Thank you, Dr. Ballentine!

1. Thank you, Dr. Ballentine! • All the information presented could be helpful to you as community Geriatric Resource Nurses, as you deal with vulnerable older adults who may be wanting to stay in their homes as long as possible. • The complex issues facing these older adults are best handled with a collaborative team effort of specific inter-professionals, depending on the challenges being faced.

2. Your Important Role • As a community GRN, you have the skills, knowledge, and resolve to • Contact the inter-professionals needed • Coordinate their efforts • Follow-up so that the vulnerable older person continues to receive the care he or she needs • As a care-giver yourself, please make sure you have the inter-professional team support you, as you support the vulnerable older person and his/her family care-givers.

3. Case Review Mrs. Johnson is a 83 year-old woman who resides with her daughter in her home. She was transferred to the acute care hospital due to increasing agitation, confusion and difficulty breathing. Mrs. Johnson has the diagnosis of Alzheimer’s Disease and Depression, Atrial Fibrillation, Congestion Heart Failure, and Severe Degenerative Disc Disease. Her daughter is supportive and would like to care for her mother at home.

4. Case Review Medication List from Home: No Known Drug Allergies Digoxin 0.125mg every day Lasix 40 mg every day OxyContin 10 mg TID Oxycodone 5-325mg every 4hrs as needed for pain; Lexapro 20mg daily Aricept 10 mg OD Namenda 10 mg BID Gabapentin 300mg 2tabs 3 times daily; Omeprazole 20mg daily;

5. Case Review Chief Complaints: • At the Emergency Room Mrs. Johnson presented with difficulty breathing and increased agitation and confusion. Chest X-ray shows left lower lobe pneumonia. • Mrs. Johnson was started on IV anti-biotics, given Ativan 0.5 mg due to her agitation and Oxygen at 2 liters. • Due to her lethargy upon arrival from the ER Mrs. Johnson’s pain medication was not transcribed for admission to the medical unit.

6. Case Review Chief Complaints (cont.): • Mrs. Johnson was admitted to the medical unit without difficulty and slept most of the first 24 hours. • When her daughter visited her the second day of admission her mother was complaining of increasing anxiety, agitation and vivid dreams of people trying to harm her. Her daughter noticed her confusion was increasing.

7. Case Review Chief Complaints (cont.): • When the daughter asked the nurses to verify her mother’s medication she discovered her mother was not receiving her pain medication nor the medication for her dementia. • The nurses reassured the daughter her mother did not appear to be in pain. • The daughter was concerned that her mother may be going through withdrawal as she has been taking it for over a year. She felt the symptoms of increased confusion, agitation, and “vivid dreams” were symptoms of withdrawal.

8. Case Review Chief Complaints (cont.): • The daughter asked the nurses to verify the orders for pain medication and the medication to slow the dementia. • She was concerned about withdrawal from the narcotic • She was concerned about the potential to decline without the “medications” for Alzheimer’s disease. • When the daughter returned that evening neither of the medications had been ordered. She contacted the Nursing Supervisor and the patient care advocate. • The daughter began to advocate for an early discharge home.

9. Case Review Upon discharge what issues need to be addressed to assist the patient and family to maintain her placement in the community?

10. Case Review • Current Social issues: • Mrs. Johnson resides in her daughter’s home. • The daughter attends a monthly Alzheimer’s Support Group • The daughter has members of her church stay with her mother so she can go shopping and out with friends once a week for 2 hours.

11. Case Review Current Psychiatric Issues: • Mrs. Johnson is currently taking medications for depression and to slow the Alzheimer’s disease: Lexapro 20 mg daily Aricept 10 mg Daily Namenda 10 mg BID • Prior to the current emergency room visit there have been no behavioral issues.

12. Case Review Communication Issues: • Ensure discharge planning to include identified staff to be primary care manager. • Communicate with patient’s Primary Care Physician regarding the discharge medication and outpatient community based plan. • Ensure medication continues throughout continuum of care.

13. Case Review Functional Issues: • Patient returned home after 3 days of inpatient hospitalization. • Mrs. Johnson was ambulating with assistance at the hospital on day 2. • PT evaluation felt an In-Home PT and Occupational evaluation would support the plan to remain at home.

14. Case Review Client’s Strengths/Resources: • Patient has supportive family and resources. • Daughter has some knowledge of home and community-based services.

15. Case Review • Which professionals need to be involved for this individual to receive good care in the community?

16. Case Review • How would you as a GRN facilitate the involvement of these professionals and their collaboration with you and each other?

17. Case Review • What else would you as a GRN do for follow-up?

18. Reminder: • Our next Inter-Professional and Geriatric Case Reviews will be held May 23rd from 12:30 – 2:00 PM. Please register via the Survey Monkey link that is emailed to you the week before. • Mark your calendars for our Fall 2012 Inter-Professional Case Reviews and Geriatric Case Reviews from 12:30 to 2:00 PM: • October 17th • November 14th • December 12th

19. Reminder: Save the Date • Mark your calendars: the next GRN Semi-Annual training will be held via Webinar on December 3rd from 12:15 – 3:15: • Topic – “Update on Alzheimer’s Disease and Dementia” • Presenters: David Gill, MD (pending) and Linda Shumaker, RN—BC, MA

20. Reminder: Responsibilities of Participants • You need to complete a new demographic form (Required for PSNA Contact Hours). This is to meet one of the requirements of our funder for this project. This will be available at the website for the link to the evaluation form (see below).

21. Reminder: Responsibilities of Participants (cont.) • You will be emailed a link to the evaluation form, which includes the post-test question and attestation, after this training has concluded. This must be completed no later than midnight on Wednesday, May 16th. The post-test is ONE question! You will not be awarded your PSNA certificate unless you complete the entire evaluation form, including the attestation, post-test, and a new demographic form (found at same link).

22. This is the link: www.olderpa.org/grnho

23. Thank you for your attention, hard work, and commitment to helping older persons in your community receive the best care possible through a collaborative, inter-professional team approach.

24. Please use the GoogleGroup to network with each other, ask for advice, give advice, share resources, etc. It takes a village….