1. #150: PROGNOSTICATION IN DEMENTIA BY RACHEL KERN UNIVERSITY OF IOWA

2. TOPIC SELECTION: The topic selected for this project is #150, Prognostication In Dementia. This subject was chosen because I feel families that are newly introduced to Dementia have a tough time learning how their loved ones develop this disease and often struggle with accepting their loved ones may someday forget who they are.

3. HOW DO WE DEFINE DEMENTIA? It is an irreversible diagnosis that takes over the person, eventually the person will die from progressive brain deterioration and activities of daily living. According to Gealogo (2013), Dementia affects 7% of the people in the world, 65 years or older and 25- 30% for ages 80 years and above. There are four types of dementia that affect functional processes. These types include mild, moderate, severe and terminal (Tsai & Arnold, 2007). It’s not easy to determine exactly what causes dementia, and many family members struggle with not having an exact cause. Families at times have their hands tied when it comes to needing help with their loved ones as the individual’s ADLs decrease and the care they need starts to increase. This causes the care giver distress and the feeling of needing help starts to become overwhelming.

4. THE STAGES OF DEMENTIA According to healthline.com (2015), “Five stages of progressive dementia have been outlined in this slide. They are part of the Clinical Dementia Rating (CDR), this is a tool professionals use to evaluate the progression of symptoms in patients with dementia. Stage 1: CDR-0 or No Impairment Stage one of the CDR represents no impairment in a person’s abilities. No significant memory problems, fully oriented in time and place, have normal judgment, can function out in the world, have a well-maintained home life, and are fully able to take care of their personal needs. Stage 2: CDR-0.5 or Questionable Impairment A score of 0.5 on the CDR scale represents very slight impairments. Minor memory inconsistencies. Struggle to solve challenging problems and have trouble with timing. May be slipping at work or when engaging in social activities. However, can still manage their own personal care without any help. Stage 3: CDR-1 or Mild Impairment With a score of 1, noticeably impaired in each area. Changes are still mild. Short-term memory is suffering and disrupts some aspects of their day. Starting to become disoriented geographically and may have trouble with directions and getting from one place to another. Start to have trouble functioning independently Stage 4: CDR-2 or Moderate Impairment A score of 2 means moderately impaired. Need help taking care of hygiene. Although well enough to go out to social activities or to do chores, need to be accompanied. More disorientation when it comes to time and space. They get lost easily and struggle to understand time relationships. Short-term memory is seriously impaired and it is difficult to remember anything new, including people they just met. Stage 5: CDR-3 or Severe Impairment most severe. Cannot function at all without help. They have experienced extreme memory loss. have no understanding of orientation in time or geography. It is almost impossible to go out and engage in everyday activities, even with assistance. Function in the home is completely gone and help is required for attending to personal needs.” (para. 1-6)

5. PROGNOSTICATION IN DEMENTIA There are several recourses that will help determine Hospice eligibility for the deteriorating individual. When the individual with Dementia shows distinguished characteristics such as the one listed in the last slide, hospice can step in to help with end stage or terminal dementia. “The National Hospice and Palliative Care Organization (NHPCO) recommends the Functional Assessment Staging (FAST), a 7-step staging system to determine hospice eligibility” (Tsai & Arnold, 2007).

6. PROGNOSTICATION IN DEMENTIA CONTINUED Tsai & Arnold (2007), suggested helping to determine eligibility for hospice care assistance is “The Mortality Risk Index (MRI), a composite score based on 12 risk factor criteria obtained from using the MDS (Minimum Data Set)”. These 2 website has several excellent references to refer to if you are questioning the eligibility of your loved one: https://www.caring.com/articles/determining-hospice-eligibility-for-dementia http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913927/

7. MEDICAL INTERVENTIONS Medical interventions will vary from patient to patient. It will also depend on what the patient and or family’s wishes are for life sustaining measures as medical problems start to take over the demented patient.

8. CONCLUSIONS Dementia is a unique and devastating diagnosis for any individual and their loved ones to deal with. There is so much information being discovered and yet so much left unknown. With such little research on prognostication of dementia, the new Mortality Risk Index seems to be reassuring in providing clarity for end of live care. The MRI will help care providers with referring to hospice. This tool will also help families determine what path of care they want to choose for their loved one that suffer with this diagnosis.

9. REFERENCES: Determining Hospice Eligibility for Dementia. (n.d.). Retrieved May 8, 2015, from https://www.caring.com/articles/determining-hospice-eligibility-for-dementia Disease Progression: The 5 Stages of Dementia. (n.d.). Retrieved May 7, 2015, from http://www.healthline.com/health/dementia/stages#Overview1 Gealogo, G. (2013). Dementia With Lewy Bodies: A Comprehensive Review for Nurses. Journal Of Neuroscience Nursing, 45(6), 347-359. doi:10.1097/JNN.0b013e3182a3ce2b Porock, D., Parker-Oliver, D., Petroski, G., & Rantz, M. (n.d.). The MDS Mortality Risk Index: The evolution of a method for predicting 6-month mortality in nursing home residents. Retrieved May 8, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913927/ Tsai, S., & Arnold, R. (2007). Fast Fact #150 Prognostication In Dementia. Journal of Palliative Medicine, 10(3), 806-807. Van Der Steen, J. (2010). Dying with Dementia: What We Know after More than a Decade of Research. Journal of Alzheimer's Disease, 22, 37-55. Van Der Steen, J., Radbruch, L., Hertough, C., De Boer, M., Hughes, J., Larkin, P.,... Volicer, L. (2014). White paper defining optimal palliative care in older people with dementia: A Delphi study and recommendations from the European Association for Palliative Care. Journal of Palliative Medicine, 28(3), 189-209.