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Case 2: Assessing Capacity, Goals of Care, and Decision Making in the Context of a Patient With an Abdominal Aortic Aneurysm and Comorbidities

Learning Objectives
1. Define the stages of dementia and the role of dementia in patient decision-making capacity
2. Recognize disease trajectory and manage patient expectations
0.5 Credit CME

An 84-year-old man comes to the primary physician for an annual follow-up examination 10 days after undergoing routine surveillance ultrasonography for a known abdominal aortic aneurysm (AAA).

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Accreditation: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American Geriatrics Society and the American Board of Medical Specialties. The American Geriatrics Society is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement: The American Geriatrics Society designates this enduring continuing medical educational activity for a maximum of 0.50 AMA PRA Category 1 Credits™.

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As an ACCME accredited provider of Continuing Medical Education, the American Geriatrics Society must ensure balance, independence, objectivity and scientific rigor in all of our educational activities We have implemented a process wherein everyone who is in a position to control the content of an education activity has disclosed to us all financial relationships with ineligible company within the prior 24 months. Ineligible companies are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. AGS then reviews the disclosure information to determine which financial relationships are relevant and mitigates relevant financial relationships with ineligible companies to prevent commercial bias in the content.

Advisory Panel

The following members of the advisory panel had no relevant financial relationships with ineligible companies to disclose:

  • Ruben Azocar, MD

  • George Drach, MD

  • Sandhya Lagoo-Deenadayalan, MD, PhD

  • Andrew Lee, MD

  • Mike Malone MD

  • Myron Miller, MD

  • Arvind Nana, MD

  • Tom Robinson, MD

  • Victoria Tang MD, MAS

The following members of the advisory panel have reported relevant financial relationships with ineligible companies that have been mitigated through peer review of planning decisions by persons without relevant financial relationships and recusal from any aspect of planning and content related to the financial relationship:

  • Kevin Biese MD, MAT is a paid consultant for Call 9 Telemedicine Medical Advisor and Bristol Meyers Squibb/Pfizer

  • Daniel Mendelson, MS, MD is a paid consultant for Point Click Care Touchscreen

Writing Panel

The following members of the writing panel had no relevant financial relationships with ineligible companies to disclose:

  • Tomas Griebling, MD

  • Joseph Hejkal, MD

  • Melissa Hornor, MD

  • Jason Johanning, MD

  • Sushila Murthy, MD, MPH

  • Tony Rosen, MD, MPH

  • Kate Schenning, MD, MPH

The following members of the writing panel have reported relevant financial relationships with ineligible companies that have been mitigated through peer review of content by persons without relevant financial relationships:

  • Charles Brown, MD is a paid consultant for and receives grants from Medtronic

  • Badrinath Konety, MD, MBA is a paid consultant for NxThera, and Bristol Myers Squibb, Opko and receives grant funding from Photocure, Genentech, and Genomic Health

Reviewers:

The following reviewers had no relevant financial relationships with ineligible companies to disclose:

  • Shamsuddin Akhtar, MD

  • Patrick Kortebein, MD

  • Joseph LoCicero, MD

Support Statement

This CME activity is supported by a grant from the John A. Hartford Foundation.

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For questions regarding the content of this activity assistance, contact info.amger@americangeriatrics.org or 212-308-1414.

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References:
1.
Sessums  LL, Zembrzuska  H, Jackson  JL.  Does this patient have medical decision-making capacity?  JAMA. 2011;306(4):420–427. http://jamanetwork.com/journals/jama/article-abstract/1104154Google Scholar
2.
Jennings  LA, Palimaru  A, Corona  MG, Cagigas  XE, Ramirez  KD, Zhao  T, Hays  RD, Wenger  NS, Reuben  DB.  Patient and caregiver goals for dementia care.  Qual Life Res. 2017;26(3):685–693. https://link.springer.com/article/10.1007%2Fs11136-016-1471-7Google Scholar
3.
Covinsky  KE, Eng  C, Lui  LY, Sands  LP, Yaffe  K The last 2 years of life: functional trajectories of frail older people.  J Am Geriatr Soc. 2003;51(4):492–498. https://www.ncbi.nlm.nih.gov/pubmed/12657068Google Scholar
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