% of those 85 and older. Estimated annual economic cost of dementia is $214 billion. Alzheimer’s dementia is the most common form of dementia. Cerebrovascular disease contributes to various subtypes of dementia. Although a definitive diagnosis of a syndrome often requires a postmortem examination, a comprehensive approach with a thorough history-taking, physical examination, tailored laboratory work and imaging studies, and neuropsychiatric testing when appropriate permit a probable diagnosis in the majority of cases. Despite the availability of diagnostic guidelines, routine screening of older adults is not recommended. Advances in understanding the pathophysiology of dementia have led to more targeted pharmacological therapies

  • Chapter 6 - Healthy aging: exercise and nutrition as medicine for older adults

  • from Section I - General approach to the care of the elderly
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book:
    Reichel's Care of the Elderly
    Published online:
    05 June 2016
    Print publication:
    23 June 2016, pp 69-96

  • Summary

    Effective exercise and nutrition prescriptions, along with counseling and support of healthy lifestyle choices, are as important as treatment of disease in promoting healthy aging. Exercise prescriptions should consider individual risks and benefits, appropriate modality and dose; possible drug interactions, and use of behavioral techniques to optimize adoption and adherence. The elderly, women, minorities, and those with low income, low educational level, disabilities, or chronic health conditions are at highest risk for low levels of physical activity. They also bear a large burden of diseases amenable to prevention and treatment with exercise but often have the least opportunity for physical activity. Physical activities for older adults have previously focused on improving cardiorespiratory fitness and prolonging life; however, exercise designed to maintain or improve functional independence can also be beneficial. Age-related changes in metabolism, loss of integrity of the oral cavity, social isolation, and chronic illness are among factors putting the elderly at risk of malnutrition syndromes, including anorexia, cachexia, and sarcopenia.

  • Chapter 2 - The biology of aging

  • from Section I - General approach to the care of the elderly
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book:
    Reichel's Care of the Elderly
    Published online:
    05 June 2016
    Print publication:
    23 June 2016, pp 17-27

  • Summary

    The aging process has been studied at the molecular and physiologic level for decades, and many theories have been proposed for why this universal phenomenon evolved. Multiple tissue-level changes occur with aging, including chronic, “sterile” inflammation; cellular senescence; macromolecular damage, and progenitor cell function decline. These changes underlie age-related pathologies that lead to a decline in global function of the individual. In the study of aging biology, there is much to be learned from exceptionally long-lived humans, such as centenarians, as well as animal models of exceptional longevity, like the naked mole rat. In addition, attention should be paid to disparities that exist in life span even within the United States. Importantly, drugs have been developed that extend life span, enhance health span, or delay or alleviate age-related conditions in mice. The field of aging biology is more poised than ever to turn toward the translation of basic research findings into clinical applications that might extend human health and life span.

Reichel's Care of the Elderly
  • Clinical Aspects of Aging
  • 7th edition
  • Edited by Jan Busby-Whitehead, Christine Arenson, Samuel C. Durso, Daniel Swagerty, Laura Mosqueda, Maria Fiatarone Singh, William Reichel
  • Published online:
    05 June 2016
    Print publication:
    23 June 2016
  • This fully updated seventh edition remains the pioneering text for practicing physicians and allied health staff confronted with the unique problems of an increasing elderly population. Dr Reichel's formative text is designed as a practical and useful guide for all health specialists. Emphasizing the clinical management of the elderly patient with simple to complex problems, this is a must-read for all practitioners who need practical and relevant information in a comprehensive format. Chapters have been updated and re-organized to reflect the clinical approach to aging, beginning with a general approach to the management of older adults, followed by a review of common geriatric syndromes, and proceeding to an organ-based review of care. The final section addresses principles of care, including care in special situations, psychosocial aspects of our aging society, and organization of care. Particular emphasis is placed on cost-effective, patient-centered care, including a discussion of the Choosing Wisely campaign.

