Collaboration Between Dental and Medical Providers Improves Treatment for Elderly
Older adults often suffer from complex medical issues that are exacerbated by dental conditions. Recent data from researchers in Nashville, TN, and teams in Boston and Chicago show that coordination and collaboration between physicians and dentists helps improve care and produce better outcomes for patients. (Source: Caring for the Ages)
Source: Caring for the Ages - December 31, 2016 Category: Health Management Authors: Jason Harris Source Type: news

News From the Society
Society corporate member Kindred Nursing and Rehabilitation Center –Mountain Valley in Kellogg, ID, has received the 2016 Malcolm Baldrige National Quality Award. This is the nation’s highest Presidential honor for sustainable excellence through visionary leadership, organizational alignment, systemic improvement, and innovation. The announcement was made in la te November by U.S. Commerce Secretary Penny Pritzker. (Source: Caring for the Ages)
Source: Caring for the Ages - December 31, 2016 Category: Health Management Source Type: news

Wound Care: What the Medical Director Needs to Know
The field of wound care has expanded quickly over the last 2 decades, and progress has brought new challenges for long-term care. We now have a sicker population, multiple specialists claiming expertise in wound care, and a variety of expensive products with little evidence that one works better than the other. In this environment of health care reform, cost control, and data-driven quality measures, it is important that medical directors become knowledgeable on these issues to get the best care for their residents. (Source: Caring for the Ages)
Source: Caring for the Ages - November 30, 2016 Category: Health Management Authors: Jeffrey M. Levine Source Type: news

Joint European Atrial Fibrillation Guidelines Break New Ground
ROME — The 2016 joint European guidelines on management of atrial fibrillation break new ground by declaring as a strong Class IA recommendation that the novel oral anticoagulants are now the drugs of choice — preferred over warfarin — for stroke prevention. (Source: Caring for the Ages)
Source: Caring for the Ages - November 30, 2016 Category: Health Management Authors: Bruce Jancin Source Type: news

FRAIL Scale Predicted 1-Year Functional Status of Geriatric Trauma Patients
WAIKOLOA, HAWAII — The FRAIL scale questionnaire predicts functional status and mortality at 1 year among geriatric trauma patients and is a useful tool for bedside screening by clinicians, results from a single-center study demonstrated. (Source: Caring for the Ages)
Source: Caring for the Ages - November 30, 2016 Category: Health Management Authors: Doug Brunk Source Type: news

Metabolic Dysregulation May Predict Treatment Failure in Late-Life Depression
SAN FRANCISCO — Metabolic dysregulation and particularly abdominal obesity lead to failure to obtain complete remission with treatment of late-life depression, according to a multicenter, prospective cohort study. (Source: Caring for the Ages)
Source: Caring for the Ages - November 30, 2016 Category: Health Management Authors: Amy Karon Source Type: news

Autumn: Time to Reap What You Sow
I had the pleasure last month of being invited to the Oregon Geriatrics Society (OGS) annual meeting at the Sunriver resort to present on a couple of my favorite topics. At this meeting, David Barnard, JD, PhD, shared an unusual multimedia presentation entitled “Aging as the Autumn of Life: A Tour Through the Arts.” It included paintings, opera, poetry, and some beautiful old manuscripts describing the four seasons and their corresponding “elements.” I’m not quite sure how they got the CME accreditation for the presentation, but it was a refreshi ng change from the usual didactic format. (Sour...
Source: Caring for the Ages - November 30, 2016 Category: Health Management Authors: Karl Steinberg Tags: on my mind Source Type: news

Baseline Extrapyramidal Signs Predicted Non-Alzheimer ’s Dementia in Patients With MCI
SAN FRANCISCO — Among patients with mild cognitive impairment, those with extrapyramidal signs were about six times more likely to develop non-Alzheimer’s forms of dementia than those without baseline extrapyramidal signs, according to a prospective multicenter analysis. (Source: Caring for the Ages)
Source: Caring for the Ages - November 30, 2016 Category: Health Management Authors: Amy Karon Source Type: news

Navigating the Maze of New Regulations in the Final Rule
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - November 30, 2016 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr. Jeff Source Type: news

