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5 Health Care Response to Cognitive Aging
Pages 209-226

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From page 209...
... This chapter focuses on the health care response to cognitive aging, including attitudes and practices of health care professionals and the health system, needs for improving the health care response through provider education and training, and opportunities for using medical visits to assess and to address cognitive aging.
From page 210...
... Health care practitioners view addressing prevention and risk reduction concerning cognitive impairment and dementia in clinical practice as a challenge. As is the case with addressing prevention in routine care for other conditions, the major barriers include a lack of reimbursement and finding enough time to address both behavioral counseling and patients' more immediate health issues (Day et al., 2012; Yarnall et al., 2009)
From page 211...
... For health care providers, the primary needs include practice recommendations to guide assessment and counseling regarding cognitive aging, access to tools for evaluating cognition and advising patients regarding normal aging performance patterns, knowledge of effective interventions and recommendations for patient and family counseling, and decision aids to help identify when to refer patients for further evaluation and diagnosis or intervention. For health care systems and private and public health insurance companies there are numerous opportunities to provide educational materials and programs for older adults and family members and training for health care professionals to discuss cognitive aging and to promote cognitive health.
From page 212...
... Hartford Foundation and administered by the Society for General Internal Medicine, which brings geriatricians and internists together to discuss the care of older adults. In addition, a number of websites have been established as resources for improving training for health care professionals in the topics of aging populations and clinical practice.
From page 213...
... The website offers six modules covering medication management, trauma and falls, atypical presentations, functional assessment, end-of-life care, and cognitive impairment. Reviewing the available literature and electronic resources reveals that a number of important steps have been taken toward designing content to increase health care professionals' awareness of and education in cognition and aging.
From page 214...
... The involvement of a clinical pharmacist to review potential interactions is an important strategy for assuring the optimal management of more complex drug regimens. Practice Guidelines and Core Competencies A review of the resources necessary for minimum geriatric competencies in various health disciplines, including medicine, nursing, and social work, finds few competencies that are specific to normal cognitive aging.
From page 215...
... In general, cognitive aging competency should include what is known about such topics as patterns of changes in cognition with BOX 5-1 Examples of Practice Guidelines for Health Care Professionals Relevant to Cognitive Aging American Association of Colleges of Nursing •  lder Adult Care Competencies. This briefly mentions that nursing per O sonnel should be prepared to assess and treat cognition (among other functional domains)
From page 216...
... Core competencies should encompass: • The importance of cognitive health in basic medical care across all settings of care; • The features and typical trajectories of cognitive aging, includ ing an understanding of the differences between expected changes and those that may signal deficits related to disease and also an acknowledgment of the wide variability in changes in cognitive function over time among older adults; • Assessment methods; • Monitoring the effects of medications and combinations of medica tions on delirium and cognitive decline; • Reversible conditions that contribute to cognitive deficits and de clines, including depression, thyroid disease, and delirium; • Interventions to minimize cognitive decline associated with medi cal conditions such as stroke, diabetes, head trauma, renal insuf ficiency, vision and hearing losses, and cardiac disease; • Screening for delirium risk factors and implementing delirium pre vention strategies for older persons in high-risk settings, such as preadmission or pre-surgery; • Vulnerabilities associated with daily living, including driving, health care management and decision making, and financial responsibility, as well as strategies to mitigate those vulnerabilities; • Health-promoting behaviors that may reduce the risks of cognitive decline, including exercise and social and intellectual engagement; • Unhealthy behaviors that increase the risk of cognitive decline, such as cigarette smoking, excessive alcohol consumption, and a sedentary lifestyle; • Evidence-based information regarding products that may be harm ful or without benefit, including nutraceuticals and other interven tions; and • Perceptions, fears, and common misunderstandings about aging and cognitive decline. The coordination of care takes on increasing importance in older individuals, particularly in the presence of cognitive aging and multimorbidity.
From page 217...
... Within the health care setting, which is designed to meet the needs of a diverse population of patients, there are opportunities to respond to the varying concerns of individuals and their families and to address cognitive aging through screening, diagnostic assessment, and patient education and counseling. The Medicare Annual Wellness Visit The Medicare Annual Wellness Visit (CMS, 2014b)
From page 218...
... Answering these questions requires an evaluation of the reported symptoms and the patient's cognitive performance and function to determine whether the individual's cognitive and functional patterns meet the established criteria for mild cognitive impairment or dementia. Health care professionals encounter questions of when and how to assess, which instruments to use, and when to refer the patient for a further comprehensive evaluation and workup.
From page 219...
... . •  ealth Care Professionals' Cognitive Assessment Toolkit.
From page 220...
... Resources for Educating and Counseling Patients on Cognitive Aging Although each medical encounter potentially is an opportunity to discuss cognitive aging and to address prevention and risk and protective factors, a survey of health care providers discussed earlier in the chapter indicates that these discussions often do not occur (Day et al., 2012)
From page 221...
... . RECOMMENDATIONS Recommendation 6: Develop and Implement Core Competencies and Curricula in Cognitive Aging for Health Professionals The Department of Health and Human Services, the Department of Veterans Affairs, and educational, professional, and interdisciplinary associations and organizations involved in the health care of older adults (including, but not limited to, the Association of American Medical Colleges, the American Association of Colleges of Nursing, the National Association of Social Workers, the American Psychologi cal Association, and the American Public Health Association)
From page 222...
... and actions that they can take to maintain cognitive health and prevent cognitive decline; and • encourage individuals and family members to discuss their concerns and questions regarding cognitive health. In addition, other components of the health care system have a cognitive health promotion role: • CMS should develop and implement demonstration projects to identify best practices for clinicians in assessing cognitive change and functional impairment and in providing appro priate counseling and prevention messages during, for ex ample, the Medicare Annual Wellness Visit or other health care visits.
From page 223...
... 2015. Health Care Professionals and Alzheimer's.
From page 224...
... 2012. Alzheimer's Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting.
From page 225...
... 2014a. Assessing cognitive impairment in older patients: A quick guide for pri mary care physicians.
From page 226...
... :A59. http://www.cdc.gov/pcd/issues/2009/apr/08_0023.htm (accessed December 15, 2014)


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