Loading presentation...

Present Remotely

Send the link below via email or IM


Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.


iPad Project

No description

on 10 March 2014

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of iPad Project

Dementia is a growing problem in the United States
Behavioral and psychiatric symptoms of dementia (BPSD)
Pharmacologic interventions (antipsychotics) shown to be relatively unsafe and with poor efficacy
Need for non-pharmacologic interventions

Case/Feasibility Studies:
Goal of iPad use with patients at SBH
iPad as a tool for redirection
Personalizing iPad use to the patient based on interests and abilities:
Pandora, TalkingTom2, & Pottery
Individualizing iPad use through patient interactions, patient histories and suggestions from the interdisciplinary treatment team
iPad Study Patients
Customization of iPad use to type of impairments
Understand human-device interaction:
deconstruction of cognitive processes used for apps
Feasibility study:
increasing sample size
decreasing confounders
Simulated Presence
82 y.o. Caucasian woman
Dementia NOS, Psychosis NOS
MoCA: 8/30
Behavioral and physical Concerns:
sundowning, agitation, perseveration, labile mood
high fall risk
M & the iPad:
iPad introduction
redirectable with iPad
Assessment of iPad interactions:
not independent
interaction with iPad and staff
memory of "amazing dog" app
iPads for Controling Behavior & Symptoms in Older Psychiatric Patients
Dementia & Associated Symptoms
iPad Use With Patients
Protocol Development:
Macular degeneration and other vision impairments in pts (Such as our patient, I.=>anti-glare screen protector)
hearing impairments (speakers)
Understanding the appropriate use of the ipad for the purposes of the study:
i.e. appropriate to use in patients with chronic anxiety in acute anxiety spell?
Introducing the iPad to patients on admission
Fine-Tuning the Process
By Jennifer Gahan and Elizabeth Ryer
M Graph
The iPad Project
Study design: Open study design, in order to assess feasibility in a wide range of clinical presentations, and to generate hypotheses.
-case studies vs. feasibility study

Variables to measure and compare:
PRN Medication Administration
Behavioral changes before & after intervention
Case/Feasibility Studies:
General Study Design
Interventions for BPSD: Categories
or Environmental-Oriented
i.e. Simulated presence therapy: audio recordings of a patient's family
i.e. Decreasing patient density in special care units
Teaching Points Learned Study So Far
Nurse #2
Nurse #1
Research Assistant
Social Interaction:
I. Graph
I. is a 91-year-old Caucasian female who presented to the Senior Behavioral Health unit with severe dementia (likely AD)
Cognitive and visual impairments=>severe dementia
Preferred apps: Amazing Dog, Soilitaire, Pandora
Polypharmacy=>gabapentin=>sedation and confusion. Risperidone=>parkinsonianism
Co-morbidities: UTI and Psychosis NOS
A Case Study
Other controls to consider for future studies: age, gender, severity of dementia, time of day/year, degree of impairment, highest level of education obtained, time iPad used, app used etc.
New Format:
Old Format:
Accounting for degree of staff interaction: how do we measure it?
Multi-Sensory Stimulation (MSS)
Amazing Dogs
iPad project at the Senior Behavioral Health (SBH) unit at UCSD Medical Center, Hillcrest

iPads are both stimulation- and cognitive-oriented non-pharmacological strategies to treat BPSD

Prior studies support the use of technology in improving symptoms in dementia patients

Benefits of using iPads:
customization to cognitive and physical impairments
broad spectrum of options

