Download Care Coordination - ACT on Alzheimer`s

Best Practices for
Optimizing Dementia Care
for Care Coordinators
Rev 04-03-16
Objectives
• Understand the value of timely detection and employ
simple approaches to assessing cognition among older
patients
• Describe medication and non-medication treatments
• Employ best practices in care coordination for patients
with Alzheimer’s disease
• Identify caregiving risks and connect patients and
caregivers to evidence-based therapies, resources and
services
2
Introduction to
ACT on Alzheimer’s
What is ACT on Alzheimer’s?
statewide
500+
60+
O R G A N I Z AT I O N S
INDIVIDUALS
volunteer
driven
collaborative
I M PA C T S O F A L Z H E I M E R ’ S
BUDGETARY
SOCIAL
PERSONAL
Focus on Quality Health Care
www.ACTonALZ.org
5
ACT Tool Kit
• Evidence- and consensusbased best practice standards
for Alzheimer’s care
• Tools and resources for:
– Primary care providers
– Care coordinators
– Community agencies
– Patients and care partners
www.actonalz.org/provider-practice-tools
6
Health Care Settings: Care
Coordination
www.actonalz.org/provider-practice-tools
Dementia and Alzheimer’s
8
FAQ
What is the difference between
dementia and Alzheimer’s
disease?
Dementia Diagnoses
FTD
Alzheimer’s disease: 60-80 %
• Includes mixed AD + VD
Lewy Body
Dementia
Lewy Body Dementia: 10-25 %
Vascular
Dementia
– Parkinson spectrum
Alzheimer’s
Disease
Vascular Dementia: 6-10 %
– Stroke related
Frontotemporal Dementia: 2-5 %
– Personality or language
disturbance
Disease Education: What is AD?
http://youtu.be/ECbjK4Ra-Ys
11
Stages of Alzheimer’s Disease
Alzheimer’s Disease:
Challenges and Opportunities
Alzheimer’s: A Public Health Crisis
• Scope of the problem
– 5.4M Americans with AD in 2015
– Growing epidemic expected to impact 13.8M Americans by
2050 and consume 1.1 trillion in healthcare spending
– Almost 2/3 are women (longer life expectancy)
– If disease could be detected earlier incidence would be
much higher
• Pre-clinical stage 1-2 decades
• Some populations at higher risk
– Older African Americans (2x as whites)
– Older Hispanics (1.5x as whites)
Alzheimer’s Association Facts
and Figures 2016
14
The Lens of Health Equity
• Take into consideration health
disparities and inequities
• Seek the attainment of the
highest level of health for all
people
• Help create a new style of
“curb cut” by promoting
cultural competence
15
Base Rates
• 1 in 9 people 65+ (11%)
• 1 in 3 people 85+ (32%)
Ages of People with Alzheimer’s
Disease in the United States
Alzheimer’s Association Facts
and Figures 2016
16
Patients with Dementia
• A population with complex care needs
2.5 chronic
conditions
(average)
5+
medications
(average)
3 times more
likely to be
hospitalized
Many
admissions
from
preventable
conditions,
with higher
per person
costs
• Indisputable correlation between chronic conditions and costs
Alzheimer’s Association Facts
and Figures 2014
17
Challenges & Opportunities
• AD under-recognized by providers
– Fewer than 50% of patients receive formal diagnosis
• Millions unaware they have dementia
– Diagnosis often delayed on average by 6+ years after
symptom onset
– Significant impairment in function by time it is
recognized
• Poor timing: diagnosis frequently at time of crises,
hospitalization, failure to thrive, urgent need for
institutionalization
Boise et al., 2004; Boustani et al., 2003; Boustani et al., 2005; Silverstein & Maslow, 2006
18
Disease Education: Facts & Figures
https://youtu.be/kcI5UVwFyN0
19
Identifying Cognitive Impairment
20
Practice Tips
• Often signs and symptoms are not recognized
until they are quite pronounced
– Attribution error: “What do you expect? She is 80
years old.”