Doulas Partner With Practitioners to Support Peaceful Dying
Geri Topfer experienced “extreme pain, agony, sadness, fear, and depression” when her 73-year-old mother died recently. But she was able to balance her grief and loss with an “abundance of gratitude, love, and joy,” due in large part to the presence of an end-of-life doula. (Source: Caring for the Ages)
Source: Caring for the Ages - November 30, 2016 Category: Health Management Authors: Joanne Kaldy Source Type: news

A Call You Don ’t Want: A STAT Page to Admitting
Another STAT page! My already busy medical director ’s day now looked even grimmer. Oddly, I recognized the source number on my cell phone as the admitting office. Perhaps the family of a new admission — or even a staff member working in the office — had suffered a medical emergency. (Source: Caring for the Ages)
Source: Caring for the Ages - November 30, 2016 Category: Health Management Authors: James Lett Tags: Caring Transitions Source Type: news

Low BMI and Weight Loss Both Impact 6-Month Nursing Home Mortality
A low body mass index (BMI) and weight loss greater than 5 kg in the past year were both independent and “equally relevant” risk factors for the 6-month mortality of nursing home residents in a large international cross-sectional survey. And when both were present, the mortality risk was disproportionately increased. (Source: Caring for the Ages)
Source: Caring for the Ages - November 30, 2016 Category: Health Management Authors: Christine Kilgore Source Type: news

Midlife Hypertension Linked With Cognitive Impairment
Unchecked hypertension has “devastating” long-term implications for cognitive health, the American Heart Association concluded in a recent scientific statement. (Source: Caring for the Ages)
Source: Caring for the Ages - November 30, 2016 Category: Health Management Authors: Amy Karon Source Type: news

Experts Offer Tips on Anxiety, Depression, and Psychosis in Parkinson ’s
SAN FRANCISCO — Depression and psychosis were strongly correlated in Parkinson’s disease, while the presence of clinical anxiety upped the odds of psychosis by a statistically significant 8%, in a cross-sectional study presented at the 2016 congress of the International Psychogeriatric Association. (Source: Caring for the Ages)
Source: Caring for the Ages - November 30, 2016 Category: Health Management Authors: Amy Karon Source Type: news

Journal Highlights From the December Issue of JAMDA
Nursing home residents who take psychotropic medications on a regular schedule are nearly three times more likely to fall than patients who do not use these agents, according to a 2-year retrospective observational study in the Netherlands. (Source: Caring for the Ages)
Source: Caring for the Ages - November 30, 2016 Category: Health Management Source Type: news

News From the Society
The Society has announced that Peter Hanson, MD, author of the best-seller The Joy of Stress, will present Saturday ’s keynote address at the 2017 Annual Conference, March 16–19, 2017, in Phoenix, AZ. (Source: Caring for the Ages)
Source: Caring for the Ages - November 30, 2016 Category: Health Management Source Type: news

Inflammation, Depression, Slow Gait Define High-Risk Phenotype in Seniors
SAN FRANCISCO — Patients with unchecked inflammation, depression, and slow gait make up a “depressed frail phenotype at grave risk of death,” Patrick J. Brown, PhD, said at the 2016 congress of the International Psychogeriatric Association. (Source: Caring for the Ages)
Source: Caring for the Ages - November 30, 2016 Category: Health Management Authors: Amy Karon Source Type: news

Know Your Options for Treating Depression
Caring for the Ages Editor-in-Chief Karl Steinberg, MD, CMD, HMDC, talks about treatments for depression in older adults. (Source: Caring for the Ages)
Source: Caring for the Ages - November 30, 2016 Category: Health Management Tags: Caring Source Type: news

Legislators: Investigate Medicare Fraud Before Paying Doctors
Republican leaders in Congress are calling on the Centers for Medicare& Medicaid Services to impose stricter safeguards against fraudulent Medicare billing by physicians. (Source: Caring for the Ages)
Source: Caring for the Ages - November 30, 2016 Category: Health Management Authors: Alicia Gallegos Source Type: news

Good Nutrition Becoming a Potent Tool to Boost Immune System in Elderly
Few nursing home residents have escaped the process of immunosenescence. With age comes a sweeping and well-studied decline in immune responsiveness that leaves older individuals increasingly susceptible to developing infections and more likely to have prolonged and difficult recoveries. (Source: Caring for the Ages)
Source: Caring for the Ages - October 27, 2016 Category: Health Management Authors: Christine Kilgore Source Type: news

