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CARE DEPENDENCY

Population

  • – Older adults.

Recommendation

WHO 2019

  • – Screen older adults for declines in intrinsic capacity: cognitive decline, mobility limitations, malnutrition, visual impairment, hearing loss, and depressive symptoms. (See WHO: ICOPE Screening Tool in Appendix Chapter 39.)

  • – Further evaluate and purse care pathways potential limitations

  • – Cognitive decline:

    • Evaluate with tools such as Mini-Cog,a Montreal cognitive assessment,b mini-mental state examination,c or general practitioner assessment of cognition.d

    • Optimize malnutrition, delirium, polypharmacy, cerebrovascular disease, depressive symptoms.

    • Prevent further decline with multimodal exercise, and provide cognitive stimulation.

    • Optimize smoking cessation, hypertension, and diabetes.

    • Environment: assess need for social care, provide personal care and support with activities of daily living (ADL), give advice to maintain independent toileting, assess for caregiver burden, develop social care and support plan.

  • – Mobility:

    • If abnormal Chair Rise Test (cannot rise from chair 5 times in 14 seconds without using arms), perform Short Physical Performance Battery.e

    • If SPPB score is normal or mildly limited, consider a multimodal exercise program such as Vivifrail.f

    • Optimize polypharmacy, osteoarthritis, osteoporosis, frailty, and pain.

    • Environment: assess fall risk in physical environment, adapt home for fall prevention, consider assistive device, and identify safe space for walking.

  • – Nutrition:

    • Evaluate with mini-nutritional assessment or other tool.

    • Environment: overcome barriers to good nutrition, encourage family and social dining, arrange assistance with preparation of food.

  • – Vision:

    • Optimize hypertension, diabetes, and steroid use.

    • Environment: adapt home with lighting and contrasting colors to prevent falls, and remove hazards from walking path.

  • – Hearing:

    • If abnormal audiology, provide hearing age or refer to hearing specialist if severe or atypical (ear pain, drainage, dizziness, otitis media, unilateral).

    • Environment: emotional support, auditory aids for phone and doorbell.

  • – Depression:

    • If depressive symptoms, offer cognitive behavioral therapy, multimodal exercise, and mindfulness practice.

    • If significant depression, consider specialized care.

    • Optimize polypharmacy, anemia, malnutrition, thyroid disease, and pain.

    • Environment: strengthen social support, minimize stressors, promote daily activities, and work against loneliness.

Source

  • Integrated Care for Older People (ICOPE): Guidance for Person-Centred Assessment and Pathways in Primary Care. Geneva: World Health Organization; 2019 (WHO/FWC/ALC/19.1).

COGNITIVE DECLINE AND DEMENTIA

Population

  • – Adults.

Recommendation

WHO 2019

  • – Recommend physical activity to adults with normal cognition and mild cognitive impairment (MCI).

  • – Recommend the Mediterranean diet for adults with normal cognition or MCI.

  • – Pursue tobacco cessation.

  • – If harmful alcohol use, pursue reduction in use.

  • – Manage hypertension and diabetes according to existing guidelines.

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