Dementia Care: An Evidence-Based Approach PDF
Preview Dementia Care: An Evidence-Based Approach
Marie Boltz James E. Galvin Editors Dementia Care An Evidence-Based Approach 123 Dementia Care Marie Boltz (cid:129) J ames E. Galvin Editors Dementia Care An Evidence-Based Approach Editors Marie Boltz James E. Galvin William F. Connell School of Nursing Professor and Associate Boston College Dean for Clinical Research Chestnut Hill , MA , USA Charles E. Schmidt College of Medicine Florida Atlantic University Boca Raton , FL , USA ISBN 978-3-319-18376-3 ISBN 978-3-319-18377-0 (eBook) DOI 10.1007/978-3-319-18377-0 Library of Congress Control Number: 2015941313 Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. T he use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. T he publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com) Pref ace M ost of us know someone who has dementia or who is affected by it in some way. The number of people living with dementia in the United States is almost six million, with worldwide estimates of 35.6 million. This number is expected to double globally by 2030 and more than triple by 2050 [1]. As one of the major causes of disability and dependency among older people world- wide, it is overwhelming not only for the people who have it but also for their caregivers and families. Furthermore, dementia presents diagnostic and treat- ment challenges to the clinician, as well as complex conundrums for the researcher and policy maker. T he National Alzheimer’s Plan [2] identifi es the following goals: the pre- vention and early detection of Alzheimer’s disease, effective treatment, sup- port of people with dementia and their families, and effi cient and coordinated care delivery. Consistent with these goals, the purpose of this book is to describe the evidence-based practices that support the patient and family across the trajectory of the dementia clinical course. We also offer the per- spective of the patient and family, as their views and experiences ideally shape clinical decisions and program development. The fi rst section of the book is Dementia Prevention, Detection, and Early Support . As the population ages at an unprecedented rate, effec- tive strategies to promote cognitive functioning and health are imperative. The chapter, P revention of Dementia , describes the pathological changes that occur with cognitive decline and the risk factors linked to the occur- rence of Alzheimer’s disease. The effi cacy of preventive measures includ- ing diet, nutritional interventions and dietary supplements, modifi cation of cardiovascular risk (including physical activity and lifestyle modifi ca- tions), cognitive engagement, and pharmacologic strategies is presented. Early detection is important in order to secure targeted treatment, prevent avoidable complications, initiate planning for future needs, and mobilize support and resources to the patient and family. The chapter, Detection of Dementia, describes the elements and benefi ts of a comprehensive mental status as well as common barriers to implementation. Assessment methods and use of currently available biomarkers to improve detection of dementia are discussed. Memory clinics and care management offer ser- vices and supports during, the initial phases of care delivery and onward. The chapter, Memory Clinics and Care Management Programs, reviews memory clinics from a historical perspective and describes its attributes, population serviced, staffi ng, and outcomes, as well as gives a review of v vi Preface care management models. A diagnosis of dementia often brings with it feel- ings of loss, social stigma, and uncertainty, placing major demands on the coping abilities for the individual. The chapter, E arly Stage Dementia: Maximizing Self-Direction and Health , presents strategies to support the person’s integrity and autonomy. Diagnostic disclosure, legal and fi nancial planning, supporting functional independence, and maximizing dementia- specifi c resources are some of the approaches discussed. T he second section of the book is Clinical Management of Dementia . No treatments are currently available to cure the progressive course of dementia. There are, however, interventions designed to manage symptoms and pro- mote safety, while maximizing the sense of well-being in the person with dementia. The chapter, C hallenges and Opportunities in Primary and Specialty Memory Care to Provide Best Practice Care , examines the chal- lenges to recognizing, diagnosing, and treating dementia in both primary and specialty care and offers strategies, including collaborative care delivered by an interdisciplinary teams. The chapter, T reatment of Dementia: Pharmacological Approaches, discusses current and promising pharmaco- logic approaches to managing the cognitive, functional, and behavioral aspects of Alzheimer’s disease. The chapter, T reatment of Dementia: Non- pharmacological Approaches , describes the behavioral symptoms common in persons with dementia, their impact, origins, and triggers, and assessment. Non-p harmacological interventions, including sensory stimulation, cognitive stimulation and training, emotion-oriented interventions, physical activity and exercise, and behavioral education and training interventions, are pre- sented. These interdisciplinary interventions are consistent with the International Association of Gerontology and Geriatrics, the Center for Medicare and Medicaid (CMS), and the National Alzheimer Project Act (NAPA) advocacy for the use of non-pharmacologic interventions as fi rst-line treatment in the management of behavioral symptoms [3–5]. P ersons with dementia