Aging Course 4G - Assessment and Treatment of [Non-Alzheimer's] Cognitive and Behavioral Dysfunction in Aging Adults

This course is written, copyrighted and published by Marsha Naylor, MA, LPC - Co-owner of CEU By Net. The course has been revised to include DSM V Diagnoses and other data. The course now earns 6 Clock Hours of credit for multiple State Boards including Florida, Texas Mental Health Boards, TCBAP-TCB-TAAP, California CCADE and CADTP, Alabama, and Florida Certification Board (Addiction). EACC 4 PDHs Domain II, III expires June 30, 2024. Also earns 4 NBCC and 4 CA BBS Hours of Credit. Based on these credentials, the course is accepted by most state boards for multiple licenses.

This course presents a STRUCTURED SKILLS-BASED, STRENGTH-BASED TREATMENT APPROACH to assessing, treating, and managing NON-Alzheimer's cognitive impairment and associated behavioral difficulty in the elderly including those with a history of long term misuse of alcohol and other drugs (SUDs). Interventions are appropriate for use in multiple settings including nursing facilities, personal care homes, day treatment programs, outpatient settings, and in-home support.

This course is appropriate for mental health and addiction counselors, CEAPs, social workers, LMFTs, Rehabilitation Specialists, and others who work directly with affected individuals. It is also appropriate for those who are working with adults who are coping with an impaired person's cognitive and behavioral disturbance on a day to day basis - seeking to prevent burnout and 'melt down' of an elderly patient's family members and treatment staff.

The assessment and treatment interventions taught in this course address COGNITIVE CONFUSION AND IMPAIRMENT in aging individuals (which at times may mimic dementia) - oftentimes appearing concurrent with long-term SUDs and serious AFFECTIVE conditions (such as DEPRESSION with or without agitation) and BEHAVIORAL difficulties (such as angry or explosive behavior, aggression, refusal to perform essential activities, and other behaviors which may lead to inpatient care if not stabilized).

DIFFERENTIAL DIAGNOSIS in this age group is crucial and oftentimes more difficult than with the non-elderly client population. The clinical picture presented by such clients is oftentimes confusing and misleading, i.e., what “looks like Alzheimer’s” isn’t always Alzheimer’s disease, and isn’t always a case of organically based dementia which can be unresponsive to non-medical treatment interventions.

In the non-Alzheimer’s client, what we frequently see is cognitive confusion and behavioral abnormality following long-term abuse of alcohol and drugs, medical trauma including strokes and major surgery, loss of health or home or independence, and other such disruptive events. These functional difficulties are oftentimes complicated by depression and anxiety, and perhaps by difficulty in communicating basic wants and needs. These issues may lead to withdrawal from the environment and from social interaction, which can mimic organically based dementia.

Oftentimes we must “back into a diagnosis” . . . interacting with the individual in the treatment environment for a period of time that exceeds that normally required with non-elderly clients, and then formulate a differential diagnosis based on our experiences with the individual.

Perhaps more than with any other age group, ASSESSMENT AND DIAGNOSIS with the elderly is a DYNAMIC process. We must observe changes in affect and functional response to treatment interventions for a period of time that extends beyond a formal “intake evaluation”. How best to approach these non-Alzheimer's AGING issues, therapeutically, in a variety of settings? That’s the focus of this course.

Details: The course presents a STRUCTURED SKILLS-BASED, STRENGTH-BASED APPROACH to assessing, treating, and documenting cognitive and behavioral difficulties of the elderly, in various settings. We present information that will allow you to effectively ASSESS and PRIORITIZE the cognitive and behavioral issues at hand, and to develop creative INTERVENTIONS that work!

We may find our aging clients in an outpatient clinic, residing in nursing facilities or participating in Day Care Centers operated by churches or private individuals – or simply living at home with adult children or other relatives.

More details: The interventions are particularly helpful with COGNITIVE confusion or impairment and BEHAVIORAL difficulties associated with any one of a number of precipitating factors – e.g., a mild stroke resulting in cognitive disturbance (with sensory-motor issues, perhaps receptive or expressive aphasia, mental confusion, etc) .... or cognitive confusion resulting from grief, loss, dislocation, etc. (e.g., a move to a nursing home, the loss of one’s personal home and possessions, death of a spouse, loss of independence, etc.).

