act on alzheimer’s disease curriculum
DESCRIPTION
ACT on Alzheimer’s Disease Curriculum. Module VIII: Quality Interventions. Quality Interventions. These slides are based on the Module V: Quality Interventions text Please refer to the text for all citations, references and acknowledgments. Learning Objectives. - PowerPoint PPT PresentationTRANSCRIPT
ACT on Alzheimer’s Disease Curriculum
Module VIII: Quality Interventions
2
Quality Interventions
• These slides are based on the Module V: Quality Interventions text
• Please refer to the text for all citations, references and acknowledgments
Learning Objectives
Upon completion of this module the student should:• List pharmacological and non-pharmacological
interventions.• Summarize the interventions that can be used with
a person that has a diagnosis of Alzheimer’s disease.• Gain insight on how physical, cognitive and social
activities along with diet can be used as a positive intervention
Intervention Goals
Intervention Overview
• The treatment for Alzheimer’s disease is symptomatic as there is no cure
• All available FDA-approved drugs for Alzheimer’s disease target cognitive and behavioral symptoms
• There are many interventions that can improve the quality of and extend life
Intervention Overview
• Available interventions for Alzheimer’s disease can be broken down into two categories:– Non-pharmacological interventions– Pharmacological interventions
• An intervention checklist has been developed to guide providers on the available non-pharmacological and pharmacological interventions
Non-Pharmacological Interventions
Non-Pharmacological Interventions
• There are a number of non-pharmacological interventions that have been shown to be effective at improving the quality of life of individuals with Alzheimer’s disease– Counseling, education, support & planning– Stimulation / activity / maximizing function– Safety– Advance care planning– Referral to neurologist or geriatrician for diagnostic
uncertainty or behavioral management
Counseling, Education, Support and Planning
• Counseling, education, support and planning are critical for sustained management of dementia
• Research and clinical practice indicate that counseling, education and support provides the following benefits for care:– Reducing behavioral symptoms– Promotes compliance with treatment plans– Provides a support system– Improving mood– Delaying institutionalization
Counseling, Education, Support and Planning
• The ensure proper attention to counseling and education, the primary healthcare provider should:– Discuss diagnosis and treatment with patient and
family– Encourage individuals and caregivers to participate in
educational and support groups– Involve individuals in care planning decisions– Address caregiver support on an ongoing basis– Connect individual to community resources
Counseling, Education, Support and Planning
• A community-based organization can supplement the interventions introduced by the primary care provider
• Community-based organizations provide: counseling, education, support, planning, care management/coordination, physical activity, cognitive stimulation, home and safety services, legal/financial services, advanced care planning and medication management
• Connecting to adult day programs is an important service of community organizations
Stimulation/Activity/Max Function
• Multiple lifestyle changes may help optimize function in individuals with Alzheimer’s disease– Physical activity– Cognitive activity– Social activity– Healthy diet
Counseling Regarding Safety
• There are many counseling options that can improve safety for individuals with Alzheimer’s disease– Legal/financial planning– Driving– Home safety– Medication management– Behavioral issues
Advanced Care Planning
• It is important for primary care providers to discuss end-of-life treatment goals and options for individuals with dementia and their families earlier in the disease process
• End-of-life treatment goals should consider pain management and the goals of the individual via advanced directive
Pharmacological Interventions
Pharmacological Interventions
• There are a number of categories of pharmacological interventions– Medications for cognitive symptoms– Medications for behavioral and neuropsychiatric
symptoms– Contraindicated medications– Vitamins and supplements
Medications for Cognitive Symptoms
• Cholinesterase inhibitors are the cornerstone of pharmacotherapy for Alzheimer’s disease
• To date, research on these medications is mixed• FDA approved cholinesterase inhibitors include:– Donepezil (Aricept), a selective acetylcholinesterase – Rivastigmine (Exelon), inhibits butyrylcholinesterase– Galantamine, further moderates nicontinic receptor
Medications for Behavioral and Neuropsychiatric Symptoms
• 61-92% of individuals with Alzheimer’s disease will experience neuropsychiatric disturbances which include: irritability, agitation, disinhibition, wandering, delusions, hallucinations, anxiety, depression and sleep disruption.
Medications for Behavioral and Neuropsychiatric Symptoms
• Approximately 30% of individuals with Alzheimer’s disease suffer from depression, treatment with the following is indicated:– Selective serotonin reuptake inhibitor (SSRI)– Serotonin norepinephrine reuptake inhibitor
(SNRI)
Medications for Behavioral and Neuropsychiatric Symptoms
• During the moderate and late stage of the disease, individuals may have increased symptoms of irritability, agitation and psychosis. There may be modest benefits to an antidepressant prior to starting a neuroleptic
• Common neuroleptics include:– Quetiapine (Seroquel)– Risperidone (Risperdal) – Olanzapine (Zyprexa)
Medications for Behavioral and Neuropsychiatric Symptoms
• Sleep disturbances occur in 46-64% of individuals with dementia
• Sleep disturbances lead to a wide variety of difficult conditions that can lead to earlier institutionalization
• The decision to use a sleep aid is critical and can lead to improved quality of life for both individual and caregiver
Contraindicated Medications
• Guidelines have been developed to inform the primary care provider about drugs that may negatively impact cognition or inducing delirium
• As a general rule, providers should avoid anticholinergics, benzodiazepines, hypnotics, and narcotics in geriatric populations
• The Beers Criteria have been developed to guide care in populations aged 65 and older
Vitamins and Supplements• There have been many studies that have examined the
benefits of the following vitamins and supplements for individuals with Alzheimer’s disease– Vitamin E– Gingko biloba– Estrogen supplementation– Omega 3 fatty acids– Vitamin B
• There is no evidence that vitamins or supplements can help in the treatment or prevention of Alzheimer’s disease
Interventions Summary
• In 60-80% of all Alzheimer’s disease cases, the interventions described in this module will be helpful
• A provider may be faced with an atypical disease presentation in which case a referral should be made to a dementia specialist
Organizing Principle of Care
• The primary care provider leads a team approach which depends on regular assessments of the individual’s cognitive, behavioral and functional status over time
• The organizing principle of care originates with an initial assessment, a care plan and reassessment over time