2017 AMDA Conference

This session will introduce participants to evidence-based, non-pharmacologic interventions that will expand knowledge and competence regarding strategies to address behavioral symptoms in persons with dementia and improve quality of life. Through three presentations, the interactive session will highlight non-pharmacologic interventions appropriate for the LTC setting with specific strategies for implementation of one, Cognitive Stimulation Therapy (CST), into the residential environment. The first presentation focuses on the evidence and options for interprofessional non-pharmacologic interventions with specific attention being devoted to Reminiscence Therapy, Validation Therapy, and Reality Orientation. The second and third presentations will focus on a well-researched non-pharmacologic intervention, Cognitive Stimulation Therapy (CST) which can be delivered by residential staff at multiple levels of clinical training to address behavioral symptoms and issues in persons with dementia.

Learning Objectives:
(1) Discuss the evidence for non-pharmacologic interventions for persons with dementia.
(2) Describe criteria for appropriateness to receive non-pharmacologic interventions for persons with dementia.
(3) Apply knowledge and skills gained to introduce Cognitive Stimulation Therapy within the residential care setting.
(4) Implement strategies for integration and evaluation of Cognitive Stimulation Therapy.

This session will present a comprehensive approach to nursing home improvement based on key clinical and management principles, focusing on clinical reasoning. The presenters are jointly responsible for overseeing approximately 60 facilities across multiple states as regional medical directors. In collaboration with those of other key disciplines, they have conceived, developed, and implemented a program that cuts across all measures and topics. The “Thinking Right and Acting Right” program, based on clinical reasoning and across-the-board accountability, has been deployed successfully across multiple facilities and in multiple states. This session will show in detail how this common approach has led to multiple desirable outcomes including sustained improvement in care, improvement in diverse quality measures, better regulatory survey outcomes, more effective medical practitioner roles, and a general strengthening of facility processes and systems. The session will show in detail how medical directors can provide leadership for comprehensive, facility-wide improvement of care and performance in nursing homes. Actual cases and data will be presented to show how this common approach is sustainable and reproducible across settings, and can be understood and applied by those of all disciplines, not just medical practitioners.

Learning Objectives:
(1) Identify key clinical and management principles for meaningful and sustained improvement in a nursing home's care and performance.
(2) Discuss the critical role of medical directors in leading a nursing home to analyze and improve its entire approach to care.
(3) Identify and address in meaningful ways challenges to improvement including the major impact of cognitive biases on care quality.
(4) Implement meaningful, sustained improvement in a nursing facility using efficient and effective clinical and management strategies.

The session will highlight the latest scientific evidence through a series of brief oral presentations from leading researchers in the field of PA/LTC medicine. 10 minute oral presentations will be followed by a 5 minute dialogue between the audience and speakers.

Learning Objectives:
(1) Describe recent research studies conducted in the PA/LTC settings.
(2) Disseminate research results and conclusions with peers in the PA/LTC field.
(3) Direct clarifying questions to researchers about studies performed in PA/LTC settings.

Health care is changing fast and no setting is being affected more than the PA/LTC setting. Stakeholders are demanding high quality, and so are patients and their families. In the context of these changes and funding constraints, the value of innovation and implementation has been amplified. Last year, the Society conducted an Innovations Forum that provided members a platform to voice their ideas around the Society's role in PA/LTC innovations. The message was clear: the Society needs to be the leader in PA/LTC innovation and change. In response, the Board of Directors nominated the Innovations Platform Advisory Committee (IPAC) that consists of clinicians, entrepreneurs, and academicians to promote the Society as an innovations leader in the PA/LTC setting. In this session, IPAC leaders will provide an overview of the IPAC charter and initial projects undertaken by the group. The session will also invite several PA/LTC innovators to present their work to the audience who will then select the two winners of the first ever Society Innovations Challenge.

Learning Objectives:
(1) Describe the Innovations Platform Advisory Committee (IPAC) Charter for AMDA Innovations.
(2) Discuss next steps to incorporate Innovations in to AMDA's culture.
(3) Review finalists selected by the IPAC to compete in the Shark Tank competition.

This session will discuss the ethical dilemmas involved in an advance directive that asks the provider to withhold food and fluid in patients with dementia. The presentation will focus on the dilemma of autonomy and the injustice inherent in a decision to implement or to refuse to implement the advance directive. A panel discussion by members of the Society Ethics Committee will follow.

Learning Objectives:
(1) Discuss the concepts of Voluntarily Stopping Eating and Drinking (VSED) and Stopping Eating and Drinking by Advance Directives (SED by AD).
(2) Describe the various ethical issues involved in implementing SED on a patient with advanced dementia.
(3) Explain the difference between critical and experiential interests and how they contribute towards ethical decision making.
(4) Appreciate the practical difficulties in implementing SED in the nursing home or assisted living setting.