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.

This session aims to refresh your knowledge and stimulate interest in performing a thorough and focused physical exam (PE), particularly in the geriatric population. Whether part of a Medicare evaluation or a routine office visit, the PE provides an opportunity to develop rapport, trust, and potentially to discover clinically significant findings that might otherwise have gone unrecognized. A series of brief scenarios will be used to illustrate important yet basic concepts such as differentiation between normal age-related findings versus indicators of worrisome disease processes and atypical presentation of disease. Now, Let’s Get Physical! 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.

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.

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.

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.

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.

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.

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.