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Election 2012 and the 113th Congress: The Stakes for Mental Health and Aging Advocates
2013 AAGP Annual Meeting DEMENTIA PATIENTS WITH BEHAVIORAL DISTURBANCES: CURRENT TREATMENT STRATEGIES Helen H. Kyomen, MD, MS1; Istvan J. Boksay, MD, PhD2 1 2
NSMC/McLean Hospital/PartnersHealthcare/Harvard Medical School, Belmont, MA New York University School of Medicine, New York, NY
Abstract: Behavioral symptoms of dementia are associated with accelerated cognitive decline, increased functional impairment, decreased mean survival time, increased co-morbid conditions, and increased danger to self and others. They lead to increased health care service utilization, higher risk of institutionalization and greater caregiver stress and burden. Eighty to 90% of patients with dementia exhibit behavioral symptoms over the course of the illness, and such symptoms are prevalent in community and long-term care settings. Reviewed in this symposium: (1) Identification of specific patterns of behavioral disturbances associated with dementia, (2) Comprehensive patient evaluation, (3) Nonpharmacologic behavioral and functional interventions, and (4) Pharmacologic/somatic interventions. Faculty Disclosures: Istvan J. Boksay, MD, PhD Nothing to disclose Helen H. Kyomen, MD, MS Nothing to disclose
ELECTION 2012 AND THE 113TH CONGRESS: THE STAKES FOR MENTAL HEALTH AND AGING ADVOCATES Karen Blank, MD1; David Wasserman2 1 2
Institute of Living, Hartford, CT The Cook Political Report, Washington, DC
Abstract: As strong as the Democratic win was in the 2008 elections, with Barack Obama leading the party to quite large majorities in the House and Senate, large numbers of independent voters switched their partisan positions in 2010. The massive victories of Republicans in the 2010 Congressional elections seemed to be a repudiation of the Obama Administration and the large Democratic majorities in Congress. Democrats held onto control of the Senate, but with a greatly reduced majority and a rejuvenated Republican opposition, and in 2012 faced the problem of having to defend 23 seats, as opposed to only 10 seats held by Republican incumbents. The House of Representatives moved firmly into Republican hands in 2010, and Democrats confronted considerable odds in winning back control in 2012. As daunting as the Democrats’ task was heading into the 2012 elections, Republicans faced extraordinary pressures as well. In Congressional races, Democrats took heart in their candidate’s May 2011 victory in a special election in upstate New York for a seat that had been held by Republicans for 40 years. The race was run on the issue of Medicare and the House Republicans’ proposal to make extensive changes to that program. In the months leading up to the November 2012 elections, there was a great deal of interest in the staying power of that issue, along with the country’s overall economic and unemployment situation. In the 2012 battle for Congress, Republicans needed to net four seats to gain the Senate majority. House Democrats needed a net gain of 25 seats to reclaim the Speaker’s gavel. In recent years, both parties have experienced the consequences of complacency and the difficulty of maintaining voters’ loyalty, especially when there is unrest about the economy and unemployment. With the increasing volatility of the electorate, control of both Houses of Congress could easily be up for grabs. In the Presidential election, President Obama faced no primary opposition; and while the Republicans had a grueling and lengthy primary season, former Massachusetts Governor Mitt Romney ultimately prevailed as most pundits had long predicted he would. By the spring of 2012, many polls showed the presidential race as virtually a dead heat, with only a few percentage points separating the two candidates. This public policy session will explore the key issues in the 2012 elections, with special attention paid to the role of health care, including the recent passage of President Obama’s health care reform legislation and budget decisions impacting the Medicare
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Am J Geriatr Psychiatry 21:3, Supplement 1
2013 AAGP Annual Meeting and Medicaid programs. The speaker will examine the political environment that shaped the 2012 Congressional and Presidential elections and then turn to policy issues and developments that might shape the 2014 mid-term elections. Finally, the session will identify strategies for AAGP and individual geriatric psychiatrists to utilize to ensure that the candidates for office are aware of the mental health and aging issues that will impact their practices and their patients in the years to come. Faculty Disclosures: Karen Blank, MD Nothing to disclose David Wasserman Nothing to disclose
ENHANCING DIGNITY IN END OF LIFE CARE: A COLLABORATIVE APPROACH
Cindy J. Grief, MD, MSc1,2; Daphna Grossman, MD, CCFP(EM) FCFP1,3; Linda Mah, MD, MHSc4,2; David Conn, MB1,2 1
Baycrest, Toronto, ON, Canada University of Toronto, Department of Psychiatry, Division of Geriatric Psychiatry, Toronto, ON, Canada 3 University of Toronto, Department of Family and Community Medicine, Division of Palliative Care, Toronto, ON, Canada 4 Rotman Research Institute, Baycrest, Toronto, ON, Canada 2
