Transcript Health Issues and the Pediatric Visit - 204.39 KB

Grandparent Caregivers:
Health Issues and the Pediatric
Visit
Amanda D. Soong, MD
Assistant Professor of Pediatrics
University of Alabama at Birmingham
Objectives

Identify key health issues for:
Grandparent Caregivers

Discuss ways for the pediatrician to assist in the
evaluation of Grandparent’s health during a
pediatric visit

Discuss resources available in the community for
grandparents in need of medical evaluation
Definitions

For the purposes of this talk, Grandparent
Caregivers are defined as grandparents that
provide the majority of care for their grandchildren
under the age of 18.

This may include grandparents with formal or
informal custodial arrangements, or grandparents
that provide childcare for working parents.

Also included are other older relatives that may
have custody/provide care.
The Issue

According to 2011 American Community Survey
Estimates:
2,870,639 Grandparents are primary caregivers to
one or more grandchildren.

Some estimate that in the inner city, 30-50% of
children are in the care of grandparents.
Grandparent Health

Grandparents who care for grandchildren often
neglect their own health for a myriad of reasons

We may be the only health care providers a
grandparent sees if they have been overlooking
their own health in the process of caring for their
grandchild.
At Well Child Checks…..

You should already be asking about the Family
Medical History during your well child checks.

When dealing with grandparents, ask specifically
about their health instead of just asking what runs in
the family.
At Well Child Checks..

After asking about the child’s medications, ask
about other medications in the home and how the
medications are stored.

This may offer you more insight into the
grandparent’s health, and also provide invaluable
information in the case of an ingestion of an
unknown substance.
Health of Grandparent Caregivers

Multiple studies have examined the health of Grandparent
Caregivers.

Almost all of the studies have concluded that Grandparent
Caregivers have worse health than their peers not raising
children.
Health of Grandparent Caregivers

Besides worsening of adult illnesses like DM2, hypertension and arthritis, grandparent
caregivers may face other challenges.

Multiple studies have documented that
grandparent caregivers have greater
difficulty than their non-caregiving peers with
performing activities of daily living such as
performing day to day tasks, climbing a flight
of stairs, and moving around the house.
Health of Grandparent Caregivers

The caregivers are also more likely to report
depression than their non-caregiving peers.

Depression is known to have a significant
impact on overall health.
Health of Grandparent Caregivers

Your interaction with the grandparent
caregiver can also give you valuable insight
into their health.

Observe how well the caregivers seems able
to walk when going in or out of the exam
room.

Do they appear to have hearing or sight
issues?
Health of Grandparent Caregivers

While talking with the caregiver, do they
appear forgetful or confused?

As the child’s pediatrician you should
consider if you feel as if the child would be
safe with the caregiver.

If you have concerns for the safety of the
child, social work should be contacted.
Dementia or Cognitive Impairment

There is a continuum that exists between
mild cognitive impairment and dementia.

Early dementia may also be difficult to
differentiate from just a disorganized or
overwhelmed caregiver.
Signs of Dementia

Cognitive Changes:
New forgetfulness, increasing trouble understanding
written and spoken communication, work finding
difficulty, disorientation.

Psychiatric Symptoms:
Withdrawal or apathy, depression, suspiciousness,
anxiety, paranoia, hallucinations

Personality Changes:
Excessive friendliness, flirting; frustration, disinterest,
explosive outbursts.
Signs of Dementia

Problem behaviors:
Wandering, agitation, noisiness, restlessness

Changes in day-to-day Functioning:
Trouble driving, getting lost; neglecting self care
or chores, trouble shopping, cooking and paying
bills.
Diagnosis

There are 3 main categories to think of in the
continuum of dementia.
 Age Related Cognitive Decline- memory loss without other cognitive
issues. Within normal limits given a person’s age.
 Mild Cognitive Impairment- patient with some cognitive impairment,
but not to the degree found in dementia.
 Dementia- according to the DSM-IV, cognitive impairment to the
degree that social or occupational function is reduced, with the
functional impairment representing a decrease in the patient’s normal
ability.
What should you do if you suspect a caregiver has
dementia or signs of cognitive decline?

If during the visit you are concerned by what you
observe, ask the child if they are old enough, if they
have noted any changes.
Are there any other relatives you could talk to?

You could ask the grandparent open ended
questions like, “Do you find you have more trouble
doing X than you used to?” If they say yes, probe
further.

If you are concerned for the child’s safety, social
services and DHR should be contacted.
Identifying dementia

As stated before, you may be the only contact with a
medical professional for the grandparent caregiver.

If you suspect dementia, there is an easy, quick
screen you could perform in the clinic to help guide
your decision making called the Mini-Cog exam, or
clock drawing test.

http://www.alz.org/documents_custom/minicog.pdf
The Mini-Cog

The test consist of 3 steps:
1) Instruct the caregiver to listen carefully to and
remember 3 unrelated words and then repeat the
words back.
2) Have the caregiver draw a clock face, and once
the face is drawn, ask them to add clock hands to
read a specific time like 10:20. You can repeat
instructions, but give no other instructions. This is
called the Clock Drawing Test (CDT)
3) Ask the patient to repeat back the 3 words
previously presented.
Scoring the Mini-Cog

Give 1 point for each recalled word at the end (1-3
points)

A score of 0 is a positive screen for dementia.

A score of 1 or 2 with an abnormal CDT indicates a
positive screen.

A score of 1 or 2 with a normal CDT is a negative
screen.

A score of 3 indicates a negative screen.
The Mini-Cog

As with any screen, further evaluation is needed for
a positive screen.

If concerns persist despite a normal screen, further
evaluation is also warranted.
Health Resources for Grandparent
Caregivers
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Be aware of resources for geriatric patients in your
community. If concerns regarding cognitive
impairment arise, a physician specializing in
Geriatric Medicine may be able to assess the
patient and offer recommendations.
Social Support

Studies have indicated that Grandparent Caregivers
can benefit from taking part in support groups with
their peers.

Information regarding groups in your area may be
found at: http://www.aarp.org/relationships/friendsfamily/grandfacts-sheets/
Conclusions

Remember to ask about who is the primary
caregiver in the home.

Always ask about family history, but in the case of a
grandparent caregiver, try to get a complete history
and assess their access to care.

Consider screening for dementia if indicated.
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Encourage the caregiver to seek medical care.
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Advise caregivers of available community support
groups.
Sources

Minkler, M, Driver, D, et al. Community Interventions To Support Grandparent Caregivers.
The Gerontologist, 33( 6). 807-811.

Kelley, S., Whitley,D. Psychological Distress in Grandmother Kinship Care Providers: The
Role of Resources, Social Support, and Physical Health. Child Abuse & Neglect. 24(3) 311321.

Minkler, M., Fuller-Thomson, E. The Health of Grandparents Raising Grandchildren: Results
of a National Study. American Journal of Public Health. 89(9) 1384-1388.

Clinical Toolbox for Geriatric Carehttp://www.hospitalmedicine.org/geriresource/toolbox/mini_cog.htm

Grandfacts: A State Fact Sheet for Grandparents and Other Relatives Raising Children.
AARP. Alabama, August 2007
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Santacruz, Karen, and D. Swagerty. Early Diagnosis of Dementia; American Family
Physician. Vol63, No 4; pages 703-713.
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Personal communication with Dr. Marsha Crowther, Associate Professor of Psychology at
the University of Alabama