Cognitive functioning changes with age.
Some older adults age succesfully, while others show a certain
degree of cognitive decline and still others develop age- related
conditions that grossly deteriorate cognitive functioning.
A. Inpatients
(hospital based)
Among hospitalized older patients delirium, also known as acute
confusional state, is a common, serious and potentially preventable
source of morbidity and mortality. The prevalence of delirium
in hospitalized elderly patients is reported, in several studies
to be as high as 50%. It is reported to be present in 11 to
24% of older adults on admission to the hospital and may develop
in another 5 to 35% of patients. This common condition is frequently
unrecognized or misdiagnosed, especially in the elderly population.
Patients with delirium require longer hospitalization; there
is a high frequency of complications, these patients are more
likely (subsequently) to require institutional care. All these
factors add substantially to the cost of care. Optimal management
of delirium depends primarily, on reducing modifiable risk factors
and early detection of high- risk cases. Treatment requires
multifaceted, interdisciplinary efforts that address both the
underlying causes and the symptoms of delirium.
Neurology, Psychiatry and Geriatrics all have their role
in the prevention, detection and treatment of delirium. Geriatric
nurses are highly qualified to provide comprehensive geriatric
assessment, to coordinate the interdisciplinary team, provide
education to nursing staff and create the necessary supportive
environment. Social workers are involved in family-consultation
and discharge planning to the community. When necessary, dieticians,
physical therapists and occupational therapists must be included
in the program.
B. Outpatient
1.Memory Clinic
Memory Clinic offers a facility to evaluate people with memory
problems and to establish a diagnosis of dementia with a view
to improved management; to treat curable causes of memory
loss and to control psychiatric symptoms. The devastating
impact of cognitive impairment (in particular Mild Cognitive
impairment -MCI, Alzheimer Disease- AD, Vascular dementia)
effects not only the physical, mental and cognitive functioning
of the patient, but that of his family as well. Memory impairment
and dementia in old age often co-exist with other physical
or psychiatric ailments. Many renowned medical settings all
over the world recommend a multidisciplinary approach for
the comprehensive assessment and treatment of this disorder.
The multidisciplinary approach we suggest would include:
- A medical evaluation by a geriatric physician to rule
out any medical conditions that may cause memory problems
(physical examination, blood tests, EEG, Brain CT, PET Scan)
- A neurological examination and neuro-psychological/cognitive
testing
- Functional/psycho-social/socioeconomic evaluation - by
geriatric nurse and/or social worker
- Nutrition screening by dietician
- Interview with psychiatrist - if requested
- Referrals to other services as required, such as physical
therapy, occupational therapy
- Patient and family conference, with multidisciplinary
team (doctor, nurse, social worker etc.) where the patient's
diagnosis and prognosis is explained to patient and family.
- Treatment interventions may include education, psychological
support, environmental change, non-pharmacological behavior
management and medication if appropriate
- Regular follow-up care on a ongoing basis
- Research
Memory Improvement Program
For the "worried well" (those without morbid deficits
who are, nevertheless, worried about their memory) we would
like to offer a memory wellness approach. Workshops where
middle aged and older adults will be taught memory techniques
that are easy to learn and that can be used in daily living.
A multidisciplinary Memory Clinic, based on the cooperation
between the best health-professionals of the Hadassah hospitals,
should attract the ever-growing older adult population of
Jerusalem and its environment. This patient population could
be involved in various clinical studies to check the influence
of medication on cognitive impairment and Alzheimers Disease
and be part of basic research .
Staff members recommended
(full-and part-time)
Director and coordinator of the program
Geriatric Nurse specialist
Geriatrician
Neurologist
Neuro-psychologist
Geriatric Social Worker
Geriatric Psychiatrist
Dietician
Physio-therapist
Occupational therapist
The members of the multidisciplinary team of the Geriatric
Unit in Hadassah Ein Kerem have a ten-year long experience
in the assessment of physical, mental, functional and psychosocial
aspects of the elderly population and is highly qualified
to form the basis for the implementation of this proposed
program.
We contacted Dr. Cynthia Green, the founder and director
of the Memory Enhancement Program at Mount Sinai School of
Medicine in New York, who might be available to us as a consultant,
if we pursue setting up in Hadassah a program similar to the
one in Mount Sinai.
Estimated costs for the program: endowment fund of $ 1000.000-
$1500.000
|
