Research and advancement increase the capability of medicine to provide complex care. Technology can keep patients alive in states that they might not desire. Today, clinicians are responsible for (1) anticipating future care needs and (2) guiding treatments as patients become more ill and less functional. An essential tool in the clinician armamentarium, advance care planning is a skill set that must be honed to ensure that patients receive care both consistent with their informed preferences and appropriate to their prognosis. Advance care planning includes serial discussion with patients about clinical circumstances and prognosis, incorporates specific tools, requires coordination among the team of clinicians caring for a patient across venues of care, and may be facilitated by advance care planning structures. Sometimes the process also requires setting limits and addressing maladaptive coping. Building strong relationships with patients and families, and a consistent focus on goals of care is key to high quality treatment for the complex patient and achieving optimal end of life care.
Polypharmacy, defined as the use of multiple drugs or more than are medically necessary, is a growing concern for older adults. With older adults living longer and experiencing multiple chronic comorbidities, medication regimens are becoming increasingly complex and lengthy. It is not unusual to see patients taking 10 or more medications. Unfortunately, polypharmacy has been associated with an increased risk of adverse drug events (ADEs), drug-interactions, medication non-adherence, reduced functional capacity and multiple geriatric syndromes. This lecture will present real-world cases of polypharmacy and review the concepts of de-prescribing, what medications are no longer considered helpful to older adults, and how to safely reduce polypharmacy in real-world settings among patients.
Mobility disorders are a menace of old age, often resulting in falls, injuries, and especially hip fractures -- the sixth leading cause of death in the elderly. Primary care physicians have difficulties in both detecting and correctly identifying these abnormalities. In a paper published in the Journal of the American Geriatrics Society in 2004 [52(9):1527-31], the authors concluded that "community physicians appear to underdetect falls and gait disorders, leading to a paucity of recommendations and treatments." Hence the need to revisit the most common gait abnormalities. This multimedia presentation will provide a panorama of bipedalism, from its origin six million years ago in the savannahs of East Africa, to its rise as the unique trait of our species, and eventually to its status as a major cause of disability once full bipedalism is lost. The talk will review the physiology of ambulation and the prevalence of gait disorders in the population. In addition to detailed information on psychogenic and antalgic gaits, participants will learn about the seven major gait abnormalities. Whenever possible, the speaker will enliven the delivery by reviewing "famous patients," or vignettes of historical figures and celebrities who suffered the disorder.
As the proportion of older adults increases, providing up to date and quality care to them is of great importance to general internists, who provide the bulk of their primary care. Update in Geriatrics will review important advances in the clinical care of older adults published recently. Topics will include advances in the diagnosis and management of geriatric syndromes, management of multi-morbidity, and systems of care. Chronic disease treatment trials focused on older adults or with a significant proportion of older adults will also be included. The strength of the evidence will be discussed as well as potential impact the work could have on current clinical practice and education. Articles selection criteria will emphasize high quality studies that may be immediately applicable in practice.
Join this talk for an enlightening look at health system waste and failures. Dr. Nash will provide an essential road map connecting high-value care to population health. With this model, participants will be equipped to evaluate and improve the future of patient engagement.This presentation will (1) provide an update on criteria to diagnose osteoporosis and identification of persons at high risk of fracture; (2) review treatment guidelines; and (3) discuss new concepts regarding treatment, such as drug selection, duration of treatment, drug holidays, and standard treatment approach vs. goal-directed treatment.
Our patients are aging before our very eyes. A 72-year-old patient who used to come bounding down the hallway, is now, fifteen years later, using a walker and taking ten minutes to enter the exam room. We are facing questions from concerned adult children about whether their parents -- your patients -- are safe living, driving, or managing finances alone. Participants will review the factors that impact aging-in-place, learn about office-based tests evaluating a senior’s independence, receive information regarding available support resources, and gain insights on navigating transitions to long-term communities. The lecture will also discuss the options in long-term care living and innovative alternatives in the long-term care field.
Many clinicians struggle to differentiate between patients presenting with delirium and those presenting with dementia. In this lecture, the faculty will describe the important dos and don’ts of managing both patient populations. You will review common precipitants of delirium and consider the diagnosis and management of patients with dementia who present with delirium.
Lack of in-person social encounters and out-of-the-house activities are difficult for anyone but can be especially detrimental for our elderly patients and family. In this podcast, geriatrician Lee Lindquist, MD, will discuss ways to help older adults during shelter-in-place and social distancing. She will review methods to stimulate cognition, encourage socialization, and describe activities to do from a distance. She will discuss pointers for maintaining physical and emotional well-being in this population, which can apply to any period where an older adult is homebound.
Treating chronic pain in older individuals and balancing analgesia and adverse effects in this population, which is often afflicted with multiple comorbidities, is challenging. This program reviews the assessment and nonpharmacologic treatment of chronic pain in patients aged 65 years and older. This activity is supported by an independent educational grant from the Opioid Analgesic REMS Program Companies. Please see https://ce.opioidanalgesicrems.com/RpcCEUI/rems/pdf/resources/List_of_RPC_Companies.pdf for a listing of REMS Program Companies. This activity is intended to be fully compliant with the Opioid Analgesic REMS education requirements issued by the US Food and Drug Administration (FDA).
This engaging session will review risk factors for falls and the approach to treating a patient who has fallen or is at high risk of falling. Participants will learn about guidelines and validated tools for gait and fall risk assessment and review evidence-based interventions that have been shown to prevent falls in community-dwelling older adults.
This talk will review differences in prescribing to older adults and age-associated changes in metabolism. Polypharmacy and the Beers criteria will be discussed to summarize common adverse drug effects. Real world examples will assist in outlining a systematic approach to prescribing and describe tools that help this process. Learners will walk away with tips to enhance safe medication use.
This talk will focus on the normal aging process in older adults. Specifically, the faculty will discuss hormonal changes, including changes in estrogen and testosterone levels. The faculty will also review physiologic changes and speak to how age impacts the circadian pattern of body temperature, cortisol levels, and sleep. Following this session, you will have a full picture of possible treatments—as well as their risks and benefits—for common symptoms associated with age-related hormonal changes.