Additional Information
Book Details
Abstract
This issue of Clinics in Geriatric Medicine, guest edited by Dr. Soo Borson, is devoted to Geriatric Psychiatry. Articles in this issue include: Diagnosis; Providing high quality care for dementia patients and family caregivers; Common psychiatric problems in cognitively impaired patients – causes and management; Partnering with family caregivers; Palliation and end of life care; Geriatric depression; Treatment for depression and evaluating response; Post-traumatic stress in older adults; Sleep disorders; Substance Abuse; Suicide; and Mental Health Services for Older Adults.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Geriatric Psychiatry\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| Clinics in Geriatric Medicine\r | xi | ||
| Update in Geriatric Psychiatry | xiii | ||
| Developing Dementia-Capable Health Care Systems | 395 | ||
| Key points | 395 | ||
| The problem | 395 | ||
| The solution | 397 | ||
| Step 1: Think Differently About Dementia | 397 | ||
| Step 2: Increase Recognition of Dementia in Primary Care Settings | 399 | ||
| Step 3: Engage Family Members as Soon as Cognitive Impairment Is Suspected | 399 | ||
| Step 4: Diagnose and Manage Dementia as a Disease Process | 400 | ||
| Step 5: Screen for and Manage Mood and Behavioral Problems | 401 | ||
| Step 6: Account for Dementia in Clinical Decisions Regarding Evaluation and Treatment of Comorbid Conditions, Patient Safet ... | 402 | ||
| Life expectancy | 402 | ||
| Interactions of dementia with comorbid conditions | 403 | ||
| Everyday safety | 404 | ||
| Driving | 404 | ||
| Injuries | 404 | ||
| Medication problems | 404 | ||
| Misadherence | 404 | ||
| Misprescribing | 404 | ||
| Unusual but serious medication side effects | 404 | ||
| Potentially avoidable acute care | 405 | ||
| Step 7: Make Caregivers Your Clinical Partners. Assess Their Information, Health, and Care Needs | 405 | ||
| Caregivers as people, proxies, and partners | 406 | ||
| Patient centeredness: application to dementia caregiving networks | 406 | ||
| Being a caregiver | 407 | ||
| Managing the problems of caregiving | 407 | ||
| Caregivers as patients | 408 | ||
| The dementia caregiving network as the unit of health care | 408 | ||
| Step 8. Set Specific Quality Goals for Care of Patients with Dementia, and Organize Clinical Information Gathering, Decisio ... | 408 | ||
| Step 9. Plan for Complexity (and Measure It) | 410 | ||
| Step 10. Negotiate Defined Roles and Responsibilities for All Partners in Care, and Integrate Them by Care Coordination | 410 | ||
| The role of the PCP | 410 | ||
| The role of community-based organizations | 411 | ||
| The dementia care manager within the health care system | 412 | ||
| Step 11. Create Effective Communication Tools that Make Information Accessible to Providers, Family and Community Care Part ... | 412 | ||
| Step 12. Make PCP Job Satisfaction a Priority | 413 | ||
| Summary | 413 | ||
| Acknowledgments | 415 | ||
| References | 415 | ||
| Dementia and Cognitive Impairment | 421 | ||
| Key points | 421 | ||
| Introduction | 421 | ||
| Impact of Dementia | 423 | ||
| Dementia in the Population | 423 | ||
| Prevalence | 423 | ||
| Incidence | 423 | ||
| Risk and Protective Factors | 423 | ||
| Demographic Risk Factors | 426 | ||
| Genetic Factors | 426 | ||
| Medical Risk Factors | 426 | ||
| Psychiatric Risk Factors | 426 | ||
| Head Injury | 427 | ||
| Lifestyle and Environmental Risk Factors | 427 | ||
| Protective Factors | 427 | ||
| Education and Cognitive Activity | 427 | ||
| Cognitive activity | 427 | ||
| Pharmacologic Factors | 428 | ||
| Lifestyle Factors | 428 | ||
| Clinical assessment | 428 | ||
