Cancer Pain in Relation to Metropolitan Area Segregation and Nursing Home Racial and Ethnic Composition
To estimate pain reporting among residents with cancer in relation to metropolitan area segregation and NH racial and ethnic composition. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - March 25, 2020 Category: Health Management Authors: Bill M. Jesdale, Deborah S. Mack, Sarah N. Forrester, Kate L. Lapane Tags: Original Study Source Type: research

Health Care Utilization and Unmet Needs in Chinese Older Adults With Multimorbidity and Functional Impairment
This study aimed to compare health care utilization among Chinese older adults at different levels of chronic disease and functional impairment. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - March 24, 2020 Category: Health Management Authors: Chaofan Li, Rui Zhou, Nengliang Yao, Thomas Cornwell, Shuangshuang Wang Tags: Original Study Source Type: research

Skilled Nursing Facility Differences in Readmission Rates by the Diagnosis-Related Group Category of the Initial Hospitalization
The US Health and Human Services Office of the Inspector General report on nursing homes found that skilled nursing facilities (SNFs) exhibit wide differences in overall hospital readmission rates.1 Because there is evidence that hospital readmission rates can be lowered by discharging to specific SNFs,2 policy makers have begun using hospital readmission rates by SNFs as a measure of the quality of care patients receive at these facilities. Starting in October 2018, the Centers for Medicare& Medicaid Services (CMS) implemented the SNF Value-Based Purchasing Program (SNF VBP) with the goal of rewarding specific SNFs fo...
Source: Journal of the American Medical Directors Association - March 22, 2020 Category: Health Management Authors: John Oruongo, Katie Ronk, Oguzhan Alagoz, Jonathan Jaffery, Maureen Smith Tags: Letter to the Editor Source Type: research

Impact of an Antimicrobial Stewardship Program on Resistance to Fluoroquinolones of Urinary Enterobacteriaceae Isolated From Nursing Home Residents: A Retrospective Cohort Study
This study investigated the impact of an antimicrobial stewardship program on fluoroquinolone (FLQ) resistance in urinary Enterobacteriaceae isolated from residents of 3 French nursing homes. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - March 17, 2020 Category: Health Management Authors: Alessio Strazzulla, Samuel Bokobza, Edgar Ombandza, Khadjah Kherallah, St éphane Hommel, Raouf Draidi, Cédric Bonutto, Dominique Bonnet Zamponi, Rémy Gauzit, Sylvain Diamantis Tags: Original Study - Brief Report Source Type: research

Leadership, Staff Empowerment, and the Retention of Nursing Assistants: Findings From a Survey of U.S. Nursing Homes
We examined the relationship between nursing assistant (NA) retention and a measure capturing nursing home leadership and staff empowerment. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - March 16, 2020 Category: Health Management Authors: Clara Berridge, Julie Lima, Margot Schwartz, Christine Bishop, Susan C. Miller Tags: Original Study Source Type: research

“What Would It Take to Transform Post-Acute Care?” 2019 Conference Proceedings on Re-envisioning Post-Acute Care
Significant health care reforms resulting from the Improving Medicare Post-Acute Care Transformation Act (IMPACT Act) and Protecting Access to Medicare Act (PAMA) have important implications for patient selection, payment, and outcomes. These reforms promote new relationships between clinical care sites through joint accountability for costs and development of standard outcomes. The reforms also place a new emphasis on clinical outcomes —such as reducing hospital readmissions—as a part of new value-based payment models. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - March 16, 2020 Category: Health Management Authors: Christine D. Jones, Kathryn A. Nearing, Robert E. Burke, Hillary D. Lum, Rebecca S. Boxer, Jennifer E. Stevens-Lapsley, Mustafa Ozkaynak, Cari R. Levy Tags: Editorial Source Type: research