Abstract: Dignity is an important concept in palliative care but has been largely overlooked in the context of geriatric psychiatry. Yet, the notion of dying with dignity offers relevance beyond palliative care, with the potential to inform treatment approaches to individuals with advanced dementia and frailty. We explore notions of dignity from our experiences in a large geriatric health care setting from diverse perspectives, demonstrating the value of a collaborative approach. The content bridges education, research and clinical care. We present a novel interprofessional curriculum piloted with staff, students and volunteers on an inpatient geriatric palliative care unit that integrates topics in mental health, palliative care and geriatrics. Topics selected by participants highlight the theme of dignity, which is further elucidated within the session. Knowledge and attitudes towards interprofessional learning and qualitative data from focus groups are summarized. Building on these concepts, we report the results of research findings from our 31-bed geriatric palliative care inpatient unit. We initiated a pilot study to systematically evaluate the attitudes of patients towards complementary and alternative medicine (CAM). Preserving dignity is a core principal of CAM, whose modalities are increasingly utilized to promote well-being and autonomy in end of life care. The goals of these interventions include the reduction of psychological and existential distress. We characterize the degree to which our sample of older terminally ill adult inpatients experience dignity-related distress and cite its relationship to mood, anxiety and physical symptomatology. Implications of these findings, such as the feasibility of developing standardized mental health protocols for geriatric palliative care to address dignity-related and other psychosocial concerns, are discussed. Finally, we present three case examples to illustrate how the range of dignity-conserving therapies provided by an interprofessional clinical team can ensure patients and their families experience a meaningful, dignified, “good” death. Strategies for incorporating dignity-preserving care on an inpatient geriatric palliative care unit are described and the value of a patientcentred approach is underscored. This symposium is intended to highlight the salience of dignity in enhancing end of life care for older adults and their families. We continue to explore dignity in the palliative care setting, evaluate the effectiveness of interprofessional education, and assess clinical interventions to optimize dignity in end of life care. With its emphasis on dignity, the palliative care philosophy offers applicability to the wider geriatric population and may hold particular relevance for those with dementia and extreme frailty. Dignity concerns are a fertile ground for knowledge translation and interprofessional collaboration. Faculty Disclosures: David Conn, MB Nothing to disclose Cindy J. Grief, MD, MSc Nothing to disclose Daphna Grossman, MD, CCFP(EM) FCFP Nothing to disclose
Am J Geriatr Psychiatry 21:3, Supplement 1
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NSMC/McLean Hospital/PartnersHealthcare/Harvard Medical School, Belmont, MA New York University School of Medicine, New York, NY
Abstract: Behavioral symptoms of dementia are associated with accelerated cognitive decline, increased functional impairment, decreased mean survival time, increased co-morbid conditions, and increased danger to self and others. They lead to increased health care service utilization, higher risk of institutionalization and greater caregiver stress and burden. Eighty to 90% of patients with dementia exhibit behavioral symptoms over the course of the illness, and such symptoms are prevalent in community and long-term care settings. Reviewed in this symposium: (1) Identification of specific patterns of behavioral disturbances associated with dementia, (2) Comprehensive patient evaluation, (3) Nonpharmacologic behavioral and functional interventions, and (4) Pharmacologic/somatic interventions. Faculty Disclosures: Istvan J. Boksay, MD, PhD Nothing to disclose Helen H. Kyomen, MD, MS Nothing to disclose
ELECTION 2012 AND THE 113TH CONGRESS: THE STAKES FOR MENTAL HEALTH AND AGING ADVOCATES Karen Blank, MD1; David Wasserman2 1 2
Institute of Living, Hartford, CT The Cook Political Report, Washington, DC
Abstract: As strong as the Democratic win was in the 2008 elections, with Barack Obama leading the party to quite large majorities in the House and Senate, large numbers of independent voters switched their partisan positions in 2010. The massive victories of Republicans in the 2010 Congressional elections seemed to be a repudiation of the Obama Administration and the large Democratic majorities in Congress. Democrats held onto control of the Senate, but with a greatly reduced majority and a rejuvenated Republican opposition, and in 2012 faced the problem of having to defend 23 seats, as opposed to only 10 seats held by Republican incumbents. The House of Representatives moved firmly into Republican hands in 2010, and Democrats confronted considerable odds in winning back control in 2012. As daunting as the Democrats’ task was heading into the 2012 elections, Republicans faced extraordinary pressures as well. In Congressional races, Democrats took heart in their candidate’s May 2011 victory in a special election in upstate New York for a seat that had been held by Republicans for 40 years. The race was run on the issue of Medicare and the House Republicans’ proposal to make extensive changes to that program. In the months leading up to the November 2012 elections, there was a great deal of interest in the staying power of that issue, along