Talking Tom 2
The Pottery App
Introduction to iPad
Patient population
Tracking PRN Administration
agitation includes the following: restlessness, impulsivity, disruptiveness, irritability, anxiousness, pacing, yelling out, or difficulty redirecting.
Safely & effectivley use iPad with this population
no throwing/droping iPads
Diagnosis & presentation may effect ability to use iPad
stage of dementia, degree of cognitive impairment
Supplemental Hardware
Improvement in memory
A Possible Confounder
Thank you to Dr. Vahia, Omid Salaami, Dr. Jeste, Michelle Black, Dr. Sewell, SBH staff, M-STREAM
Antipsychotic Medications
Used in the elderly for delirium, dementia, or a primary psychotic disorder
Delirium: for agitation and confusion (Haloperidol, perhaps olanzipine)
Dementia (AD): for psychosis and agitation (large-scale trials for haldol, risperidone, olanzipine, quietapine, aripiprazole)
Considerations for the elderly: AE's, drug metabolism, comorbidities=> haldol and tardive dyskinesia in elderly, atypicals and orthostatic hypotension (concomitant meds)
Atypicals: diabetes and hyperlipidemia ('pines), increased risk of stroke (olanzipine/risperadone), QTc prolongation (ziprasidone)
Antipsychotic Medications: AE's
Haloperidol: EPS (mostly Parkinsonism and akathasia)
Clozipine: agranulocytosis, anticholingergic delirium, sedation, postural hypotension
Risperidone (effective for schizophrenia in elderly, agitation/psychosis seen in AD): metabolized by liver, excreted by kidney (watch out for liver/kidney disease)=> EPS & orthostatic hypotension (high doses); recent study=> stroke and TIA's
Antipsychotic Medications: AE's
Olanzapine: In elderly=> schizoprenia and agitation/psychosis in AD. AE's: Sedation, weight gain, hyperlipidemia, orthostatic hypotension, cerebrovascular accidents in dementia patients
Quietapine: for behavioral disturbances in AD and psychosis. AE's: sedation, orthostatic hypotension (less than other antipsychotics) and syncope
Ziprasidone: Qtc prolongation (avoid concomitant use of loop/thiazide diuretics and antiarrhythmics)
Aripiprazole: tx behavioral disturbances (psychosis and agitation) in AD=> sedation at high doses
Salzman C, Jeste DV, Meyer RE, Cohen-Mansfield J, Cummings J, Grossberg GT, Jarvik L, Kraemer HC, Lebowitz BD, Maslow K, Pollock BG, Raskind M, Schultz SK, Wang P, Zito JM, Zubenko GS. Elderly patients with dementia-related symptoms of severe agitation and aggression: consensus statement on treatment options, clinical trials methodology, and policy. J Clin Psychiatry. 2008 Jun;69(6):889-98. Review. PubMed PMID: 18494535; PubMed Central PMCID: PMC2674239.

Galante E, Venturini G, Fiaccadori C. Computer-based cognitive intervention for dementia: preliminary results of a randomized clinical trial. G Ital Med Lav Ergon. 2007 Jul-Sep;29(3 Suppl B):B26-32.
Kverno KS, Black BS, Nolan MT, Rabins PV. Research on treating neuropsychiatric symptoms of advanced dementia with non-pharmacological strategies, 1998-2008: a systematic literature review. Int Psychogeriatr. 2009 Oct;21(5):825-43. doi: 10.1017/S1041610209990196. Epub 2009 Jul 9. Review. PubMed PMID: 19586562; PubMed Central PMCID: PMC3058045.
Acevedo A, Loewenstein DA. Nonpharmacological cognitive interventions in aging and dementia. J Geriatr Psychiatry Neurol. 2007 Dec;20(4):239-49. Review. PubMed PMID: 18004010.
Jokel R, Rochon E, Anderson ND. Errorless learning of computer-generated words in a patient with semantic dementia. Neuropsychol Rehabil. 2010 Jan;20(1):16-41. doi: 10.1080/09602010902879859
Van Weert, van Dulman, Spreeuwenberg, Ribbe, and Bensing. "Behavioral and mood effects of Snoezelen integrated into 24-hour dementia care." J Am Geriatr Soc. 2005 Jan;53(1):24-33.
Schwab W, Messinger-Rapport B, Franco K. Psychiatric symptoms of dementia: Treatable, but no silver bullet. Cleve Clin J Med. 2009 Mar;76(3):167-74. doi: 10.3949/ccjm.76a.07270. Review. PubMed PMID: 19258463.
Citations, Cont'd
Folsom, David; Nyak, Gauri and Dilip V. Jeste. Antipsychotic Medications and the Elderly. Psychiatry Weekly August 2013
Full transcript