PREOPERATIVE DEMENTIA SCREENING AND POSTOPERATIVE DELIRIUM IN OLDER SURGICAL PATIENTS

PREOPERATIVE DEMENTIA SCREENING AND POSTOPERATIVE DELIRIUM IN OLDER SURGICAL PATIENTS

Poster Presentations: Wednesday, July 19, 2017 6 Centre for Healthy Brain Ageing (CHeBa), Sydney, Australia. Contact e-mail: [email protected]

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Poster Presentations: Wednesday, July 19, 2017 6 Centre for Healthy Brain Ageing (CHeBa), Sydney, Australia. Contact e-mail: [email protected]

Background: The protective, custodial, task-oriented care provided in residential aged care facilitates functional decline, decreases physical activity and contributes to deconditioning and disability in people with dementia. Methods: LifeFul is a 12 month restorative and relationship-focused staff culture change program in residential aged care with a focus on people with dementia. LifeFul includes: assigning a ‘focus carer’ to each resident, implementing dedicated rostering, discussing restorative care practices during handovers, changing organisation policies and practices to support LifeFul (e.g. intake and assessment procedures, resident committees, family engagement, facility events, memorial services) and 12 hours of training for all staff. A pilot in three facilities has demonstrated the feasibility of delivering LifeFul in terms of implementing dedicated rostering, focus carers and handover procedures as well as making changes to policies and procedures. Results: Results suggest promising benefits to staff practices. Barriers to the program included staff attitudes towards people with dementia, role clarity and facility leadership. Tools piloted as outcome measures (n ¼ 75 residents) included the Adult Social Care Outcomes Toolkit (ASCOT, primary outcome), Quality of Interactions Schedule, Short Physical Performance Battery, Disability Assessment for Dementia, Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia and the Measures of Individualized Care. Conclusions: We demonstrated that LifeFul is feasible to implement to change facility practices and staff behavior, a fully powered study is required to evaluate impact on residents.

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PREOPERATIVE DEMENTIA SCREENING AND POSTOPERATIVE DELIRIUM IN OLDER SURGICAL PATIENTS

Lucy Andrews, At Your Service Home Care, Santa Rosa, CA, USA. Contact e-mail: [email protected] Background: People 65 years or older are having surgery later in

life and are at risk of developing a major postoperative complication, delirium., The Montreal Cognitive Assessment, is a preoperative cognitive screening tool which was used to screen thirty-three older orthopedic surgical patients to reduce the incidence of this serious postoperative complication. Methods: Patients who scored below normal were identified as at riskand monitored to ascertain if identification and monitoring influenced their postoperative course. At the first postoperative visit each patient was evaluated for falls, confusion, and the ability to follow the required postoperative home exercise program to identify an undetected episode of delirium after discharge. Results: Of the patients screened, 34.1% (n ¼ 14) of patients fell below the cutoff for normal cognition. Subsequent monitoring and nursing interventions may have influenced their postoperative course as there were no reported episodes of delirium in the 90-day period. Conclusions: Thus, preoperative screening with the Montreal Cognitive Assessment tool provides a baseline cognitive assessment and early identification of patients at higher risk for postoperative delirium, and therefore, identification of patients at risk for postoperative delirium may allow for early interventions and decrease postoperative delirium.

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DEVELOPMENT AND EVALUATION OF A COMPUTERIZED BATTERY FOR COGNITIVE TRAINING IN PATIENTS WITH DEMENTIA

Masashi Inoue1, Miyako Taniguchi2, Katsuya Urakami2, 1Tottori University, Tottori, Japan; 2Tottori University, Yonago, Japan. Contact e-mail: [email protected] Background: One of the most important issues in Japan is the rapid

aging of society. The number of persons with dementia is estimated to have reached more than two million. It is important to detect the early stages of dementia and perform the following interventions because intervention programs, such as cognitive training, are more effective when useful cognitive function can still be preserved. We have already developed a computerized test battery to diagnose dementia1). In this study we have enhanced the battery so that it can serve cognitive training for persons with dementia. Methods: The battery consist of two programs, one for examination and the other for cognitive training which was newly implemented. The cognitive training program contains several tasks, such as visuospatial memory training, calculation and reminiscence therapy. Before the training, the user takes an examination to diagnose his/ her cognitive activity. Then the battery presents a training program according to the user’s ability level. This battery is also equipped with a communication function. The results of the examination and the training, together with the user’s anonymous personal information, are collected via the Internet and stored into database. The aim of the database is to store large amounts of data for analysis. More than two thousand time series data were obtained from 531 psychogeriatric patients in nursing home. Results: The data obtained from thirty patients who could be observed for over one year were analyzed in detail. Their cognitive activities were diagnosed by the battery’s examination program. Twenty of those patients improved their cognitive activity. Four patients deteriorated slightly and six of them became worse. It was found that patients who had an improvement in visuospatial memory training tended to improve their cognitive activity. Conclusions: Computerized training programs could offer a more flexible, personalized approach to traditional cognitive training programs. In addition, computerized programs provide real-time performance feedback and can be adjusted to the user’s ability level, keeping the activity engaging and fun. This study suggests that visuospatial memory training is an effective training to improve cognitive activity of patient with dementia. P4-307

ALZHEIMER’S DISEASE AND RELATED NEUROLOGICAL DISORDERS: STIGMA IN DEVELOPING COUNTRIES

Raj Kumar Bhatta1, Shambhu D. Joshi2, 1Community Health and Environmental Society Nepal, Kathmandu, Nepal; 2FWCH, Kailali, Nepal. Contact e-mail: [email protected] Background: Stigma is a social devaluation of a person because of

personal attribute leading to an experience of sense of shame, disgrace and social isolation. Developing countries are facing more stigma, discrimination due to poverty, illiteracy, migration, gender inequalities and lack of government policy. Methods: The nature of stigma in Alzheimer’s disease and related neurological disorders and its relationship to attribution was studied in one hundred and fifty-nine urban and rural patients during 2 years. The response of the primary care givers to fourteen questions on stigma