– Red Flag: Subjective impressions FAIL to detect
dementia in early stages
Practice Tips
• Chart Review
– Red Flag: memory concerns, forgetfulness, memory
complaints
– Red Flag: missed appointments
– Red Flag: emergency contact is main contact for all
communication with patient
– Red Flag: Patient has been prescribed on
Aricept/Donepezil or other cholinesterase inhibitors
but no Alzheimer’s disease diagnosis on Problem List
Practice Tips
• Clinical interview
– Social skills remain largely intact until later stages of
dementia
• Easy to be fooled by: sense of humor, reliance on old memories,
quiet/affable demeanor
• Red Flag: Patient who frequently defers answers to family member
– Let patient answer questions without help
• “I am going to talk with you, Mr. Jones first, then your wife Mrs.
Jones will have a chance to talk to me in a few minutes.”
Practice Tips
• Clinical Interview (in-person or telephone)
– Many patients know the correct answer for the “YES” and “NO”
questions that are asked on our patient flows.
• Red Flag: CM: “Are you taking your mediation? Do you forget to
take it?”
• Red Flag: Pt.: “Oh No! I never forget to take my medication
• “Explain to me how you take your medication? How do you
remember? When do you take it? What is _____Rx for?”
– Watch and record repetition (not normal in 7-10 min
conversation)
– Note tangential, circumstantial responses
– Does the patient loose track of the conversation?
Practice Tips
• Red Flags: Issues of Case Management
ON THE PHONE: how much of the picture are we getting?
IN THE CLINIC: if the patient is alone, how much of the
picture are we getting? If the caregiver does not feel free to
speak, how much of the picture are we getting?
IN THE HOME: if we don’t use a different lens, how much of
the picture are we getting?
Practice Tips
• Family observations – know the patient better than
anyone else and must be used as a historian to
understand the patient’s issues
–
–
–
–
–
Red Flag: getting lost while driving
Red Flag: trouble following a recipe
Red Flag: asking same questions repeatedly
Red Flag: mistakes paying bills
Red Flag: reading the same paper or book over and over
• By the time family report problems, symptoms
have typically been present for quite a while
and are getting worse
Practice Tips
• Provide “real examples” to pt. and family
members to help frame the issues the patient
is living with:
– Pt. is alone on a domestic flight across the country and the
trip required a layover with an unexpected gate change,
would he be able to manage that kind of mental task on his
own?
• Red Flag: “Not likely” for a patient of any age; this is an issue worth
exploring deeper
Practice Tips
• Intact older adult should be able to:
– Describe at least 2 current events in adequate detail (who,
what, when, why, how)
– Describe events of national significance
• 9/11, New Orleans disaster, etc.
– Name or describe the current President and an immediate
predecessor
– Describe their own recent medical history and report the
conditions for which they take medication
Cognitive Screening
29
Provider Perspective
“Avoiding detection of a serious and life
changing medical condition just because there
is no cure or ‘ideal’ medication therapy seems,
at worst, incredibly unethical, and, at best, just
bad medicine.”
George Schoephoerster, MD
Family Practice Physician
30
Cognitive Impairment ID
Screening Measures
• Wide range of options
–
–
–
–
–
Mini-Cog™ (MC)
Mini-Mental State Exam© (MMSE)
St. Louis University Mental Status Exam™ (SLUMS)
Montreal Cognitive Assessment™ (MoCA)
Rowland Universal Dementia Assessment (RUDAS)
• All but MMSE free, in public domain, and online
www.actonalz.org/screening-diverse-populations
Borson et al., 2000; Folstein et al., 1975; Nasreddine 2005; Tariq et al., 2006
Alternative Screening Tools
• Virtually all screening tools based upon a
euro-centric cultural and educational model
• Consider: country and language of origin,
type/quality/length of education, disabilities
(visual, auditory, motor)
• Alternative tools my be less biased
33
Screening Administration
• Try not to:
– Use the words “test” or “memory”
• Instead: “We’re going to do something next that
requires some concentration”
– Allow patient to give up prematurely or skip
questions
– Deviate from standardized instructions
– Offer multiple choice answers
– Be soft on scoring
– Score ranges already padded for normal errors
– Deduct points where necessary – be strict
Mini-Cog™
Contents
• Verbal Recall (3 points)
• Clock Draw (2 points)
Advantages
• Quick (2-3 min)
• Easy
• High yield (executive fx,
memory, visuospatial)
Borson et al.,
2000
Subject asked to recall 3 words
Leader, Season, Table
+3
Subject asked to draw clock,
set hands to 10 past 11
+2
www.actonalz.org/sites/default/files
/documents/Mini-Cog_.pdf
36
Mini-Cog
Pass
• >4
Fail
• 3 or less
NOTE: A cut point of <3 on the Mini-Cog has been validated for dementia screening, but many individuals with
clinically meaningful cognitive impairment will score higher. When greater sensitivity is desired, a cut point of <4 is
recommended as it may indicate a need for further evaluation of cognitive status.