Atrial Fibrillation in Older Patients with Syncope and Dementia: Insights from the Syncope and Dementia Registry
To evaluate the clinical characteristics and the long-term outcome of atrial fibrillation (AF) patients with dementia and history of syncope or falls. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - March 12, 2020 Category: Health Management Authors: Alice Ceccofiglio, Stefano Fumagalli, Chiara Mussi, Enrico Mossello, Mario Bo, Anna Maria Martone, Giuseppe Bellelli, Franco Nicosia, Daniela Riccio, Assunta Langellotto, Gianni Tava, Virginia Boccardi, Elisabetta Tonon, Pasquale Abete, Andrea Ungar Tags: Original Study Source Type: research

Reducing the Burden of Complex Medication Regimens: SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) Cluster Randomized Controlled Trial
To assess the application of a structured process to consolidate the number of medication administration times for residents of aged care facilities. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - March 12, 2020 Category: Health Management Authors: Janet K. Sluggett, Esa Y.H. Chen, Jenni Ilom äki, Megan Corlis, Jan Van Emden, Michelle Hogan, Tessa Caporale, Claire Keen, Ria Hopkins, Choon Ean Ooi, Sarah N. Hilmer, Georgina A. Hughes, Andrew Luu, Kim-Huong Nguyen, Tracy Comans, Susan Edwards, Lyntar Tags: Original Study Source Type: research

Long-Term Care Facilities and the Coronavirus Epidemic: Practical Guidelines for a Population at Highest Risk
COVID-19, the abbreviated name for the coronavirus disease 2019, has quickly drawn the attention of worldwide media, public health officials, health care providers, and a worried public. Since its identification in Wuhan, China on December 31, 2019, the virus has spread to over 100 countries, including the United States. This spread has occurred despite aggressive public health measures to contain it.1 As of March 8, 2020, there have been over 105,000 known cases of COVID-19 infection with over 3500 deaths. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - March 12, 2020 Category: Health Management Authors: David Dosa, Robin L.P. Jump, Kerry LaPlante, Stefan Gravenstein Tags: Editorial Source Type: research

Comparing Advance Care Planning in Young-Onset Dementia in the USA vs Belgium: Challenges Partly Related to Societal Context
This study aimed to explore the engagement in and the conceptualization of advance care planning from the perspective of family caregivers of persons with young-onset dementia and to identify potential similarities and differences in this area between American and Belgian persons with young-onset dementia and their family caregivers. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - March 11, 2020 Category: Health Management Authors: Romy Van Rickstal, Aline De Vleminck, Sean R. Morrison, Raymond T. Koopmans, Jenny T. van der Steen, Sebastiaan Engelborghs, Judith Neugroschl, Melissa D. Aldridge, Mary Sano, Lieve Van den Block Tags: Original Study Source Type: research

Predictors of Successful Oxygen Weaning in Older Patients Undergoing Pulmonary Rehabilitation
To identify clinical and/or functional variables predictive of successful oxygen-weaning among older patients affected by respiratory insufficiency undergoing pulmonary rehabilitation. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - March 11, 2020 Category: Health Management Authors: Tiziano Nestola, Laura Orlandini, Antonella Ferrari, Valter Monzani, Giorgio Gallimbeni, Luigi C. Bergamaschini, Matteo Cesari Tags: Original Study - Brief Report Source Type: research

Impact of Behavioral Disturbance on Caregiver Burden and Nursing Home Placement
We thank Dufournet et  al for a thorough review of factors involving nursing home placement for patients with cognitive difficulty.1 However, their conclusion gives the impression that the extent of cognitive impairment, neuropsychiatric symptoms, and behavioral disorders, has little to no impact on caregiver burden sca le that merits further discussion. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - March 10, 2020 Category: Health Management Authors: Abid Iraqi, Terry Lynn Hughes Tags: Letter to the Editor Source Type: research

Frailty Index Status of Canadian Home Care Clients Improves With Exercise Therapy and Declines in the Presence of Polypharmacy
This study aimed to investigate if exercise therapy and polypharmacy was associated with frailty state transitions for home care service recipients. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - March 9, 2020 Category: Health Management Authors: Rasmus Tolstrup Larsen, Luke A. Turcotte, Rudi Westendorp, Henning Langberg, John P. Hirdes Tags: Original Study Source Type: research

