Mayo Clinic, USA
Title: Managing mood and behaviors in long-term care facilities in the United States
Eric Tangalos is Professor of Medicine at the Mayo Clinic in Rochester, Minnesota. He was Chair of Primary Care Internal Medicine from 1997 to 2006. He received his undergraduate training from the University of Michigan, is a graduate of the Loyola University Stritch School of Medicine in Chicago, and was a resident and fellow in Internal Medicine at Mayo. He served eight years on the National Board of the Alzheimer’s Association and was a member of their Executive Committee. He continues as Co-Director of Education for the Mayo Clinic Alzheimer’s Disease Research Center and has been continuously funded by the National Institutes of Health since 1987. He is part of the original group to publish on Mild Cognitive Impairment.
Mood and behavioral problems impact the majority of patients in long-term care. The American Medical Directors Association has now developed a special one-day intensive as part of its national meeting to address these issues. Now in its forth year “Navigating mood and behavior challenges in long term care: Strategies for optimal outcomes” continues to address management decisions to optimize patient outcomes. As course director for this program, I have been intimately involved with the national policy issues, the evidence base for treatment and the educational needs of nursing home medical directors, attending physicians, nursing staff, pharmacists and families regarding both drug and non-drug interventions in the United States. When selecting therapies that address mood and behavioral disturbances special consideration must also be given to the large class of antipsychotic therapies that were never approved by the Food and Drug Administration for patients with Alzheimer’s disease and other dementias. These drugs are used on a daily basis and add to excess morbidity and mortality. Many non-drug behavioral approaches have also been trialed in long-term care settings but the study designs, data acquisition and outcomes have failed to provide reproducible models of care. Unique opportunities at Mayo clinic have also allowed us to tailor programs for families with mild cognitive impairment to preserve independence by understanding the value of over-learned behaviors and a stable environment. Further trials will require participation by interdisciplinary as well as multidisciplinary teams to reduce the impact of transitions. This presentation will review the risks and benefits of selecting atypical antipsychotic medications to treat behavioral and psychological symptoms of dementia. The Clinical practice guidelines of the American Medical Director’s Association can be used to better manage dementia, depression and altered mental states at both a facility and individual level. Multidisciplinary programs that address the environmental needs of patients with psychiatric illness and mood disturbances will be reviewed. Mandatory use of the Brief Interview for Mental Status (BIMS) and the Patient Health Questionnaire (PHQ-9) as part of the Minimum Data Set (3.0) in U.S. nursing homes provide new opportunities to screen for dementia and to treat depression. Our goal is to have each person function with minimal failure and maximal use of retained abilities.