Evaluation and Management of Behaviors in Persons with Cognitive Impairment

We offered this webinar on August 29, 2019. 

The goal of this webinar is to enable healthcare clinicians to implement a comprehensive approach to non-pharmacologic and pharmacologic management of dementia-related behaviors for the benefit of patients and their caregivers.

The DICE approach to behavior management in hospital, nursing home, and community settings involves describing the behavior, investigating underlying contributors/causes, creating an intervention (non-pharmacologic or pharmacologic) and evaluating the intervention’s effectiveness.

What Attendees Learned at This Webinar

  1. Cognitive behaviors and their management contribute to one-third of total dementia-related costs in the US. Regulations govern the use, administration and limitations of psychotropic medications in patients with cognitive impairment.
  2. Numerous factors contribute to difficult end-of-life behaviors: pain, shortness of breath, depression/ anxiety, hunger, under/over stimulation, infection, constipation, medication side effects and poor vision/ hearing. Agitation–a leading symptom of end-stage dementia–differs from delirium, terminal restlessness and aggression.
  3. Pharmacologic and non-pharmacologic interventions for dementia-related behaviors should identify the target symptoms to be treated and characterize their impact on the patient/caregiver.
  4. Non-pharmacologic interventions that are supported by evidence include physical activity (for depression and sleep), hand massage and personalized bathing experiences (for relaxation). Family caregiver problem-solving can help identify, modify and reduce behavioral symptoms in patients.
  5. Pharmacologic interventions are most helpful with agitation, aggression, psychosis, depression and irritability; they are less helpful for day/night reversal, calling out, repetitive behaviors, wandering, apathy and resistance to care. Clinicians should familiarize themselves with available medications, indications, benefits and possible side effects.

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Featured VITAS Expert

Joseph Shega, MD

Senior Vice President, National Medical Director, VITAS Healthcare

Joe Shega MDJoseph Shega, MD, joined VITAS Healthcare in 2013 as medical director, but he has been caring for, studying and teaching about geriatric patients and end-of-life care since 1999. He came to VITAS with a mission: to improve access to hospice services for underserved populations.

“That includes not only ethnic minorities,” he says, “but patients not traditionally served by hospice who would benefit from it, like end-stage renal disease patients receiving dialysis, heart failure patients receiving inotropic support and advanced cancer patients with conflicting goals.”

In addition, Dr. Shega’s focus is on the care transition to hospice and palliative care as a way to meet the goals of all stakeholders. “Patients benefit from a better quality of life, improved symptom management and an opportunity to age in place.” Dr. Shega explains. “Hospitals garner improvements in quality metrics, including decreased ED wait times via increased throughput, along with a reduction in hospital readmissions.”

As a regional medical director for VITAS programs in Florida, Georgia and Alabama, Dr. Shega oversees the medical care and treatment of VITAS patients in their homes, nursing homes, assisted living communities, personal care homes and inpatient units, supervising and working closely with the VITAS physicians in those programs.

He is board certified in geriatrics and hospice and palliative medicine. He chairs the Ethics Committee for the American Geriatrics Society and serves on the Quality Committee for the American Academy of Hospice and Palliative Medicine.

Prior to joining VITAS, Dr. Shega was an associate professor of medicine at the University of Chicago in geriatrics and palliative medicine. He worked as a primary care physician for 13 years on Chicago’s South Side, providing inpatient geriatric and palliative medicine consults, inpatient palliative care, nursing home care, outpatient geriatrics, home visits and hospice services. He also evaluated and managed patients with memory disorders from diagnosis to the end of life.

Dr. Shega completed medical school at Northwestern University in Chicago, residency in internal medicine at the University of Pittsburgh and a geriatrics fellowship at University of Chicago. The father of twins, Dr. Shega enjoys spending time with family, playing tennis, swimming and running.