NR 601 Final Wk. 7-8 Dementia,
Delirium, AD, grief, palliative, hospice
Types of elder abuse
· Physical abuse: - answer causing physical pain or injuring a vulnerable elder
Types of elder abuse
· Sexual abuse: - answer sexual contact with a vulnerable elder without his or her
consent
Types of elder abuse
Consider this? for those who present with unexplained STDs. Test for STDs if you
suspect this? - answer sexual abuse
Types of elder abuse
· Neglect: - answer failing to provide food, shelter, health care, or protection for a
vulnerable elder
Types of elder abuse
· Exploitation: - answerthe taking of funds, property, or any assets of a vulnerable elder
without legal consent and not for the benefit of the elder
Types of elder abuse
· Exploitation: Who is most vulnerable to exploitation or more at risk for financial abuse -
answerThose with diminished cognitive function
Types of elder abuse
· Emotional abuse: - answerusing verbal or nonverbal means to cause mental pain,
anguish, or distress in an elder
Types of elder abuse
· Abandonment: - answerdeserting the vulnerable elder once someone has assumed
responsibility for that individual
Types of elder abuse
· Self-neglect: - answerthe elder fails to perform the needed activities to protect his or
her own health and safety (lacks food/utilities, refuses medications, hoards, lives in
unsafe conditions, neglects his or her grooming/appearance, is unable to handle
finances, is isolated, is disoriented, develops a dependence on drugs and/or alcohol)
elder abuse
,Victims of elder abuse who do not report their abuse do not b/c of -
answerembarrassment, the feeling of some sort of responsibility for the abuse, fear of
retaliation from the abuser, fear of increased abuse, fear of being placed in the nursing
home, the belief that no one will believe them, or a lack of awareness that the situation
is abusive
Risk factors of elder abuse
Occurs in - answerone in ten older Americans & all ethnic groups and socioeconomic
classes.
Risk factors of elder abuse
Lachs and Pillemer (2015) suggest that the abused elder is more likely what Women
are more likely to be what as opposed to men - answeran older female. She generally
has a physical impairment and is in poor health. She may either live alone, with the
abuser, or in a household with many members; victims of elder abuse than men.
Risk factors of elder abuse
1. The abuser is generally found to be what gender? - answermale who has a history of
past or current substance abuse, has mental health issues, is socially isolated, and has
a history of past trouble with law enforcement
Risk factors of elder abuse
The abuser may be financially - answerdependent on the elder and be under major
stress.
Risk factors of elder abuse
1. What contributing factors do victims of have - answerSocial isolation, frailty, physical
or mental disability, and dependency are some of the contributing factors, Living with
others can also be a risk factor
Provider responsibilities in suspected abuse
If elder abuse is suspected, who has a legal obligation—to report this to either 911 or
the state elder abuse hotline - answerhealth-care professional's
Provider responsibilities in suspected abuse
If suspecting elder abuse Carefully collect information regarding the patient, using what
findings - answerphysical findings, patient's functional abilities, testing results, and
verbal information from the patient and his or her caregivers.
Provider responsibilities in suspected abuse
Use the interdisciplinary team and - answerspeak with social workers, nursing staff, and
others who may have interacted with the patient and caregiver.
Provider responsibilities in suspected abuse
Document all findings, because they may be - answerrequired to be presented in court
later.
,Provider responsibilities in suspected abuse
Especially document any differences in - answerverbal accounts between the patient
and his or her caregiver.
Provider responsibilities in suspected abuse
It is also prudent to photograph - answersuspicious injuries, as well as measuring or
comparing size of injury with a familiar object if a ruler is not available
Provider responsibilities in suspected abuse
When a patient has dementia, - answera history can be difficult to evaluate. This
collection of information will assist the adult protective services case workers in their
case investigation. The information may protect the patient from further exploitation,
neglect, or abuse.
Provider responsibilities in suspected abuse
Be sure to follow up with - answerthe case workers to determine the outcome of the
case.
Alzheimer's Dementia (Kennedy)
Distinguishing features- symptoms, subjective complaints, objective findings
Probable Alzheimer's disease is diagnosed if there is Evidence of a causative marker;
explain - answerAD genetic mutation from family history or genetic testing.
Alzheimer's Dementia (Kennedy)
Distinguishing features- symptoms, subjective complaints, objective findings
· All three of the following are present: - answero Clear evidence of decline in memory
and learning and at least one other cognitive domain (based on detailed history or serial
neuropsychological testing)
o Steadily progressive, gradual decline in cognition, without extended plateaus
o No evidence of mixed etiology (i.e., absence of other neurodegenerative or
cerebrovascular disease, or another neurological, mental, or systemic disease or
condition likely contributing to cognitive decline)
Alzheimer's Dementia (Kennedy)
Distinguishing features- symptoms, subjective complaints, objective findings
· AD is dx'ed if The disturbance is not better explained by - answercerebrovascular
disease, another neurodegenerative disease, the effects of a substance, or another
mental, neurological, or systemic disorder.