  • 5 - Leadership in interprofessional dementia care

  • Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
  • Book:
    Care of the Person with Dementia
    Published online:
    06 August 2018
    Print publication:
    15 September 2015, pp 81-92

  • Summary

    Learning outcomes

  • Outline why interprofessional leadership is required.

  • Describe the leadership skills required to facilitate interprofessional practice.

  • Discuss the development of interprofessional leadership within the interprofessional practice context.

    • Key terms

  • capabilities

  • dementia

  • leadership

    • Leadership

    Some are born to leadership; some achieve leadership; others have leadership thrust upon them.

    Marie’s letter to Malvolio in Shakespeare’s Twelfth Night

    Introduction

    Historically health service provision has worked on a hierarchical system of leadership in which the doctor has been seen to be the lead both legally and ultimately in practice for any decisions about a patient’s care. However, practice is starting to change. In 2000, in Canada, the legislation changed to ensure that any health professional could be nominated as leader and is then legally responsible for the care of the individual.

    Why has this move away from doctors always being legally responsible happened? In many situations the doctor is not always present or reachable, for example, in remote, rural locations and some community settings. As Australia has an increasingly ageing population, there are not enough doctors and other health care professionals to service their needs. This has led to the realisation that new health care models and ways of working need to be developed.

  • 8 - Person- and relationship-centred care in dementia

  • Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
  • Book:
    Care of the Person with Dementia
    Published online:
    06 August 2018
    Print publication:
    15 September 2015, pp 115-134

  • Summary

    Learning outcomes

  • Understand the principles of person-centred care of a person with dementia.

  • Understand who is the person in person-centred care.

  • Discuss approaches aimed at achieving person-centred care.

  • Understand the principles of relationship-centred care of a person with dementia.

  • Discuss the importance of the interprofessional team to collectively identify remaining abilities and the care pathway for the individual.

    • Key terms

  • interprofessional practice (IPP)

  • patient-focused care

  • person-centred care

  • relationship-centred care

    • Introduction

    In this chapter, we discuss two key concepts involved in the care of patients with dementia: person-centred care and relationship-centred care. In addition to explaining the meaning and origins of person-centred care as a term, key emphasis is placed on principles and achievement of person-centred care. We also discuss the specifics of those with dementia that need consideration and the benefits of providing person-centred care in dementia patients. Relationship-centred care is explained in the context of interplay between collaboration, communication and relationships, and key interactions involved in dementia patients are also highlighted. We discuss relationships between various stakeholders involved in care of patients with dementia from the perspective of the agency theory. The chapter concludes with a consideration of interprofessional practice (IPP) in the provision of patient-centred care in dementia and the interprofessional team work is illustrated in a case study.

  • 1 - The Model of Interprofessional Practice and Education – Dementia

  • Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
  • Book:
    Care of the Person with Dementia
    Published online:
    06 August 2018
    Print publication:
    15 September 2015, pp 11-36

  • Summary

    Learning outcomes

  • Examine the competencies and capabilities required for interprofessional practice.

  • Discuss the relevance of context for working in an interprofessional manner.

  • Explain specific capabilities required in dementia care.

  • Explain the Model of Interprofessional Practice and Education – Dementia.

    • Key terms

  • capabilities

  • competencies

  • dementia

  • evaluation

  • interprofessional

  • interprofessional education (IPE)

  • personhood

    • Introduction

    In 1978, the World Health Organization stated:

    Given that effective health care requires the services of personnel with different competencies, it is essential that trainees should have appropriate experience of such cooperative endeavours and have the ability to work towards a common goal, to communicate and share responsibility.

    As community members, students and/or practitioners, we have all worked in many team environments – for example, the workplace, sport, committees, community services, and group assignments – where people with varying skills and knowledge come together to jointly achieve a goal or provide a service. Within health settings, team practice is common where a group of professionals – for example, nurse, social worker, oncologist, pharmacist and radiographer – manage the care of a specified number of patients as a coordinated group. However, very few of these experiences can be described as interprofessional.

