Optimizing Drug Therapies in Patients with COPD in the US Nursing Home Setting

AbstractChronic obstructive pulmonary disease (COPD) can be a disabling disease, and the impact on older adults is particularly evident in the nursing home setting. Chronic obstructive pulmonary disease is present in about 20% of nursing home residents, most often in women, and accounts for significant healthcare utilization including acute care visits for exacerbations and pneumonia, as well as worsening heart disease and diabetes mellitus. The emphasis on hospital readmissions is particularly important in nursing homes where institutions have quality measures that have financial implications. Optimizing drug therapies in individuals with COPD involves choosing medications that not only improve symptoms, but also decrease the risk of exacerbations. Optimizing the treatment of comorbidities such as heart disease, infections, and diabetes that may affect COPD outcomes is also an important consideration. Depending on the nursing home setting and the patient, the options for optimizing COPD drug therapies may be limited owing to patient-related factors such as cognition and physical impairment or available resources, primarily reimbursement-related issues. Choosing the best drug therapy for COPD in older adults is limited by the difficulty in assessing respiratory symptoms using standardized assessment tools and potentially decreased inspiratory ability of frail individuals. Because of cognitive and physical impediments, ensuring optimal delivery of inhaled medications into the ...
Source: Drugs and Aging - Category: Geriatrics Source Type: research

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Antipsychotic medications are a vital part of controlling psychosis in schizophrenic patients. However, when those patients live in nursing facilities, we are obligated by CMS to undertake gradual dose reductions of antipsychotic medication if possible. Sometimes, these efforts are successful and sometimes they fail. Antipsychotic medications have many side effects, including sedation, diabetes, hyperlipidemia, weight gain, motor rigidity, impaired gait, and falls. Monitoring of blood glucose, lipids, and extrapyramidal symptoms is mandatory.
Source: Journal of the American Medical Directors Association - Category: Health Management Authors: Source Type: research
Pneumonia is the most common cause of hospitalization for nursing home residents. When deciding whether to treat a resident in the nursing home or transfer to a hospital, it is important to consider risks of hospitalization, including significant functional decline. Little is known about the functional status outcomes of nursing home residents hospitalized for pneumonia.
Source: Journal of the American Medical Directors Association - Category: Health Management Authors: Source Type: research
Background Streptococcus pneumonia is a significant cause of morbidity and mortality in adults who are immunocompromised and of advanced age. It is the standard of care to vaccinate all high-risk adults (18-64 years) and adults 65 years and older with 2 pneumococcal vaccines. However, pneumococcal immunization rates remain below the HealthyPeople2020 target goal of 90% nationally and locally.
Source: Journal of the American Medical Directors Association - Category: Health Management Authors: Source Type: research
Management of diabetes in post-acute settings needs special considerations. Hypoglycemia in the skilled nursing and rehabilitation facilities can lead to readmissions and complications including falls. Current EHR care-sets may not make a distinction between hospital and post-acute settings regarding diabetes management. The current diabetes management care-set in the EHR of our large healthcare system includes checking the blood sugar QID/AC/HS (before breakfast, lunch and dinner, and bedtime).
Source: Journal of the American Medical Directors Association - Category: Health Management Authors: Source Type: research
Chronic Obstructive Pulmonary Disease (COPD) will become the 3rd leading cause of death worldwide in 2020 and is currently the 3rd leading cause of hospital readmissions in the US. In October 2014, the Centers for Medicare and Medicaid Services (CMS) introduced penalties followed by bundle payments for care improvement initiates in patients hospitalized with an acute exacerbation of COPD (AECOPD). Fragmented care across settings cause readmissions for COPD. A patient-tailored case management initiative mitigated 30-day hospital readmissions at Sub-Acute Rehabilitation (SAR) centers.
Source: Journal of the American Medical Directors Association - Category: Health Management Authors: Source Type: research
Conclusions: Heat waves can confer additional risks of ED visits beyond those of daily air temperature, even in a region with high air-conditioning prevalence. https://doi.org/10.1289/EHP44 Received: 29 February 2016 Revised: 13 October 2016 Accepted: 24 October 2016 Published: 31 May 2017 Address correspondence to H.H. Chang, Department of Biostatistics and Bioinformatics, Emory University, 1518 Clifton Rd. NE, Atlanta, Georgia 30322. Telephone: (404) 712-4627; E-mail: howard.chang@emory.edu Supplemental Material is available online (https://doi.org/10.1289/EHP44). The authors declare they have no actual ...
Source: EHP Research - Category: Environmental Health Authors: Tags: Research Source Type: research
Here I'll point out a recent open access paper that covers the various ways in which accumulated senescent cells harm the lungs in old age. The count of senescent cells rises with age in all tissues, the consequence of increased cellular damage on the one hand and progressive failure of the immune system to destroy these cells on the other. The presence of these cells is one of the contributing root causes of aging, in fact. They generate a mix of signals known as the senescence-associated secretory phenotype (SASP) that promotes chronic inflammation, destructively remodels the extracellular matrix structures necessary for...
Source: Fight Aging! - Category: Research Authors: Tags: Medicine, Biotech, Research Source Type: blogs
We examined the risk factors and clinical characteristics contributing to bacterial co-infection with virus or influenza among the hospitalized pneumonia with COPD patients.Pneumonia in COPD patients were admitted to gachon university Gil Medical Center from 1 January 2013 to 30 August 2014. They were divided into 2 groups based upon the presence of virus or influenza. One hudred fifty four patients identified virus or influenza(Virus group). Three hundred six patients not identified virus or influenza(control group). Retrospectively, we analysed the clinical characteristics, the results of blood examination and lung funct...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: 10.1 Respiratory Infections Source Type: research
Pneumococcal disease (including community-acquired pneumonia and invasive pneumococcal disease) poses a burden to the community all year round, especially in those with chronic underlying conditions. Individuals with COPD, asthma or who smoke, and those with chronic heart disease or diabetes mellitus have been shown to be at increased risk of pneumococcal disease compared with those without these risk factors. These conditions, and smoking, can also adversely affect patient outcomes, including short-term and long-term mortality rates, following pneumonia. Community-acquired pneumonia, and in particular pneumococcal pneumon...
Source: Thorax - Category: Respiratory Medicine Authors: Tags: Epidemiologic studies, Open access, Drugs: infectious diseases, Pneumonia (infectious disease), TB and other respiratory infections, Vaccination / immunisation, Asthma, Pneumonia (respiratory medicine), Health education, Smoking, Tobacco use Review Source Type: research
CONCLUSION: DM is associated with elevated risk of 90-day post-LTx. Moreover, DM patients with coexisting renal manifestations exhibited an increased postoperative risk of mortality after LTx. PMID: 26048000 [PubMed - as supplied by publisher]
Source: European Journal of Internal Medicine - Category: Internal Medicine Authors: Tags: Eur J Intern Med Source Type: research
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