5) As the video above highlights, patients who are cared for at home create a heavy burden on families, even on families with means (as the family in the op-doc appears to have). Caregiver fatigue and burnout is increasingly recognized, and you will see and treat patients with depression and stress-related illness that stems directly from caregiver burnout. And when caregivers burn out, where do the patients with dementia wind up?
With the silver tsunami gathering strength, it's time for us to learn to 'help the helpers', because they are the ones who will determine how much of an overall burden patients with dementia present to emergency departments.
True story: a few years ago, I treated a man with advanced dementia whose wife called 911 after she knowingly gave him an overdose of his pain medication. She then could not go through with her plan, which was to kill him, and then kill herself. (Both of them became my patients--she was admitted to psychiatry.) The wife had no previous history of mental illness or depression; her symptoms stemmed entirely from caregiver burnout, and the stress of the promise she had made to her husband to 'never put him in a home.'
This is an area that is only beginning to be addressed, and is ripe for research. In September 2016, the National Academies of Sciences, Engineering, and Medicine (NASEM, formerly known as the Institute of Medicine) released a very long report on "Families Caring for an Aging America." For our purposes, read this Geri Tech Blog Post.
6) Because it's more prevalent among cognitively impaired patients: Elder Abuse, a quick reminder from LITFL.
7) Three quick news blurbs: lots of mainstream news attention on dementia and anti-psychotics/benzo use. The immediate implications are for long term prescriptions, but you will find that (as in the Geriatric ED guidelines) there is counsel to avoid them even in the ED if non-pharmacologic methods can curb behaviors instead. You should also consider this when sending dementia patients back from whence they came after they are sedated for behaviors in the ED.
a) From a March 5th, 2015 NPR post: 'Behavioral Therapy Helps More than Drugs' in dementia
b) From the March 1, 2015 NY Times: "Investigators are recommending that Medicare officials take immediate action to reduce unnecessary prescriptions to older Americans with dementia." This is mostly about anti-psychotic drugs.
c) Couple those with the February 2015 JAMA Psychiatry article "Benzodiazepine Use in the US" (abstract/scroll through is enough) -- and you will find there is a lot of pressure to de-prescribe the elderly, maybe with good reason.
The OPTIONAL (but really worth the time) blurbs:
a) Nursing homes that eschew the use of antipsychotics: from NPR.
b) A recent series from NPR, "Inside Alzheimer's" -- perspective from caregivers and afflicted.
c) Speaking of non-pharmacologic methods, do you have a working iPod you don't use? Music and Memory NEEDS IT. Check them out: awesome stuff.
d) If you didn't see the documentary Alive Inside (featuring the work Music and Memory does: won the Audience award at the 2014 Sundance film festival), this stuff is pure genius, and so, so simple. (I'd love to see a trial of using music to calm and comfort patients with dementia.)