‘ Jagruti ’ Dementia Care

1. ‘Jagruti’ Dementia Care DR. AMAR SHINDE M.B.B.S., D.P.M., F.I.P.S. (Consulting Psychiatrist) www.jagrutirehab.org

2. ‘JAGRUTI’ Rehabilitation Centre • We have 120 Bedded Rehabilitation Facility. • It is just 4 km from Hadapsar. • We provide rehabilitation facilities for schizophrenia & other psychological patients • as well as De-Addiction programme. www.jagrutirehab.org

3. Jagruti Dementia Care CenterSince 4 yrs • ‘It’s our core belief that human life is intrinsically valuable’ • Our goal at ‘Jagruti’ to provide the best possible physical and emotional support to individuals to lead to fulfillment of lives.   www.jagrutirehab.org

4. Three imp aspects • Acceptance:- Provide an atmosphere where each individual feels understood, supported, and secure. • Communication:- Verbal or Non-Verbal. • Respect:- Each individual feels valued for who they are, in happy times as well as in challenging times. www.jagrutirehab.org

5. Living condition • Private (single) • Semiprivate (Two Sharing) rooms.   • The rooms are warm and welcoming.   • Mostly we ask people to bring their own personal belongings to feel more at home and more comfortable. • Each room comes with a regular bed, but we will provide a hospital bed if a client needs one. www.jagrutirehab.org

6. Living condition • Meals: At Jagruti all meals and snacks are prepared in our kitchen and are shared in family style.  Snacks, including fresh fruit and vegetables are available • Transportation: medical appointments, community outings or simply a trip to the garden is provided. • Activities: may include listening to music and music therapy, reading, religious activities, nature, bird watching, playing in-house games.  Looking at family photo albums or items in a treasure box can help to trigger wonderful memories. • Housekeeping and Laundry : Housekeeping and laundry are included in the in house facilities.   www.jagrutirehab.org

7. SPECIALIZED CARE • High Staff Ratio: Our high staffing ratios and social activities are designed to care for the whole person and to meet each individual’s deep emotional and spiritual needs. •  We offer seminars for caregivers and family members to learn about memory care issues. • Medical Care: ‘Jagruti’ provides almost all medical care except ventilation. Physicians on call basis. • End of Life and Hospice Care:  Our goal is to provide dignified, comfortable palliative care to individuals and their families who are going through the end of life process. www.jagrutirehab.org

8. Instruments * Fowler beds* Wheelchairs of all types* Vital signs* splints* Changing tubes* Psychotropic medications * Nebulizers* Suctioning * PEG Procedure • * Feeding Tubes* Intracath & IV* Oximeters* Oxygen cylinders* Insulin pens* Air pressuremattresses/beds* Toilet Chairs* Diapers www.jagrutirehab.org

9. ‘JAGRUTI’ DEMENTIA CARE • Long term care & Rehabilitation for Dementia & Geriatric patients • > 30 Dementia patients are there currently. • Psychosocial Interventions like Group therapy, Music, Yoga, Pranayam, Occupational therapy. • Individual counseling, psychotherapy Family Therapy & their involvement in the treatment. • Social skill enhancing programme. www.jagrutirehab.org

10. Want to Share… • Antipsychotic drugs are commonly prescribed off-label to older adults for several disorders • e.g. behavioral disturbances and psychosis associated with dementia. • What I Prefer ? Psychosocial intervention 1st & then Low dose antipsychotic, as & when required • E.g. Tiapride 25-50 mg, Amisulpride 50mg, Quetiapine 25mg etc www.jagrutirehab.org

11. Psychosis in Older Patients • Psychosis in older people is common. • One half of the patients with dementia have co-morbid psychosis. • Psychosis is a serious condition, it can lead to difficulties in patient care. • Patients may hurt themselves or others, and psychosis is the most common cause for Institutionalization of dementia patients. • Psychosis needs active treatment. www.jagrutirehab.org

12. Non-pharmacologic Treatments • In some cases, especially in older patients with milder psychosis, psychosocial interventions, such as • supportive therapies • group therapies. • Music therapies. • Family therapies. • staff who work over a long period, can deliver effective intervention & can make a big difference. • Simple talking down & keeping them busy will make the difference. www.jagrutirehab.org

13. A new study conducted at the University of California, San Diego (UCSD), assessed the safety and efficacy of 4 commonly prescribed atypical antipsychotics in older individuals with psychosis of various causes. www.jagrutirehab.org

14. 1)Aripiprazole2)Olanzapine3)Quetiapine4)Risperidone www.jagrutirehab.org

15. Findings:- Effectiveness Versus Safety • No significant change from baseline to 6 months on the BPRS. • Medication to which the patient was randomized was not working or was causing intolerable side effects • One quarter of the patients had serious adverse events. • One half of the patients had non-serious adverse events. • A little more than one third developed the metabolic syndrome within 1 year of starting the treatment. www.jagrutirehab.org

16. Findings:- Lack Of Effectiveness • There is lack of effectiveness in later life. • more side effects over the age of 40. • with age, there are changes in drug metabolism, changes in the brain and other bodily systems, that can increase the risk for side effects. www.jagrutirehab.org

17. Use Antipsychotics • lowest possible dose, • increase it slowly • ‘as long as it's needed’ • it can be a clinical dilemma, as any antipsychotic will have side effects in older people. www.jagrutirehab.org

18. Other Options ??? off-label • Antidepressants like SSRI • mood stabilizers valproate, oxcarbamazepine • benzodiazepines like lorazepam, clonazepam Whatever you do, be careful to start at lower doses and increase slowly. www.jagrutirehab.org

19. Whether Pharmacologic Or Psychosocial? • There are no specific treatments that are close to the finish. • Psychosocial interventions as dance and music therapy, can be very effective, and more research is needed here. • They can have an important role and clearly have a place in overall mental health management of dementia pts. • The key lies in personalized medicine. www.jagrutirehab.org

20. ‘Jagruti’ Dementia Care • Care givers burden is too much in Dementia • Family members gets immediate relief when they admit patient in ‘Jagruti’ • Cleanliness & food are the main Targets • We charge monthly basis to reduce the charges with good medical Facilities

21. Thank You www.jagrutirehab.org