with the country’s overall economic and unemployment situation. In the 2012 battle for Congress, Republicans needed to net four seats to gain the Senate majority. House Democrats needed a net gain of 25 seats to reclaim the Speaker’s gavel. In recent years, both parties have experienced the consequences of complacency and the difficulty of maintaining voters’ loyalty, especially when there is unrest about the economy and unemployment. With the increasing volatility of the electorate, control of both Houses of Congress could easily be up for grabs. In the Presidential election, President Obama faced no primary opposition; and while the Republicans had a grueling and lengthy primary season, former Massachusetts Governor Mitt Romney ultimately prevailed as most pundits had long predicted he would. By the spring of 2012, many polls showed the presidential race as virtually a dead heat, with only a few percentage points separating the two candidates. This public policy session will explore the key issues in the 2012 elections, with special attention paid to the role of health care, including the recent passage of President Obama’s health care reform legislation and budget decisions impacting the Medicare
S12
Am J Geriatr Psychiatry 21:3, Supplement 1
2013 AAGP Annual Meeting and Medicaid programs. The speaker will examine the political environment that shaped the 2012 Congressional and Presidential elections and then turn to policy issues and developments that might shape the 2014 mid-term elections. Finally, the session will identify strategies for AAGP and individual geriatric psychiatrists to utilize to ensure that the candidates for office are aware of the mental health and aging issues that will impact their practices and their patients in the years to come. Faculty Disclosures: Karen Blank, MD Nothing to disclose David Wasserman Nothing to disclose
ENHANCING DIGNITY IN END OF LIFE CARE: A COLLABORATIVE APPROACH
Cindy J. Grief, MD, MSc1,2; Daphna Grossman, MD, CCFP(EM) FCFP1,3; Linda Mah, MD, MHSc4,2; David Conn, MB1,2 1
Baycrest, Toronto, ON, Canada University of Toronto, Department of Psychiatry, Division of Geriatric Psychiatry, Toronto, ON, Canada 3 University of Toronto, Department of Family and Community Medicine, Division of Palliative Care, Toronto, ON, Canada 4 Rotman Research Institute, Baycrest, Toronto, ON, Canada 2
Abstract: Dignity is an important concept in palliative care but has been largely overlooked in the context of geriatric psychiatry. Yet, the notion of dying with dignity offers relevance beyond palliative care, with the potential to inform treatment approaches to individuals with advanced dementia and frailty. We explore notions of dignity from our experiences in a large geriatric health care setting from diverse perspectives, demonstrating the value of a collaborative approach. The content bridges education, research and clinical care. We present a novel interprofessional curriculum piloted with staff, students and volunteers on an inpatient geriatric palliative care unit that integrates topics in mental health, palliative care and geriatrics. Topics selected by participants highlight the theme of dignity, which is further elucidated within the session. Knowledge and attitudes towards interprofessional learning and qualitative data from focus groups are summarized. Building on these concepts, we report the results of research findings from our 31-bed geriatric palliative care inpatient unit. We initiated a pilot study to systematically evaluate the attitudes of patients towards complementary and alternative medicine (CAM). Preserving dignity is a core principal of CAM, whose modalities are increasingly utilized to promote well-being and autonomy in end of life care. The goals of these interventions include the reduction of psychological and existential distress. We characterize the degree to which our sample of older terminally ill adult inpatients experience dignity-related distress and cite its relationship to mood, anxiety and physical symptomatology. Implications of these findings, such as the feasibility of developing standardized mental health protocols for geriatric palliative care to address dignity-related and other psychosocial concerns, are discussed. Finally, we present three case examples to illustrate how the range of dignity-conserving therapies provided by an interprofessional clinical team can ensure patients and their families experience a meaningful, dignified, “good” death. Strategies for incorporating dignity-preserving care on an inpatient geriatric palliative care unit are described and the value of a patientcentred approach is underscored. This symposium is intended to highlight the salience of dignity in enhancing end of life care for older adults and their families. We continue to explore dignity in the palliative care setting, evaluate the effectiveness of interprofessional education, and assess clinical interventions to optimize dignity in end of life care. With its emphasis on dignity, the palliative care philosophy offers applicability to the wider geriatric population and may hold particular relevance for those with dementia and extreme frailty. Dignity concerns are a fertile ground for knowledge translation and interprofessional collaboration. Faculty Disclosures: David Conn, MB Nothing to disclose Cindy J. Grief, MD, MSc Nothing to disclose Daphna Grossman, MD, CCFP(EM) FCFP Nothing to disclose
Am J Geriatr Psychiatry 21:3, Supplement 1
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