| Subjective Assessment | 428 | ||
| Objective Assessment | 429 | ||
| Additional Assessments | 429 | ||
| Alzheimer's Disease (AD) | 431 | ||
| Genetics of AD | 431 | ||
| Biomarkers for AD | 431 | ||
| Vascular Dementia (Vascular Neurocognitive Disorder) | 432 | ||
| Neuroimaging | 432 | ||
| Genetics | 432 | ||
| Frontotemporal Lobar Degeneration (Frontotemporal Dementia) | 432 | ||
| Genetics | 433 | ||
| Common Psychiatric Problems in Cognitively Impaired Older Patients | 443 | ||
| Key points | 443 | ||
| Introduction | 443 | ||
| General principles | 444 | ||
| The Initial Clinical Assessment | 444 | ||
| Management Overview: Nonpharmacologic Approaches | 444 | ||
| Management Overview: Pharmacologic Approaches | 446 | ||
| Acetylcholinesterase inhibitors and memantine | 447 | ||
| Identifying Symptoms and Measuring Response: Use of Rating Scales | 448 | ||
| In Summary | 448 | ||
| Agitation and aggression | 449 | ||
| Introduction | 449 | ||
| Nonpharmacologic Interventions | 449 | ||
| Pharmacologic Interventions | 450 | ||
| Antipsychotics | 451 | ||
| In summary: antipsychotics | 452 | ||
| Antidepressants | 452 | ||
| Anticonvulsants | 453 | ||
| Antiadrenergic medications | 453 | ||
| Benzodiazepines | 454 | ||
| In summary: nonantipsychotic medications for agitation | 454 | ||
| Psychosis | 454 | ||
| In Summary: Hallucinations and Delusions | 455 | ||
| Depression | 455 | ||
| Introduction | 455 | ||
| In Summary: Introduction to Depression | 456 | ||
| Nonpharmacologic Approaches | 456 | ||
| Pharmacologic Approaches | 457 | ||
| Other Treatment Considerations | 457 | ||
| In Summary: Treatment Recommendations for Depression in Dementia | 458 | ||
| Anxiety | 458 | ||
| Introduction | 458 | ||
| Nonpharmacologic Approaches | 459 | ||
| Pharmacologic Approaches | 460 | ||
| In Summary: Treatment Recommendations for Anxiety in Dementia | 460 | ||
| Summary | 460 | ||
| References | 461 | ||
| Palliative Care in Advanced Dementia | 469 | ||
| Key points | 469 | ||
| The epidemiology of advanced dementia | 469 | ||
| The rationale behind a palliative approach in dementia | 470 | ||
| The end of life in dementia | 471 | ||
| Management decisions related to care of patients with advanced dementia | 474 | ||
| The Role of Artificial Nutrition at the End of Life | 474 | ||
| Infections and the Role of Antibiotics in Advanced Dementia | 475 | ||
| Polypharmacy and Medication Appropriateness | 476 | ||
| Management of Pain in Advanced Dementia | 476 | ||
| Role of Specific Pharmacologic Agents for Dementia | 478 | ||
| Management of Terminal Delirium in Patients with Advanced Dementia | 478 | ||
| Management of Mood and Behavior | 479 | ||
| Role of Hospice and Barriers to Eligibility | 481 | ||
| Advance care planning in patients with dementia | 482 | ||
| The caregiver in advanced dementia | 484 | ||
| Future directions | 486 | ||
| References | 486 | ||
| Partnering with Caregivers | 493 | ||
| Key points | 493 | ||
| Introduction | 493 | ||
| Describing Family Caregivers | 494 | ||
| Types of Care Provision | 495 | ||
| How Long Do Families Provide Care? | 495 | ||
| Scope of the problem | 496 | ||
| Clinical correlations | 497 | ||
| Family caregiver assessment | 500 | ||
| Partnering with caregivers | 502 | ||
| Partnership-Based Health Care Theory | 502 | ||
| Partnership-based health care exemplar: the Institute for Patient- and Family-Centered Care | 504 | ||
| Traversing the gap between evidence and practice | 505 | ||
| Knowledge needs for health care in the future | 509 | ||
| References | 510 | ||
| A Systematic Approach to Pharmacotherapy for Geriatric Major Depression | 517 | ||
| Key points | 517 | ||
| Introduction | 518 | ||