Borson et al., 2000; Borson, Scanlan, Chen et al., 2003; Borson, Scanlan, Watanabe et al., 2006; Lessig, Scanlan et al., 2008;
McCarten, Anderson et al., 2011; McCarten, Anderson et al., 2012; Tsoi, Chan et al., 2015
Mini-Cog Research
• Performance unaffected by education or language
• Borson Int J Geriatr Psychiatry 2000
• Sensitivity and specificity similar to MMSE (76% vs.
79%; 89% vs. 88%)
• Borson JAGS 2003
• Does not disrupt workflow & increases rate of
diagnosis in primary care
• Borson JGIM 2007
• Failure associated with inability to fill pillbox
• Anderson et al Am Soc Consult Pharmacists 2008
Mini-Cog Improves Physician
Recognition
100
***
***
60
***
% Correct
80
Mini-Cog
Patient’s own
physician
40
20
*** p < .001
0
CDR Stage
0.5
MCI
1
Mild
Borson S et al. Int J Geriatr Psychiatry 2006; 21: 349
2
Mod
3
Sev
Cognitive Impairment Predicts
Readmissions
Mini-Cog Performance Novel Marker of Post
Discharge Risk Among Patients Hospitalized for
Heart Failure (Patel, 2015; Cleveland Clinic)
• Method: 720 patients screened with MiniCog
during hospitalization for HF
• Results: 23% failed screen (M age 78, 49% men)
– MiniCog best predictor of readmission over 6 mos.
among 55 variables
• Stronger than length of stay, cause of HF, and even
comorbidity status
• Readmission rate 2 times higher among screen fails
• Fails discharged to facility (vs. home) had lower
readmission rates within first 30 days
40
Case Study: Colleen
•
•
•
•
•
•
•
•
66 y/o presents to primary care with memory complaints
Daughter c/o short-term memory is poor
Began 1-2 years ago, getting worse
Hx Low blood sugar, history of heart attack, repeat
hospitalizations for atrial flutter
Frequent medication changes, managing independently
Patient is a retired accountant for family business
Lives with husband who is still running the family
business
Referred to Care Coordination
Mini-Cog: Colleen
http://youtu.be/DeCFtuD41WY
42
Colleen’s Clock
Colleen’s Score
Mini-Cog Exercise
Form groups of 2
• Review Mini-Cog Form
• Administer Mini-Cog to each other
• Score sample clocks
45
Clock #1
Clock #2
Clock #3
Clock #4
Clock #5
Clock #6
Clock #7
SLUMS
Tariq et al., 2006
SLUMS
High School Diploma
Less than 12 yrs education
Pass
> 27
> 25
Fail
26 or less
24 or less
Tariq SH, Tumosa N, Chibnall et al. Comparison of the Saint Louis University mental
status examination and the mini-mental state examination for detecting dementia
and mild neurocognitive disorder--a pilot study. Am J Geriatr Psychiatry. 2006
Nov;14(11):900-10.
