Abstracts

Rationale: The elderly comprise the fastest growing segment of the population, and among all age groups, they are more likely to have seizures and develop epilepsy (Hauser, 1997). We need to better understand and treat these individuals who have seizures in addition to all the other challenges associated with aging such as comorbidities with concomitant medications, increased risk for injury, loss of social supports, all which pose a threat to their quality of life(Rowan,2005). Methods: We conducted a retrospective chart review of 73 patients aged 60 or more admitted to the epilepsy unit at a university teaching hospital over the past 5 years. We wanted to understand the characteristics of this patient population and examine our clinical practice in caring for them. We tracked the reasons for admission, lengths of stay, proportion of patients who received EEG video telemetry, AEDs prescribed and special needs identified on discharge.Two case presentations illustrate the nursing challenges. Results: 73 patients aged 60 or more(ave 68 yrs, range 60-89, 36 Male,37 Female) comprised 7% of total admissions, with an average length of stay of 11.2 days. 56 patients had EEG video telemetry. 43 patients had an existing seizure disorder(32 with focal epilepsy and 11 with generalized epilepsy and 1/3 had their medications adjusted). 21 pts were admitted to establish a diagnosis (AEDs started on 3 patients diagnosed with seizures and discontinued in 6 who did not have seizures, with the remaining patients being referred to other consultants). 9 patients had new onset seizures (5 post vascular event, 2 secondary to tumour and 2 unclear etiology). 7 patients were discharged to rehab or long term care facilities due to exacerbation of pre existing motor and cognitive deficits(5 previously known epilieptics and 2 new onset post stroke). 26% of all patients reviewed were discharged with dilantin with a plan to reassess on follow up. The case presentations illustrated the role of the advanced practice nurse in assisting patients/families to identify their seizure triggers and life strategies to avoid them, in order to preserve fragile autonomy. Conclusions: The majority of our patients received EEG video telemetry to confirm seizure type,optimize the choice of AEDs and discontinue AEDs when seizures were ruled out. In elderly patients with compromised functioning, the presence of poorly controlled seizures place them at risk of losing autonomy.(Stephen et al,2000). The 10% of our sample who were not able to be discharged home support these findings. Prompt recognition and treatment of seizures can prevent severe consequences for these individuals and their families. They benefit from education to recognize seizures and address safety concerns. Families can be shown videos of the patients' seizures to help recognize subsequent attacks. Community referrals to assess home environments is needed when mobility is reduced. The Epilepsy nurse clinician is well placed to liaise between primary and secondary health care teams as well as provide ongoing support in the process of successful aging.