A Single Question as a Screening Tool to Assess Fear of Falling in Young-Old Community-Dwelling Persons
This study aimed to investigate the relationship between 2 FOF measures: the Falls Efficacy Scale-International (FES-I) and the single question on FOF and activity restriction (SQ-FAR). Factors associated with disagreement between the 2 measures were further examined. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - March 8, 2020 Category: Health Management Authors: Giulia Belloni, Christophe B üla, Brigitte Santos-Eggimann, Yves Henchoz, Laurence Seematter-Bagnoud Tags: Original Study Source Type: research

Assisted Living Communities During Hurricane Irma: The Decision to Evacuate or Shelter in Place and Resident Acuity
To investigate the factors associated with whether assisted living communities (ALCs) in Florida evacuated or sheltered in place for Hurricane Irma in 2017, focusing on license type as a proxy for acuity of care. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - March 6, 2020 Category: Health Management Authors: Lindsay J. Peterson, Joseph June, Nazmus Sakib, Debra Dobbs, David M. Dosa, Kali S. Thomas, Dylan J. Jester, Kathryn Hyer Tags: Original Study - Brief Report Source Type: research

Temporal Relationship Between Depressive Symptoms and Cognition in Mid and Late Life: A Longitudinal Cohort Study
To examine the bidirectional temporal relationship between depressive symptoms and cognition in relation to risk, reaction, and prodrome. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - March 5, 2020 Category: Health Management Authors: Roopal Desai, Georgina M. Charlesworth, Helen J. Brooker, Henry W.W. Potts, Anne Corbett, Dag Aarsland, Clive G. Ballard Tags: Original Study Source Type: research

TEMPORARY REMOVAL: The Impact of Music and Memory on Resident Level Outcomes in California Nursing Homes
The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated.The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - March 3, 2020 Category: Health Management Authors: Debra Bakerjian, Kristen Bettega, Ana Marin Cachu, Leslie Azzis, Sandra Taylor Source Type: research

Reducing Transfers among Long-Stay Nursing Facility Residents to Acute Care Settings: Effect of the 2013 ‒2016 Centers for Medicare and Medicaid Services Initiative
From 2013 to 2016, the Centers for Medicare and Medicaid Services Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents ( “the Initiative”) tested a series of clinical interventions and care models, through organizations called Enhanced Care and Coordination Providers (ECCPs), with the goal of reducing avoidable inpatient hospital admissions among long-stay nursing home residents. We identify the effect of the Init iative on the probability and count of acute care transfers [capturing any transfer to the hospital, including hospitalizations (inpatient stays), emergency department visi...
Source: Journal of the American Medical Directors Association - March 3, 2020 Category: Health Management Authors: Alison J. Vadnais, Emily Vreeland, Nicole M. Coomer, Zhanlian Feng, Melvin J. Ingber Tags: Original Study - Brief Report Source Type: research

The Impact of Music and Memory on Resident Level Outcomes in California Nursing Homes
To study the effects of a nonpharmacologic intervention, Music and Memory (M&M), on residents with dementia and/or behavioral problems living in nursing homes (NHs). (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - March 3, 2020 Category: Health Management Authors: Debra Bakerjian, Kristen Bettega, Ana Marin Cachu, Leslie Azzis, Sandra Taylor Tags: Original Study Source Type: research

Effects of Statins for Secondary Prevention on Functioning and Other Outcomes Among Nursing Home Residents
Studies examining the effects of statins after acute myocardial infarction (AMI) excluded frail older adults, especially nursing home (NH) residents, and few examined functional outcomes. Older NH residents may benefit less from statins and be particularly susceptible to adverse drug events like myopathy-related functional decline. We evaluated the effects of statins on 1-year functional decline, rehospitalization, and death in NH residents. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - March 2, 2020 Category: Health Management Authors: Andrew R. Zullo, Richard Ofori-Asenso, Marci Wood, Allison Zuern, Yoojin Lee, Wen-Chih Wu, James L. Rudolph, Danny Liew, Michael A. Steinman Tags: Original Study Source Type: research