54
SLUMS: Colleen
http://youtu.be/jyp0ShPiUH8?list=UUOPv8U5bHcdDCm4edmQDY9g
55
SLUMS Scoring: Colleen
56
SLUMS Scoring: Colleen
57
SLUMS Scoring: Colleen
58
MoCA
Nasreddine et al., 2005
MoCA
Pass
• > 26
Fail
• 25 or less
Nasreddine 2005
60
MoCA: Sam
http://youtu.be/ryf8SG0NQLQ?list=UUOPv8U5bHcdDCm4edmQDY9g
61
MoCA Scoring: Sam
• Interactive scoring exercise
62
MoCA Scoring: Sam
63
MoCA Scoring: Sam
64
MoCA Scoring: Sam
65
MoCA Scoring: Sam
66
Screening Tool Selection
Montreal Cognitive Assessment (MoCA)
• Sensitivity:
• Specificity:
90% for MCI, 100% for dementia
87%
St. Louis University Mental Status (SLUMS)
• Sensitivity:
• Specificity:
92% for MCI, 100% for dementia
81%
Mini-Mental Status Exam (MMSE)
• Sensitivity:
• Specificity:
18% for MCI, 78% for dementia
100%
Larner 2012; Nasreddine et all, 2005; Tariq et al., 2006; Ismail et al., 2010
Family Questionnaire
www.actonalz.org/pdf/Family-Questionnaire.pdf
RUDAS
• Developed intentionally for
patients with low levels of
education, limited language
fluency, & diverse cultural
backgrounds
• Measures wide variety of
cognitive abilities
• Score range of 0-30 useful for
tracking change over time
• Strong psychometric
properties
• 10-15 minutes to administer
69
RUDAS
70
RUDAS
71
AD8 Dementia Interview
http://knightadrc.wustl.edu/About_Us/PDFs/AD8form2005.pdf
Dementia Work-up,
Diagnosis and Treatment for
Providers
73
Dementia Work-Up
• H&P
• Objective cognitive measurement
• Diagnostics
– Labs
– Imaging ?
– More specific testing (e.g., neuropsychometric)?
• Diagnosis
• ‘Family’ meeting
Treatment: Medications
• Anticholinergics
– Donepezil, Rivastigmine, Galantamine, Cognex
– Possible side effects: nausea, vomiting, syncope,
dizziness, anorexia
• NMDA receptor antagonist
– Memantine
– Possible side effects: tiredness, body aches,
dizziness, constipation, headache
75
Treatment: Medications
• Antipsychotics
• Antidepressants
• Mood stabilizers
Managing Behaviors Flow Chart:
actonalz.org/pdf/Figure1.pdf
76
Care and Treatment
• The care for patients with Alzheimer’s has
very little to do with pharmacology and
much to do with psychosocial interventions
• Care Coordination
77
Dementia Care Coordination
78
Care Coordination
What are some of the challenges
you face when working with people
with dementia and their families?
79
ACT Practice Tool
Dementia Care Plan Checklist
Identify Care Partner(s)
• Educate the patient: Dementia dx. require a
team approach
• Ask the patient to identify a support system
– Think outside the box:
• Family, friends, neighbors, religious congregation
members, colleagues, community organization
volunteers or workers)
– Task specific (e.g., doctor visits, managing meds.)
82
Comprehensive Assessment
83
Comprehensive Assessment
HCH Care Coordination Tool Kit
http://mn4a.org/wpcontent/uploads/HCH-ClinicCoordinator-Toolkit_3-1915_ADA-FINAL.pdf
84
Comprehensive Assessment
• Patient & Primary Care Partner / Caregiver
Identify language, cultural, health equity barriers
Identify physician(s)
Assess substance use / misuse
Behavioral health, depression
• PHQ9, CES-D, GDS
85
Comprehensive Assessment
• Primary Care Partner / Caregiver
– Consider assessing cognition (if over 65 or signs /
symptoms present)
– Caregiver burden (Zarit Burden Interview Short)
http://www.uconnaging.uchc.edu/patientcare/memory/pdfs/zarit_
burden_interview.pdf
86
Care Plan
87
Dementia Care Planning
•
•
•
•
•
•
•
•
Build a care team (patient & care partners)
Educate, support & connect to resources
Maximize abilities
Promote health, wellness & social
engagement
Encourage planning, preparedness
Ensure safety
Reduce excess disability
Avoid unnecessary hospitalization
88
Disease Education
• ASK the patient / care partner:
What the doctor told them about their memory
loss / diagnosis
What they know about the disease / questions
about the diagnosis / disease
Biggest concerns; barriers to care / health
89
Home & Personal Safety
• Develop a plan for the 6 F’s:






Falls
Fire
Finances
Firearms
Freedom
Freeways
90
Home & Personal Safety
• Refer to OT or PT




Fall risk assessment
Sensory / mobility aids
Home safety inspection / modifications
Driving evaluation
• Encourage Medic Alert® Safe Return®


6 out of 10 people with dementia will wander at
some point during the disease
www.alz.org/care/dementia-medic-alert-safereturn.asp
91
Home & Personal Safety
• Encourage emergency plans
 Key phone numbers labeled / programmed
 Fire plan
• Ask: What would you do if there was a fire at your
house?
