BRANCH LEADERSHIP CONFERENCEApril 10, 2010

MOST COMMON REASONS FOR CARE

DEMENTIA

DEMENTIA - Overview• Characterized by loss of or decline in memory and other cognitive abilities

• Caused by various diseases and conditions that result in damaged brain cells.

• Must include decline in memory and in at least one of the following cognitive abilities.– ability to generate coherent speech or understand spoken or written language;– ability to recognize or identify objects, assuming intact sensory function;– ability to execute motor activities, assuming intact motor abilities, sensory

function and comprehension of the required task– ability to think abstractly, make sound judgments and plan and carry out

complex tasks.

• The decline in cognitive abilities must be severe enough to interfere with daily life.

ALZHEIMER’S DISEASE• Most common type of dementia – accounts for 60 to 80 percent of the cases

• Fifth leading cause of death for those aged 65 and older

• According to 2009 statistics, 5.3 million Americans have Alzheimer's disease.

• One in eight persons age 65 and older have Alzheimer’s disease.

• Every 70 seconds, someone in America develops Alzheimer’s disease.

• It is predicted that by mid-century, someone will develop Alzheimer’s every 33 seconds.

• Live an average of 8 – 10 years from diagnosis

10 Signs Of Alzheimer's• Memory loss that disrupts daily life• Challenges in planning or problem solving• Difficulty completing familiar tasks at home, at work or at

leisure• Confusion with time or place• Trouble understanding visual images and spatial relationships• New problems with words in speaking or writing• Misplacing things and losing the ability to retrace steps• Decreased or poor judgment• Withdrawal from work or social activities• Changes in mood and personality

Cognitive/Intellectual Symptoms 4 A’s Of Alzheimer’s Disease• Amnesia—loss of memory or the inability to remember facts or events.

– Short term memory (recent, new) is damaged and lost first.– Understand non-verbal behavior such as smiling

• Aphasia—the inability to communicate effectively.– Loss of ability to speak and write or understand spoken or written works

• Apraxia—the inability to do pre-programmed motor tasks or to perform activities of daily living such as brushing teeth and dressing.– Chewing, swallowing and walking are lost in the last stages

• Agnosia—the inability to correctly interpret signals from a person’s five senses– Inability to recognize familiar people and objects– Inability to perceive internal information such as a full bladder or chest

pain.

Psychiatric Symptoms

• Personality Changes– may be evident in early stages– signs include irritability, apathy, withdrawal, isolation

• Depression– may occur at any stage

• Psychotic Symptoms– hallucinations and delusions usually middle stage– hallucinations are typically auditory and/or visual

Alzheimer’s Disease – Caregiver Opportunities

• Respite services for family members (breaks from care giving)

• Companion and Homemaker services – Shopping for groceries, preparing meals , providing transportation

• Personal care – Bathing, dressing, feeding, helping the person use the bathroom or providing incontinence care– helping the person take medications correctly and follow recommended

treatment– supervising the person to avoid unsafe activities such a wandering and getting lost

• Skilled care • Hospice care• Medical social worker

• Additional care to family caregivers – Their personal health deteriorates– increased hospitalizations and new diseases such as hypertension,

or coronary heart disease

PARKINSON’S DISEASE

• Progressive neurodegenerative disorder effecting motor function

• After Alzheimer’s disease, Parkinson’s disease is the most common neurodegenerative disease

• Affects men and women in almost equal numbers

• One million Americans currently affected

• It’s estimated there are 50,00 – 60,00 new cases annually

Parkinson’s Disease-Stages of Progression

• Stage One– mild symptoms of tremors on one side only; changes in posture, walking and facial

expressions

• State Two– symptoms on both sides with minimal disability, posture and walking are affected

• Stage Three– significant slowing of body movements; early impairment of equilibrium which affects

walking or standing; generalized dysfunction that is moderately severe

• Stage Four– severe symptoms; can still walk to a limited extent; rigidity and very slow movements;

tremors may be less than earlier stages due to rigidity– no longer able to live alone

• Stage Five– physical wasting with loss of weight and muscle mass; cannot stand or walk– requires constant nursing care

Parkinson’s Disease – Caregiver Opportunities

• Companion care

• Homemaker care

• Personal care

• Skilled care– Nurses– Physical Therapists– Occupational Therapists– Speech Therapists– Hospice Care – Medical social worker

CEREBROVASCULAR ACCIDENT (CVA) / STROKE

Strokes usually damage only one side of the brain. Because nerves in the brain cross over to the other side of the body, symptoms appear on the side of the body opposite the damaged side of the brain.

