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Amy Moore DNP FNP-CEmily Merrill, PhD, APRN, FNP BC, CNE, FAANP

The NP Role in Adult Protective Services: Opportunities and Challenges

Disclosure Statement of Financial Interest

We do not have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

• Identify the APRN role in collaborating with APS.• Discuss skills and tools used to assess cognition and

capacity.• Analyze case studies related to cognitive impairment

and capacity.• Explore unique opportunities for APRNs in protecting

and advocating for elderly patients with cognitive impairment.

.

Session Objectives

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Location Covered

APRN Collaboration with APS

• APS Mission/Goals

• Initial meetings

• Needs assessment

• APRN training/consultation

• Contract initialization

• Unique opportunity

• Patient advocate

• Patient safety

• APRN safety

• Schedules

• Communication

• Reports

APRN Role in Capacity Testing

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Defining Competency

• Competence: legal concept-determined by judge/court

• Capacity• Four abilities assessed when determining decision making

capacity

• Understanding

• Appreciation

• Reasoning

• Expressing a choice

Process for Assessment

• Initial contact

• Appointment

• Assessment

• Collaborate with social worker

• Report

• Exhibit A if required

• Satisfaction reports

Assessment

• Mini mental state exam (MMSE)• Montreal Cognitive Assessment (MoCA)• Saint Louis University Mental Status Examination

(SLUMS)• Physical assessment including H & P• Geriatric depression scale• Duke social support scale• Self-related health mortality scale• Functional activities questionnaire• Clock-drawing test

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Neuro-Cognitive Impairment

• Aging – Numbers increasing

• Alzheimer’s – 5.7 million

• Dementia – term of symptoms

• Delirium - reversible

• Depression – may affect testing

Tools for Capacity Testing

• Mini mental exam• MoCA• SLUMS• Clock Test

SLUMS

• Scoring

• Strengths

• Weaknesses

http://aging.slu.edu/pdfsurveys/mentalstatus.pdf

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MoCA Test

• Scoring

• Strengths

• Weaknesses

https://www.parkinsons.va.gov/resources/MOCA-Test-English.pdf

MoCA Cognitive Domains

• Attention and concentration

• Executive functions

• Memory

• Language

• Visuospatial skills

• Conceptual thinking

• Calculations

• Orientation

Case Study # 1 Medical vs Mental

65 Year-old male living in shedØ Medical history

Ø HypertensionØ Physical Examination

Ø Significant for B/P 142/90. Patient had not taken any prescription medications in several months

Ø Mental AssessmentØ SLUMS 14/30

Ø Geriatric Depression Scale 2Ø Functional Assessment

Ø Independent in all areas

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Case Study #2 – Dementia vs Substance AbuseØ Medical history

Ø Alcoholism

Ø Home EnvironmentØ 65 year old female living in hotel x 3 months

Ø Physical assessmentØ Nutrition

Ø Alcohol

Ø Mental Status assessmentØ SLUMS

Ø Financial exploitationØ Challenges

“I’m in disgustingly good health!”

Case Study # 3

• 84-year-old female

• Child-like behaviors

• SLUMS 2/30

• No medical care

• Home safety issues

• Cared for by husband• Husband also presents with dementia during visit

Conclusion

1. Opportunities to advocate for patients with cognitive impairment

2. Opportunities to collaborate with APS

3. APRNs can improve care for vulnerable

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Alzheimer's Association (2018). Alzheimer’s and dementia. Alzheimer’sAssociation. Retrieved from https://www.alz.org/alzheimer_s_dementia.

Knight, M., & Baune, B., (2017). Cognitive dysfunction in major depressivedisorder. Current Opinion Psychiatry 31, 26-31

McCaluley, Kathleen (2018). Studying nursing interventions in acutely ill, cognitively impaired older adults, American Journal of Nursing 114, 44-52.

Stites, S., Harkins, K., Rubright, J., & Karlawish, J. (2018). Relationships betweencognitive complaints and quality of life in older adults with mild cognitiveimpairment, mild Alzheimer's disease dementia, and normal cognition.Alzheimer Disease Association, 00, pp. 1-8.

References and Resources

Thanks!

We would like to thank;

• TTUHSC School of Nursing

• Adult Protective Services – Lubbock

• Dr. Susan Andersen

• Dr. Rosalinda Jimenez

• Dr. Wendy Thal

Contacts

• Dr. Emily Merrill –Emily.Merrill@ttuhsc.edu

• Dr. Amy Moore – amy.moore@ttuhsc.edu

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