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Palliative and Therapeutic Harmonization (PATH): A New Model for Decision-Making in Frail Older Adults

Palliative and Therapeutic Harmonization (PATH): A New Model for Decision-Making in Frail Older Adults

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2
Teaser: 

Paige Moorhouse, MD MPH FRCPC, and Laurie Mallery MD FRCPC, Division of Geriatric Medicine, Dalhousie University, Halifax Nova Scotia

www.pathclinic.ca

Abstract
As the population ages, advances in medical technology paradoxically result in the accumulation of multiple chronic health conditions—known as frailty. Despite increasing numbers of frail older adults, healthcare systems have not been designed to meet the challenges associated with caring for this patient population. This article describes the characteristics of health systems that exacerbate the complex issues associated with caring for those who are frail and reviews one possible model, known as PATH—Palliative and Therapeutic Harmonization, as a way to respond to these system challenges.
Keywords: frailty, care planning, dementia, knowledge translation, health program.

Neural Plasticity and Cognitive Reserve

Neural Plasticity and Cognitive Reserve

Teaser: 

Zahra Bardai, BSc, MD, CCFP, MHSc, FCFP, Community Family Physician, Lecturer, University of Toronto, Assistant Clinical Professor (Adjunct), Department of Family Medicine, McMaster University, Hamilton, ON.

Abstract
Neural plasticity in the context of normal aging and dementia can be evaluated on a number of levels. Traditionally there has been much focus on cellular dysfunction, which is evidenced by the plaques and tangles that are the hallmarks of Alzheimer type dementia. Now, more than ever, there is an emerging spotlight on the preservation of functional levels despite failing cognition be it from normal aging, mild cognitive impairment (MCI) or diagnosed dementia. Neural plasticity can be viewed as the complex interaction between the neurons' electrical, biochemical and physical structure and the individual's behavioural, psychological and sociological activities.1 This article will briefly review the neurobiology of cognition and the sequence of events that lead to its demise. The remainder of this review concentrates on tangible, evidence based strategies to uphold clinical cognition through the aging process.
Keywords: neural plasticity, aging, dementia, cognition, neurons.

…there were neurons in her head, not far from her ears, that were being strangled to death, too quietly for her to hear them. Some would argue that things were going so insidiously wrong that the neurons themselves initiated events that would lead to their own destruction. Whether it was molecular murder or cellular suicide, they were unable to warn her of what was happening before they died.

-Still Alice
Lisa Genova

Later Stage Dementia: Promoting Comfort, Compassion and Care

Later Stage Dementia: Promoting Comfort, Compassion and Care

Teaser: 

Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Baycrest Geriatric Health Care System; Professor of Medicine, University of Toronto, Toronto, ON.
 

Learning Objectives

When it comes to dementia much of the focus is related to diagnosis and treatment(s). A terminal phase is not always considered with conditions that cause dementia-but must be to properly plan care.

To address clinical and ethical challenges that face health care providers and families for this population and to provide health care providers with processes by which to address such ethical dilemmas.

Keywords: dementia, caregiving, end-of-life planning

When to Have the Critical Conversation? Issues in Planning for Persons with Dementia and their Caregivers

When to Have the Critical Conversation? Issues in Planning for Persons with Dementia and their Caregivers

Teaser: 

Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Baycrest Geriatric Health Care System; Professor of Medicine, University of Toronto, Toronto, ON.

Of the many challenges that face families when looking after their older loved ones, of the most difficult is deciding on end-of-life decisions. The accepting or rejecting artificial nutrition and hydration, apparently life-saving antibiotic intervention for an aspiration pneumonia or urinary tract infection or the implementation of theoretically life-saving cardio-pulmonary resuscitation are among the many decisions that substitute decision-makers, who are often close family members, have to make. More often than not, these types of decisions are required in urgent situations where a time-consuming deliberative process that might be expected for a well-thought out decision to be reached is not possible because of the pressures of the potentially fatal clinical situation. Proper preparation for such eventualities usually requires time and thought that includes exploration of personal values and wishes in what ideally should occur during conversations between older loved ones at risk of or in the throes of dementia when discussions might still take place. These revealing communications must occur with those that are responsible for making these very personal and potentially life-altering clinical decisions.

The Art of Listening Again and Again

Author(s): 
Deck: 
Often in a geriatric medicine practice one of the salient complaints by families is how often their loved one tells them the same thing over and over again.
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Teaser: 

Often in a geriatric medicine practice one of the salient complaints by families is how often their loved one tells them the same thing over and over again.