 ER / Hospital Medical Emergency Kit - @ bedside




POLST, POA, Health Care POA, Living Will
Updated Medication List + allergy list
Slippers / Clothes (including adult diapers, if worn)
List of important contact numbers (doctors, family,
minister, helpful friends)
 Comfort objects (music, photos, blanket, etc.)
92
Medication Therapy & Management
• Discuss prescribed and OTC medications
 simplify medication regimen
 reduce / eliminate anticholinergics,
benzodiazepines, hypnotics, narcotics
• Create plan with care team
 Family plan for managing meds
 Med management aids (pill boxes, alarms)
 Create & review medication log
93
Medication Therapy & Management
94
Dementia & Hospitalization
• Reduce Unnecessary Hospitalization
– Falls
– UTI / other medical conditions
– Medications / medication
mismanagement
– Dementia-related behavior
– Hospitalization alternatives
• Hospitalization – Pre-Planning
– http://www.nia.nih.gov/alzheimers/publicati
on/hospitalization-happens
95
Dementia & Hospitalization
– More preventable hospitalizations
– Higher rates of:
 delirium, falls, new incontinence, indwelling urinary catheters,
pressure ulcers, functional decline & new feeding tubes
– Significantly less likely to regain preadmission
functional abilities at 1, 3, or 12 months after
discharge
– 3-7 times more likely to be living in a nursing
home 3 months after discharge
96
Maximize Abilities
• ID/treat conditions that may worsen symptoms or
lead to poor outcomes
 Diabetes, HTN, sleep dysregulation
• Refer to OT to maximize independence
 simplify environment, maximize independence & self-care
abilities
• Offer strategies to reduce behavioral symptoms
 Communication strategies, wellness & social engagement,
routine
97
Dementia-Related Behavior
• Studies identify that 50%-90% of persons with
dementia will develop “challenging behaviors”
• Anxiety is the most prominent in the earlier
stages of dementia
• 42% become physically aggressive
• 50% have depressive symptoms
• Prevalence of behavior is directly associated
with the approach used by the care partner
98
Common Dementia-Related
Behaviors
•
•
•
•
•
•
•
•
Repeating
Anger, Anxiety, Agitation
Daytime sleeping / night-time wakefulness
Wandering, Pacing, Shadowing
Apathy
Resisting Care
Aggression (yelling, hitting, biting)
Socially inappropriate behaviors (e.g., things that
may be ok in private, but not in public – like
disrobing)
99
Causes of Challenging Behaviors
• Physical Health (Medical)
Pain
 Urinary Tract Infection
 Illness

• Environment
Unfamiliar surroundings/environment
 Over/under stimulation

• Other
 Communication
 Unmet needs/boredom
 Task-related
 Emotional health
100
Reduce Behavioral Symptoms
• REMEMBER:
– behavior is communication
– communication impacts behavior
• Think like a behavioral analyst
– Detective work, ask:
•
•
•
•
•
Who (is involved/present)
What (exact description, be specific)
When (time dependent? only in morning? triggers?)
Where (location specific?)
Why (what happens right before, right afterwards? what do family
think is cause? Has anything changed recently?)
101
Considerations
• Ask: Is this behavior really a problem?
– Is it hurting anyone?
• Help care partners know what to expect
and normalize these reactions.
– Avoid: unrealistic, non-dementia expectations,
arguing, correcting, rushing
– Advise: Take a deep breath, slow down, step back,
simplify, smile, redirect, reassure, try again later
102
Maximize Abilities: Routine
103
Health, Wellness & Engagement
Encourage lifestyle changes that may reduce
disease symptoms or slow progression







Exercise
Nutrition
Stress reduction
Meaning & purpose
Relationships
Health management
Routine
www.alz.org/mnnd/documents/15_ALZ_Living_Well_Workbook_Web.pdf
104
Health, Wellness & Engagement
 Understanding the disease
 Partnering with doctors
 Telling others about the
diagnosis
 Strategies for managing
symptoms & coping
 Safety
 Legal / financial issues
http://www.alz.org/mnnd/documents/15_ALZ_Taking_Action_Workbook.pdf
Patient Engagement:
Research Participation
• Alzheimer’s Association Trial Match
– Free, easy-to-use clinical studies matching
service that connects individuals with
Alzheimer's, caregivers, healthy volunteers and
physicians with current studies.
