helping your parents age in place

8/6/2019 Helping Your Parents Age in Place

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Helping Your Parents

AGE IN PLACEStart with the Basics

Connie Lambert, PT, CCM, PhD


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"Life is no brief candle to me. Itis a sort of splendid torch

which I

have hold of for the moment,

and I want to make it burn as

brightlyas possible before handing it

on to future generations."

George Bernard Shaw

1856-1950, Irish-Born Writer


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FACTS

0%

5%

10%

15%

20%

25%

65 or over

1985

2000

2015


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WHOWILL 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

74

75

76

77

78

79

80

81

82

1st Qtr

1998

2001


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THE NATURAL AGING

PROCESS

We do NOT age from the top down Up to 15% slowing in cognitive process

Process remains intact and accurate


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DEMENTIA IS NOT GLOBAL

Mental Assets Remain !


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ASPECTS OFDEMENTIA

Cognitive

Loss ofcognitivefunction or

intellectual

abilities

Behavioral

Behavioral or socialdysfunction


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COMMONDEMENTIAS

Alzheimers Disease (40% of total

cases)

Vascular Dementia Small Vessel Dementia

Frontal Lobe Dementia

Dementia with Lewy bodies Parkinsons Disease with Dementia

Mixed Dementia


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ALZHEIMERSDISEASE

Memory loss

(85%) Denial of problem

Behaviors latestage

Variable speed ofprogression


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VASCULAR DEMENTIA

CVA

Emotional lability

Personalitychanges

Stepwise

progression

Multi-infarct

dementia


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FRONTAL LOBEDEMENTIA

2nd most common

Social Inadequacy

Inertia

Progressive loss

of speech

Frontal release

View of Human

Brain,Right


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SMALL VESSEL DEMENTIA

Circulatory and

Vascular

disease

Diabetes

Diffuse damage

Orthostasis


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DEMENTIA WITH LEWY BODIES

Delusions Hallucinations,

Severe muscle rigidity

Cerebellum, Midbrain,

Brainstem


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PARKINSONSDISEASE

25% develop dementia

Stooped Posture Rigid Muscle Tone

Festinating gait

Facial masking


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RISKS OFUNRECOGNIZED

DEMENTIA

PROBLEM

1. Medication errors

2. Mismanaged, fragmented

medical care

3. Delirium (acute confusion)

4. Mismanagement of personal

finances

RISKS1. 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


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RISKS OFUNRECOGNIZED

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.F

uture needs go unmet

8. Failure to receive treatment

to reduce and manage

symptoms


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MANAGING THE PROBLEM -

The 7 R s

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


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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


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THE RIGHT ENVIRONMENT

Assessment of personal skills i.e. banking,

driving, grooming, cooking, socialization.

Assessment of gaps between skills andrequirements ofcurrent setting.

APLAN for progressing from one setting

to another.


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BEHAVIORS OF DEMENTIA

Depression & Apathy

Anxiety & Fear

Agitation

Aggression

Wandering

Sundowning

Repetitive

Questioning

PoorVerbal Abilities

Paranoia

Delusions

Hallucinations

Hypersexuality

Excessive Disability

and Neediness

Shadowing


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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.


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MEDICATION- examples

Atypical Antipsychotics

seroquel, risperidal, zyprexa, abilify

Antidepressants

celexa, lexapro, paxil, zoloft, cymbalta

Novel Antidepressantseffexor, remeron

Antiepileptics (mood stabilizers)

depakote, tegretal

Antianxiolyticsativan, buspar. xanax

NeurotransmiterManipulatives

aricept, exelon, reminyl, namenda


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THE RIGHT INTERVENTION

Determine in advance the conditions underwhich 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.


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GET STARTED

Leave Apprehension at the Doorway

Be Proactive !

Advocate Seek Out Qualified Professionals to Help

Empower Yourself with Knowledge

Trust Your Instincts


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STRESS INDICATORS FOR

CAREGIVER

Sadness

Withdrawn Tired

Trouble Sleeping

Health Problems

Irritability

Isolation

Depression

Anxiety

helping your parents age in place

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