- Email: [email protected]
127 Recommending treatment decisions for Alzheimer patients
$32
FIFTH INTERNATIONAL CONFERENCE ON ALZHEIMER'S DISEASE
medical care management in clinical and program settings. The second explored the parameters for diagnostic and assessment practices and proposed diagnostic criteria for use with adults with mental retardation and the third explored epidemiological considerations and recommended the adoption of a uniform data set. The author will cover the key findings of each of the Colloquium's workgroup reports and discuss follow-up activities, particularly as they apply to continued research in care management and diagnostics.
observed in four VD patients. We were unable to detect any significant relationships between changes in EEG measures and changes in clinical manifestations. The number of occurrences of rapid eye movements (REM) on the EOG is an index that reflects alertness level and mental tension, while slow eye movements (SEM) are an index related to drowsiness and sleepiness. EOG analysis showed decreased REM in ATD and mild cases of VD patients with exhibiting clinical improvement, whereas REM increased and SEM decreased in moderate and severe cases of VD. These findings suggest that group psychotherapy has two different effects. One is an effect of relieving mental tension and decreasing the abnormally increased alertness level, while the other is an effect of raising reduced alertness levels and increasing ability of attention.
125 CANDID: A unique new service providing information & support. P. Roques*, R.J. Harvey, N. Fox, J. Walton and M. Rossor. Dementia Research Group, The National Hospital for Neurology and Neurosurgery, 8-11 Queen Square, London WC1N 3BG, UK. CANDID (Counselling and Diagnosis in Dementia) is a unique service providing support and information to professionals and carers on the wide range of dementias which may affect people before the age of sixty-five. Advice is given by trained nurses to patients and caters by telephone, in person and via electronic mail. The advice given is discussed with a Consultant Neurologist and a Psychiatrist. A copy of the problem and advice is also sent to the caller's General Practitioner. All activity for the new service was audited for the first 8 months of operation: Four hundred calls were registered, 180 from patients under our care and 220 from people who had learned about the service from promotions and the media. For patients under our care, the callers were mainly family earegivers (69%) and General Practitioner (8%). The mean age at onset of the disease in these patients was 52 years with 45% having Alzheimer's disease, 19% Pick's disease, 9% Frontal lobe dementia, and 27% other dementias. Teaching is a vital component of CANDID, with involvement in various postgraduate medical and nursing courses and study days highlighting the problems encountered when a younger sufferer is involved. A forum was established enabling professionals working in different disciplines to meet together to discuss common issues. The Interact is a global communications and data network which was used by CANDID to establish an e-mail mailing list and World Wide Web pages. One hundred and seventy people joined the mailing list, with members from the UK, Europe, USA, Australia and the Far East. One third were family caregivers with the remainder being professionals, educators and students. More than 500 accesses per month were recorded for the Web pages, with very positive feedback. We have devised a new service that has received rapid acceptance. It has utilised modem communication methods to overcome the problems of providing a service to people from a wide geographical area. We have also been able to demonstrate the usefulness, acceptability and potential of providing support to dementia carets using the Intemet.
127 Recommending Treatment Decisions for AIzheimer Patients A. C. Hurley~ V. F. Rempusheski, S. T. Fry and L. Volicer Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Bedford, MA 01730, USA Decisions about limiting aggressive interventions such as CPR, intensive medical care and tube feeding for Alzheimer patients are difficult because patients lose their decision making capacity. Autonomy may be maintained by carrying out previous wishes, but often these wishes were never expressed or were general and require further interpretation. Thus, a surrogate decision maker (SDM) often has to make specific decisions affecting patient care; to establish an Advance Proxy Plan (APP). Our team conducted a series of studies in four 25 bed dementia special care units that offer palliative care options. Using the grounded theory method and the constant comparative method of data analysis, we examined the nursing role in the APP in which the family SDM is provided a recommendation for their consideration. Nurse caregiver data were obtained by observation and during consensus meetings, individual interviews and a focus group meeting; family SDM data by observation, informal discussion, private interview, and survey; and patient data were abstracted from the medical record. We developed a four phase model, "Achieving Consensus: Decision Making to Determine Treatment Options for Patients with Alzheimer's Disease." Patient decline, family coping, professional development of nursing staff, and nursing unit philosophy were community characteristics found to be important antecedents to the process of reaching consensus. Achieving consensus constructs included interactive process components of patient/family/staff adjustment,.caring and knowing. Timing and trust were influential catalysts to family and staff readiness factors for achieving consensus. Outcomes were the advice provided by staff and the SDM decision. Consequences were the APP and patienf care which limited CPR, transfers to acute care medical units and tube feeding in 94% patients and an aggressive diagnostic workup and intravenous antibiotic treatment for infection in 45% patients. (Supported by the VA, NINR-NIH Grant #5R03NR02829, the American Nurses Foundation, and Theta Chapter, Sigma Theta Tau)
