Co-Morbidities and Dementia

VOLUME 21 ISSUE 1 SPRING- SUMMER 2011 Published by the National Association of Professional Geriatric Care of Managers 3275 West Ina Road Suite 130 Tucson, Arizona Geriatric Care Management 85741 520.881.8008 / phone 520.325.7925 / fax www.caremanager.org Co-Morbidities and Dementia Guest Editor’s Message .............................................................................2 By Karen Knutson, MSN, MBA Dementia, Diabetes, Hypertension, and Alcohol Abuse: A Case Study of Medical Co-morbidities ....................................................3 By Karen Knutson, MSN, MBA Alzheimer’s Disease Co-morbidities ............................................................7 By M. Reza Bolouri, M.D. Frontal Lobe Disorders and Dementia.........................................................9 By Patricia Gross, Ph.D., ABPP-CN A Different Dementia: Different Challenges ...............................................13 By Sharon Mayfield, BSN of Geriatric Care Management Spring/Summer 2011 Guest Editor’s Message Coordinating the Complex Care of Clients with Dementia and Co-Morbidities By Karen Knutson, MSN, MBA, RN Care managers play a pivotal role in in psychiatric classification, co- options available for our clients? coordinating the care of their clients. morbidity does not necessarily imply Selected articles have been chosen As people live longer, the complexity the presence of multiple diseases, to provide more understanding of of life will continue and the increasing but rather an inability of a single the co-morbidities associated with prevalence of chronic disease will diagnosis to account for all of the dementia. Hopefully you will find pose many challenges for coordinating individual’s symptoms. new insights and approaches to such complex care. While the experts hash out integrate into your practice. In health care, co-morbidity is definitions of co-morbidity there The first article which I authored, defined in two different ways. The is a great need for public policy “Dementia, Diabetes, Hypertension, first defines a medical condition to acknowledge and address the and Alcohol Abuse: A Case Study of existing simultaneously but increasing complexity of individuals Medical Co-morbidities” uses a case independently with another condition. living longer in our society and the study that describes the relationship The second defines a medical challenges these co-morbidities of the client’s dementia and diabetes, condition that causes, is caused by, represent. hypertension, and alcohol abuse. or is related to another condition. This issue of the Geriatric Care Integrating the client’s history, In reviewing the literature the first Management Journal highlights observation, and functional assessment definition is the standard and the dementia and co-morbidities. What instruments help to develop a plan second definition is newer than the is it that we do as care managers that of care. The article demonstrates standard and less well accepted. In is especially important? How do how care managers can incorporate psychiatry, psychology, and mental we sort out the co-morbidities when their knowledge of dementia and co- health counseling, co-morbidity refers more than one chronic illness is morbidities to improve both client and to the presence of more than one present? What are the most effective family outcomes. diagnosis at the same time. However, assessment, treatment, and care continued on page 3 EDITORIAL BOARD Rona Bartelstone, LCSW Fort Lauderdale, FL Cathy Cress, MSW Santa Cruz, CA Lenard W. Kaye, PhD Orono, ME Carmen Morano PhD of New York, NY Leonie Nowitz, MSW, LICSW New York, NY Journal Emily Saltz, MSW, LICSW Newton, MA Geriatric Care Management Monika White, PhD Santa Monica, CA Published by the: National Association of Professional Geriatric Care Managers 3275 West Ina Road, Suite 130, Tucson, Arizona 85741 • www.caremanager.org EDITOR-IN-CHIEF Published two times a year for members of NAPGCM Karen Knutson Non-member subscriptions: $95.00 per year MSN, MBA, RN Charlotte, NC © Copyright 2011 The Journal of Geriatric Care Management is published as a membership benefit to GRAPHIC members of the National Association of Professional Geratric Care Managers. Non-members may subscribe DESIGN to Journal of Geriatric Care Management for $95.00 per year. Send a check for your one-year subscription to: HagerDesigns Subscription Department, NAPGCM, 3275 West Ina Road, Suite 130, Tucson, Arizona 85741. Dallas, Texas PAGE 2 of Spring/Summer 2011 Geriatric Care Management Dementia, Diabetes, Hypertension and The second article “Alzheimer’s Alcohol Abuse: disease co-morbidities” by Reza Bolouri describes the psychiatric co- morbidities of depression, anxiety, A Case Study of psychosis, agitation, and aggression as well as the often-overlooked Medical Co-morbidities personality disorder. Symptom management, environmental By Karen Knutson, MSN, MBA modifications, and medication therapies are explored as the author describes a comprehensive approach Michael B, a 63-year-old single house. He had a lovely home full to managing co-morbidities. retired business