Estimated Glomerular Filtration Rate and Muscle Mass in Older Patients: Diagnostic Accuracy of Creatinine-Based Equations and Implications in Practice
The study by Carnevale et  al compared the different methods used to measure estimated glomerular filtration rate (eGFR) with the estimated total skeletal muscle mass (eTSMM) and highlighted the high degree of variability.1 The decline in muscle mass or sarcopenia that occurs with aging renders the value of serum creatinine as a poor estimate of eGFR, especially in the frail old, a fact demonstrated decades ago.2 In particular, the modification of diet in renal disease (MDRD) study included only a limited number of older adults, as acknowledged by the authors, in a comparison of the MDRD formula with the Cockcroft-Gau...
Source: Journal of the American Medical Directors Association - March 1, 2020 Category: Health Management Authors: Thiruvinvamalai S. Dharmarajan, Jinil Yoo Tags: Letter to the Editor Source Type: research

The Effect of Using PARO for People Living With Dementia and Chronic Pain: A Pilot Randomized Controlled Trial
To evaluate the effect of interaction with a robotic seal (PARO) on pain and behavioral and psychological symptoms of people with dementia and chronic pain. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 28, 2020 Category: Health Management Authors: Lihui Pu, Wendy Moyle, Cindy Jones, Michael Todorovic Tags: Original Study Source Type: research

Adapting Gerontechnological Development to Hospitalized Frail Older People: Implementation of the ALLEGRO Hospital-Based Geriatric Living Lab
Gerontechnology aims at improving the functioning of older people and their carers in their daily lives as well as improving gerontological practices. To promote gerontechnology innovation in the hospital and bridge the gap between gerontechnology developers and hospitalized frail older patients, our objective was to create and implement a hospital-based geriatric living lab. We designed a hospital-based living lab, providing reflexive workshops bringing around the table gerontechnology users and developers, supplemented with an experimental hospital room receiving both the users and the devices to be tested. (Source: Jour...
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Fr édéric Noublanche, Cécile Jaglin-Grimonprez, Laurence Laignel, Guillaume Sacco, Philippe Allain, Cédric Annweiler, SAM Group Tags: Pragmatic Innovations in Post-Acute and Long-Term Care Medicine Source Type: research

A Case of Trunnionosis After Total Hip Arthroplasty
Trunnionosis is a complication after placement of prosthetic devices that composes 2% of revisions of total hip arthroplasty. Metal-on-metal hip replacements include the ball, the stem, and the prosthesis that rests on top of the ball. The trunnion is where the femoral neck attaches to the femoral head. This area can wear, creating trunnionosis; the mechanism is unclear, but theory suggests shearing forces and micromotion within the prosthetic joint cause corrosion products that destroy surrounding tissues. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Michael Silverman, Hila Miskin, Ricardo Blondet, Deepak Mandi, Sandra DiScala, Michael Silverman Tags: Case Report/Case Series Source Type: research

A Recipe for Disaster: Gabapentin and Opioid Use in an Older Adult
Chronic pain is common among older adults, as is the use of medications to treat these symptoms. Aging physiology, in combination with a higher likelihood of medication use and declining renal function, makes older adults more susceptible to adverse drug effects. As such, monitoring for side effects and changes in renal function is important to avoid drug toxicity, especially during acute illness when medication errors and acute changes in renal function are more likely to occur among older adults. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Patricia Guzman Rojas, Patricia Guzman Rojas, Karin Johnson, Belinda Setters Source Type: research

An Unusual Case of Fever and Altered Mental Status
Parkinsonism hyperpyrexia syndrome (PHS) is a dysautonomic disorder that was described in 1981 for the first time. It can present after reduction or discontinuation of antiparkinson medications, co-prescription of neuroleptic medications, dehydration, hot weather, discontinuation of deep brain stimulator, and wearing off phenomenon. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Patricia Guzman Rojas, Patricia Guzman Rojas, Laura Morton Source Type: research