Such elderly individuals oftentimes present with agitated or angry behavior, along with confusion. Such behavior is oftentimes accompanied by depressed and anxious emotionality, which can mimic dementia. How best to approach these issues therapeutically? And how best to resurrect cognitive skills which have fallen into disuse or impaired due to a stroke or situational trauma? That’s the focus of this course.

More details: The interventions we describe can be employed in multiple settings, including mental health clinics, professionally operated church day care programs for aging individuals with mental health issues, nursing homes – and at home with family, under professional supervision.

LEARNING OBJECTIVES OF THIS COURSE:

1. Understand the precipitants of cognitive, functional, and behavioral dysfunction in the elderly, when not the result of Alzheimer's Disease - including acute reactions to destabilizing events, SUDs, and misuse of prescription medication.

2. Based upon detailed case histories, understand the interactive relationship between depression with cognitive confusion and behavioral dysfunction in the elderly.

3. Understand the issue of 'differential diagnosis' in the elderly, and how to apply this understanding at a practical level. Know that cognitive confusion, depression, and behavioral dysfunction in the elderly can be confused with active neurological disease, serious psychiatric illness, and Alzheimer's disease.

4. Understand that the symptoms of cognitive confusion and behavioral dysfunction are oftentimes an acute reaction to destabilizing events and circumstances in the elderly, and may also be the product of treatable depression.

5. Through review of specific SKILLS BASED, STRENGTH-BASED techniques and approaches, know how to prioritize target behaviors, and to bring about improvement both in functional COGNITION and in disruptive BEHAVIORAL difficulty.

6. Learn practical approaches to stabilize and revitalize impaired COGNITIVE skills - thereby improving DAILY FUNCTIONING [cognitive, behavioral, and emotional] and reducing stress upon caregivers.

IT'S NOW FREE TO VIEW! You may now view the entire course and the quizzes for free, before enrolling, if you like - or even before you register on our site. There are four 'chapters' or 'Study Guides' in this course, and one quiz for each Study Guide. Just click the links below.

To view Study Guide 1 now CLICK HERE
To view Study Guide 2 now CLICK HERE
To view Study Guide 3 now CLICK HERE
To view Study Guide 4 now CLICK HERE
To view and print QUIZ 1 for free, CLICK HERE
. To view and print QUIZ 2 for free, CLICK HERE.
To view and print QUIZ 3 for free, CLICK HERE.
To view and print QUIZ 4 for free, CLICK HERE.

Course 2D - The Ethics of Advance Directives: Assisting Clients and Families with Preferences for End of Life Care Including Those with HIV-AIDS

This course is sponsored by CEU by Net and is approved and/or pre-approved or automatically approved for 2 credit hours by multiple State Boards including Texas and Florida, TCBAP (Texas Certification Board) and TAAP, IC&RC, NAADAC, Florida Certification Board, and California CCADE and CADTP. EACC - 2 PDHs Domain III expires June 30, 2024. The course also awards 1.25 CA BBS Hours and 1.25 NBCC Hours.

This research-based study is published by the federal Agency for Healthcare Research and Quality (AHRQ), an agency of the US Department of Health and Human Services, and is written by Barbara L. Kass-Bartelmes, M.P.H., C.H.E.S., and Ronda Hughes, Ph.D..

The course is both an ETHICS course and a COUNSELING INTERVENTION course and is appropriate for professionals who are working with [or may encounter] cancer patients, HIV-AIDS patients, stroke patients, terminally ill children, those who are in intractable pain, and others for whom End of Life care is an Issue. Say the authors, "Predicting what treatments patients will want at the end of life is complicated by the patient’s age, the nature of the illness, the ability of medicine to sustain life, and the emotions which patients and families endure."

Counseling dying or gravely ill or at-risk people and their families regarding their decisions for End of Life Care (Advance Directives) is fraught with both ETHICAL and INTERVENTION issues. Such counseling assistance is a delicate matter and can be difficult for counselors to carry out without inadvertently inserting their own biases into the intervention. This course teaches a 5-step research-based method to avoid such conflicts.

