The latest installment of the #PWChat series centered around trends in continuing medical education.
Below are the highlights from the chat. You can read the full transcript here, by scrolling through the questions and answers provided by participants in reverse chronological order.
Welcome to the latest #PWChat, on the complexities of #dementia care, with co-host @DrLindaMD. Our plan is to go until 3pm EST, officially, but let’s keep the convo going well after!
— Physician’s Weekly (@physicianswkly) June 29, 2021
Q1: It’s no secret that dementia care is complex for patients, clinicians, and personal caregivers alike. What are the biggest day-to-day challenges facing clinicians who care for patients with dementia currently?#PWChat
— Physician’s Weekly (@physicianswkly) June 29, 2021
A1: Uncertainty/ambiguity. Dementia exemplifies the need for biopsychosocial care. Especially since the pathophysiology is hard to see but behavioral & psychological symptoms are not. #PWChat
— Dr Benjamin Bensadon (@DrBensadon) June 29, 2021
A1. Additionally, there are no diagnostic tests to confirm this disease in early stages. Patients cannot always give a good history, and family members are often burned out. #PWchat #Alzeihmers https://t.co/dMKBOmMwdQ
— Linda Girgis MD (@DrLindaMD) June 29, 2021
Dementia affects both patient & his/her loved ones. Often family, which includes all the history/dynamics unique to the family system. #PWChat
— Dr Benjamin Bensadon (@DrBensadon) June 29, 2021
Q2: What advice can you give to clinicians to help them address these challenges in their daily practice?#PWChat
— Physician’s Weekly (@physicianswkly) June 29, 2021
A2. Understand how much stress caregivers are under. Know social services, eg dementia day care, in your area that you can connect caregivers to. #PWchat https://t.co/TKX1FnDNCC
— Linda Girgis MD (@DrLindaMD) June 29, 2021
Agree. And we should always refer patients sooner rather than later. #Pwchat
— Linda Girgis MD (@DrLindaMD) June 29, 2021
In past I required medical students attend support groups for patients & caregivers. To sensitize them to the Pt/family experience & therapeutic impact these services can provide. #PWChat https://t.co/RoZNeqwtwk
— Dr Benjamin Bensadon (@DrBensadon) June 29, 2021
Depends on illness stage/comorbidities, including Pt’s mood (depression/anxiety), goals/preferences, & social support (family/friends). If feasible “healthy lifestyle” (exercise, nutrition) helps. Behavioral health (psychology) should be integrated for related discussion. #PWChat https://t.co/uM5HCkpJ2J
— Dr Benjamin Bensadon (@DrBensadon) June 29, 2021
Depends on illness stage/comorbidities, including Pt’s mood (depression/anxiety), goals/preferences, & social support (family/friends). If feasible “healthy lifestyle” (exercise, nutrition) helps. Behavioral health (psychology) should be integrated for related discussion. #PWChat https://t.co/uM5HCkpJ2J
— Dr Benjamin Bensadon (@DrBensadon) June 29, 2021
Q4: Serving as the personal caregiver for a patient with dementia can be an exhausting, overwhelming, and thankless—but critically important—full-time job. How do you support these caregivers, and what advice can you give other clinicians to do the same?#PWChat
— Physician’s Weekly (@physicianswkly) June 29, 2021
A3. By listening to their concerns and answering them honestly. #pwchat https://t.co/UwUccRnFyu
— Linda Girgis MD (@DrLindaMD) June 29, 2021
We don’t have to do this in pediatrics…fortunately. I can’t imagine giving a diagnosis to a family…
— David Epstein, MD, MS, FAAP (@DavidEpsteinMD) June 29, 2021
Indeed. Medical training curricula in communicating “bad news” is suboptimal. Leaves physicians on their own. Created EoL simulation w geriatric standardized Pts. Learner reactions ran the gamut. Similar efforts w IM residents, in hospital/clinic settings.https://t.co/VSAEDf7QwG
— Dr Benjamin Bensadon (@DrBensadon) June 29, 2021
Q4: Serving as the personal caregiver for a patient with dementia can be an exhausting, overwhelming, and thankless—but critically important—full-time job. How do you support these caregivers, and what advice can you give other clinicians to do the same?#PWChat
— Physician’s Weekly (@physicianswkly) June 29, 2021
A4. Caregivers need help. We need to help find services that can help. I think there are many available to dementia patients but I feel as physicians we don’t know about them as much as we should. #Pwchat https://t.co/8pnkRbQSxA
— Linda Girgis MD (@DrLindaMD) June 29, 2021
A4: US health care must consider family caregivers as inseparable from geriatric care. It does not. In truth, as dementia progresses, Pts often are less aware of their problems. Caregivers are not. Caregiver support is a clinical service. Must be reimbursed as such. #PWChat https://t.co/yB5DYvZVWl
— Dr Benjamin Bensadon (@DrBensadon) June 29, 2021
Q5: What do you make of the recent accelerated FDA approval of #aducanumab? Cause for celebration or concern? Why?#PWChat#Alzheimers #AlzheimersDisease
— Physician’s Weekly (@physicianswkly) June 29, 2021
Slight correction. We do know that it is clinically ineffective.
