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Volume 7, Issue 5 (Suppl)
J Palliat Care Med, an open access journal
ISSN: 2165-7386
Geriatrics 2017
September 4-5, 2017
September 4-5, 2017 | Edinburgh, Scotland
Geriatrics Gerontology & Palliative Nursing
7
th
International Conference on
GOALS OF CARE DISCUSSION SHOULD DRIVE REHABILITATION DECISION FOR
TERMINAL CONDITIONS SUCHAS CREUTZFELDT-JAKOB DISEASE: ACASE REPORT
Rebecca Siegel
a
and
Kristofer Feeko
a
a
Thomas Jefferson University, USA
Case Description:
64 year old male with bipolar disorder presents with two-month decline in cognition and motor function
attributed to Depakote levels. Initial presentation included insomnia and difficulty walking, progressing to myoclonic jerking.
CSF cell counts and autoimmune panels were normal, CT chest/abdomen/pelvis were negative for malignancy. Brain MRI
demonstrated cortical ribboning. Familial Creutzfeld-Jakob disease was confirmed after CSF resulted positive for RT-QuiC.
Patient was transferred to acute rehab prior to discharge and care coordinated with neurology, psychiatry and palliative care.
On admission patient was straight cath dependent and incontinent of bowels, need IV hydration and mechanical soft diet with
thickened liquids and was dependent for mobility, transfers and activities of daily living. Hospice care was deferred, but family
was willing and able to implement his wishes and goals of home discharge, maintenance of self-feeding and bowel and bladder
continence following hospice care led goals of care discussion.
Results:
Through coordinated physical, occupational, speech therapy and rehabilitation psychology, the patient achieved setup
for regular consistency self-feeding with weighted utensils, was able to maintain hydration using a weighted cup and straw and
allowed for discontinuation of IV fluids. Foley catheter was discontinued, and he demonstrated initiation for voiding and was
continent with a condom catheter overnight. Agitation, insomnia and myoclonus were also addressed. Family was adequately
trained in his medical, nursing and rehabilitation care. Eventually, after revisiting his goals of care, the patient was discharged
home with hospice services.
Conclusion:
Patients with terminal conditions such as this one with fCJD can benefit from acute rehabilitation. Through
coordinated care with palliative care and regular discussion focusing on goals of care, clear and attainable goals were identified
that necessitated the skilled care of acute rehabilitation and can be accomplished in a time frame that considers disease
progression trajectory.
J Palliat Care Med 2017, 7:5(Suppl)
DOI: 10.4172/2165-7386-C1-012