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Supporting the Carer: Where to Go from Here

Supporting the Carer: Where to Go from Here. Peter V. Rabins, MD, MPH Johns Hopkins School of Medicine. Cognitive Trajectory. Adjusted for dementia duration. Functional Trajectory. Adjusted for gender and dementia duration.

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Supporting the Carer: Where to Go from Here

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  1. Supporting the Carer: Where to Go from Here Peter V. Rabins, MD, MPH Johns Hopkins School of Medicine

  2. Cognitive Trajectory Adjusted for dementia duration

  3. Functional Trajectory Adjusted for gender and dementia duration

  4. Common Ethical Challenges(Practical Dementia Care, 2nd Ed. Chapter 13, in press) • The person who doesn’t want to be evaluated • The person who lives alone • The person who demands to drive • The use of medication and restraints to control behavior and protect from harm • The use of lying to better patient’s life and prevent harm • The person with poor oral intake • Medical decision making for the severely incapacitated

  5. Decision Making in Late-Stage DementiaDemographic Characteristics(n=125) Residents Surrogates Females 55 % 77 % White 84 % 82 % Age - Mean (SD) 81.5 (7.0) 60.2 (12.1) Education - Mean (SD) 11.5 (3.5) 14.7 (3.3) Widowed 54 % 4.0 % Married 30 % 75.2 % Sep, Div, Nev Mar 15 % 20.8 % Daughter or Son -- 51.2 % Spouse -- 25.6 % Other Relative -- 15.2 % Non-Relative-- 8.0 %

  6. CORRELATES OF HAVING ADVANCEDIRECTIVES a Fisher’s Exact Test

  7. End Life Wishes Expressed in Advance DirectiveSUPPORTIVE CARE

  8. End Life Wishes Expressed in Advance Directive ACTIVE TREATMENTS C same patients

  9. Betty Black Hillary Phillips David Blass Linda Fogarty Holly Taylor Tom Finucane David Loreck Alva Baker Linda Hovanek Michelle Knowles Kate Hicks Pearl German Research Team

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