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  

66%

Nursing Home  

70% 37%      >  64   9%    All  ages  

Acute Hospital   Primary  Care  

13%


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

27.0

Hypertension

69.2

Diabetes

32.9

Arthri@s

73.3

Stroke

27.0

Coronary artery  disease

29.1

Cardiac dysrhythmia

22.2

Conges@ve heart  failure

35.0

Pain Moderate daily  pain

22.5

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