This session will review a paradigm for treating two separate groups of people living in the PA/LTC setting. The session will focus on how to maintain stability for those who live with chronic mental illness who now live long enough to age into multiple comorbidities. There may be a history of homelessness, substance abuse, and intermittent institutionalization. Next, Maureen Nash, MD, MS, will review an evidence-based approach to managing dementia with behavior disturbance with an emphasis on treating aggression and sexual disinhibition.
Dr. Nash is the medical director of the Providence ElderPlace Oregon Program of All-inclusive Care for the Elderly (PACE). As the medical director, she has increased the integration of behavioral health in the primary care clinics of the ElderPlace Oregon health care system, improving the quality of care while decreasing inappropriate utilization of health care services for dual eligible frail older adults. Prior to that she was the medical director of two different geriatric psychiatry inpatient units, one in upstate New York and one in Oregon. She is Board Certified in Internal Medicine and Psychiatry and is active in the American Association for Geriatric Psychiatry and the American Psychiatric Association Council on Geriatric Psychiatry. Dr. Nash is an affiliate assistant professor in psychiatry at Oregon Health and Sciences University School of Medicine.
Describe three reasons why those with chronic mental illness are likely to end up living in long-term care settings.
Discuss the risks and benefits of behavioral and nonpharmacological interventions as part of the overall approach to working with people who have chronic mental illness.
Explain an evidence based approach to considering risks and benefits of pharmacological interventions.
Use an evidence based algorithm for treating those with behavior disturbance in the context of moderate to severe dementia.
Discuss the evidence for treating sexual disinhibition and differentiate that from intimacy seeking behaviors.