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AMDA Long Term Care Medicine - 2013


C11 - Another Patient with Parkinson's Disease? A Comprehensive Approach to Treatment of Parkinson's Disease and Parkinsonism


Mar 23, 2013 2:30pm ‐ Mar 23, 2013 3:30pm

Standard: $24.00

Description

Accreditation
The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement:
The American Medical Directors Association designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMDCP Credit Designation:
This session has been approved for a total of clinical 1.0 credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

Session Description:
This session will incorporate case reviews of various clinical approaches for different presentations of Parkinson’s disease as well as parkinsonism in order to provide concrete examples of treatment concepts for this very prevalent issue in long term care and assisted living environments.  Management of Parkinson’s disease and parkinsonism can be very complicated and difficulties can be exacerbated by comorbidities, particularly dementia and psychoses.  In addition, there are numerous commonly used medications that can induce parkinsonism or exacerbate Parkinson’s disease.  Management approaches should include pharmacological interventions as well as an interdisciplinary approach to treatment.  Skilled nursing environments can be particularly effective in implementing an interdisciplinary team approach to maximize function and provide the best quality of life.  At end-of-life, there are additional challenges including when to implement comfort care measures like withdrawing medications, modifying provision of nutrition and other elements of care.  Family members and care partners are typically highly involved in care planning and would benefit from clinical expertise, quality information and relevant resources including internet resources. 

Learning Objective(s):

  • Recognize how to utilize medications to treat Parkinson’s disease as well as related sequelae such as dementia and psychoses to maximize relief and minimize side effects as well as reducing the risk of medication-induced parkinsonisms.
  • Identify when to withdraw medications, modify nutrition and address other life-saving measures at the end of life.
  • Describe the components of an interdisciplinary team and identify when therapeutic interventions can be beneficial to improve function, quality of life and safety as well as minimizing suffering at the end of life.
  • Identify how family involvement in the treatment process can affect outcomes and quality of life and discuss how to guide family members and other interested individuals towards participation that leads to the best results.



Speaker(s):
John M. Dean, MA, CCC, SLP; Nora Reznickova, MD 

Disclosure(s):
None

Reference(s):
Bennett DA, Beckett LA, Murray AM, Shannon KM, Goetz CG, Pilgrim DM, Evans DA. 'Prevalence of parkinsonian signs and associated mortality in a community population of older people'. N Engl J Med. 1996 Jan 11;334(2):71-6. de Lau LM, Breteler MM. 'Epidemiology of Parkinson 's disease'. Lancet Neurol. 2006 Jun; 5(6):525–35. Friedman JH, Fernandez HH, Trieschmann MM. Parkinsonism in a nursing home: underrecognition. J Geriatr Psychiatry Neurol. 2004;17:39-41 Kaltenboeck A, Johnson SJ, Davis MR, Birnbaum HG, Carroll CA, Tarrants ML, Siderowf AD., 'Direct costs and survival of medicare beneficiaries with early and advanced Parkinson 's disease' Parkinsonism Relat Disord. 2012 May;18(4):321-6 Lapane KL, Fernandez HH, Friedman JH. Prevalence, clinical characteristics, and pharmacologic treatment of Parkinson 's disease in residents in long-term care facilities. SAGE Study Group. Pharmacotherapy 1999 Nov; 19(11): 1321-7. Mitchell SL, Kiely DK, Kiel DP, Lipsitz LA. The epidemiology, clinical characteristics, and natural history of older nursing home residents with a diagnosis of Parkinson 's disease. JAGS 1996 Apr; 44(4):394-9.

Speaker(s):

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