diane w. healey november 18, 2008. functional progression of dementia: fast scale 1 no functional...
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Diane W. HealeyNovember 18, 2008
Functional progression of dementia: FAST Scale
1 No functional decline.2 Personal awareness of some functional decline.3 Noticeable deficits in demanding job situations. 4 Requires assistance in complicated tasks such as
handling finances, planning parties, etc.
5 Requires assistance in choosing proper attire.6 Requires assistance dressing, bathing, and toileting.
Experiences urinary and fecal incontinence.
7 Speech ability declines to about a half-dozen intelligible words.
Progressive loss of abilities to walk, sit up, smile, and hold head up.
Cycle of frailty
Falls riskGait and balance disorderPsychotropic drug useArthritisVisual impairmentOrthostasisNeurologic diseaseCardiovascular diseaseHypovitaminosis D
Falls risk for dementia vs no dementia1017 people fell 5,438 times during the 2-year study
Rate of falls: 4.05 per person-year with dementia, 2.33 per person-year without dementia (P<.0001) 1.74relative risk (95% confidence interval (CI)=1.34-2.25)
Van Doorn C, et al. J Am Geriatr Soc 51(9):1213-1218, 2003.
Stage of dementia and falls risk Unimpaired (*scoring 0-1) were less likely
to fall Mild or moderate cognitive impairment (*scoring 2- 4) RR=0.67, 95% CI=0.49-0.92
Severe cognitive impairment (*scoring 5-10) no more likely to fall than residents with mild or moderate cognitive impairment (scoring 2-4) (RR=0.99, 95% CI=0.80-1.21)
*MDS cognition scale
Van Doorn C, et al. J Am Geriatr Soc 51(9):1213-1218, 2003.
Injurious falls per person-year*Dementia : 1.61Non-dementia: 0.99(P<.002)
*This is related to the number of increased falls with dementia patients, not that each fall is more injurious
Van Doorn C, et al. J Am Geriatr Soc 51(9):1213-1218, 2003
Interventions for fallsTreat postural hypotensionModification of environmental hazardsMinimizing psychotropic medicationsCardiovascular disorder treatmentMuscle strengthening and balance trainingTai Chi
No data specific for dementia
Mrs. R78 yo WF with >5 year history of Alzheimer’s
disease, taken care of at home by her husband
Previously has been an avid swimmer, hiker and biker
No longer able to do her own ADLsNot sleeping well 8/11 husband admits her to the healthcare
center of the CCRC where they have been residing in an independent home
Medications on admit:Irbesartan (Avapro) 150mg dailyMemantine (Namenda) 10mg bidGalantamine (Razadyne ER) 16mg dailySimvastatin (Zocor) 60mg daily
AdmissionWeight 101 lbs, thinGait slightly unsteady, with forward center
of gravity, leaning to the left, takes short steps, and looks to the floor when walking
No focal neurologic findingsPt appears fearful, aphasicPlan: Physical therapy evaluation due to falls
risk
Pt. not sleeping day or night: concern for increased risk of falls due to fatigue. Gait becoming more apraxic.
9/5 ramelteon (Rozerem) startedFalls: 9/8, 9/13,14,15,159/16 ramelteon discontinuedFall: 9/179/19 Melatonin startedFalls: 9/26, 30, 10/13, 17
Date/time Circumstances
Injury Interventions
9/8 8am Fell in room after bkft
Abrasion R forehead
Assist with meals
9/13 ? Fall Bump L forehead, L shoulder
?fall. Husband took comforter home
9/14 8:15pm Walking, fell on buttocks in room
No injury Encourage rest periods
9/15 7:30 am FOF in BR “painting” with feces
No injury Hold ramelteon
9/15 8pm ?Sat down on floor No injury Hipsters
9/17 6:30pm Tripped over another residents foot pedals
Skin tear L shin Assist with all ADLs
9/26 5:40am Found sitting on floor, scooting
No injury
9/30 3:25pm Tried to sit in chair and missed
No injury
10/13 6:30pm Found on floor No injury Therapy screenPharmacist review
10/17 5am Found on floor,scooting
No injury