– http://www.alz.org/research/clinical_trials/find
_clinical_trials_trialmatch.asp
• National Institute of Health (NIH)
– http://clinicaltrials.gov
106
Legal & Financial Planning
• Encourage patient / care partner to assign
durable POA
 Refer to Elder law attorney
• Encourage patient / care partners to talk
about long-term care and when they would
access support

http://www.alz.org/i-havealz/downloads/worksheet_financial_legal.pdf
107
Advance Care Planning
• Encourage patient to discuss / document
preferences for care in a health care
directives
 Connect patient with advance care planning
facilitator
 Document choices (Honoring Choices, MN
Healthcare Directive)
• Discuss palliative and hospice options
 Palliative Care Consultation Program
 When is the right time?
108
Care Coordinator:
Visit Frequency & Communication
• Schedule regular check-ins
• Educate patient / care partner WHEN to
contact you





Change in condition
Assistance with med management
Before / after hospitalization
Change in living environment
New needs
109
Care Coordinator:
Visit Frequency & Communication
• Facilitate physician appointments
 Reminders, transportation
• Educate on physician engagement
strategies
 Encourage care partner(s) to attend medical
appointments
 Educate about HIPAA, as needed
 Educate on use of appointment log,
medication log
110
Appointment Log
HIPAA Q & A
• HIPAA (Health Insurance Portability and
Accountability Act)
• Federal law that protects medical information
• Allows only certain people to see information
– Doctors, nurses, therapists and other health care
professionals on the patient’s medical team
– Family caregivers and others directly involved with
a patient’s care (unless the patient says he/she does
not want this information shared with others)
www.nextstepincare.org/Caregiver_Home/HIPAA/
United Hospital Fund, 2002
112
HIPAA: Sharing Patient Information
• If the patient is present and has the capacity to make
health care decisions, a health care provider may
discuss the patient’s health information with a family
member, friend, or other person if the patient agrees
or, when given the opportunity, does not object.
• If the patient is not present or is incapacitated, a
health care provider may share the patient’s
information with family, friends or others as long as
the health care provider determines, based on
professional judgment, that it is in the best interest of
the patient.
www.nextstepincare.org/Caregiver_Home/HIPAA/
United Hospital Fund, 2002
113
Care Plan: Caregiver Support
• Providing support for dementia caregivers is a
societal imperative
– 70% of individuals with Alzheimer’s disease live at
home
– In 2012, an estimated 15 million unpaid caregivers
provided an estimated 17.5 billion hours of unpaid
care
– The health care system could not sustain the cost
of care without unpaid caregivers
Dementia Caregiving Risks
• Physical risks:
risk of health problems
• Social risks:
feelings of social isolation
• Psychological risks:
risk of depression and burden
• Financial risks:
financial burden due to lost wages & cost of care
Common Caregiver Challenges
•
•
•
•
•
•
•
•
•
•
Lack of disease knowledge / education
Emotional stress, burden
Need for support and respite
Role changes
Challenging family dynamics
Communication difficulties
Neglected health
Putting patient needs first
Challenging patient behaviors
Planning for the future
116
Caregiver Support
• There is a strong correlation between the
health and well-being of a care partner and
the quality of care that she can provide.
• A care partner with a balanced outlook and
good self-care practices can provide care for
longer periods of time while maintaining his
own health and well-being.