Atypical Progressive Meningioma: Not Always Benign
While relatively rare in the general population, meningiomas are the most common tumors in the CNS. Most meningiomas are benign (80%) and can be managed only with continued observation without need for surgery or radiation therapy. There is also a significant number of cases that progress to malignancy (1%-4%). However, there is also a subset of atypical meningioma that portends a worse prognosis and can present many challenges during treatment. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Sean Huang, Sean Huang, Edward Gometz Source Type: research

Avoiding Sodium Polystyrene Sulfate (SPS) in Hyperkalemia
Hyperkalemia, defined as a concentration of potassium greater than 5.5 mEq/L in adults, is commonly found on labwork in the subacute nursing facility, often seen in the setting of kidney disease as a result of impaired excretion of potassium in the urine. Treatment is focused upon inducing potassium loss, often through use of loop diuretics such as furosemide. Sodium polystyrene sulfate (SPS) is often used; however, it carries with it significant associated risks and potential complications. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Sean Huang, Sean Huang, Edward Gometz Source Type: research

Catatonia as an Usual Cause of Change of Mental Status in a Veteran in a Long-Term Care Facility
Catatonia – a diagnosis that involves motor, cognitive, behavioral, and autonomic irregularities -- may be seen in a variety of medical, psychiatric, and neurologic conditions or medication exposures. Here, we describe a case of catatonia seen in a VA Long term Care (LTC) facility. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Mariana Gonzalez, Mariana Gonzalez, Mary Hofmann, Johanne Louis Source Type: research

Discontinuation of Antipsychotic Medication in Two Nursing Home Patients with Diagnosis of Schizophrenia
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)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Cynthia Kuttner, Cynthia Kuttner Source Type: research

Early Identification of Acute Pulmonary Emboli Through the Use of Contact-Free Continuous Patient Monitoring
Skilled nursing facilities (SNFs) are faced with providing care for residents with increasing clinical complexity. Residents are being discharged from hospitals to post-acute care earlier and with multiple active co-morbidities. Clinicians working in the SNF are charged with delivering high-quality medical care in the facility and reducing avoidable re-hospitalizations. Initially developed for use in the acute care setting, contact-free continuous patient monitoring (CFCPM) is a system designed to continually collect vital signs and other clinical parameters. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Zachary J. Palace, Zachary J. Palace, Resmi Sulekha Source Type: research

Fever, Myalgia, and Headache Progressing to Confusion: A Case of Neuroinvasive West Nile Virus in the Older Adult
West Nile Virus (WNV) infection is the most common mosquito-borne illness in the United States. Most cases are asymptomatic or with mild symptoms. Older adults are more likely to have central nervous system (CNS) involvement, and a higher risk for mortality. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Hyungseok Oh, Hyungseok Oh, Jamie Bass Source Type: research

Hemichorea – A Rare Sequela of Striatal Infarction
We present a rare case of hemichorea associated with a hemorrhagic stroke in the contralateral striatum. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Ali Ahmad, Ali Ahmad, Karun Badwal, Shanojan Thiyagalingam, Halina Kusz, Paul Takahashi Source Type: research

New Onset Chest Pain in a Long-Term Care Resident With Dementia: First, Believe the Patient!
Atypical chest pain is of diverse origin. Typically, we initially consider cardiac etiology. When pain appears non-cardiac, there is a tendency to underestimate the illness, especially if the patient has neuropsychiatric illness. Our resident with dementia and anxiety disorder had chest pain; the diagnosis was unexpected. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Thiruvinvamalai Dharmarajan, Rachana Yalamanchili, Robin Russell, Thiruvinvamalai Dharmarajan Source Type: research

Parkinson's Disease vs Parkinsonism as a Result of Aging
Parkinson ’s Disease is a condition characterized by degeneration of the nigrostriatal pathways resulting in marked bradykinesia. Studies have reported that nearly 25% of Medicare beneficiaries with Parkinson’s Disease reside in long-term care facilities (LTCFs). Residents of LTCFs are older and may also have other age-related mobility disorders. It is important for providers to know that Parkinsonism symptoms can also occur as a result of natural aging and will not respond to standard therapy for Parkinson’s Disease. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Karun Badwal, Karun Badwal, Ali Ahmad, Shanojan Thiyagalingam, Anupum Chandra Source Type: research