| Are antidepressants effective for the treatment of major depressive disorder? | 518 | ||
| Are the results of randomized controlled trials of antidepressants applicable to real-world geriatric practice? | 518 | ||
| How should clinicians select antidepressants to treat their older patients? | 523 | ||
| What can we learn from guidelines on pharmacotherapy for geriatric depression? | 524 | ||
| An updated algorithm for the pharmacologic treatment of geriatric depression | 524 | ||
| First-Line Antidepressant | 527 | ||
| Second-Step Treatment of Nonresponders | 527 | ||
| Third-Step Treatment of Nonresponders | 528 | ||
| Second-Step or Third-Step Treatment of Partial Responders | 528 | ||
| Summary | 528 | ||
| Conflicts of interest | 529 | ||
| References | 529 | ||
| Choosing Treatment for Depression in Older Adults and Evaluating Response | 535 | ||
| Key points | 535 | ||
| Introduction | 535 | ||
| Late Life Depression Defined | 535 | ||
| Effects and Effectiveness of Treatment | 536 | ||
| Evidence-based treatments reviewed | 537 | ||
| Alternative therapeutic approaches | 537 | ||
| Psychoeducation and Bibliotherapy | 538 | ||
| Physical Exercise | 538 | ||
| Supportive Interventions | 538 | ||
| Selecting treatment | 539 | ||
| Age | 539 | ||
| Executive Dysfunction | 539 | ||
| Socioeconomic Factors | 541 | ||
| Data-driven decision-making | 542 | ||
| Access to care and treatment preferences | 542 | ||
| Future directions for improving treatment of LLD | 543 | ||
| References | 545 | ||
| Suicide in Later Life | 553 | ||
| Key points | 553 | ||
| Introduction | 553 | ||
| Suicide | 554 | ||
| Suicidal Ideation as a Risk Factor for Suicide | 555 | ||
| The Interpersonal Theory of Suicide | 555 | ||
| Clinician and Family Reactions to Suicide | 556 | ||
| Hope for New Models of Care and Decreased Suicide | 558 | ||
| Assessment of the Patient with Suicidal Ideation | 558 | ||
| Special Older Adult Populations Vulnerable to Suicidal Ideation and Suicide | 559 | ||
| Long-term care residents | 559 | ||
| Suicide in dementia | 560 | ||
| Caregivers | 560 | ||
| Assisted dying and physician-assisted dying | 561 | ||
| Definitions | 561 | ||
| Assisted Dying and Physician-Assisted Dying in the United States | 562 | ||
| Impact on Family and Caregivers | 562 | ||
| Physician-Assisted Dying: Assisted-Dying with Physician Involvement | 564 | ||
| Psychological effects of Death with Dignity on physicians | 564 | ||
| Patients choosing physician-assisted dying | 564 | ||
| Patient requirements for Death with Dignity | 566 | ||
| Physician involvement in Death with Dignity in Oregon and Washington | 567 | ||
| Responding effectively to Death with Dignity requests | 568 | ||
| Essential elements and safeguards of Death with Dignity | 568 | ||
| Assessment/Plan | 568 | ||
| Summary | 572 | ||
| References | 572 | ||
| Posttraumatic Stress in Older Adults | 577 | ||
| Key points | 577 | ||
| Introduction | 577 | ||
| The Condition | 577 | ||
| Risk Factors | 578 | ||
| Scope of the Problem | 578 | ||
| Clinical Correlations | 579 | ||
| Diagnostic standards and dilemmas | 579 | ||
| Process of Eliminating Alternative Diagnoses/Problems | 579 | ||
| Comorbidities | 579 | ||
| Clinical findings | 579 | ||
| Source of Data | 579 | ||
| Examination | 580 | ||
| Recommended Rating Scales | 580 | ||
| Interventions: current evidence base and what to do when evidence is lacking | 580 | ||
| Psychopharmacologic treatment | 581 | ||
| Benzodiazepines | 581 | ||
| Preferred pharmacologic management of PTSD symptoms | 581 | ||
| Sleep | 581 | ||
| Hyperarousal, Avoidance, and Reexperiencing | 582 | ||
| Psychosis | 582 | ||
| Nonpharmacologic treatment | 582 | ||
| Lifespan Context | 582 | ||
