Page 1

A Paradigm Flip: Aging Care=DementiaCare Peter V. Rabins, MD, MPH Department of Psychiatry Johns Hopkins School of Medicine

Popula'on Pyramid  for  Germany  in  1956,  2006,  2050  

Christensen, 2009  

Best-­‐prac'ce Life  Expectancy    for  Women  in   Selected  Countries  from  1840  to  2007  

Gain in  life   expectancy  is  3   months  per   year  or     2  ½  years  every   decade  

Linear regression  trend  depicted  by  solid  grey  line  with  a  slope  of  0.24  per  year  

Christensen,  2009  

Age-­‐specific Contribu'ons  to  the  Increase  in   Record  Life  Expectancy  in  Women   1850-­‐2007  

Christensen, 2009  

Dementia Syndrome Declines in 2 or more cognitive capacities Normal level of consciousness and alertness Onset in adulthood

Common Causes of Dementia Alzheimer disease Vascular dementia Dementia with Lewy bodies Fronto-temporal dementia

66% 15-20% 8-15% 5%

Diagnostic Features of Alzheimer Disease Slowly progressive dementia No other etiology identified: non-contributory neurological examination, laboratory evaluation and brain imaging Decline in memory plus either: -aphasia -apraxia -agnosia -(dysexecutive function )

3 ‘Stages’ of Alzheimer Disease 1. Decline in memory -personality change -executive function impairment 2. Cortical phase -aphasia -apraxia -agnosia 3. Physical Decline -incontinence -gait disorder -swallowing/feeding -muteness

Prevalence of  Demen@a   By  SeCng  

Popula'on  <  65   Popula'on    >  64  

Home Health   Public  Housing  

0.3% 10%  

18% 11%  

Assisted Living  


Nursing Home  

70% 37%      >  64   9%    All  ages  

Acute Hospital   Primary  Care  


Propor'on of  Community-­‐Living  Adults  Age  65  and  Older  with  Selected   Physical  Health  Condi'ons  in  Two  Michigan  Home  Care  Programs,     N=  18,939   Physical  Health  Condi'ons

Prevalence Rate (%)

Chronic lung  disease,  including  emphysema  and  asthma










Coronary artery  disease


Cardiac dysrhythmia


Conges@ve heart  failure


Pain Moderate daily  pain


Severe daily  pain

25.1 Source: Li  and  Conwell,  2007  

Care Challenges BEYOND Diagnosis 1.  Focus on function NOT memory 2.  Behavioral/psychiatric symptoms of dementia increase likelihood of placement 3.  Medical co-morbidity increases complexity geometrically

Humanizing Dementia 1.â&#x20AC;Ż Framing the diagnosis for the family and resident in an accepting manor 2.â&#x20AC;Ż Rehab approach: -Identify strengths and weaknesses 2. Avoid infantilizing 3. Discussing the disease with the person

Care Challenges BEYOND Diagnosis 4. Family expectations are increasing 5. Non-cognitively impaired residents are an increasing minority 6. Increasing pressure to NOT use medications to treat behavioral/ psychiatric symptoms

Making Quality of Life Decisions

The Opportunities 1.  Leadership 2.  Imbuing a culture 3.  Modeling 4.  Reviewing successes and failures (feed forward system approach)

Memory Care in 2020 and Beyond  

In this session, Dr. Rabins will analyze the dramatic growth likely to be seen in the number of older adults, domestically and globally, liv...

Read more
Read more
Similar to
Popular now
Just for you