    Respectful working relationships with shared decision making, shared leadership and shared learning are the hallmarks of interprofessional practice (IPP). In addition to specific professional competence, other skills are required: the ability to work collaboratively; to take responsibility for your own actions and the actions of the team as a whole; to take a leadership role or follow the lead of others depending on circumstances; and the ability to provide a consistent service while under pressure.

  • 3 - National and international perspectives: Interprofessional education and collaborative practice

  • Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
  • Book:
    Care of the Person with Dementia
    Published online:
    06 August 2018
    Print publication:
    15 September 2015, pp 49-62

  • Summary

    Learning outcomes

  • Discuss the drivers and imperatives for changing the way health care is provided.

  • Define interprofessional education and collaborative practice.

  • Discuss how interprofessional education and practice can respond to the imperatives and drivers in changing health contexts.

  • Discuss the relevance of interprofessional education and collaborative practice in the context of dementia care.

    • Key terms

  • collaborative practice (CP)

  • integrated approach

  • interprofessional education (IPE)

    • Introduction

    Many factors have precipitated increased interest in interprofessional education (IPE) and collaborative practice (CP). Demographic changes, in particular an ageing population and increased incidence of long-term health issues, require health care teams to work with people with complex care needs. New models of care and technological advances in diagnosis, treatment and rehabilitation practice require specialised knowledge to provide appropriate, safe and cost effective services. And, despite increasing university places for health professionals, the demand for qualified health professionals continues to exceed supply.

    This chapter will look at the origins of IPE internationally, and the health care environment in which dementia care is to be provided, and ask: What is it? How was it developed? Why do we need it? What does it look like?

    Drivers for changing the way health care is provided

    In 2012, Health Workforce Australia published documentation looking to the future of what would be required for the health workforce in 2025. It articulated the need to develop a health workforce that would work towards new models of health care and, therefore, the need to develop new models of education and training. However, this concept is not new. Indeed Flexner (1910) advocated the need to transform medical education, shifting from an idiosyncratic apprenticeship model to a more rigorous systematic biomedical and educational approach.

  • Introduction to dementia

  • Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
  • Book:
    Care of the Person with Dementia
    Published online:
    06 August 2018
    Print publication:
    15 September 2015, pp 1-10

  • Summary

    Learning outcomes

  • Describe what dementia is in broad descriptive medical terms.

  • Describe the impact of dementia on the Australian population in terms of disability burden.

  • Identify some of the key challenges for individuals and their families and carers throughout the course of the disease.

  • Reflect on the impact of culture and membership of different special needs groups on the experience of dementia.

  • Outline how interprofessional ways of working are needed in the care of people with dementia.

    • Key terms

  • aged care services

  • autonomy

  • communication

  • culture

  • dementia

  • interprofessional

  • neurocognitive disorder (NCD)

  • respect

    • Introduction

    Dementia is a life limiting condition. The needs of people living with dementia are at the forefront of the minds of people concerned with receiving, resourcing, managing, providing and evaluating services for older people. In particular, there is an urgent need for health care teams and service providers to respond in innovative ways (Productivity Commission, 2011) to address the ‘mismatch of professional competencies to patient and population priorities’ and the chronic shortfall in health workforces (Frenk et al., 2010 ; Health Workforce Australia, 2012).

    As people live longer, the shape of society has changed and is continuing to change; creating both benefits and challenges that humanity has not met before. One of these challenges is the increased prevalence of dementia (Productivity Commission, 2011). Dementia embodies our greatest fears: a living death; cognitive decline; lost abilities; increasing dependence; loss of the person as others know them. While acknowledging that a person with dementia and their families require complex care and support over an extended period of years, perhaps there are lessons to be learned by society about what it means to be human and the real priorities of living and dying.

  • 6 - Personal and professional knowledge

  • Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
  • Book:
    Care of the Person with Dementia
    Published online:
    06 August 2018
    Print publication:
    15 September 2015, pp 93-104

  • Summary

    Learning outcomes

  • Articulate the personal and professional attributes that may influence an individual’s practice.

  • Discuss the course of dementia from health to illness to death.

  • Discuss the significance of the person’s life lived before the onset of this disease.