Dr. Michael Gordon is currently medical program director of Palliative Care at Baycrest, co-director of their ethics program and a professor of Medicine at the University of Toronto. He is a prolific writer with his latest book Late-Stage Dementia: Promoting Comfort, Compassion, and Care and previous two books being Moments that Matter: Cases in Ethical Eldercare followed shortly on his memoir: Brooklyn Beginnings-A Geriatrician’s Odyssey. For more information log on to www.drmichaelgordon.com

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Helping Families Worried About Developing Dementia

Helping Families Worried About Developing Dementia

Teaser: 

Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

One of the challenges faced by those of us who practice geriatric medicine or through another specialty is helping family members understand the hodgepodge of medical literature especially as it is reported by internet/Google searches rather than careful reviews of the peer reviewed literature. Even in the latter there is a wide range of opinions which even for physicians sometimes presents a challenge in how we make our recommendations. This is especially the case when dealing with dementia.
Keywords: dementia, burden, stress, fear, guilt, families.

Cognitive Decline and Dementia Risk in Type 2 Diabetes

Cognitive Decline and Dementia Risk in Type 2 Diabetes

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2
Teaser: 


Liesel-Ann Meusel1, PhD, Ekaterina Tchistiakova2,3, BSc, William Yuen4,5, BSc, Bradley J Macintosh2,3, PhD, Nicole D Anderson1,6, PhD, and Carol E Greenwood4,5, PhD
1Rotman Research Institute, Baycrest Centre, Toronto, ON. 2HSF Centre for Stroke Recovery, Sunnybrook Research Institute, Toronto, ON. 3Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON.
4Kunin-Lunenfeld Applied and Evaluative Research Unit, Baycrest Centre, Toronto, ON. 5Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON. 6Departments of Psychology and Psychiatry, University of Toronto, Toronto, ON.

Abstract
Type 2 diabetes mellitus is increasingly common, and previously unrecognized complications are emerging; namely, cognitive impairment and dementia. The mechanisms that link these factors together are still unknown, but likely result from the interplay of several variables, including vascular change, poor glycemic control, inflammation, and hypothalamic pituitary adrenal overactivity. At present, it is still too early to propose best practices related to the management of diabetes-induced cognitive change. All things considered, however, patients should be aware that proper management of metabolic and vascular complications may minimize the adverse effects of type 2 diabetes on cognitive function and quality of life.
Keywords: type 2 diabetes, cognition, dementia, vascular, metabolic
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The Launch of the Dementia Educational Resource: Interview With the Editor-in-Chief Dr. Michael Gordon

The Launch of the Dementia Educational Resource: Interview With the Editor-in-Chief Dr. Michael Gordon

Teaser: 


Michael Gordon, MD, MSc, FRCPC, FACP, FRCPEdin
Geriatrician, ethicist, educator, speaker, author.

Following on the footsteps of the recent announcement of the launch of the Dementia Educational Resource, www.HealthPlexus.net recently interviewed Dr. Michael Gordon who was appointed as Editor-in-Chief for the newly re-focused educational channel. Dr. Barry Goldlist asked Dr. Gordon a few questions about the format and the plans for this project.

Assault as Treatment: Mythology of CPR in End-of-Life Dementia Care

Assault as Treatment: Mythology of CPR in End-of-Life Dementia Care

Teaser: 

Many people have come to view cardiopulmonary resuscitation (CPR) as a routine intervention following cardiac arrest, and they insist on CPR for their loved ones even when the physician explains its likely futility. Physicians who refuse a family member’s request to perform unwarranted CPR risk becoming the center of media, legal, and disciplinary scrutiny. Although CPR is largely perceived as a benign life-saving intervention, it inflicts indignity and possibly pain on a dying patient and should not be used when it is unlikely to succeed or to benefit the patient if successful. The growing acceptance of do-not-resuscitate orders for patients with advanced cancer has not spread to families of patients suffering from the late stages of other degenerative or terminal illnesses. Having blunt discussions about the true consequences and risks of CPR might foster greater willingness to abstain from administering CPR to patients unlikely to benefit.

This article was originally published by HMP Communications LLC (Annals of Long-Term Care: Clinical Care and Aging), 05/16/2011.

Functional Limitations Predict Future Decline in Mild Cognitive Impairment

Functional Limitations Predict Future Decline in Mild Cognitive Impairment

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2
Teaser: 

Lovingly Quitania Park, PhD, Alzheimer’s Disease Center, Department of Neurology, University of California, Davis, CA.
Sarah Tomaszewski Farias, PhD, Assistant Professor, Department of Neurology, University of California, California, CA.

Abstract
Mild Cognitive Impairment (MCI) is a term used to describe the transitional stage between normal aging and dementia, wherein changes in cognitive abilities are limited enough to maintain independence. Although the degree of functional impairment present does not yet warrant a diagnosis of dementia in MCI, there are subtle changes in everyday activities that may indicate the presence of an underlying neurodegenerative condition. The goal of this paper is to review the types of functional changes that are detectable in MCI and the prognostic value of assessing everyday functioning in this population.
Keywords: MCI, Functional Impairment, ADL, Dementia, Aging
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