Transcript 5. Moderately severe cognitive decline

AGEISM, prejudice and discrimination against older people
 Primary (genetic) VS secondary aging (environmental)
Three definitions of aging, the greatest influence on these stages is caused by
ENVIRONMENT:
1. Average life expectancy
2. Useful life expectancy
3. Maximum life expectancy
 PRIMARY and/ or COMMON forms of illnesses that will effect these definitions:
1. COPD
2. CHF
3. cancer
4. ***Vascular dementia - slow, physically caused, cognitive decline
“organic”
(CVA’s) a blood vessel bursts VS transient ischemic attacks (TIA’s)
disorders
5.***Alzheimer's – has a genetic component
6.***Parkinson’s- a movement disorder due to deficiency of dopamine
of the
brain
 One of the most devastating diseases because it can/does strike in middle age and
follows a progressive and LONG LASTING course for 3-20 YEARS
 There is no cure
 Only TRUE form of Diagnosis is AUTOPSY/
 NEUROFRIBRILLARY TANGLES AND PLAQUE
 There are SEVEN STAGES, these are used for frames of reference for making future
plans:
1. No impairment
2. Very mild cognitive decline
3. Mild cognitive decline, (still classified as dementia, Alzheimer's can be diagnosed in
some cases
4. Moderate cognitive decline, clear cut deficiencies in:
a) Knowledge of recent or current events/ short term memory
b) Decreased capacity to perform complex tasks
c) Reduced memory of personal history/ loss of long term memory
d) ***APPEARANCE of WITHDRAWAL in social or mentally challenging situations
5. Moderately severe cognitive decline (moderate or mid-stage Alzheimer’s disease
a) unable to recall current address, date, day of the week, season
**** (MENTAL STATUS EXAM)****
a) Know their name and family members
b) **Still can perform daily living skills***
6.Severe Cognitive Decline (mid-stage)
a) Lose of most awareness of the “here and now”
b) Can distinguish faces but not names
c) ***LOSE DAILY LIVING SKILLS***
d) Disturbance of normal sleep
e) SIGNIFICANT PERSONALITY CHANGES
f) ***WANDERING****
7. Very Severe cognitive decline (late stage)
a) Lose organized speech
b) Help with eating/toileting, ultimately may result with a feeding tube
c) Inability to walk, sit, reflexes become abnormal and muscles are rigid
1. Home care in the early stages by:
a) Utilizing medications: cholinesterase inhibitors – improve memory TEMPORARILY
b) OPTIMIZING ENVIRONMENTAL CONDITIONS-***LABEL/CUE/REMIND
c) Utilizing supportive services - respite care/daycare
2. Nursing Home Care:
a) In the sixth stage, ambulatory patients
b) Special Alzheimer’s units to contend with wandering and aggressiveness
3. SKILLED nursing home care
a) The seventh stage, difficulties with mobility
b) Provide controlled environment to keep individual comfortable and assist with death
process
c) Fragility leads to compromised immune system with the occurrence of pneumonia,
anorexia, and other medical complications
 LIFE REVIEW - process of reflection on events and experiences
Acceptance of everything but dependency
Study of aging is called- GERONTOLOGY
SENESCENCE- declines in physical functioning associated with age
 The largest growing population=Baby boomers/65 and older
 90% depend on Social Security for income
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Coping mechanisms-Adaptive defenses
Cognitive –Appraisal model-consciously choose by analyzing a situation
Problem- focused coping (PROACTIVE) –solving problems
Emotion-focused coping- (PASSIVE) directed towards feeling better
(acceptance of POWERLESSNESS)
Helpful with AMBIGUOUS LOSS, things we can’t control
 Disengagement VS activity Theory
1. Disengagement-moderately withdrawing
2. Activity-staying fully engaged, finding substitutes for lost roles, + successful
 Continuity theory –staying connected to past and present
 It is both internal and external structures
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FULL RETIREMENT – withdrawal from a full-time occupation
Family focused lifestyle-doing what comes along, it is financially low cost
Balanced investment-family/work/leisure
Serious leisure-dominated by an activity that demands full focus
1. crisp- complete break from employment
2. blurred – repeatedly leaving and returning to work
3. bridge job – the job that is held between one’s exit from a career job and final
retirement
4. Volunteerism
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Marital/ Remarriage
Siblings
Cohabitation
Friendships
Gay and lesbian
children
 Loss of independence and or physical capacity
1. Frail older adults – physical disabilities, very ill, and have cognitive and or
psychological disorders
2. Activities of daily living – basic self care activities
3. Instrumental activities of daily living – actions that require intellectual
competence and planning
 Changes or stability in relationships, marriage conflict or honeymoon stage
Living arrangements:
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Aging in place-remaining in your home