126 Group psychotherapy for Alzheimer-type Dementia and Vascular Dementia Y. Kawamuro *'1, M. Shigeta 2, K. Hyoki 3 and M. Fujino 3 I Departmant of Neuropsyehiatry, 3 EEG Laboratory, Joshinso Kawamuro Hospital, 71 Kitashinbo, Joetsu-shi, Niigata 943-01, Japan, 2Department of Psychiatry, Jikai University School of Mediclne, 3-25-8, Nishi-Shimbashi, Minatoku, Tokyo 105, Japan We conducted group psychotherapy oriented the familiar interpersonal communication with an interaction to treat elderly patients with Alzheimer-type dementia (ATD) and cerebrovascular dementia (VD). The control group were giving nursing care in their daily lives but were not given psychotherapy. Six patients with ATD (mean age: 81.5 years) and 11 patients with VD (mean age: 83.0 years) were included in the group psychotherapy group (GP group), while the control group (CG group) was comprised of 8 VD patients (mean age: 83.0 years). Group psychotherapy sessions were conducted once a week for three months. The group psychotherapy consisted of a designed program which emphasized seasonality and culture. Before and after the conduct of group psychotherapy, intellectual function was evaluated by the MMSE and daily life activity by the GBS scale. EEGs and EOGs (electro-oculograms) were recorded and analyzed to assess the efficacy of group psychotherapy from a neurophysiological standpoint. The evaluations in the CG group were conducted in the same manner as in the GP group. The clinical improvements described below were observed in the GP group. Improvements in the MMSE and in emotional function on the GBS were observed in three ATD patients, and improvement in intellectual function on the GBS was
128 Demented Elderly and the Great Hanshin Earthquake in Japan: Manifestation and exacerbation of their symptoms K. Maeda *~, C. Tanaka I and T. Kakigi-' ~Hyogo Institute for Aging Brain and Cognitive Disorders, 2Department of Psychiatry, Kobe University School of Medicine, 520 Saishou-koh, Himeji 670 Japan On Jan. 17, 1995, at 5:46 a.m., an earthquake measuring 7.2 on the Richter scale shook southeastern area of Hyogo prefecture of Japan, including Kobe city. By this earthquake, refered as the Great Haoshin Earthquake later, over 6,000 people were killed, 150,000 buildings and houses collapsed and more than 300,000 people temporalily evacuated. Forty four % of victims were aged over 60. We reported five survivors with senile dementia of the Alzheimer's type, who developed delusion after the quake. They were a man and four women, and their ages were 76 to 93 years. They had been living alone without problems and functioning fairly well. Their sons or daughters did not realize their dementia symptoms betore the earthquqke. None of them was injured by the quake. They
FIFTH INTERNATIONAL CONFERENCE ON ALZHEIMER'S DISEASE
medical care management in clinical and program settings. The second explored the parameters for diagnostic and assessment practices and proposed diagnostic criteria for use with adults with mental retardation and the third explored epidemiological considerations and recommended the adoption of a uniform data set. The author will cover the key findings of each of the Colloquium's workgroup reports and discuss follow-up activities, particularly as they apply to continued research in care management and diagnostics.
observed in four VD patients. We were unable to detect any significant relationships between changes in EEG measures and changes in clinical manifestations. The number of occurrences of rapid eye movements (REM) on the EOG is an index that reflects alertness level and mental tension, while slow eye movements (SEM) are an index related to drowsiness and sleepiness. EOG analysis showed decreased REM in ATD and mild cases of VD patients with exhibiting clinical improvement, whereas REM increased and SEM decreased in moderate and severe cases of VD. These findings suggest that group psychotherapy has two different effects. One is an effect of relieving mental tension and decreasing the abnormally increased alertness level, while the other is an effect of raising reduced alertness levels and increasing ability of attention.
125 CANDID: A unique new service providing information & support. P. Roques*, R.J. Harvey, N. Fox, J. Walton and M. Rossor. Dementia Research Group, The National Hospital for Neurology and Neurosurgery, 8-11 Queen Square, London WC1N 3BG, UK. CANDID (Counselling and Diagnosis in Dementia) is a unique service providing support and information to professionals and carers on the wide range of dementias which may affect people before the age of sixty-five. Advice is given by trained nurses to patients and caters by telephone, in person and via electronic mail. The advice given is discussed with a Consultant Neurologist and a Psychiatrist. A copy of the problem and advice is also sent to the caller's General Practitioner. All activity for the new service was audited for the first 8 months of operation: Four hundred calls were registered, 180 from patients under our care and 220 from people who had learned about the service from promotions and the media. For patients under our care, the callers were mainly family earegivers (69%) and General Practitioner (8%). The mean age at onset of the disease in these patients was 52 years with 45% having Alzheimer's disease, 19% Pick's disease, 9% Frontal lobe dementia, and 27% other dementias. Teaching is a vital component of CANDID, with involvement in various postgraduate medical and nursing courses and study days highlighting the problems encountered when a younger sufferer is involved. A forum was established enabling professionals working in different disciplines to meet together to discuss common issues. The Interact is a global communications and data network which was used by CANDID to establish an e-mail mailing list and World Wide Web pages. One hundred and seventy people joined the mailing list, with members from the UK, Europe, USA, Australia and the Far East. One third were family caregivers with the remainder being professionals, educators and students. More than 500 accesses per month were recorded for the Web pages, with very positive feedback. We have devised a new service that has received rapid acceptance. It has utilised modem communication methods to overcome the problems of providing a service to people from a wide geographical area. We have also been able to demonstrate the usefulness, acceptability and potential of providing support to dementia carets using the Intemet.