Pilonidal Sinus or Non-healing Pressure Ulcer?
New or worsening changes in skin integrity and pressure ulcers are a reportable quality measure in skilled nursing facilities (SNFs). Their management requires comprehensive evaluation for predisposing and precipitating factors and comorbidities that may impede healing. A thorough history and clinical examination is an essential first step in this process. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Shanojan Thiyagalingam, Shanojan Thiyagalingam, Anupam Chandra, Karun Badwal, Ali Ahmad Source Type: research

POA Pickle: How to handle POA Resignation in LTC
Advance care planning can be challenging in the long-term care setting, especially in patients with cognitive impairment. This case presentation provides an example how the interdisciplinary facility team including administrator and medical director successfully navigated an ethical dilemma. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Ellen W. Kaehr, Ellen W. Kaehr Source Type: research

Reducing Unnecessary Antibiotics for Bilateral Cellulitis
We present a case of bilateral lower leg swelling and redness in a patient with peripheral vascular disease with venous stasis that was mistakenly diagnosed as cellulitis and treated with five courses of antibiotics over a period of 18 months. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Aaiza Aamer, Aaiza Aamer, Ilia Bernstein, Ravneet Sandhu, John Naumovski Source Type: research

The Carrot Battle: An Acupuncture Wonder
Chronic pain is among the most common reasons for seeking medical attention. In the United States, 1 in 5 adults had chronic pain in 2016 and it is estimated to cost over $500 billion annually in direct medical costs and disability. It is a prevalent problem among residents in the nursing home. Non-pharmacologic therapies are the most preferred treatment for chronic pain as pharmacological therapies, such as opioids, have proven to be less effective and associated with numerous side effects among older adults. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Shyam Kolangara, Shyam Kolangara, Jade Kim, Xiangrong Shao Source Type: research

The Frequent Faller in Long-Term Care: Listen to the Resident for the Answer!
Falls are common in long-term care residents, often multifactorial. Our case highlights recurrent falls in a resident with comorbidities, assumed to be from his diseases, although he expressed frankly that the cause was different. Paying attention to his complaint ended his falls. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Thiravinvamalai Dharmarjan, Leili Shahgholi, Padmawathi Murakonda, Thiravinvamalai Dharmarjan Source Type: research

The Impact of a Geriatric Medicine Consultation on the Decision for a Percutaneous Endoscopic Gastrostomy Tube in a Geriatric Patient
This is the case of a 94-year-old female with a prolonged hospitalization for a small bowel obstruction complicated by multiple intubations and dysphagia leading to a recommendation for a percutaneous endoscopic gastrostomy (PEG) tube for enteral feeding. Geriatric medicine was consulted and an unnecessary PEG tube placement was avoided. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Andrea J. Landi, Andrea J. Landi, Alexander Sasha Rackman Source Type: research

The Right to Refuse: Ethical Issues in Capacity Assessment for Older Adults With Aphasia and Possible Dementia
Cerebrovascular accident is a common diagnosis in the rehabilitation and long-term care setting and can be associated with deficits in both language and cognition. Because capacity assessment requires a patient to both understand the decision in question and express a choice, it can be particularly challenging to determine capacity in patients with aphasia. Complex medical decision-making and use of healthcare proxies in this setting require careful navigation of patient needs, goals, and rights. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Rose Onyeali, Rose Onyeali, Emily Fessler Source Type: research

The Role and Influence of Culture in End-of-Life Care
End-of-life care is often assumed to be similar across cultures, countries, religions, and the ethnic background. Its concept and understanding is as varied as the cultures and religions it represents. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Janaki Samaraweera, Janaki Samaraweera, Josephine Gomes Source Type: research