Living alone
Living with adult children
Living in institutions:
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assisted living facility – a facility which is housed on a “campus” with access to
nursing staff and/or facilities
Intermediate care – 24 hour care necessitating nursing SUPERVISION
skilled nursing care – requires 24 hour nursing CARE
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 bioethics – the study of human values (ethics) and technological advances in
health sciences
 euthanasia – the practice of ending life for reasons of mercy
1. active euthanasia – deliberate ending of a life which may be based on a clear
statement of the person’s wishes (mercy killing or assisted suicide)
2. passive euthanasia – allowing someone to die by withholding available
treatment
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clinical death – no heartbeat or respiration
brain death – no identifiable signs of brain activity
persistent vegetative state – cortical functioning ceases while brainstem activity
continues
 living will – a healthy or unhealthy person legally states their wishes about life
support
 Durable power of attorney – a legal document that gives a representative
power over financial and medical decisions.
 health care surrogate – identifies an individual to make medical decisions if you
are incapacitated
 Organ donation – harvesting organs as a result of brain death
 Kubler-Ross – identified stages of dying in terminally ill patients
 Many people believe that these stages of grief are also experienced by others
when they have lost a loved one, they reflect DISCONTINUITY
 The process is easier? If the death was expected due to old age (less guilt)
 The stages Kubler-Ross identified are:
1. Denial (this isn't happening to me!)
2. Anger (why is this happening to me?)
3. Bargaining (I promise I'll be a better person if...)
4. Depression (I don't care anymore)
5. Acceptance (I'm ready for whatever comes)
 grieving for a loved one last seven years before the process can be
completed, if at all.
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“caregiver syndrome”. During the illness/dying process which can go on for
months or years the ill person has become a focus of the individual’s attention
and consumed most if not all of their free time. The actual physical absence of
having to care for the individual leaves the caregiver “empty” and every activity
TRIGGERS the memory of the person. This is what type of conditioning?
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In older individuals whose lose a spouse of 40 -50+ years it is not uncommon for
them to die within the year following the death of the loved one.
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“Complicated Bereavement”. Severe symptoms continue for up to year but
eventually begin to diminish. If the individual remains in a severe state of
incapacity they may be treated and eventually identified as:
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Major Depressive Episode
The “normal” symptoms of depressed mood, insomnia, anhedonia (loss of all
pleasure), and lack of appetite will PERSIST beyond two months.
The individual feels guilt about things OTHER than the actions taken or not taken
by the survivor at the time of the death.
Thoughts of death OTHER than the survivor feeling that he/she would be better
off dead or should have died with the deceased person.
morbid preoccupation with worthlessness
marked psychomotor retardation (inability to get out of bed)
prolonged and marked functional impairment (inability to work or do household
chores)
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“Each of us has the right to die pain-free and with dignity”
The focus is on CARING not curing
1. PALLIATIVE CARE - to make comfortable by treating a person’s symptoms
from an illness – no attempt to treat the illness
2. Most reimbursement sources require a prognosis of six months or less
3. They use a “TEAM APPROACH”
4. They treat on a multidimensional level: physical, psychological, and/ or spiritual.
5. The goal is to help keep the patient as pain-free as possible, it is NOT normal
and can be observed even if it cannot be communicated
6. It is provided at “HOME”, the definition is multidimensional
7. Hospice does provide it’s own inpatient facility for those without support
systems
8. Primary “caregiver” – anyone who is directly responsible for care in the home,
usually a family member
 Makes short-term inpatient care available when pain or symptoms become too
difficult to manage at home, or the caregiver needs respite time
 Best interest - a standard for making health care decisions based on what
others believe to be "best" for a patient by weighing the benefit /risk ratio
 Life-sustaining treatment - Treatments (medical procedures) that replace or
support an essential bodily function, also referred to as:" extraordinary means”