| Eliciting the Trauma Narrative | 584 | ||
| Reducing Isolation | 585 | ||
| Managing Hyperarousal | 585 | ||
| Assuaging Worry | 585 | ||
| Early intervention | 586 | ||
| Knowledge Needs for Health Care Improvement Going Forward | 586 | ||
| References | 586 | ||
| Sleep in Older Adults | 591 | ||
| Key points | 591 | ||
| Introduction | 591 | ||
| Overview of Sleep | 591 | ||
| Sleep stages | 592 | ||
| Changes with sleep with age | 592 | ||
| Subjective changes | 593 | ||
| Cultural Perspectives on Sleep | 593 | ||
| Coping with Sleep Problems | 594 | ||
| Measuring Sleep | 595 | ||
| Sleep Disorders | 595 | ||
| Insomnia | 595 | ||
| Insomnia Disorder Description | 595 | ||
| Scope of the Problem | 597 | ||
| Insomnia Clinical Correlations | 599 | ||
| Diagnostic Standards and Dilemmas for Insomnia Disorder | 600 | ||
| Insomnia Disorder Clinical Findings | 600 | ||
| Examination | 601 | ||
| Recommended rating scales | 601 | ||
| Diagnostic modalities | 601 | ||
| Insomnia Disorder Management | 602 | ||
| Interventions/Current Evidence Base | 602 | ||
| Nonpharmacologic | 603 | ||
| Sleep hygiene | 603 | ||
| CBT-I | 603 | ||
| Pharmacologic | 604 | ||
| Combination Therapies | 608 | ||
| Treating Insomnia Disorder in Institutionalized Settings and in Cognitively Impaired Patients | 608 | ||
| Caregiver Perspectives for Insomnia Disorder | 608 | ||
| Sleep apnea | 609 | ||
| Sleep Apnea Description | 609 | ||
| Scope of the Problem | 609 | ||
| Sleep Apnea Clinical Correlations | 610 | ||
| Diagnostic Standards and Dilemmas for Sleep Apnea | 612 | ||
| Sleep Apnea Clinical Findings | 613 | ||
| Sleep Apnea Management | 613 | ||
| Interventions/Current evidence base | 613 | ||
| Other sleep disorders | 616 | ||
| Summary | 617 | ||
| References | 617 | ||
| Substance Abuse Among Older Adults | 629 | ||
| Key points | 629 | ||
| Introduction | 629 | ||
| Prevalence of substance use among older adults | 630 | ||
| Alcohol Use | 630 | ||
| Tobacco Use | 630 | ||
| Illicit Substance Use | 631 | ||
| Prescription, Nonprescription, and Over-the-Counter Medication Use | 631 | ||
| Unique vulnerabilities for older adults using mood-altering substances | 631 | ||
| Alcohol | 632 | ||
| Medications and Illicit Drugs | 632 | ||
| Risk factors for older adults using substances | 633 | ||
| Demographics | 634 | ||
| Physical and Mental Health | 634 | ||
| Coping Style | 634 | ||
| History of Alcohol Problems | 635 | ||
| Social Factors | 635 | ||
| Diagnosis | 635 | ||
| Screening and assessment | 639 | ||
| Overall Considerations | 639 | ||
| Screening Tools | 641 | ||
| CAGE-Adapted to Include Drugs (CAGE-AID) | 641 | ||
| The Michigan Alcohol Screening Test-Geriatric Version | 641 | ||
| The Alcohol Use Disorders Identification Test | 642 | ||
| The Alcohol, Smoking, and Substance Involvement Screening Test | 642 | ||
| The Comorbidity-Alcohol Risk Evaluation Tool | 642 | ||
| Interventions | 642 | ||
| Brief Intervention | 643 | ||
| Pharmacology | 643 | ||
| Case Management | 644 | ||
| Types of Care Available in the Formal Treatment System | 645 | ||
| Self-help groups | 646 | ||
| Summary | 646 | ||
| References | 646 | ||
| Community Treatment of Older Adults | 655 | ||
| Key points | 655 | ||
| Introduction | 655 | ||
| Health service interventions | 656 | ||
| Home-Based Care for Depression | 656 | ||
| Barriers to Effectiveness of Mental Health Services Interventions | 657 | ||
| A Special Population: Residents of Long-term Care Facilities | 658 | ||
| Proposed Collaborative Care Management for Depression in Nursing Homes | 658 | ||
| Nursing Homes and Management of Severe and Persistent Mental Illness | 659 | ||
| Summary | 659 | ||
| References | 660 | ||
| Index | 663 |