CMS Releases Final Rule Revising Nursing Home Regulations
The Centers for Medicare& Medicaid Services has issued the long-awaited final rule that will revise the requirements that long-term care facilities must meet to participate in Medicare and Medicaid programs. This is the first change in the nursing home regulations since the Omnibus Budget Reconciliation Act that was implemented in 1990. According to CMS, these changes reflect advances that have been made in the theory and practice of how care is administered to residents in these facilities, as well as address safety issues. (Source: Caring for the Ages)
Source: Caring for the Ages - October 27, 2016 Category: Health Management Authors: Carey Cowles Source Type: news

The Truth About Authenticity
As a health care provider looking after mostly geriatric, or chronically or terminally ill patients, I have many opportunities for meaningful interactions with my patients and their families. And these interactions are a big part of the reason I love my work. I am blessed to have decent penmanship and work at nursing homes that still use paper charts, so I can sit and look patients and their families in the eye during most of our time together, instead of looking at a computer screen. (Source: Caring for the Ages)
Source: Caring for the Ages - October 27, 2016 Category: Health Management Authors: Karl Steinberg Tags: on my mind Source Type: news

FDA: New Boxed Warning on Combining Opioids, Benzodiazepines
Labeling for prescription opioid pain or cough medicines and benzodiazepines will now carry the strongest available warning regarding serious side effects and death associated with their combined use, according to the Food and Drug Administration. (Source: Caring for the Ages)
Source: Caring for the Ages - October 27, 2016 Category: Health Management Authors: Sharon Worcester Source Type: news

Frailty, Prefrailty Increase Diabetes Risk
Frail and prefrail older adults are at increased risk of developing incident type 2 diabetes mellitus compared with individuals with no frailty, according to a longitudinal study in Padova, Italy. (Source: Caring for the Ages)
Source: Caring for the Ages - October 27, 2016 Category: Health Management Authors: Jeffrey Eisenberg Source Type: news

Sarcopenia Reduces the Benefits of Exercise in COPD
Patients diagnosed with chronic obstructive pulmonary disease and sarcopenia appeared to derive less benefit from short-term high-intensity exercise than those without sarcopenia. (Source: Caring for the Ages)
Source: Caring for the Ages - October 27, 2016 Category: Health Management Authors: Jason Harris Source Type: news

Steps Toward Building a Better Team
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - October 27, 2016 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr. Jeff Source Type: news

Ten Tips to Mitigate Legal Risks of Opioid Prescribing
Opioid-related lawsuits against physicians are on the rise. Common allegations include unnecessary prescribing, failing to heed contraindications, and missing warning signs of a likely overdose, said Ericka L. Adler, JD, a Chicago-based health law attorney. To mitigate the risk of being sued, legal and clinical experts offered the following advice. (Source: Caring for the Ages)
Source: Caring for the Ages - October 27, 2016 Category: Health Management Authors: Alicia Gallegos Source Type: news

Risk Management for a Resident Who Won ’t Follow Medical Advice
Mrs. H and her husband are residents at a skilled nursing facility. They are elderly and have extensive gait instability, but are cognitively intact. Mr. H is rehabilitating after a compression fracture of the thoracic spine. They are both receiving physical therapy and occupational therapy. After rehab, Mr. H is discharged home to the community to live with his adult children, but his wife must remain in the SNF. (Source: Caring for the Ages)
Source: Caring for the Ages - October 27, 2016 Category: Health Management Authors: William C. Wilson Tags: Legal Issues Source Type: news

INTERACT: A Nurse ’s Perspective
Jill M. Shutes, MSN, GNP-BC, sees nursing home care and decision-making from both sides of the fence. Having worked both as a geriatric nurse practitioner and a clinical services manager for Evercare, she knows how challenging it can be, as a clinician, to receive information about a resident that is more “big picture” than concise. And she knows how frustrating it can be, as a nurse, to lack confidence in communicating with a clinician about a resident’s status and to receive orders that are sometimes unclear and even indefinite in nature. (Source: Caring for the Ages)
Source: Caring for the Ages - October 27, 2016 Category: Health Management Authors: Christine Kilgore Source Type: news

