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In this session, Dr. Rabins will analyze the dramatic growth likely to be seen in the number of older adults, domestically and globally, living with dementia, and discuss the implications for senior living organizations. What will the operational challenges be when the number of senior living residents living with dementia, or who have undetected early signs of dementia, outnumber residents with normal cognition? Dr. Rabins will explore the potential impacts of this dramatic shift on how prepared your current physical environment and programming, marketing and admission criteria are, and discuss possible steps that executive directors and senior living organizations can take to be prepared to manage the changes to come.
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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
CChristensen, 2009
Best-‐prac'ce Life Expectancy for Women in Selected Countries from 1840 to 2007
Linear regression trend depicted by solid grey line with a slope of 0.24 per year
Gain in life expectancy is 3 months per year or 2 ½ years every decade
Christensen, 2009
Age-‐specific Contribu'ons to the Increase in Record Life Expectancy in Women
1850-‐2007
Dementia Syndrome
Declines in 2 or more cognitive capacities Normal level of consciousness and alertness Onset in adulthood
Common Causes of Dementia
Alzheimer disease 66% Vascular dementia 15-20% Dementia with Lewy bodies 8-15% Fronto-temporal dementia 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
13%
9% All ages
70%
66%
11%
18%
10%
0.3%
37% > 64
Primary Care
Acute Hospital
Nursing Home
Assisted Living
Public Housing
Home Health
Popula'on > 64
Popula'on < 65
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
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
1. Focus on function NOT memory
2. Behavioral/psychiatric symptoms of dementia increase likelihood of placement
3. Medical co-morbidity increases complexity geometrically
Care Challenges BEYOND Diagnosis
Humanizing Dementia 1. Framing the diagnosis for the family and
resident in an accepting manor
2. Rehab approach: -Identify strengths and weaknesses
2. Avoid infantilizing 3. Discussing the disease with the person
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
Care Challenges BEYOND Diagnosis
Making Quality of Life Decisions
1. Leadership
2. Imbuing a culture
3. Modeling
4. Reviewing successes and failures (feed forward system approach)
The Opportunities
![Halilovich H. 2011 Beyond the Sadness... Memory Studies [1]](https://img.dokumen.tips/doc/110x75/5572003349795991699effec/halilovich-h-2011-beyond-the-sadness-memory-studies-1.jpg)
