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.

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.

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.

Dementia afflicts over five million Americans. Although no cure exists, symptomatic treatments can provide temporary benefits and improve quality of life. Several medications that are effective in reducing symptoms and slowing decline are available, and other medicines and innovative treatments are in development. Healthy lifestyle habits have been shown to reduce risk and delay onset of symptoms. This presentation will review the latest information on diagnosis and treatment of dementia and discuss new approaches in the pipeline. The speaker will also highlight healthy behaviors shown to reduce symptoms, compensate for age-related cognitive decline, and protect brain health. * What's New in Dementia? may meet the criteria of the Medical Board of California for 0.75 credit of Geriatrics. Visit www.mbc.ca.gov for details.

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.

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 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.

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.

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.

This episode focuses on older adults and caregivers/partners in relation to their intimacy and sexuality for patients experiencing changes in cognition.

Falls in the older population are associated with significant morbidity and mortality yet little evidence exists to determine best practices for prevention. Join us while we discuss a recent RCT that examined Tai Chi versus more traditional exercising in older individuals and its impact on reduction in falls for those at greatest risk.

Join us as we discuss deprescribing; the provider-supervised process of discontinuing inappropriate medication(s). We will review minimizing risk, improving quality of life and maximizing patient-centered care.