executive with demen- of artwork and sculpture that he had In her article, “Frontal tia, diabetes, hypertension, and a his- collected over the years. The care Lobe Disorders and Dementia,” tory of alcohol abuse, living in Char- manager found him overwhelmed dur- Patricia Gross describes the lotte, North Carolina, was referred for ing the course of two visits to complete lesser understood medial frontal care management services by a friend. the evaluation because, as he said, “my syndrome, frontal convexity Michael’s older brother Eric, a retired house is out of control, and I can’t attorney, lives in Hawaii and had not syndrome, and orbital frontal seem to maintain it.” seen Michael in two years. Michael’s syndrome and provides case younger sister Linda, a teacher and Newspapers, mail, catalogs, dirty examples and treatment Michael’s health care POA, lives in dishes, glasses, and garbage were on options. She demonstrates how California and had not seen him in the the floor of every room on the lower neuropsychological evaluation can past year. Both brother and sister were level. The food in the refrigerator was be an important tool to help the scared and worried. They usually spoiled, and the freezer was a block care manager determine the client’s called him after work in the evening of ice. The sink was stopped up, and cognitive strengths and weaknesses which was often when Michael was the kitchen was bug infested. Spe- and how to best intervene. drinking. They didn’t know what else cific prescriptions ordered were never Sharon Mayfield has written a they could do. His sister said that filled and others including his insulin first-hand account of her work with Michael had become suspicious of had not been reordered in the past clients experiencing frontotemporal people who were trying to help him. four months. He was not taking his lobe disorders and the lessons He told her that he thought she wanted medications, and he was not testing she has learned while assisting to come and see him to declare him his blood sugar. The care manager families in their caregiving roles. incompetent. Michael’s friends and checked his blood sugar and it was She describes different symptoms, family reported to the care manager as 543, which was a seriously high level. she interviewed them that they were caregiving approaches, and explores He had lost his credit cards, calendar, experiencing difficulty in their rela- successful strategies that family and wallet and was unaware of his tionships with Michael and relation- caregivers can use. Case examples financial spending. He had accrued ships with one another as they tried to $25,000 in debt on one credit card illustrate how the care manager help him. can help. that he thought he had paid off. He Early in 2009 Michael participat- also looked at a bill for the purchase ed in a residential treatment program References of art and couldn’t remember what he for two months, but was drinking purchased or why. His cable was cut Valderas JM, et al. Defining again within 48 hours of returning off because of an unpaid balance. co-morbidity: implications for home. He went to a second residential understanding health and health services. Annals of Family Medicine. treatment program for 3 months, came The Challenges of 2009, 7(4): 357-63. back home, began drinking again, and Sorting It Out after an incident at work was forced First MB. Mutually exclusive versus to resign in January of 2010. Michael Sorting out the relationships co-occurring diagnostic categories? The between dementia and other chronic challenge of diagnostic co-morbidity. finally allowed the care manager into Psychopathology. 2005, 38(4): 206-10. his house on her fourth visit to the continued on page 4 PAGE 3 of Geriatric Care Management Spring/Summer 2011 Dementia, Diabetes, 140 over 90 or higher can also seem to information including the time of Hypertension and Alcohol spur Alzheimer’s disease-like process- onset of Michael’s cognitive deficits, Abuse: A Case Study of es. The clinical approach at present is the progression of his symptoms, and Medical Co-morbidities to maintain as low a blood pressure as family history of dementia from his continued from page 3 possible to prevent dementia as well as siblings, friends and medical provid- stroke. There are no other potentially ers. The care manager uncovered that illnesses can be difficult. A clearer effective therapies. Michael had a five-year history of understanding of the client’s dementia symptoms. Over the past medical co-morbidities can help Relationship of two years he began eating and drink- the care manager develop a more dementia and ing excessively, made art and sculp- comprehensive understanding and alcoholism ture purchases of over $100,000, and approach to care planning. Most studies have indicated was reported by friends to have poor Relationship of that excessive alcohol consumption judgment on a number of issues. At dementia and diabetes leads to cognitive impairment but one time he had a regular routine of the pathological mechanism remains eating, drinking, and shopping.

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