Cerebrovascular Accident (CVA) / Stroke Overview• Stroke is the sudden death of brain cells due to lack of oxygen.

• Caused by the blockage of blood flow or rupture of an artery to the brain.

• Symptoms of a stroke can include: sudden severe headache with no known cause, sudden difficulty seeing in one or both eyes, sudden tingling, muscle weakness, paralysis on one side of the body, difficulty with balance, loss of coordination, dizziness, difficulty with speaking, or swallowing, problems with vision and visual perception, memory and reasoning problems, coma and death.

• In the United States, stroke is the third largest cause of death.

• One third of stroke survivors are expected to experience another stroke within five years.

• The major cost or impact of a stroke is the loss of independence that occurs in 30% of the survivors.

Outcomes of a Stroke• Stroke can affect patients physically, mentally, emotionally, or a combination of the three.

Dysfunctions correspond to areas in the brain that have been damaged.

• Disabilities include:– paralysis, numbness which could lead to pressure sores– incontinence,– swallowing difficulties may lead to aspiration pneumonia or dehydration and under-

nutrition– inability to perform learned movements which means they have difficulties carrying out

daily activities, – speech loss,– cognitive deficits resulting in problems with attention and memory– inability to recognize his/her own disabilities– emotional problems such as anxiety, panic attacks, severe depression, wide mood swings

• Up to 10% of all stroke patients develop seizures

Stroke – Caregiver Opportunities

• Companion care• Homemaker care• Personal care• Skilled care• Physical therapy• Speech therapy• Occupational therapy• Medical social worker

Traumatic Brain Injury (TBI)

Traumatic Brain Injury (TBI)• Acquired brain injury occurs when a sudden trauma damages the brain.

– half of all TBIs are due to accidents due to automobiles, motorcycles, bicycles and pedestrians

– falls– violence (firearms, physical abuse)– sports injuries– veterans returning from Iraq and Afghanistan

• Disabilities resulting from a TBI depend upon:– severity of the injury,– location of the injury, – age– general health of the individual.

• Symptoms can be mild, moderate or severe depending on the extent of the damage to the brain

Traumatic Brain Injury (TBI)• Mild may include:

– headache– dizziness and vertigo– memory problems and difficulty concentrating– sleeping problems– restlessness, irritability

• Moderate include: – problems with cognition (thinking, memory, and reasoning)– sensory processing (sight, hearing, touch, taste, and smell)– communication (expression and understanding)– behavior or mental health (depression, anxiety, personality changes, aggression, acting out, and

social inappropriateness)– Inability to talk and walk– Loss of higher level mental skills

• Severe head injuries may result in:– stupor– coma– vegetative state

Caregiver Opportunity• Companion care/Homemaker care• Personal care• Skilled care• Physical therapy• Occupational therapy• Speech and language therapy• Medical social worker• Case manager

Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD)

• Refers to a group of lung diseases that block airflow and make it increasingly difficult for a person to breathe.– Emphysema– Chronic bronchitis– Chronic asthmatic bronchitis.

• In all cases, damage to the airways eventually interferes with the exchange of oxygen and carbon dioxide in your lungs.– damage to the lungs can't be reversed.

• In the U.S. about 12 million suffer with COPD

• COPD is the fourth leading cause of death in the U.S.

• Results in many long term cases of disability

• Symptoms of COPD don't appear until significant lung damage has occurred, and they usually worsen over time.

COPD - Emphysema

• Signs and symptoms include:– shortness of breath, especially during physical

activities– wheezing– chest tightness

COPD - Chronic Bronchitis

• Chronic bronchitis occurs mainly in smokers. • Signs and symptoms include: – having to clear the throat first thing in the morning– chronic cough– shortness of breath in the later stages– frequent respiratory infections

COPD - Chronic Asthmatic Bronchitis • Chronic asthmatic bronchitis is usually chronic

bronchitis combined with asthma (bronchospasm).