  • Consider the impact of the journey of dementia on family and friends.

    • Key terms

  • interprofessional

  • personality

    • Introduction

    In Chapter 1 , we identified one key aspect of the Model of Interprofessional Practice and Education - Dementia (MIPPE-D) as being personal and professional knowledge. This capability looks at the practitioner as a whole, as well as the client, and recognises not only the professional knowledge that the individual brings to the situation but also their life skills, empathy and personal experiences.

    What is personal knowledge?

    In the previous chapters of this book, we have emphasised that every client is different and the importance for all health professionals to recognise their client’s journey through life. We have also shown that health professionals need to develop background knowledge and skills to work in a professional and client-centred way.

    However, we must also recognise that each professional will have had personal experiences outside their professional background. These will impact on how they see the world, how they react in situations and their values. They may, therefore, have a wide set of life skills that can be put into practice very effectively.

  • Conclusion

  • Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
  • Book:
    Care of the Person with Dementia
    Published online:
    06 August 2018
    Print publication:
    15 September 2015, pp 171-182

  • Summary

    Learning outcomes

  • Discuss ways in which the interprofessional approach might assist individuals with dementia and carers at each stage of the dementia journey.

  • Discuss ways in which individuals with dementia and their carers can contribute to the work of the team at each stage of the journey.

  • Consider how a big team, consisting of a range of professionals with various roles, might work together, particularly in the middle stages where the person living with dementia is requiring maximum support in the home.

  • Discuss the issues relating to leadership in team care and how the team might resolve these issues in different clinical settings.

    • Key terms

  • dementia

  • evidence-based practice (EBP)

  • leadership

    • Introduction

    Many of the key messages from this book are about how health professionals should work together in the care of people living with dementia. To summarise some of the key points, we will follow Mary as she travels along a dementia journey, and explore some of the many ways in which professionals can work together to help her on that journey.

    Early signs of dementia

    Mary, aged 76, lives alone. Her husband died shortly after he retired some 10 years ago and the couple had no children. Mary used to work in an office, but has lost touch with most of her former workmates now. Her one companion is a much loved dog named Freddie, although there is also a niece who visits from time to time. She has been a patient of her GP for over 10 years. She books a regular monthly appointment for a blood pressure check, repeats of her eight medications when necessary and a bit of a chat. She has quite stable diabetes, for which she is taking oral medication, and every three months she has this reviewed under a chronic disease management plan. She has never brought along her niece to these appointments.

  • 9 - Understanding ethics and dementia care

  • Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
  • Book:
    Care of the Person with Dementia
    Published online:
    06 August 2018
    Print publication:
    15 September 2015, pp 135-158

  • Summary

    Learning outcomes

  • Understand the importance of the concepts of self and personhood in the context of dementia.

  • Demonstrate knowledge of ethical concepts.

  • Be able to reflect on the impact that cultural understanding may have on giving or receiving dementia care.

  • Understand that relationships are important in caring for others.

    • Key terms

  • autonomy

  • culture

  • dementia

  • ethics

  • palliative care

  • value

    • Introduction

    It can be easy to look at ethics as simply following codes or a set of principles that inl uence what people do. Both of these are important but, in a health setting, particularly one involving dementia care, codes and principles may not be enough because they do not adequately take account of the special situation of someone who needs care, especially those who can be challenging to care for.

    This chapter discusses some key ethical concepts. It also looks at what might be helpful for carers to understand so they may act ethically towards those with dementia. It shows professionals that ethics influences what they do with the information that they have. It is as necessary a part of an interprofessional and evidence-based practice as sound science, good skills or lived experience.

    At a basic level, people need to know about ethics simply to get along with each other, as ethics enters into every interaction that they have with others. In some way or other, at its heart, ethical behaviour must take into account how each person might affect others. This means that people should consider the possible consequences of what they do. But ethics is more than thinking about the possible consequences of actions. Each person needs also to reflect on the reasons for doing things, on what sort of person they want to be and how relationships might be valued and nurtured in even the most challenging care environments.

Page 29 of 104