Transcript HELEN ZIENKIEVICZ

Cognitive
Impairment &
Health Literacy
Helen Zienkievicz: APRN-CNP
Hospice Quality Care, Midwest City, OK
Porter Adventist Hospital, Denver, CO
No disclosures or known conflict of interests
Objectives
• Identify the prevalence of cognitive impairment (CI) and low
health literacy (HL) in our palliative care population & the
impact these conditions can have on disease and symptom
management
• Explore actions that each member of healthcare team can
take to identify, mitigate and combat cognitive impairment
and low health literacy in our palliative care population
• Promote organizational initiatives to implement
comprehensive approaches to deal with cognitive
impairment and low health literacy
Cognitive Impairment (Deficit)
An inclusive term used to describe
impairment in an individual’s mental
processes that lead to the acquisition of
information and knowledge, and drive how
an individual understands & acts in the world
emedicine.medscape.com
Cognitive Domains
Attention/Concentration
Ability to focus awareness of given stimulus or task
long enough to accomplish a goal.
Language
Ability to comprehend, repeat and express oral and
written language
Cognitive Domains
Visio-spatial & Visuo-construction Skills
Ability to make sense of shapes, angles, the meaning of
forms & reproduce them
Motor Skills
Ability to demonstrate gross, manual and fine motor skills
Cognitive Domains
Executive Functions
Ability to plan, conceptualize, organize and evaluate
Memory
Ability to store, consolidate and retrieve information
Cognitive Domains
Orientation
Ability to be accurately oriented to name, date and place
Contributing Factors
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History acute respiratory distress &/or critical illness
Chronic pulmonary diseases: ie. COPD
Cardiovascular disease including heart failure
Renal disease
Anemic or circulatory hypoxia
Iron-deficiency with or without anemia
Neurological diseases: ie. Parkinson’s
Chemical imbalances: electrolytes, drug & alcohol abuse
Chemotherapy side effects
Traumatic brain injuries
Aging process changes, poor sleep or breathing quality
OK COPD by Age
18 - 44 yr
4.2%
45 – 54 yr
9.5%
55 – 64 yr
13.9%
65 – 74 yr
15.0%
> 75 yr
13.8%
Self-care Challenges
Contributing Factors
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History acute respiratory distress &/or critical illness
Chronic pulmonary diseases: ie. COPD
Cardiovascular disease including heart failure
Renal disease
Anemic or circulatory hypoxia
Iron-deficiency with or without anemia
Neurological diseases: ie. Parkinson’s
Chemical imbalances: electrolytes, drug & alcohol abuse
Chemotherapy side effects
Traumatic brain injuries
Aging process changes, poor sleep or breathing quality
Hypoxic Types
Hypoxic hypoxia
Stagnant hypoxia
Conditions that block the exchange at
the alveolar capillary level
Occurs with insufficient blood flow
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Pneumonia
Asthma
Pulmonary edema
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Heart Failure
Decreased blood volume
Vasodilitation or pooling
Neurological shock
Anemic hypoxia
Histotoxic hypoxia
Body can’t transport available
oxygen to target tissues.
Body tissues can’t use the oxygen
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Acute or chronic blood loss
Carbon monoxide poisoning
Medications; sulfa & nitrates
Hemoglobin abnormalities
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Alcohol consumption
Narcotics
Cyanide poisoning
Alaska Air Medical Escort Training Manual, Fourth Edition &
www.faa.gov/pilots/training_education/topics_of_interest/hypoxia
Contributing Factors
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History acute respiratory distress &/or critical illness
Chronic pulmonary diseases: ie. COPD
Cardiovascular disease including heart failure
Renal diseases
Anemic or circulatory hypoxia
Iron-deficiency with or without anemia
Neurological diseases: ie. Parkinson’s
Chemical imbalances: electrolytes, drug & alcohol abuse
Chemotherapy side effects
Traumatic brain injuries
Aging process changes, poor sleep or breathing quality
Cognitive Measurement
Health Literacy
The degree to which individuals obtain,
process, and understand basic health
information and services to make
appropriate health decisions
http://www.iom.edu/?id=19750
Outcomes of Limited Health Literacy
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Decreased health knowledge
Poor self-management skills
Decreased use of preventative services
Poor medication adherence or ability to identify meds.
Decreased ability to complete activities of daily living
Decreased physical and mental health
Increased hospitalizations & use of emergency service
Increased healthcare costs
Increased mortality
www.hfsa.org
Risk Factors
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Older age
Limited education
Lower income
Chronic disease
English as a second language
Poor mental or physical health
Certain medications
Quality sleep deprivation
http://www.iom.edu, http://www.ahrq.gov, NIH, Paashche-Orlow MK, et al. The prevalence of health literacy. J Gen Intern Med 2005;20:175-84, www.hfsa.org
Learning Retention
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10% of what they read
20% of what they hear
30% of what they see
50% of what they hear
and see
Medication &
Treatment
Errors
Comply Less
with
Treatments
Fail to Seek
Preventative
Care
Less able to manage their health
•Higher risk for hospitalization
•Incur higher health care costs
Lack SelfEmpowerment
Where do I begin?
Medication Adherence Aid
Resources
Resource Websites
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Government: cdc.gov, ahrq.gov, nih.gov, iom.gov
Organization: hpna.org, hfsa.org, aafp.org
Educational Institutions: .edu sites
Pharmaceutical
Manufacturers of medical device sites
Teaching aid companies
Actions We Can Take Today
• Keep explanations simple & concise
• Don’t overwhelm: limit to 3 points
• Summarize & have client repeat back
Visit Summary: ASK
What questions do
you have?
vs
Do you have any
questions?
Cognitive Domain Review
• Attention/Concentration: ability to focus on task long enough
• Language: ability to comprehend, repeat oral & written language
• Visiospatial/Visuoconstruction: ability to make sense of
shapes
• Motor Skills: ability to demonstrate gross, manual, & fine motor skills
• Executive Function: ability to plan, organize & evaluate
• Memory: ability to store, consolidate & retrieve information
• Orientation: ability to be accurately oriented to name, date and place
Institution Actions