Alzheimer's Dementia Screening from Lecture
What tests do you want to run - answerFocused history, cognitive & functional
assessment, CBC CBC, CMP panel & vitamin B12(looking for deficency); will also order
MRI
AD Staging guidelines (Kennedy p.444)
, Preclinical AD includes what features - answerImpaired memory, excused or covered
Insidious instrumental ADLs losses (money handling, bills) Preserved basic ADLs Poor
judgment and decisions Subtle personality changes
Decreased spontaneity, sense of initiative Increased anxiety, socially normal
2-4 years or longer
AD Staging
mild disease starts in what lobe of the brain - answermedial temporal lobe and
progressive to the lateral temporal lobe and parietal lobe.
AD Staging
In moderate, the disease spreads to what lobe of the brain - answerlateral lobe.
AD Staging
In severe, the disease spreads to what lobe of the brain - answeroccipital lobe.
AD Staging guidelines (Kennedy p.444)
AD Mild- moderate - answerObvious memory impairment
Overt instrumental ADL impairment
Basic ADLs failing
Prominent behavioral difficulties
Shortened attention span Language difficulty Variable social skills Supervision required
2-10 years
AD Staging guidelines (Kennedy p.444)
AD Severe - answerMemory fragments only
No recognition of familiar people
Assistance with basic ADLs required
Fewer troublesome behaviors
Reduced mobility
Weight loss, infections Seizures, dysphagia Incontinence Groaning, moaning, grunting
1-2 years or longer
AD Treatment from lecture
You will treat mild to moderate patients with - answerDONEPEZIL (ARICEPT) &
Rivastigmine (EXCELON) & Galantamine (RAZADYNE)
AD Treatment from lecture
You will treat moderate to severe with - answerMEMANTINE (NAMENDA)
AD Treatment
FDA-Approved Medications for Alzheimer ' s Disease
DONEPEZIL (ARICEPT) - answerFDA approval 1996; mild, moderate, severe AD
Benefit: Typically well tolerated; improves cognitive and behavioral status, caregiver
burden, and capacity for ADLs
Dosage strengths (mg) 5, 10
Delirium, AD, grief, palliative, hospice
Types of elder abuse
· Physical abuse: - answer causing physical pain or injuring a vulnerable elder
Types of elder abuse
· Sexual abuse: - answer sexual contact with a vulnerable elder without his or her
consent
Types of elder abuse
Consider this? for those who present with unexplained STDs. Test for STDs if you
suspect this? - answer sexual abuse
Types of elder abuse
· Neglect: - answer failing to provide food, shelter, health care, or protection for a
vulnerable elder
Types of elder abuse
· Exploitation: - answerthe taking of funds, property, or any assets of a vulnerable elder
without legal consent and not for the benefit of the elder
Types of elder abuse
· Exploitation: Who is most vulnerable to exploitation or more at risk for financial abuse -
answerThose with diminished cognitive function
Types of elder abuse
· Emotional abuse: - answerusing verbal or nonverbal means to cause mental pain,
anguish, or distress in an elder
Types of elder abuse
· Abandonment: - answerdeserting the vulnerable elder once someone has assumed
responsibility for that individual
Types of elder abuse
· Self-neglect: - answerthe elder fails to perform the needed activities to protect his or
her own health and safety (lacks food/utilities, refuses medications, hoards, lives in
unsafe conditions, neglects his or her grooming/appearance, is unable to handle
finances, is isolated, is disoriented, develops a dependence on drugs and/or alcohol)
elder abuse
,Victims of elder abuse who do not report their abuse do not b/c of -
answerembarrassment, the feeling of some sort of responsibility for the abuse, fear of
retaliation from the abuser, fear of increased abuse, fear of being placed in the nursing
home, the belief that no one will believe them, or a lack of awareness that the situation
is abusive
Risk factors of elder abuse
Occurs in - answerone in ten older Americans & all ethnic groups and socioeconomic
classes.
Risk factors of elder abuse
Lachs and Pillemer (2015) suggest that the abused elder is more likely what Women
are more likely to be what as opposed to men - answeran older female. She generally
has a physical impairment and is in poor health. She may either live alone, with the
abuser, or in a household with many members; victims of elder abuse than men.
Risk factors of elder abuse
1. The abuser is generally found to be what gender? - answermale who has a history of
past or current substance abuse, has mental health issues, is socially isolated, and has
a history of past trouble with law enforcement
Risk factors of elder abuse
The abuser may be financially - answerdependent on the elder and be under major
stress.