— Robert Howard (@ProfRobHoward) June 29, 2021
Public should know that the drug has been shown efficacious in clearing Amyloid protein in the brain. Not necessarily relieving symptoms. Amyloid is normal. Many w Amyloid build up develop Alzheimer’s. But many do not. #PWChat https://t.co/4YIzdbF0Mg
— Dr Benjamin Bensadon (@DrBensadon) June 29, 2021
Agree. I think this was a bad move by the FDA. #PWchat
— Linda Girgis MD (@DrLindaMD) June 29, 2021
A5: All but 1 physician on the “independent” advisory board voted against approval. Approved anyway. In the US the FDA, which approves the medication, is financially incentivized by Pharma, which sells the medication. Conflict of interest. #PWChat https://t.co/4YIzdbF0Mg
— Dr Benjamin Bensadon (@DrBensadon) June 29, 2021
Part of why MCI is poorly managed is our system. Cognition feels ezier to medicalize than emotion. Psychological factors = “diagnosis of exclusion.” Thus MCI is considered a legitimate clinical entity while dep/anx aren’t. Data refute this. Integration can help solve this #PWChat https://t.co/EKG3xConvs
— Dr Benjamin Bensadon (@DrBensadon) June 29, 2021
Q6: It seems that nearly every day, news is published about a potential new target for dementia therapy, a new biomarker to catch Alzheimer’s earlier, or modifiable risk factors linked with dementia. What recent news can we really “hang our hats on?”#PWChat
— Physician’s Weekly (@physicianswkly) June 29, 2021
A6. I don’t think we have that kind of news yet. #PWchat https://t.co/klBUOW9lfZ
— Linda Girgis MD (@DrLindaMD) June 29, 2021
Q7: Is the current US healthcare system equipped to properly care for the increasing numbers of patients with dementia as our elderly population continues to grow?#PWChat
— Physician’s Weekly (@physicianswkly) June 29, 2021
Absolutely not
— Dr. Jeffery Hayden (@DrJefferyHayden) June 29, 2021
A7. No, we’re not doing a good job of it as it is. #PWchat #Alzeihmers https://t.co/WUPMVcMWe6
— Linda Girgis MD (@DrLindaMD) June 29, 2021
The healthcare system needs to pay for services to help patients and their caregivers such as day care for dementia patients, in home assistants, etc. #Pwchat
— Linda Girgis MD (@DrLindaMD) June 29, 2021
A7. Advanced age = number one known AD risk factor. In a curative model of medicine, the value-add of geriatrics training is a tough sell. Reimbursement is relevant. Bias is relevant. And US society, obsessed w youth, is relevant. https://t.co/t6qunoRLPc #PWChat https://t.co/714zgdyx7k
— Dr Benjamin Bensadon (@DrBensadon) June 29, 2021
A7. US is blanketed w chronic conditions (including dementia). The system remains acute/sub-acute. There are support groups for most chronic medical conditions Physicians/psychologists in training should see them in standard curricula. Increase knowledge, decrease stigma. #PWChat https://t.co/9xDBIfw29y
— Dr Benjamin Bensadon (@DrBensadon) June 29, 2021
Q8: What does the future have in store for dementia care? What can patients, clinicians, caregivers, and at-risk people expect in the next 10 years? The next 20 years?#PWChat
— Physician’s Weekly (@physicianswkly) June 29, 2021
A8. I think the system will reach a crisis point where they have to do a better job covering and providing services for dementia patients. I am hopeful that new medications will be discovered that can stop the progression of dementia once detected. #pwchat https://t.co/fakI68Ebgr
— Linda Girgis MD (@DrLindaMD) June 29, 2021
We’re officially out of time, but PLEASE, let’s keep this very important discussion going!
In the meantime, we give special thanks to @DrLindaMD & @DrBensadon for co-hosting!#PWChat
— Physician’s Weekly (@physicianswkly) June 29, 2021