Wet, Wacky, Wobbly, and WILD: Disinhibition as an Outcome of Post-traumatic Hydrocephalus
Post-traumatic hydrocephalus (PTH) or secondary normal pressure hydrocephalus (NPH) are common complications that follow traumatic brain injury (TBI). PTH clinical features are similar to NPH and can be characterized by a triad of gait apraxia, cognitive deficits, and urinary incontinence. Symptoms may progress to psychomotor slowing, dementia, and the need for institutionalized care. Additionally, patients with TBI often experience a loss of impulse control, aggressive behaviors, and personality changes. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Hemal Patel, Hemal Patel, Lauren Mazzurco Source Type: research

2020 Annual Conference Oral Presentations
A Deep Dive into Urinary Tract Infections (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Source Type: research

Avoid the ER! Using Simulation-Based Mastery Learning to Teach Common Procedures Needed in Post-Acute Care
The objective of this study is to evaluate the effectiveness of a post-acute care procedures course that uses simulation-based mastery learning to teach gastrostomy tube removal and replacement, tracheostomy tube replacement, knee joint aspiration and injection, and basic suturing. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Sara Bradley, Sara Bradley, Jeffrey Barsuk, Vanessa Ramirez-Zohfeld, Theresa Rowe, Katherine O'Brien, Dwayne C. Dobschuetz, Ruqayyah Muhammad, Lee Lindquist Tags: Education Source Type: research

Choosing Wisely in Post-Acute and Long-Term Care: Evaluating internal medicine residents knowledge gaps
In 2013, the Choosing Wisely Campaign launched 5 recommendations pertaining to the care of patients in the post-acute and long-term setting. This was done in an effort to educate clinicians, patients, and other providers about potentially inappropriate medical tests and procedures in this setting. In 2015, the list was expanded to 10 recommendations. Internal medicine (IM) residents (PGY 1, 2 and 3) were surveyed at our institution in 2014 (1 year after the release of the initial 5 recommendations) to assess their understanding of the Choosing Wisely recommendations. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Ariadne Panagiotou, Ariadne Panagiotou, Keerti Sharma Source Type: research

ECHO ™-Skilled Nursing Facilities: Telementoring for Nurses in Skilled Nursing Facility Leadership Positions
It is common for nurses with limited specialized training in geriatrics to care for older adults at skilled nursing facilities (SNFs). In SNFs on the south side of Chicago, prior needs assessments have identified a gap in knowledge in geriatrics topics. To address knowledge gaps, we utilized the Extension for Community Healthcare Outcomes (ECHO ™) model to provide case-based, interdisciplinary geriatrics medical education and telementoring, at no cost, to nurses in leadership positions at SNFs across Chicago’s South side. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Lauren J. Gleason, Lauren J. Gleason, Michelle Martinchek, Stacie Levine, Monica Long Source Type: research

Impacts of UTI Protocol Initiation on Long-Term Care Nursing Staff
Concerns of urinary tract infections (UTI) are widespread in long-term care (LTC) settings. Non-specific symptoms can lead to unnecessary testing and inappropriate antibiotic use. There have been numerous protocols developed to standardize diagnosis of UTIs, including the McGeer criteria. At our LTC facility, we initiated a modified McGeer criteria for ordering urinalyses (UA) and culture. Our project examines the knowledge retention of the complexities of urinary tract symptoms and the comfort level of nursing staff when communicating with providers. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Yoon H. Kim, Yoon H. Kim, Ujjwala Seetha Bhagavatula, Lauren W. Mims, Neema Sharda, Mamata Yanamadala Source Type: research

Staff Education on a Urinary Tract Infection Algorithm in a Skilled Nursing Facility
A nation-wide initiative has been established for antibiotic stewardship in an effort to reduce over-treatment and over-diagnosis of infections. In our Skilled Nursing Facility (SNF), there are minimal guidelines for ordering urinalyses (UAs) in patients suspected of urinary tract infections (UTIs). Chart review demonstrated that UAs were ordered without systematic guidelines. We designed a project to educate SNF staff on a diagnostic algorithm adapted from McGeer criteria for UTIs (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Ujjwala Seetha Bhagavatula, Ujjwala Seetha Bhagavatula, Mamata Yanamadala, Neema Sharda, Yoon H. Kim, Lauren W. Mims Source Type: research