Continuing Medical Education
Dr Liz Geriatrics is an education and advisory organization, providing effective, interesting, (and sometimes entertaining) educational knowledge and telehealth help to those on the front line caring for elders.
When I started in Medicine, I dreaded some seniors, particularly those who could not give me answers, and I did not always help as I should. One elderly man was brought in to the office with chest pain, so I asked my staff to get an EKG. He was hitting my staff, and I said for the wife to have him go to the ER, there was nothing he would allow us to do.
Not a proud moment for me.
Alzheimer’s Dementia Care
Luck brought me to the Mt Sinai Medical School Geriatrics Fellowship. It was a revelation. It was the Ah-hah moment. So instead of trying to get my tasks done…. I looked at how this elder and their family needed help. So the first thing that a difficult patient needs to do is to assess whether this is delirium. What are his goals of care? Does the wife have the help she needs to care for him? Does he have pain? What triggers his agitation?
In my Geriatric Medicine Fellowship, I learned the medical ins and outs of care of frail elders, determining capacity, addressing elder abuse, treating pain, minimizing medications as well as calming agitation without sedation. Now, I had a plan.
The plan worked Sue, an elder with diabetes and hypothyroid who had lived alone in a cabin in Tahoe until her dementia progressed to the point she could not care for herself. She could not get herself food, let alone her medications. Sue was brought to my community. She refused all care and medications.
I realized first we needed to treat her psychosis to allow care before we gave her all the necessary pills to treat her diabetes and her thyroid. After a few weeks, we tested her blood and adjusted her medications, and she enjoyed the community and a raised garden on the patio to fill her afternoons.
As an assistant professor of Medicine at the University of California, San Francisco, I taught residents and nurse practitioners. It was helping them learn an approach that helped me. It met with varying results. One afternoon, I had the residents speak with the long-term care residents and determine their capacity. Joe, an elderly man, sounded OK socially, but he had very poor judgment and could not care for himself. The resident who spoke with him said he had the capacity…. but could not tell me why. I explained that he could not do simple math calculations, nor could he make plans and follow through for his needed care.
Little steps.
At a social worker support group, I heard about a Betty, who would come to the hospital infusion center for chemotherapy. For the last month, she had been disconnecting the infusion bag and flinging chemo solution on the staff and patients. She had had discussions and signed contracts but still persisted in this dangerous behavior.
To me, I saw that Betty, who likely had dementia, needed an evaluation and should not have this type of treatment. There are other treatments that are safer to administer.
Dementia Training for Health Professionals
For the last twenty years, I have greatly enjoyed working with the teams caring for elders: social workers, care managers, nurses, nurse practitioners, fiduciaries, conservators, elder care lawyers, Adult Protective Service team members, dementia community staff, nursing home and hospital staff.
Alzheimer’s CEU for Nurses
We really are all on the same team. It takes a village to care for elders. It takes a skilled team to care for people with dementia whose medical needs increase when the elderly lose their safety awareness. Medications have more severe side effects for seniors. Alzheimer’s and other dementias may not be recognized by the primary doctor.
Seniors with cognitive loss often do not see the need they have for help; whether financial or care at home. That is when the team must be skilled to recognize the problem, be creative with solutions and be ready for emergencies.
Dr Liz Geriatrics provides the DLG Community to discuss the challenges, find ideas, have a support group, and Ask the Expert, Dr Liz, about burning questions.
Dementia CEU
Many specialties have CEU requirements for Dementia Training. However, it is difficult to find easily accessible training. Even more importantly, it is critical to get the needed information, not just check the box for a falls course that mainly discusses “Falls Scales” but does not provide step-by-step skill building to take back to work that day.
CME Credits
Our DLG Education provides insights from a seasoned geriatrician who has worked on the frontline for over twenty years. This approach is more medical for non-physicians, but it will teach eldercare professionals when to call, not fax, the doctor, how to keep elders moving and stronger, and how to avoid the medical pitfalls that can lead to catastrophe.
One dementia coach was speaking with a woman about the approach to her father, who was delusional and, at times, irritable. The coach had great tips about interacting with him, turning off the TV, covering the mirrors, taking him outside, and staying busy with the garden tools, which took him back to the yard work he enjoyed. However, they got to the point that the elder got COVID, became weaker, stopped walking, developed pressure ulcers, then sepsis, and died.
It takes a village. There are good resources for engagement, activities, and caregiver support. DLG Community and DLG Education provide geriatric expertise to fill in the gaps, making the work of the eldercare professional easier and providing a platform for ideas for everyone to share their experience.