Guideline Recommends Optimal Perioperative Management of Geriatric Patients
SAN DIEGO — As the number of surgery patients older than 65 continues to grow, clinicians have a resource to help them provide optimal perioperative care to this patient population. (Source: Caring for the Ages)
Source: Caring for the Ages - October 27, 2016 Category: Health Management Authors: Doug Brunk Source Type: news

Alzheimer ’s Diseases Manifests Differently in Hispanic Elders
Some symptoms associated with the development of Alzheimer ’s disease, including agitation and depression, affect Hispanics more frequently and severely than other ethnicities, according to study results published in the Journal of Neuropsychiatry and Clinical Neuroscience. (Source: Caring for the Ages)
Source: Caring for the Ages - October 27, 2016 Category: Health Management Source Type: news

Inflammation, Depression, Slow Gait Define High-Risk Phenotype in Seniors
SAN FRANCISCO — Patients with unchecked inflammation, depression, and slow gait make up a “depressed frail phenotype at grave risk of death,” Patrick J. Brown, PhD, said at the 2016 International Psychogeriatric Association Congress. (Source: Caring for the Ages)
Source: Caring for the Ages - October 27, 2016 Category: Health Management Authors: Amy Karon Source Type: news

From Blue to Black: Is It Holiday Blues or Clinical Depression?
Caring Editor in Chief Karl Steinberg, MD, CMD, HMDC, talks about how to tell if you or a loved one just have the blues or something more serious. (Source: Caring for the Ages)
Source: Caring for the Ages - October 27, 2016 Category: Health Management Tags: Caring Source Type: news

FRAIL-NH Simplifies Frailty Screening
In a comparison study of two frailty screening tools, the FRAIL-NH was shown to quickly screen residents at the bedside and to predict adverse outcomes, according to a speaker at the AMDA – the Society for Post-Acute and Long-Term Care Medicine Annual Conference in Orlando, FL. (Source: Caring for the Ages)
Source: Caring for the Ages - October 27, 2016 Category: Health Management Authors: Carey Cowles Source Type: news

Journal Highlights From the November Issue of JAMDA
High-quality oral nutritional supplements can improve strength in malnourished older individuals with mild to moderate sarcopenia, according to a multi-center randomized double-blinded controlled clinical trial in Lincoln, NE. (Source: Caring for the Ages)
Source: Caring for the Ages - October 27, 2016 Category: Health Management Source Type: news

A Path To Building Accountable ‘MediCaring’ Communities
Two years ago, Joanne Lynn, MD, wrote: “Medicare 2014 has achieved the main goal of Medicare 1965. Nevertheless, the system designed for the priorities of 1965 does not match the needs of 2014, and beyond. Addressing needs and correcting course to change habits of overtreatment and cost inflation for older people living with multiple c hronic conditions is a historic opportunity to build Medicare 2030.” (Source: Caring for the Ages)
Source: Caring for the Ages - October 27, 2016 Category: Health Management Authors: Bill Kubat Tags: Community LTC Source Type: news

News From the Society
The best ideas often start with an acute observation or an interesting question. The Foundation for Post-Acute and Long-Term Care Medicine Quality Awards, presented during the Society ’s Annual Conference earlier this year, seek to highlight innovative answers. (Source: Caring for the Ages)
Source: Caring for the Ages - October 27, 2016 Category: Health Management Source Type: news

Putting a Stop to Schemes, Scams That Destroy Lives
Those who say “It’s only money” likely have never been the victim of fraud or financial abuse. When elders are defrauded of their money or other assets through scams or deceit, “I believe it can kill them,” said Elizabeth Loewy, general counsel for EverSafe and a former New York City prosecutor. (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2016 Category: Health Management Authors: Joanne Kaldy Source Type: news

Withdrawing Antipsychotics Is Safe, Feasible in Long-Term Care
TORONTO — Antipsychotics can be safely withdrawn from some patients with dementia in long-term care facilities, two new studies from Australia and Canada have determined. (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2016 Category: Health Management Authors: Michele G. Sullivan Source Type: news

ENSURE-AF Trial Supports Edoxaban for Electrical Cardioversion
ROME — Results of the largest-ever randomized clinical trial of anticoagulation for electrical cardioversion of patients with nonvalvular atrial fibrillation demonstrate that edoxaban is a safe, effective, and convenient alternative to the standard strategy of enoxaparin as a bridge to warfarin. (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2016 Category: Health Management Authors: Bruce Jancin Source Type: news

