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.

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.

There is a well-recognized need to improve communication about end of life care between medical providers and patients. Advance care planning involves clarifying patients’ illness understanding and understanding their values, beliefs, and goals of care to ensure care at the end of life honors these goals. Unfortunately, simply increasing completion rate of advance directives does not impact care at the end of life. Strategies for successful advance care planning in primary care clinic will be discussed in this talk. Specifically, the talk will outline a framework for discussing care planning for healthy, chronically ill, and terminally ill patients.

The role of the primary care clinician is crucial in defining the quality of care and life a patient experiences in the final months and year. Caring for patients longitudinally is core to the principles of primary care. Even nearing the end, there is always more we can do, and navigating and supporting patients in crafting what optimal care looks like for them in key to the alleviation and prevention of suffering and enhancement of quality of life as disease progress. In this talk we will explore practical clinical, communication, and operations skills to integrate of palliative care principles into primary care, at all stages of a serious illness.

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.

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.

Now that the capabilities of medicine provide increasingly complex care and technology to keep patients alive in health states they might not desire, the clinician is responsible for anticipating future care needs and guiding treatments as patients become more ill and less functional. Advance care planning is an essential tool in the primary care practitioner’s armamentarium, and this skill set must be honed to ensure that patients receive care consistent with their informed preferences and appropriate to their prognosis. Clinicians must feel comfortable introducing advance care planning, carrying out serial discussions with patients about prognosis, using appropriate tools and practice structures, and coordinating care among the team of clinicians caring for their patients across care venues. Sometimes the process 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.

Falls are a major cause of morbidity and serious health issues in older adults that can have devastating outcomes. Using real-world cases and audience participation, this lecture will discuss a hands-on approach to identifying fall risks, preventing falls, assessing patients post-fall, and treating older adults. Office-based balance and gait assessments that can be conducted in small spaces will be demonstrated. Evidence will be presented about updated recommendations on fall treatments, including simple recommendations to multi-level interventions that improve the care of older adults. Advice on selecting the right durable medical equipment (e.g., canes, walkers, rollators, wheelchairs, and scooters) and measuring for the correct size equipment will be provided. Very few people outlive their canes so many older adult patients use hand-me-downs, resulting in poor posture, gait instability, and additional falls. After attending this lecture, you will understand how to best care for your older adult patients who are prone to fall. Please note that any data, indications, and guidelines presented in this activity are current as of the recording/release on February 8, 2020, and they are subject to change as new information is published.

It is important to recognize and address cognitive complaints and dementia symptoms early in the disease continuum and as part of routine care. Steps to diagnose mild cognitive impairment and Alzheimer’s disease will be discussed, as will the importance of early treatment. Approaches to Alzheimer’s disease prevention, including lifestyle changes, will be presented, along with emerging disease-modifying therapies.

COVID-19 has disproportionately impacted older adults through early high infection rates, social isolation, anxiety, depression and mortality. This session on polypharmacy and COVID-19 will improve how you treat the sequalae of COVID-19 in older adults and increase your awareness of polypharmacy. It will also provide the newest research on non-pharmacologic ways of treating the long-term effects of COVID-19 on older adults. Through interactive patient cases, Dr. Lee Lindquist will provide examples on how to safely and effectively manage the medications of your older adult patients during the COVID-19 pandemic. Please note that any data, indications, and guidelines presented in this activity are current as of the recording/release on 8/13/2020, and they are subject to change as new information is published.

Opioids are an important therapy for the management of pain in older patients with cancer-related chronic pain, as well as in some with chronic noncancer pain. This program reviews important concepts in initiating and continuing opioid therapy in older patients. 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). ​

As we see more patients with cognitive impairment, understanding the real-world care for this population is vital. This lecture will review the most efficient means of assessing cognitive impairment, examine common issues in caring for the older adult with cognitive impairment, and discuss pharmacologic/non-pharmacologic means of treating patients. Dr. Lindquist will also address updates on what medications are useless/useful and what testing should be avoided. Polypharmacy is common among older adults and associated with adverse outcomes. This case-based session will review how to avoid inappropriate prescribing, recognize adverse drug events, and identify opportunities to deprescribe. Dr. Bradley will review recent literature updates that inform our prescribing practices including the 2019 AGS Beers criteria. Tips to enhance safe medication use will be shared. The updates will be followed by an “Ask the Expert” session with Drs. Lindquist and Bradley where they will review common questions and take questions from attendees.