127 Recommending Treatment Decisions for AIzheimer Patients A. C. Hurley~ V. F. Rempusheski, S. T. Fry and L. Volicer Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Bedford, MA 01730, USA Decisions about limiting aggressive interventions such as CPR, intensive medical care and tube feeding for Alzheimer patients are difficult because patients lose their decision making capacity. Autonomy may be maintained by carrying out previous wishes, but often these wishes were never expressed or were general and require further interpretation. Thus, a surrogate decision maker (SDM) often has to make specific decisions affecting patient care; to establish an Advance Proxy Plan (APP). Our team conducted a series of studies in four 25 bed dementia special care units that offer palliative care options. Using the grounded theory method and the constant comparative method of data analysis, we examined the nursing role in the APP in which the family SDM is provided a recommendation for their consideration. Nurse caregiver data were obtained by observation and during consensus meetings, individual interviews and a focus group meeting; family SDM data by observation, informal discussion, private interview, and survey; and patient data were abstracted from the medical record. We developed a four phase model, "Achieving Consensus: Decision Making to Determine Treatment Options for Patients with Alzheimer's Disease." Patient decline, family coping, professional development of nursing staff, and nursing unit philosophy were community characteristics found to be important antecedents to the process of reaching consensus. Achieving consensus constructs included interactive process components of patient/family/staff adjustment,.caring and knowing. Timing and trust were influential catalysts to family and staff readiness factors for achieving consensus. Outcomes were the advice provided by staff and the SDM decision. Consequences were the APP and patienf care which limited CPR, transfers to acute care medical units and tube feeding in 94% patients and an aggressive diagnostic workup and intravenous antibiotic treatment for infection in 45% patients. (Supported by the VA, NINR-NIH Grant #5R03NR02829, the American Nurses Foundation, and Theta Chapter, Sigma Theta Tau)
126 Group psychotherapy for Alzheimer-type Dementia and Vascular Dementia Y. Kawamuro *'1, M. Shigeta 2, K. Hyoki 3 and M. Fujino 3 I Departmant of Neuropsyehiatry, 3 EEG Laboratory, Joshinso Kawamuro Hospital, 71 Kitashinbo, Joetsu-shi, Niigata 943-01, Japan, 2Department of Psychiatry, Jikai University School of Mediclne, 3-25-8, Nishi-Shimbashi, Minatoku, Tokyo 105, Japan We conducted group psychotherapy oriented the familiar interpersonal communication with an interaction to treat elderly patients with Alzheimer-type dementia (ATD) and cerebrovascular dementia (VD). The control group were giving nursing care in their daily lives but were not given psychotherapy. Six patients with ATD (mean age: 81.5 years) and 11 patients with VD (mean age: 83.0 years) were included in the group psychotherapy group (GP group), while the control group (CG group) was comprised of 8 VD patients (mean age: 83.0 years). Group psychotherapy sessions were conducted once a week for three months. The group psychotherapy consisted of a designed program which emphasized seasonality and culture. Before and after the conduct of group psychotherapy, intellectual function was evaluated by the MMSE and daily life activity by the GBS scale. EEGs and EOGs (electro-oculograms) were recorded and analyzed to assess the efficacy of group psychotherapy from a neurophysiological standpoint. The evaluations in the CG group were conducted in the same manner as in the GP group. The clinical improvements described below were observed in the GP group. Improvements in the MMSE and in emotional function on the GBS were observed in three ATD patients, and improvement in intellectual function on the GBS was
128 Demented Elderly and the Great Hanshin Earthquake in Japan: Manifestation and exacerbation of their symptoms K. Maeda *~, C. Tanaka I and T. Kakigi-' ~Hyogo Institute for Aging Brain and Cognitive Disorders, 2Department of Psychiatry, Kobe University School of Medicine, 520 Saishou-koh, Himeji 670 Japan On Jan. 17, 1995, at 5:46 a.m., an earthquake measuring 7.2 on the Richter scale shook southeastern area of Hyogo prefecture of Japan, including Kobe city. By this earthquake, refered as the Great Haoshin Earthquake later, over 6,000 people were killed, 150,000 buildings and houses collapsed and more than 300,000 people temporalily evacuated. Forty four % of victims were aged over 60. We reported five survivors with senile dementia of the Alzheimer's type, who developed delusion after the quake. They were a man and four women, and their ages were 76 to 93 years. They had been living alone without problems and functioning fairly well. Their sons or daughters did not realize their dementia symptoms betore the earthquqke. None of them was injured by the quake. They