Sarcopenia Gets a Code of Its Own
On Oct. 1, sarcopenia received its own International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) code. The assigned code, M62.84, can now be used by post-acute and long-term care practitioners to indicate sarcopenia, and will improve access to research data, help advance new therapies, and improve physician reimbursements for treatment. (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2016 Category: Health Management Source Type: news

Great Expectations: The Most Important Conversation of All
Although I am biased, I think there ’s a lot to be learned from 12-step programs, and a lot that can be applied to the post-acute and long-term care setting. One of the slogans from my favorite 12-step program is as follows: “An expectation is nothing more than a premeditated resentment.” In other words, if we have high expectat ions, there’s a decent chance that we will be disappointed. And by the same token, if we keep our expectations low enough, we are unlikely to be let down. (There’s a corollary to this slogan that is not relevant to my column, but I like it so much I’m going to sh...
Source: Caring for the Ages - September 29, 2016 Category: Health Management Authors: Karl Steinberg Tags: On My Mind Source Type: news

There ’s No ‘I’ in ‘Team’: Working Together in Long-Term Care
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2016 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr. Jeff Source Type: news

Most Sepsis Cases Begin Outside of the Hospital
Sepsis is a medical emergency that begins outside of the hospital in 79% of cases. In addition, 72% of patients with sepsis had recently used health care services or had chronic diseases that required frequent medical care. (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2016 Category: Health Management Authors: Doug Brunk Source Type: news

Non-TCA/SSRI Antidepressants Increase Fall Risk in Elderly Frail Women
Antidepressants from classes other than tricyclics (TCAs) and selective serotonin reuptake inhibitors (SSRIs) did not appear to reduce the risk for falls, according to results of the Zoledronic acid in frail Elders to STrengthen bone (ZEST) study. (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2016 Category: Health Management Authors: Jason Harris Source Type: news

Do No Harm … Whatever That Means
The phrase “first do no harm” (in Latin, primum non nocere) is fundamental to the ethics of medical treatment in the Western world and has endured for approximately 2,500 years. It is attributed to Hippocrates, who wrote that “The physician must ... have two special objects in view with regard to disease , namely, to do good or to do no harm.” These are the principles of beneficence (“to do good”) and nonmaleficence (“to do no harm”). The Hippocratic oath contains similar language. Many practitioners today still pledge that oath or at least receive a copy of it early in their...
Source: Caring for the Ages - September 29, 2016 Category: Health Management Authors: Jonathan M. Evans Tags: Medical ethics Source Type: news

The Virtuous Cycle Is Broken
The “Virtuous Cycle,” as it applies to the modern mega-academic health science center, represents the circular synergism of medical education, research, and patient care. The mission of the Association of Academic Health Centers — an advocacy organization based in Washington, D.C. — is to help t hese medical meccas “transform, adapt, and thrive in the changing health care landscape.” (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2016 Category: Health Management Authors: Jerald Winakur Tags: Meditations on Geriatric Medicine Source Type: news

Job Task Analysis Surveys Underway to Establish PA/LTC Medicine as Specialty
This month, practitioners in post-acute and long-term care medicine have an unusual and important opportunity to help shape the body of knowledge for this unique field by responding to a pair of job task surveys, one for medical directors and the other for attending physicians. This project is the most recent step the Society and its affiliates are taking to define the skills, training, and experience needed to practice medicine and medical direction today in the changing world of PA/LTC. (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2016 Category: Health Management Source Type: news

Frailty, Sarcopenia Increased Risk for Hospitalization, Functional Decline in Diabetics
Researchers at Saint Louis University School of Medicine have determined that, among older patients with diabetes, frailty and sarcopenia are predictors for hospitalization and new disabilities. (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2016 Category: Health Management Authors: Jason Harris Source Type: news

Teaching the Bulls About the China Shop
The bulls of the U.S. health care market (hospitals and payers, heavyweights in influencing national health care policy) have entered the fragile ecosystem of the post-acute care china shop to reform the care of vulnerable older adults. These reforms have at their core a belief that shifting payments to quality-based metrics, and assigning joint responsibility for costs and outcomes to the sites involved in transitioning older adults from the hospital to post-acute care, will in fact decrease costs and improve outcomes. (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2016 Category: Health Management Authors: Robert E. Burke Tags: Caring Transitions Source Type: news