This 5-step counseling approach is also appropriate for working with clients who have chronic diseases such as cancer, kidney failure, CHF, and HIV/AIDS -- where there is considerable uncertainty about when death is likely to occur, but which is nevertheless a complex issue which may exacerbate co-occurring disorders including SUDs.

The main issue in working with people who are seriously ill is, how far do you want medical personnel to go, to delay death? HIV-AIDS patients differed significantly from other ill patients, in several areas. There are also circumstances in which the reaction of the patient to discussing such issues varies significantly, depending upon the specific stage or type of illness and age of the individual - including the reaction of terminally ill children.

The research therefore calls upon Behavioral Health and other medical professionals to tailor the approach according to the illness and the situation, i.e., HIV-AIDS vs Cancer vs Stroke vs. Alzheimer's .... and impending death vs. uncertainty of when death will occur.

The approach is, accordingly, a 'KNOWLEDGE FRAMEWORK’ and a 'GUIDELINE' for working with individuals with differing medical issues and life circumstances including HIV-AIDS -- and to do this work ethically. The research included discussion with patients with various medical conditions which they could face when he or she nears the end of life, including severe intractable pain, disabling stroke, permanent coma, mental deterioration, etc.. The patients were then asked to indicate which of these circumstances they would consider worse than death, i.e., under which conditions they would NOT want measures to be taken to prolong life. HIV-AIDS patients differed significantly from other ill patients in not wanting to prolong life under these circumstances.

This course is also helpful for those providers who work with HEALTHY individuals who work in life-threatening situations including MILITARY deployment to war zones, police officers, firemen, SWAT teams, undercover agents and other such at-risk occupations.


GOALS OF THIS COURSE:

1. Learn the terms pertaining to individuals' and surrogates' LEGAL RIGHT to make 'End of Life' care decisions.

2. Based upon the extensive research which produced this document, become aware of the need for clearer documentation and communication of patients' and surrogates' preferences for End of Life Care within the clinical record and in the direct communication provided to the treating physician and other caretakers.

3. Understand the THERAPEUTIC BENEFITS and the ETHICS of engaging in discussions about ‘end of life preferences‘ with applicable clients and their partners, spouses, families or surrogates (representatives).

4. Know that discussion and decisions about Advance Directives are important at multiple stages of proximity to death -- whether death is potentially imminent (as with late-stage AIDS patients and other critically ill people), or when the individual is adjusting to a diagnosis of serious illness which may ultimately result in death including HIV and cancer, or when preparing for high-risk medical procedures, or when coming to terms with the risk of critical injury in high-risk employment (military, law enforcement, etc.).

5. Based upon the extensive research presented in this document, learn that the choices for End of Life Care vary significantly, depending upon the specific type of life-threatening illness or circumstance -- such as the prevalent desire of those with HIV/AIDS to limit or rule out medical interventions to prolong life, vs. the preference of those with a different illness or life threatening situation to extend life through direct medical intervention.

6. Learn a five-part, research-supported PROCESS for structuring discussions about End of Life preferences, which inherently supports our ETHICAL RESPONSIBILITY for assuring the welfare and legal rights of the client.


This publication is dated 2003. However, the AHRQ considers this document to be nevertheless highly relevant to the subject at hand, when compared to other documents available within their research library and available elsewhere on the internet. This article is listed 3rd on the list of 261 AHRQ publications on this topic when most recently reviewed.

Note: You are free to read, download, save, and print the Study Guide(s) and Quiz(zes) for this Course, before deciding to enroll in the course. These course materials are public domain, and CEU By Net is sponsoring the course for CE Credit. You may STUDY THIS COURSE and the quiz AT NO CHARGE. You may enroll in the course at any time. You must take the quiz ONLINE, by logging into your My Home Page , clicking on the course you want to complete, completing the quiz or quizzes required, and submitting the Feedback Form. You will then instantly receive your course completion certificate! For more information on this course - and to see a COPY of the online quiz - click the '+' symbols, below:

Course 2D - The Ethics of Advance Directives: Assisting with Preferences for End of Life Care Including Those with HIV-AIDS

Click here to view this study material. Click here to view and print the quiz you will take for this material.