Risk factors of elder abuse
1. What contributing factors do victims of have - answerSocial isolation, frailty, physical
or mental disability, and dependency are some of the contributing factors, Living with
others can also be a risk factor
Provider responsibilities in suspected abuse
If elder abuse is suspected, who has a legal obligation—to report this to either 911 or
the state elder abuse hotline - answerhealth-care professional's
Provider responsibilities in suspected abuse
If suspecting elder abuse Carefully collect information regarding the patient, using what
findings - answerphysical findings, patient's functional abilities, testing results, and
verbal information from the patient and his or her caregivers.
Provider responsibilities in suspected abuse
Use the interdisciplinary team and - answerspeak with social workers, nursing staff, and
others who may have interacted with the patient and caregiver.
Provider responsibilities in suspected abuse
Document all findings, because they may be - answerrequired to be presented in court
later.
,Provider responsibilities in suspected abuse
Especially document any differences in - answerverbal accounts between the patient
and his or her caregiver.
Provider responsibilities in suspected abuse
It is also prudent to photograph - answersuspicious injuries, as well as measuring or
comparing size of injury with a familiar object if a ruler is not available
Provider responsibilities in suspected abuse
When a patient has dementia, - answera history can be difficult to evaluate. This
collection of information will assist the adult protective services case workers in their
case investigation. The information may protect the patient from further exploitation,
neglect, or abuse.
Provider responsibilities in suspected abuse
Be sure to follow up with - answerthe case workers to determine the outcome of the
case.
Alzheimer's Dementia (Kennedy)
Distinguishing features- symptoms, subjective complaints, objective findings
Probable Alzheimer's disease is diagnosed if there is Evidence of a causative marker;
explain - answerAD genetic mutation from family history or genetic testing.
Alzheimer's Dementia (Kennedy)
Distinguishing features- symptoms, subjective complaints, objective findings
· All three of the following are present: - answero Clear evidence of decline in memory
and learning and at least one other cognitive domain (based on detailed history or serial
neuropsychological testing)
o Steadily progressive, gradual decline in cognition, without extended plateaus
o No evidence of mixed etiology (i.e., absence of other neurodegenerative or
cerebrovascular disease, or another neurological, mental, or systemic disease or
condition likely contributing to cognitive decline)
Alzheimer's Dementia (Kennedy)
Distinguishing features- symptoms, subjective complaints, objective findings
· AD is dx'ed if The disturbance is not better explained by - answercerebrovascular
disease, another neurodegenerative disease, the effects of a substance, or another
mental, neurological, or systemic disorder.
Alzheimer's Dementia Screening from Lecture
What tests do you want to run - answerFocused history, cognitive & functional
assessment, CBC CBC, CMP panel & vitamin B12(looking for deficency); will also order
MRI
AD Staging guidelines (Kennedy p.444)
, Preclinical AD includes what features - answerImpaired memory, excused or covered
Insidious instrumental ADLs losses (money handling, bills) Preserved basic ADLs Poor
judgment and decisions Subtle personality changes
Decreased spontaneity, sense of initiative Increased anxiety, socially normal
2-4 years or longer
AD Staging
mild disease starts in what lobe of the brain - answermedial temporal lobe and
progressive to the lateral temporal lobe and parietal lobe.
AD Staging
In moderate, the disease spreads to what lobe of the brain - answerlateral lobe.
AD Staging
In severe, the disease spreads to what lobe of the brain - answeroccipital lobe.
AD Staging guidelines (Kennedy p.444)
AD Mild- moderate - answerObvious memory impairment
Overt instrumental ADL impairment
Basic ADLs failing
Prominent behavioral difficulties
Shortened attention span Language difficulty Variable social skills Supervision required
2-10 years
AD Staging guidelines (Kennedy p.444)
AD Severe - answerMemory fragments only
No recognition of familiar people
Assistance with basic ADLs required
Fewer troublesome behaviors
Reduced mobility
Weight loss, infections Seizures, dysphagia Incontinence Groaning, moaning, grunting
1-2 years or longer
AD Treatment from lecture
You will treat mild to moderate patients with - answerDONEPEZIL (ARICEPT) &
Rivastigmine (EXCELON) & Galantamine (RAZADYNE)
AD Treatment from lecture
You will treat moderate to severe with - answerMEMANTINE (NAMENDA)
AD Treatment
FDA-Approved Medications for Alzheimer ' s Disease
DONEPEZIL (ARICEPT) - answerFDA approval 1996; mild, moderate, severe AD
Benefit: Typically well tolerated; improves cognitive and behavioral status, caregiver
burden, and capacity for ADLs
Dosage strengths (mg) 5, 10
