Office Care

Office treatment of medical issues in dementia patients is challenging. The impact of impaired decision making, inability to report adverse events, and problems with adherence can alter usual risk/benefit calculations (Brauner et al., 2000). Family members often need to be involved to help

Box 48-10 A-B-C-D Evaluation of Behavior Problems in Delirium and Dementia

A. What is (are) the antecedent(s) to the behavior?

B. What exactly is the behavior?

C. What are the consequences of the behavior?

D. What disaster might result from the behavior?

Modified from American Medical Directors Association. Delirium and Acute Problematic Behavior Clinical Practice Guideline. Columbia, Md, AMDA, 2008.

weigh the risks, burdens, and benefits of therapy, particularly therapy that does not lead directly to symptomatic improvement. Office care usually involves patients with mild to moderate disease. Goals of care typically include patient and family education and completion of formal advance directives while the patient is still able to have some input into decision-making. An RCT comparing usual care management with "medical home" care using an advanced-practice nurse-led IDT showed fewer behavioral and psychological symptoms among patients and caregivers (Callahan et al., 2006).

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