Top 5 Resources for
Patients and Families
118
Disease Education: After a Diagnosis
http://youtu.be/zEst_VxwA4U
119
#1 Promote Wellness &
Function
http://www.actonalz.org/sites/default/files/
documents/ACT-AfterDiagnosis.pdf
www.alz.org/mnnd/documents/15_ALZ_Livi
ng_Well_Workbook_Web.pdf
http://www.alz.org/mnnd/documents/15
_ALZ_Taking_Action_Workbook.pdf
120
#2 Manage Behavioral Challenges
• Coping with Behavior
Change in Dementia
• Coach Broyle’s Playbook for
Alzheimer’s Caregivers
• The Alzheimer’s Action Plan
• ACT on Alzheimer’s
resources, “Mid-Late Stage
Practice Tool”
•
•
•
http://actonalz.org/pdf/Table1.pdf
http://actonalz.org/pdf/Table2.pdf
http://actonalz.org/pdf/Figure1.pdf
121
#3: Address the 6 F’s
Alzheimer’s Association Driving Center:
www.alz.org/care/alzheimers-dementia-and-driving.asp
Falls, Finances, Fire, Firearms,
Freedom, Freeways
http://www.thehartford.com/sites/t
hehartford/files/at-the-crossroads2012.pdf
122
#4 Assist with Planning
123
#5 Connect to Resources
Alzheimer’s Association
24/7 Helpline | 800.272.3900
www.alz.org/mnnd
Senior LinkAge Line
800-333-2433
www.minnesotahelp.info
124
Case Studies
125
Case Study: Colleen
•
•
•
•
•
•
•
•
66 y/o presents to primary care with memory complaints
Daughter c/o short-term memory is poor
Began 1-2 years ago, getting worse
Hx Low blood sugar, history of heart attack, repeat
hospitalizations for atrial flutter
Frequent medication changes, managing independently
Patient is a retired accountant for family business
Lives with husband who is still running the family
business
Referred to Care Coordination
Case Example: Medications
https://youtu.be/3lp0n9DOEWQ
127
Care Coordination: Colleen
• Discussion
–
–
–
–
–
Observations? What did you notice?
What was done well?
What could have been done differently, better?
What might you incorporate into your practice?
What recommendations / referrals would you make to
Colleen?
– What might you do differently if Colleen was not a
native English speaker or was from a diverse cultural
community?
128
Case Example: Legal Planning
https://youtu.be/a-gIojhzGOY
129
Care Coordination: Colleen
• Discussion
–
–
–
–
–
Observations? What did you notice?
What was done well?
What could have been done differently, better?
What might you incorporate into your practice?
What recommendations / referrals would you make to
Colleen?
– What might you do differently if Colleen was not a
native English speaker or was from a diverse cultural
community?
130
Watch the Complete Session:
https://youtu.be/5Kxj-5Ezlzw?list=PLGu3PyEblnIKVrTqVj9NzR5f_fcCbTd9T
131
Care Plan Exercise
In small groups, develop a 3-5 step care plan for Colleen
and her family.
Consider:
• Which areas of the care plan tool should be incorporated in the
plan?
• What educational materials would you give?
• What referrals would you make?
• When would you like to see the patient again?
• How would you communicate the plan to the care team
(physicians, family, patient, etc.)
Questions?
• Download ACT on Alzheimer’s practice tools at:
www.ACTonALZ.org/provider-practice-tools
• For more information
– email: [email protected]
– Web: www.ACTonALZ.org
133
Questions
134
Evaluation
135
ACKNOWLEDGEMENTS
This presentation was created by ACT on Alzheimer’s, an award-winning, nationally recognized,
volunteer-driven collaborative seeking to create supportive environments for everyone touched by
Alzheimer’s disease and to prepare Minnesota for its impacts.
ACT on Alzheimer’s®
Executive Co-Leads: Olivia Mastry, JD, MPH and Michelle Barclay, MA
Lead Presentation Authors: Terry Barclay, PhD and Michelle Barclay, MA
Special thanks to the ACT on Alzheimer’s Detection and Quality Health Care Leadership Group and
Medical Speaker’s Bureau Members
Visit www.actonalz.org/provider-practice-tools for
more information and to access supportive tools and
resources.
ACKNOWLEDGEMENTS
This project is/was supported by funds from the Bureau of Health Professions (BHPr), Health
Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS)
under Grant Number UB4HP19196 to the Minnesota Area Geriatric Education Center (MAGEC) for
$2,192,192 (7/1/2010—6/30/2015). This information or content and conclusions are those of the
author and should not be construed as the official position or policy of, nor should any
endorsements be inferred by the BHPr, HRSA, DHHS or the U.S. Government.
