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November 29, 2018

Why you shouldn't dismiss a 'senior moment'

Daily Briefing

    Read Advisory Board's take: 5 ways to improve care for dementia patients

    People often dismiss temporary mental lapses as "senior moments"—but neurologist William Shankle in KevinDM writes that seemingly harmless "dismissive phrase ... leads to devastating, debilitating disease."

    What to do if your patient has a 'senior moment'

    Shankle, director of the memory and cognitive disorders program at Hoag Memorial Hospital Presbyterian, contends that the only way for providers to successfully treat and, one day, cure Alzheimer's disease and other forms of dementia is to" stop dismissing memory loss and other behaviors as 'normal aging.'"

    Shankle writes, "For too long, the 'senior moment' excuse has masked problems that could have been cured or curbed if they had been taken more seriously."

    Fortunately, Shankle writes an Alzheimer's Association workgroup recently published a list of recommendations that aim to help providers meet the "urgent need for more timely and accurate Alzheimer's disease diagnosis and improvement in patient care." According to Shankle, the recommendations "at their core" advise providers to:

    • Evaluate in a timely manner all middle-aged or older patients who either self-report, or whose caretaker or clinician report, "cognitive, behavioral, or functional changes";
    • Not dismiss any concerns as "normal aging" without a proper assessment; and
    • Involve not only the patient and clinician in evaluation, but "almost always also involve a care partner (e.g., family member or confidant)."

    Ultimately, these recommendations can help providers—particularly primary care providers—"'catch' problems before they get out of hand," Shankle writes. He explains, "By identifying candidates for treatment before cognitive function is impaired, primary care physicians can play a key role in curing the disease." For example, Shankle writes providers can direct patients to "clinical trials that appear to remove the 'gunk' that leads to Alzheimer's," or point patients toward "the 'use it or lose it' cognitive treatment model of preventing or delaying dementia."

    A rarely discussed disease

    According to Shankle, many patients don't discuss dementia because they find the disease so terrifying—and because it's so infrequently discussed, "too few [providers] screen for it." He notes that memory screening should as prevalent as colorectal screenings, mammograms, and prostate exams. "If every person over the age of 45 underwent an annual memory screen, we would have a chance at preventing dementia entirely or greatly delaying it from claiming more brilliant minds," Shankle writes.

    Shankle writes that he's confident Alzheimer's disease will one day be cured, but first, the disease must be identified. He concludes, "So please stop blaming 'senior moments,' and start getting screened" (Shankle, KevinMD, 11/2; Alzheimer's Association release, 7/22).

    Advisory Board's take

    Anna Yakovenko, Practice Manager, Market Innovation Center and Emily Heuser, Consultant, Market Innovation Center 

    We commend this neurologist for highlighting the importance of screening for Alzheimer's and dementia. As life expectancy increases and the baby boomer generation reaches Medicare age, the number of Americans diagnosed with dementia—particularly Alzheimer's disease—is projected to skyrocket. Currently, 5.7 million Americans have Alzheimer's—a figure expected to rise to 14 million by 2050.

    Providers need to make sure they are prepared to address this rise and meet the unique needs of patients with dementia. Here are 5 ways they can begin to prepare:

    1. Educating the community about the condition

      Providers can play a valuable role in the community by providing patients and their caregivers with information about early detection of dementia. This education is pivotal for encouraging early detection and decreasing the cost burden of dementia care—as a patient with mild symptoms costs $18,400 to treat annually, whereas a patient with severe symptoms costs up to $36,132 on average.

      Our research on baby boomers indicates that they are highly apprehensive about developing the condition—in one survey 87% of boomers said they were 'extremely' or 'very concerned' about staying mentally sharp in the future—and are highly receptive to education about early detection. Therefore, this education is not only appreciated, but can also brand your hospital as a go-to dementia provider.

    2. Strengthening staff skills

      Dementia patients require unique skills among care staff, who can best excel in providing high-level care when they fully understand the condition and its progression. Your organization can encourage staff to exceed state requirements for dementia training by becoming a Certified Dementia Practitioner or taking other Alzheimer's and dementia trainings offered through the National Council of Certified Dementia Practitioners

    3. Creating cross-service line dementia care teams

      Cross-service line care teams can help to improve care coordination for dementia patients and make their hospital experience less overwhelming and stressful. For instance, at New York-Presbyterian Hospital, dementia patients receive care from a multidisciplinary team of healthcare professionals including neurologists, neuropsychologists, social workers, nurse practitioners, and rehabilitation specialists. In addition to screening and treatment services, this team provides neuropsychological assessments, patient and caregiver education, and assistance in managing patient care.

    4. Promoting treatment in outpatient settings

      Work with PCPs to encourage dementia patients to seek care at outpatient centers. Although patients can still feel disoriented and confused in outpatient clinics, these sites of care tend to be less overwhelming and upsetting to dementia patients than inpatient settings.

      When possible, you can structure consultations or tests to be conducted in outpatient facilities before inpatient admission. Learn more about outpatient geriatric assessment centers and geriatric emergency departments if you're interested in alternative options for better accommodating dementia patients.

    5. Demystifying the discharge process

      Create easily-understandable, printed discharge materials about planning for future care for dementia patients and their caregivers. A JAMA study found that even elderly patients without dementia struggle to understand normal discharge directions. Materials written at an accessible reading level and accompanied by pictures can help patients and their caregivers understand post-treatment procedures and how to prevent complications.

    To learn the best practices in creating a dementia program, download our research report on Building a Financially Sustainable Alzheimer's Disease & Memory Disorders Program. Then, for a quick overview about developing your geriatrics program, download our Geriatrics Cheat Sheet.

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