• Asthma can occur when inflamed and infected secretions irritate the smooth muscles in the airways.

• Symptoms are similar to those of chronic bronchitis, but the person is also likely to have intermittent — or even daily — episodes of wheezing.

Complications of COPD• Respiratory infections.

– frequent colds, flu or pneumonia• makes it much more difficult to breathe • produces further irreversible damage to the lung tissue

• High blood pressure (pulmonary hypertension)

• Heart problems– increases the person’s risk of heart disease, including heart attack.

• Lung cancer– smokers with chronic bronchitis are at a higher risk of developing lung cancer than are

smokers who don't have chronic bronchitis.

• Difficulty breathing– progressively unable to perform normal activities

• Depression – difficult to deal with a disease that is progressive and incurable.

Caregiver Opportunities

• Companion care• Homemaker care• Personal care• Skilled care• Respiratory therapy• Hospice

Osteoarthritis

Osteoarthritis• Sometimes called Degenerative Joint Disease.

• Cushioning (cartilage) between the bones wears away in the joints.

• Symptoms often develop slowly and worsen over time.

• Signs and symptoms of osteoarthritis include:– pain - joint may hurt during or after movement.– tenderness – joint may feel tender when light pressure is applied. – stiffness – joint stiffness may be most noticeable upon waking and after a period of

inactivity.– joint swelling– loss of flexibility – decrease or full loss of range of motion. – grating sensation – hear or feel a grating sensation when the joint is moved.– muscle weakness around arthritic joints– bone spurs – extra bits of bone, which feel like hard lumps, may

form around the affected joint.

Caregiver Opportunities

• Companion care• Homemaker care• Personal care• Skilled care• Physical therapy

Falls Among Older Adults

Falls In Older Adults

• More than one third of adults 65 and older fall each year in the United States.

• Among older adults, falls are the leading cause of injury deaths.

• Most common cause of nonfatal injuries and hospital admissions for trauma.

• Rates of fall-related deaths among older adults rose significantly over the past decade.

• Men are more likely to die from a fall.

• Women are 67% more likely than men to have a nonfatal fall injury.

• Rates of fall-related fractures among older adults are more than twice as high for women as for men.

Outcomes Linked To Falls• 20% to 30% of people who fall suffer moderate to severe injuries such as bruises, hip fractures, or

head traumas. – affects mobility and limits independent living. – increases the risk of early death.

• Falls are a common cause of traumatic brain injuries, or TBI. In 2000, TBI accounted for 46% of fatal falls among older adults.

• Most fractures among older adults are caused by falls.

• Most common fractures:– spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand. – about 1 out of 5 hip fracture patients dies within a year of their injury.

• Many people who fall, even those who are not injured, develop a fear of falling.

• Fear may cause people to:– limit their activities, leading to reduced mobility and physical fitness, and

increasing their actual risk of falling.

Caregiver Opportunities

• Companion care• Homemaking care• Personal care• Skilled care• Physical therapy• Occupational therapy

References• Alzheimer’s Association

– www.alz.org– 1.800.272.3900

• Alzheimer’s Foundation of America– http://www.alzprevention.org/about-alzheimers-disease.php– 1-866-AFA-8484

• National Parkinson Foundation– http://www.parkinson.org– 305-243-6666 or 800-327-4545

• American Stroke Association/American Heart Association– http://www.strokeassociation.org– 1- (888)- 4STROKE.

References (cont.)• National Institutes of Health

– http://stroke.nih.gov– 1-800-352-9424

• Centers for Disease Control and Prevention (CDC)– http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.htm– 800-232-4636

• National Institutes of Health – Senior Health– http://nihseniorhealth.gov/falls/toc.html

• National Heart Lung and Blood Institute– http://www.nhlbi.nih.gov/health/public/lung/copd/index.htm

References (cont.)

• Mayo Clinic – C OPD– http://www.mayoclinic.com/health/copd/DS00916

• National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)– http://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp

• Mayo Clinic – Osteoarthritis – http://www.mayoclinic.com/health/osteoarthritis/DS00019

• National Institute of Neurological Disorders and Stroke– http://www.ninds.nih.gov/disorders/tbi/tbi.htm

QUESTIONS

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