Emerging Priorities in Aging

Conferences & Workshops - Aging Research & Innovation Forum • October 26, 2012 • Kingston, ON

On October 26, 2012, as part of our series of Aging, Research & Innovation Forums, over 100 educators, clinicians, students, caregivers and researchers from across Ontario attended the Emerging Priorities in Aging conference at Portsmouth Olympic Harbour Restaurant in Kingston to discuss ideas, projects and research about the care and welfare of older adults.

Aging, Research & Innovation Forums

September 15, 2011 • November 23, 2011 • February 16, 2012 • Kingston, ON

Through a series of consultations, the Centre for Studies in Aging & Health at Providence Care identified a desire to create networking opportunities in aging research and practice at Providence Care and Queen’s University. Beginning in September 2011, CSAH organized a series of Aging, Research & Innovation Forums, inviting researchers, physicians, geriatric specialists and health care planners.

This presentation summarizes the behavioural and psychological symptoms of dementia. Dr. Puxty uses cases to review brain function and behaviour, as well as an approach for collaborative care planning within a primary care setting. Both non-pharmacological and pharmacological treatments are explored. 42 Slides.

As people age, they experience many changes, including physical, psychological, social and environmental; every individual reacts to these changes differently (1).

Older adults who are no longer able to communicate their needs and desires effectively  may engage in responsive behaviours, also refered to as challenging behaviours (2). This type of behaviour can include feeling annoyed, wandering, not wanting care, use of foul language, hitting and throwing (2). In these situations, it is helpful to use simple words, move slowly through activities and remain patient (3).

Caring for someone experiencing episodes of responsive behaviour is challenging. As a caregiver, it is essiental to stay emotionally, mentally and physically healthy. Seeking the support of community services, family members and friends can help ease stress or burden brought on by caregiving (3). Sharing tasks, solving problems and savouring the humour along the caregiving journey with others will help maintain your health. Finally, staying educated on your friend or family member’s condition can help you understand their experience and allow you to provide the best care you can (3).

References

(1)  Hilger. Z. (2009). Behaviour and emotions of aging. Retrieved from http://www.familycaregiversonline.net/online-education/behavior-and-emotions-of-aging/

(2)  Ontario Behavioural Support System Project Team. (2010). Behaviours have meaning -The Ontario behavioral support system project. Retrieved from http://www.nelhin.on.ca/Page.aspx?id=12028

(3)   Robinson, L., Wayne, M. S., & Segal, J. (2018). Tips for Alzhemier’s caregivers. Retrieved from https://www.helpguide.org/articles/alzheimers-dementia-aging/tips-for-alzheimers-caregivers.htm

Behavioural issues also known as responsive behaviours are generally characterized by challenging outbursts of aggression, agitation, repetitive or bizarre actions, shouting and/or disinhibited behaviours. They are generally associated with cognitive impairments due to complex mental health conditions and addictions (substance abuse), dementia or neurological conditions.

Why is it Important?

  • 15-40 % of Canadian seniors require mental health services and 5-10% of have severe psychiatric impairment that may require specialized services (1)
  • Approximately 30% of home care clients with a diagnosis of dementia exhibit some degree of behavioural symptoms (1)
  • Often presents as a crisis situation
  • The majority of older persons with responsive behaviours can be managed at home with specialized geriatric community supports and early recognition (2)

Common Causes

May be precipitated by variety of triggers (follow P.I.E.C.E.S. acronym):

Physical: pain, constipation, polypharmacy, infections; especially UTI and pneumonia
Intellectual: Review Brain and Behaviour
Emotional: depression, anxiety
Capacity: miss match between functional ability and expectations
Environmental: changes in living environment, relocation, admission to hospital
Social: change or stress/illness of caregiver

Key Considerations

  • The goal of care is to support the person and their family to remain in the community
  • Assess medical, neurological, medications, functional and psychiatric status: refer to Geriatric Psychiatry or Geriatrician services as necessary. Early symptoms are commonly “under recognized”
  • Early referral to community supports: Community Care Access Centre for home and family supports: Aging at Home, SMILE Program, Alzheimer’s First Link, etc.
  • Assess the impact of behavioural issues on the individual’s quality of life and signs of caregiver stress
  • Determine concerns (e.g.  fears) and expectations (hopes) of the person and family using the 3 question framework:
    1.  What are the main concerns and what has changed?
    2.  What are the RISKS and possible causes (Think P.I.E.C.E.S. TM)?
    3.  What is the action?
  • Continuity of health care providers, services and a case management approach supports both the individual and  the  family (1)
  • Identify conditions that may be responsive to medications and those which only respond to environmental or caregiving approaches. Utilize the Beers criteria for potentially inappropriate medication use in older adults

References

1. Dudgeon, S. & Reed, P. (2010). Older Adults Behaviour Support System. Retrieved Feb 19, 2014 from: 
    http://brainxchange.ca/Public/Resource-Centre-Topics-A-to-Z/Behavioural-Supports-Ontario.aspx

2. Family Caregiver Alliance. (2012). Retrieved Feb 18, 2014 from:
    http://www.caregiver.org

3. Puxty, J. & Rivard, M. (2009) Introduction to Behavioural and Psychological Symptoms of Dementia
    (BPSD): A Handbook for Family Physicians (2nd ed.) Retrieved Feb. 2014 from:
    www.sagelink.ca/bpsd_handbook

4. Mental Health Commission of Canada. (2014). Retrieved Feb. 18, 2014 from:
    http://www.mentalhealthcommission.ca/English

This booklet provides a condensed version of the BPSD in LTC for caregivers to understand these “challenging” behaviours and promote a therapeutic response. Topics include risk factors, prevention, making the diagnosis, treatment ( including Pharmacological Treatment: P.I.E.C.E.S. Psychotropic Template chart), Quality Improvement, Resident and Family education along with template questions for P.I.E.C.E.S., U-First and U.R.A.F. 25 Pages.

BPSD are prevalent and persistent in LTC. They contribute to cognitive and functional decline, significant suffering, poorer quality of life for the residents and caregivers, and a reciprocal cycle of resident-staff abuse. Informal and formal caregivers are often challenged by these changes in behaviour and mood, which may be misinterpreted as being volitional or intentional. Consequently, they may respond in ways that damage their relationship with the individual with dementia. This manual provides comprehensive resources for both formal and informal caregivers to understand these “challenging” behaviours and promote a therapeutic response. Topics include risk factors, prevention, making the diagnosis, treatment, Quality Improvement, Resident and Family education along with the BPSD toolkit and assessment tools. 508 Pages.

Primary Care Clinical Resource Toolkits were designed as part of the Geriatrics, Interprofessional, Interorganizational Collaboration (GiiC) project. Its purpose was to support family health teams and community health centers in the delivery of care for frail seniors.

The resources offer a systematic and inter-professional approach to common care issues through the "identify, prepare, evaluate, action" framework. This basic clinical approach can be used for the evaluation and management of any chronic condition.

The Bridges to Care Long-Term Care Project, funded by Health Force Ontario, was aimed at improving evidence-based knowledge-to-practice resources for clinicians within Long Term Care. Tools are grouped according to various practice settings including primary care, emergency care, acute care, community care, specialized care and long-term care. Tools are also organized alphabetically and by common geriatric issue.

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