Minnesota Area Geriatric Education Center (MAGEC)
Grant #UB4HP19196
Director: Robert L. Kane, MD
Associate Director: Patricia A. Schommer, MA
References & Resources
•
•
2012 Updated AGS Beers Criteria:
http://www.americangeriatrics.org/files/documents/beers/2012BeersCriteria_JAGS.pdf
After a Diagnosis (ACT): http://www.actonalz.org/sites/default/files/documents/ACT-AfterDiagnosis.pdf
Alzheimer’s Association
•
Basics of Alzheimer’s Disease: https://www.alz.org/national/documents/brochure_basicsofalz_low.pdf
•
Caregiver Notebook - http://www.alz.org/care/alzheimers-dementia-caregiver-notebook.asp
•
Driving Center: www.alz.org/care/alzheimers-dementia-and-driving.asp
•
Facts & Figures video: http://youtu.be/waeuks1-3Z4
•
Facts & Figures Report: http://www.alz.org/documents_custom/2016-facts-and-figures.pdf
•
Family Questionnaire: http://www.alz.org/mnnd/documents/Family_Questionnaire.pdf
•
Know the 10 Signs. http://www.alz.org/national/documents/checklist_10signs.pdf
•
Living with Alzheimer’s – Mid Stage: https://www.alz.org/documents_custom/middle-stage-caregiver-tips.pdf
•
Living with Alzheimer’s – Late Stage: https://www.alz.org/documents_custom/late-stage-caregiver-tips.pdf
•
Living Well workbook: http://www.alz.org/mnnd/documents/15_ALZ_Living_Well_Workbook_Web.pdf
•
Taking Action Workbook: http://www.alz.org/mnnd/documents/15_ALZ_Taking_Action_Workbook.pdf
•
Trial Match: http://www.alz.org/research/clinical_trials/find_clinical_trials_trialmatch.asp
138
References & Resources
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
AD8 Dementia Screening Interview: http://knightadrc.wustl.edu/About_Us/PDFs/AD8form2005.pdf
At the Crossroads: http://www.thehartford.com/sites/thehartford/files/at-the-crossroads-2012.pdf
Caring for a Person with Alzheimer’s Disease:
http://www.nia.nih.gov/sites/default/files/caring_for_a_person_with_alzheimers_disease_0.pdf
Coping with Behavior Change in Dementia: A Caregier’s Guide: http://www.amazon.com/Coping-BehaviorChange-Dementia-Caregivers/dp/0692385444
Coach Broyles Playbook on Alzheimer’s: http://www.caregiversunited.com
Honoring Choices Minnesota: http://www.honoringchoices.org
Health Care Directive (MN): http://www.ag.state.mn.us/pdf/consumer/healtcaredir.pdf
Hospitalization Happens: http://www.nia.nih.gov/sites/default/files/hospitalization_happens_0.pdf
Medicare Annual Wellness Visit: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNMattersArticles/downloads/MM7079.pdf
MiniCog™ http://www.actonalz.org/sites/default/files/documents/Mini-Cog_.pdf
MN Health Care Home Care Coordination Tool Kit:
http://www.health.state.mn.us/healthreform/homes/collaborative/lcdocs/cliniccarecoordtoolkit.pdf
Montreal Cognitive Assessment (MoCA)http://www.mocatest.org
National Alzheimer’s Project Act: http://aspe.hhs.gov/daltcp/napa/NatlPlan.pdf
Next Step in Care: http://www.nextstepincare.org
Physician Orders for Life Sustaining Treatment (POLST): http://www.polst.org
139
References & Resources
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St. Louis University Mental Status (SLUMS) examination
http://medschool.slu.edu/agingsuccessfully/pdfsurveys/slumsexam_05.pdf
The Alzheimer’s Action Plan:http://www.amazon.com/The-Alzheimers-Action-Plan-Know/dp/0312538715
Zarit Caregiver Burden Interview: http://www.uconnaging.uchc.edu/patientcare/memory/pdfs/zarit_burden_interview.pdf
140
Legal & Financial Planning Resources
• National Academy of Elder Law Attorneys
www.naela.org/
• Volunteers of America
www.voamnwi.org/estate-and-elder-law
• Legal and Financial Planning for people with
Alzheimer’s disease
www.nia.nih.gov/alzheimers/publication/legal-and-financial-planningpeople-alzheimers-disease-fact-sheet
• Planning Ahead with Alzheimer’s disease
www.alz.org/care/alzheimers-dementia-planning-ahead.asp
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