Saturday, August 23, 2008

Medication Induced Cognitive Impairment

These are easy to fix, should be evaluated, and not missed. Registration required, but free.

Saturday, August 9, 2008

Tuesday, July 29, 2008

Rember

Twice as good as current medications. The British NHS has banned Aricept.

Friday, July 4, 2008

Dementia Sensitive Culture

Here. Most aggression takes place during care. Document triggers from prior shifts. Videotape to see what mistakes are being made. Listening helps the anxious patient. So, one staff talks to the patient as another does the care. Do not kneel to put shoes on, the patient may pull the hair and kick. Tone of voice should convey choice giving and not orders.

Ethics and Law in Long Term Care

Here. Much bossiness and contradicting of clinical judgment and equally valid cultural differences.

And here. It is not settled that hospices do a better job than hospices, at the end of life, even in a specialty such as pain control.

Advantages of Flexibility with Staff

Here.

Friday, May 9, 2008

Case of Hypersexuality in Dementia Relieved by Sertraline

Patient continually demanded sex from wife, and got violent if refused. On sertraline 50 mg b.i.d., both excessive sexuality and aggressiveness diminished. ALS 8:189-190, 2007.

Antipsychotics Increased Mortality in a Large Canadian Study

Here. The effect is weak. It likely would not be felt at the clinical level. This large sample included typical neuroleptics. These cause more movement side effects, have greater effects on cardiac function and on blood pressure. The sample did not include any use of aripiprazole nor ziprasidone.

Compared to the risk of agitation, self-injury, and injury to others, this increased risk is small.

Saturday, May 3, 2008

Suicidal Ideas Among Seniors with Home Health Care

Here. About 10% thought of suicide; 7% had made an attempt; 1% in the past year.

Sunday, April 27, 2008

Guidelines for Palliative Care

Reviewed here. Regularly assess pain, dyspnea, and depression. Use proven therapies for each. All patients should have had advanced care directives.

Friday, March 21, 2008

End of Life Guidelines

What evidence exists, is about cancer. Assess and address pain, shortness of breath, and depression. Here. It has only 650 pages.

Dementia in Minority Populations

Reviewed here. Here. Most factors are modifiable.

Biological Markers of Alzheimer Dementia

Here.

Psychosocial Approaches to Alzheimer Dementia Patients

Reviewed here.

This brings up the idea of therapy with AD patients. The idea that talking to someone who will not remember the conversation a minute after leaving has no rationality.

Saturday, February 23, 2008

Use of Anti-Psychotics in Elderly Demented Patients

Reviewed here. The causes of death were varied and non-specific. The sample size was large. The rate of death was low. The wrong statistical test was applied. Although the risk of death is higher on typical anti-psychotics than on atypicals, the atypicals carry no black box warning. This is the wacko world of the moronic FDA. That agency should be disbanded.

Monday, January 14, 2008