Overseeing Challenging Behaviors in Older Adults August 23 August 24, 2010 .


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Managing Challenging Behaviors in Older Adults August 23 – August 24, 2010. Overview of Challenging Behaviors in VISN 6 Jorge Cortina, MD DFAPA. Definition of Behavior Problem.
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Overseeing Challenging Behaviors in Older Adults August 23 – August 24, 2010 Overview of Challenging Behaviors in VISN 6 Jorge Cortina, MD DFAPA

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Definition of Behavior Problem "… connected with subjective trouble, useful weakness, or traded off communications with others or nature " Tariot PN, Mack JL, Patterson MB et al. The conduct rating scale for dementia of the consortium to set up a registry for Alzheimer\'s Disease. Am J Psychiatry 1995;152:1349-57. Behavioral Excess versus Deficiency Allen-Burge R, Stevens AB, Burgio LD. Powerful behavioral intercession for diminishing dementia related testing conduct in nursing homes. Global J of Geri Psychiatry 1999;14:213-232

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Conditions w/Challenging Behaviors Dementia: meandering, animosity, and so forth. SMI:psychotic or potentially wrong Delirium: meandering, psychosis, shifting state PTSD: flashbacks, outrage, fractiousness Brain damage: dis restraint, dangerous outrage Substance Abuse: testing limits, composed Personality D/O: part, entitled, manipulative

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Dementia related: Common Challenging Behaviors Aggression (incited or unjustifiable) Physical-hitting, getting, pushing, gnawing, scratching Verbal-c ursing and harsh dialect Hyperactivity Physical-p acing, shadowing, meandering, dreary body movements, scavenging or accumulating Verbal-confused verbalizations, shouting or tedious inquiries Hypoactivity-social withdrawal, declining ADL\'s

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Presentations vary by DX Psychosis Delusions Bizarre versus Non Bizarre versus in setting of relationship Hallucinations versus Deceptions Hallucinations (sound-related versus visual) Wandering Mania Exit looking for Modeling Self Stimulation Antipsychotics symptom, Akathesia

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Prevalence 50-90% of people with mod-extreme Dementia Allen-Burge R, Stevens AB, Burgio LD. Viable behavioral mediation for diminishing dementia related testing conduct in nursing homes. Global J of Geri Psychiatry 1999;14:213-232 64-83% in US Nursing Homes Swearer JM, Drachman DA, O\'Donnell BF, Mitchell AL. Troublesome and problematic practices in dementia. Connections to conclusion and ailment severity.J Am Geriatr Soc. 1988 Sep;36(9):784-90

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What About Our Special Population? More Men= More Testosterone= More Aggression? Veterans Action Oriented Fighters:"Trained to execute" More PTSD More SMI because of socioeconomics of SMI More Dementia because of PTSD, head injury?

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Treatment Requires escalated appraisal, ABC\'s Except for SMI and maybe wooziness, antipsychotics are not demonstrated Non pharmacological mediations have been appeared to be powerful

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VA NHCU Similar to Non VA NH 59% in VA NHCU Overall 66% among the individuals who matured with Mental Illness 69% among the Dementia pts 68% among those with both Dx McCarthy JF, Blow FC, Kales HC. Problematic practices in Veterans Affairs nursing home inhabitants: how diverse are occupants with genuine dysfunctional behavior? J Am Geriatr Soc. 2004 Dec;52(12):2031-8.

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SMI versus Dementia in NHCU 16% verbal disturbance general 29% SMI versus 22% Dem versus 23% Both 11% physical hostility general 16% SMI versus 19% versus Dem vs.19% Both Dx 54% improper conduct general 58% SMI versus 61% Dem versus 62% Both Dx McCarthy JF, Blow FC, Kales HC.Disruptive practices in Veterans Affairs nursing home inhabitants: how diverse are occupants with genuine emotional instability? J Am Geriatr Soc. 2004 Dec;52(12):2031-8 .

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Numbers of Veterans in CLC in FY09 2777 veterans treated in CLC (59%=1638) 104 veterans with Dementia Tx Specialty 36 with Psychiatric Tx Specialty DSS Tx forte report pulled 8/16/10

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HBPC Population Percent of patients Disease with sickness Heart malady 72% Diabetes 48% Depression 44% Heart disappointment 35% Dementia 33% Substance mishandle 29% Cancer 29% Anxiety/Personality Disorder 24% PTSD 21% Schizophrenia 20% Tom Edes. Inno VA tions in Non-Institutional Care. GEC Leads Conference. New Orleans, LA. June 81, 2010

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Daily Census of HBPC Veterans (801)

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Summary Our veterans resemble every other person Prevalence is around 60% of CLC inhabitants Prevalence of practices is almost equivalent in SMI versus Dementia (with the exception of verbally troublesome) High predominance of SMI and Dementia in HBPC Need for expanded ability to oversee crosswise over settings

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