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What’s going on?

What’s going on?. Psychological  assessment and intervention with people aged 55+ years with possible cognitive changes and/or emotional issues   Geoff Jones Specialist clinical psychologist. Delivering a Healthy WA. Disclaimer. My own views Not those of the WA Health Dept. Case studies.

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What’s going on?

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  1. What’s going on? Psychological  assessment and intervention with people aged 55+ years with possible cognitive changes and/or emotional issues   Geoff Jones Specialist clinical psychologist Delivering a Healthy WA

  2. Disclaimer • My own views • Not those of the WA Health Dept

  3. Case studies • Moss St - Health Dept Memory Clinic • GP cued by Geriatrician • GP direct

  4. Take home messages • Suggest early memory loss be assessed • Focus on the person • Think context, emotions and understanding • Do formulation • Intervene on what may be reversible • A local service

  5. Rob’s story

  6. Rob’s story (mid 70s) • Country + contributor • MHP from cued by Geriatrician • Cognitive loss (not dementia) • Depression + anxiety • Not driving, socially isolated • Return to Rob later

  7. How many like Rob? • 1 in 5 aged >70yrs with CIND • 1 in 3 CIND has prodromal AD • 1 in 4 CIND medical conditions • 1 in 4 CIND stroke/vascular • 1 in 20 CIND depression • NB exclusive categories

  8. Assessment framework • Reversible medical causes screened • To answer questions for the person • History & everyday memory now – self & informant • Life-time level of functioning • Possible everyday contributors eg hearing, pain • Emotions and understandings • Over the table testing • Formulation and feedback

  9. Assessment of cognition • Screens with cut-offs – MMSE, MoCA, CAMCOG – Why is the MoCA good? • Neuropsychological assessment Why do more detailed assessment?

  10. Neuropsychological assessment • Why do more detailed assessment? • Increases accuracy of formulation • Opportunity for person to observe • Identify strengths and weaknesses for everyday life – for strategies • Baseline for future • Answer questions for the person

  11. Formulation with Rob • Feeling tired/unworthy/discontent with life situation/ruminations • Short term memory loss + exec • Not using hearing aid • Out of touch with previous activities • Not driving • Wife thinks too much time in the shed – tries to influence his behaviour

  12. Possible solutions with Rob • Hearing aid • Awareness of context on mood • Expand activities consistent with values – behavioural activation • Doing things for others/being a contributor • Return to driving as assessment suggests OK • Strategies to compensate for cognition • No dead man’s goals

  13. Up on the roof - handyman

  14. Missing appointments - teacher

  15. Depressed for 5+years - metal

  16. ?Dementia – country business loss

  17. ?Anxiety & Prodromal AD

  18. Rob – March 2010 • Driving • Volunteer work • Wider range of social activities • Happier – but still ‘tired/aches’ • Ruminations reduced • Memory loss reduced

  19. Rob – 12 months on • Driving – but gets lost • Volunteer work – bit less • Reducing social activities • Still ‘tired/aches’ • Says memory loss worse • No ruminations • Wife now well – talks for Rob

  20. Take home messages • Suggest early memory loss be assessed (assessment is more than screening) • Focus on the person (not the brain) • Think context, emotions and understanding • Do formulation (not just diagnosis) • Intervene on what may be reversible • Local/joined up (primary care/support services)

  21. Challenge If someone is newly diagnosed with a dementia, ask why it was not picked up earlier ............

  22. Thanks to: • Colleagues at Moss St • Assoc Prof Hilary Fine at East Freo Medical Centre • Dr John Kitchin and Mandurah GPs

  23. Future venture • Partnership with PHCS at Jandakot • More support worker cued GP referrals • From April 2011

  24. Contact Geoff Jones Specialist clinical psychologist Phone 0400 214458 Fax 08 9200 5626 Email geoffjonespsych@iinet.net.au

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