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Geriatric Gems and Palliative Pearls

Executive Function and Capacity

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The most difficult aspect of self-neglect in vulnerable elders is that many times, the elder does not recognize a problem, nor want to accept assistance. At what point as health care providers do we determine that decisional capacity is impaired?

Executive Function:

In the outpatient setting, decisional capacity extends beyond medical decision making. The patient must be able successfully practice self-care and self-protective functions such as:

  • Taking medications appropriately
  • Making and keeping medical appointments
  • Fulfilling Financial responsibilities and bill paying, and
  • Completing self care tasks:
    • Bathing
    • Grooming
    • Washing clothes
    • Food preparation
    • House keeping

It requires more than decision making ability to complete these activities, but also Executive Function! “Executive function is a cognitive ability that involves the planning and execution of goal-directed behaviors, abstract reasoning, and judgment.”

Executive Dysfunction Impacts Five Domains of Independent Living:

  1. Activities of personal care – Activities of Daily Living (ADLs) www.consultgerirn.org/uploads/File/trythis/try_this_2.pdf
  2. Activities of independent living- Instrumental Activities of Daily Living (IADLs) www.consultgerirn.org/uploads/File/trythis/try_this_23.pdf
  3. Maintenance of living environment
  4. Basic medical self management
  5. Maintaining daily financial affairs

Impairment of decision making capacity requires careful investigation of executive function.

References:

Johnson JK, Lui LY, Yaffe K. Executive function, more than global cognition, predicts functional decline and mortality in Elderly Women. The Journals of Gerontology. 2007; 62L1134-1141,

Royall DR, Palmer R, Chiodo LK, Polk MJ. Declining executive control in normal aging predicts change in functional status: the freedom house study. J Am Geriatr Soc. 2004 Mar;52(3);346-352.

Other Gems and Pearls

Current Issues in Aging

  1. Executive Function and Capacity
  2. Falls
  3. Vulnerable Elders and Self-neglect
  4. Advance Directives
  5. Medicare
  6. What is Palliative Care?
  7. Immunizations, part 1
  8. Immunizations, part 2
  9. Hip Fracture
  10. Obesity

Approach to the Patient

  1. The Complete Geriatric Assessment
  2. Dying Process
  3. Identifying Elder Abuse, Neglect and Exploitation
  4. Intervention in Cases of Suspected Elder Abuse, Neglect and Exploitation
  5. Opioid Toxicity
  6. Pain, part 1 - Overview
  7. Pain, part 2 - Dosing and Elders
  8. Pain, part 3 - Opioid Effects
  9. Pain, part 4 - Assessing and Managing Opioids
  10. Prognosis
  11. Beers Criteria: Medications to Avoid in the Elderly
  12. Polypharmacy
  13. The Role of the HC Provider
  14. Advance Care Planning
  15. Family Meeting

Care Systems

  1. ACE Units
  2. Hazards of Hospitalization
  3. Hospice 101
  4. Medical Decision Making in the Acute Care Setting
  5. Insomnia & Sleeping Difficulties in the Hospitalized Elder Patient
  6. Transitional Care

Syndromes

  1. Delirium in the Hospitalized Elderly
  2. Dementia
  3. Dementia in the Hospitalized Elderly
  4. Urinary Incontinence, part 1 - Overview
  5. Urinary Incontinence, part 2 - Diagnosis
  6. Urinary Incontinence, part 3 - Management
  7. Dyspnea
  8. Wound Assessment
  9. Wound Management
  10. Wound Prevention
  11. Pressure Ulcers
  12. Brief Overview of Wound Care
  13. Elder Malnutrition
  14. Nutritional Assessment
  15. Constipation
  16. Frailty
  17. Geriatric Failure to Thrive

Oral Care

  1. Risk Factors for Oral Health
  2. Oral Health and Arthritis
  3. Oral Disease Management
  4. Interventions in Oral Health

Psychiatry

  1. Anxiety
  2. Depression in Older Adults I
  3. Depression in Older Adults II

Disease and Disorders

  1. Acute Coronary Syndrome
  2. Recognizing Seizures in the Elderly
  3. Treatment for Seizures in the Elderly
  4. Age Related Bone Loss
  5. Facts about Osteoporosis and Aging
  6. Understanding Bone to Understand Osteoporosis
  7. Screening for Osteoporosis
  8. Treatment of Osteoporosis
  9. Prevention of Osteoporosis
  10. Conditions of the Cervical Spine
  11. Primary Hyperparathryoidism (PHPH)