Course 2E - The Treatment and Management of Depression in Adults - The Stepped Care Model

This course is sponsored by CEU By Net and earns 2 Clock Hours of credit for multiple State and national Boards including Texas, Florida, and Alabama, TCBAP-TAAP, IC&RC, NAADAC, California CCADE and CADTP, and Florida Certification Board. EACC 2 PDHs Domain I, II, III expires June 30, 2024 It also awards 1.5 CA BBS Hours and 1.5 NBCC Hours.

This 2-credit hour Treatment Intervention course is a project of the US Dept of Health and Human Services Agency for Healthcare Research and Quality (AHRQ). This online document [accessed through the link at the end of this description] uses a 4 STEP classification of depression severity, with corresponding response steps.

The Stepped Care Model’ is a STRUCTURED FRAMEWORK for identifying and accessing the most effective treatment interventions for depressed adults. In stepped care, the least intrusive, most effective intervention is provided first. If a person does not benefit from the intervention initially offered, or declines an intervention, they are offered an appropriate intervention from the next step.

Using the 4 STEP approach, the National Guidelines Clearinghouse recommends a step-wise set of interventions beginning with low intensity psychosocial interventions with a Cognitive Behavioral Therapy (CBT) approach, to Group CBT and use of prescription drugs, to high-intensity psychological interventions which may include CBT, Interpersonal Therapy (IPT), and couples therapy ... and on to more intensive interventions if need be. The study material describes the recommended approach to delivery of the step-wise interventions, as well as approaches to relapse prevention. The options, benefits and cautions for use of pharmacology are also addressed.

The NGC is a database of evidence-based clinical practice guidelines and related documents, published as a resource for treatment professionals in the United States, by the federal Agency for Healthcare Research and Quality (AHRQ). AHRQ is a division of the U.S. Department of Health and Human Services.

This material is within the public domain, and intended for education and training purposes. The course is relevant for all mental health and substance abuse treatment providers, including those identifying, referring, and/or treating dual diagnosis individuals. Addiction and depression are oftentimes co-occurring issues.

SUD treatment providers and EAPs may utilize this guideline to facilitate effective referral of individuals with depressive symptomatology for diagnosis, treatment, and assistance, if their programmatic mission does not extend to Dual Diagnosis. .

This NGC publication is not intended to teach specific therapeutic techniques or schools of thought regarding the treatment of depression. Rather, it presents a structured 4 STEP approach to EFFECTIVELY MATCHING treatment modalities to the specific characteristics of the individual, i.e., the severity of his depression, his previous response to treatment, and his preferences or rejection of specific modalities. The recommendations of the NGC are based upon an international collaborative sharing of clinical data bases.


GOALS OF THIS COURSE:

1. Know the principles for assessment, coordination of care and choosing treatments for adults with varying levels of depression.

2. Know the essentials for effective delivery of interventions for depression.

3. Understand the range of depressive severity, from persistent sub-threshold depressive symptoms to severe and complex depression, and the differences in the treatment approach to each.

4. Understand the nature and use of the five interventions in the Stepped-Care Model, recommended by the National Guidelines Clearinghouse (NGC) for treatment of adults with various levels of depression.

Note: You are free to read, download, save, and print the Study Guide(s) and Quiz(zes) for this Course, before deciding to enroll in the course. These course materials are public domain, and CEU By Net is sponsoring the course for CE Credit. You may STUDY THIS COURSE and the quiz AT NO CHARGE. You may enroll in the course at any time. You must take the quiz ONLINE, by logging into your My Home Page , clicking on the course you want to complete, completing the quiz or quizzes required, and submitting the Feedback Form. You will then instantly receive your course completion certificate! For more information on this course - and to see a COPY of the online quiz - click the '+' symbols, below:

Course 2E - The Treatment and Management of Depression in Adults

Click here to view this study material. Click here to view and print the quiz you will take for this material.