have reported loss of driving as catastrophic, lead- ing to feelings of extreme loss of independence and social isolation. The chapter, C ommunity Mobility in the Person with Dementia, describes the implications of driving in the medically at risk and offers the state of the sci- ence on screening assessments and the role of the driving rehabilitation spe- cialist. The concept of supportive transportation for the person with cognitive impairment who is transitioning from driver to passenger is also discussed. T he third section of the book is entitled T oward Person-centered Community-based Dementia Care. Expert dementia care recognizes that the patient and family are the unit of care, and the needs and well-being of the person with dementia and the family caregiver are often interwoven. Further, people with dementia and their caregivers have substantive and unique insights into their condition and life and thus should direct their care. The chapter, E xperience and Perspective of the Person with Dementia, empha- sizes the retained sense of self, well-being, and purpose in the interpersonal worlds of the person with dementia. The authors describe tools and approaches that affi rm the individual’s self-hood, self-esteem, and quality of life. The chapter, H ome-based Dementia Care Interventions, provides a systematic review of the extant research on home-based interventions that are designed Preface vii to improve the quality of life of individuals living with dementia. The authors describe interventions such as caregiver education about dementia, behavior management, activity engagement and case management, describing their merit, as well as opportunities to advancement in this area. The chapter, Experience and Perspective of the Family Caregiver of the Person with Dementia, examines the realities of dementia caregiving, from six perspec- tives of the family member. These perspectives are physical care, lifestyle changes, emotional and psychological needs of the ill person and their carers, relational changes, pragmatic (legal and fi nancial) dimensions, and fi nally ethical decision- making dilemmas. Then the chapter, I nterventions to Support Caregiver Well-B eing, describes role-related changes in family caregivers and presents interventions including those that focus on improving caregiver health (psychological and physical), offer respite, and provide post- caregiving support. T he fourth section of the book, Dementia Continuing Care, addresses the needs of persons with dementia and their family at various stages of health and in different settings. The chapter, T ransitions in Care for the Person with Dementia, describes best practices and programs for the person with dementia in periods of transition, including an admission to the hospital and relocation to and within long-term care. The chapter, D ementia Palliative Care , discusses how to provide generalist palliative care services, emphasiz- ing symptom management and psychosocial support of patients and families. The chapter, H ospice Dementia Care, offers a robust description of the hos- pice referral and eligibility requirements, the pathobiology and neuropathol- ogy, clinical management including symptom control, and bereavement care. Ethical challenges and the support of caregivers are also discussed. Finally, The chapter, C hallenges in Dementia Care Policy , offers recommenda- tions on how various public and private agencies might approach developing dementia- capable systems. Public education, early detection of dementia, worker dementia competency, quality assurance programs, and development of dementia-friendly communities are all discussed as key elements of a dementia-capable system. T he more information, we have the greater is our capacity to help persons with dementia and their family members to take and maintain control of their lives. We hope that this book provides a valuable resource for the student, the clinician, the administrator, the researcher, and the educator in their individ- ual efforts toward that goal. Chestnut Hill, MA, USA Marie Boltz Boca Raton, FL, USA James E. Galvin References 1. Alzheimer’s Association. Alzheimer’s disease facts and fi gures. 2014. Available at: http://www.alz.org/downloads/Facts_Figures_2014.pdf 2. National plan to address Alzheimer’s disease: 2014 Update. h ttp://aspe.hhs.gov/daltcp/ napa/NatlPlan2014.pdf viii Preface 3 . T olson D, Rolland Y, Andrieu S, Aquino J-P, Beard J, Benetos A, et al. International Association of Gerontology and Geriatrics: a global agenda for clinical research and quality of care in nursing homes. J Am Med Dir Assoc. 2011; 12(3):184–9. 4. Workgroup on NAPA’s scientifi c agenda for a national initiative on Alzheimer’s dis- ease. Alzheimers Dement J Alzheimers Assoc. 2012; 8(4):357–71. 5 . M itka M. CMS seeks to reduce antipsychotic use in nursing home residents with dementia. JAMA J Am Med Assoc. 2012; 308(2):119, 121. Acknowledgments We would like to thank the following for their contributions and support of this book: • The expert authors, clinicians, educators, and researchers who are recog- nized for their expertise as well as their dedication and passion to the fi eld of aging and dementia • Springer Science + Business Media for recognizing dementia care as a critical focus for their publication • Project Coordinator, Susan Westendorf, for her tremendous guidance, organization, and patience • Persons with dementia and their family members who inspire us to learn more and do more to become better clinicians, researchers, and administrators. Marie Boltz James E. Galvin ix
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