Post-Acute and Long Term Geriatric Care Clinical Advisor. Volume I

Jochanan E. Naschitz
The Technion Israel Institute of Technology, Haifa, Israel and Geriatric Medical Center, Baitbalev, Nesher, Israel

Series: Geriatrics, Gerontology and Elderly Issues
BISAC: MED032000

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Changing demographics have resulted in the elderly constituting a more significant proportion of the population. Many older people will develop functional impairment and disability, necessitating either support at home or admission to long-term care facilities, rehabilitation centers, psychiatric institutions and hospices. Guidance in the clinical challenges that face the staff of such institutions is essential.

Clinical practice guidelines dealing with many of the prevalent conditions in long-term care facilities have been published by the American Medical Directors Association; these aim to educate staff, improve patient outcomes, decrease avoidable transfers and reduce costs. Yet, guidelines do not cater methodically to problems resulting from the complex situations seen in older patients with multiple comorbidities. Textbooks are also often deficient in providing a focused approach to conditions and issues that are of importance in geriatric long-term care.

The present manuscript (Volumes I and II) focuses on case management in geriatric long-term care. Concise recommendations are provided, addressing diagnostic issues and management strategies. We have adopted an approach of dividing recommendations into ‘‘do’’ and ‘’do not’’ categories in order to guide physicians and nurses in their approach to conditions encountered frequently, to help them recognize ‘’red flag’’ signals, and to highlight significant unusual situations. When fine-tuning of management is indicated, the text goes into specifics, such as details on nutrition, pharmacology, medication dosing, therapeutic procedures, and the recognition of adverse events. Recent progress, shifting evidence, controversial issues and uncertainties are pinpointed. Expert advice is provided.

It is hoped that this book might prove to be a worthy contribution to the medical field, enriching doctors and nurses committed to long-term geriatric care.
(Imprint: Nova Biomedical)

Preface

Chapter 1. Introduction

Chapter 2. Essentials of Geriatric Care

Chapter 3. Geriatric Syndromes

Chapter 4. Urgenices and Emergencies

Chapter 5. Acute Disorders

Index

“The subject of post acute care is very important and is the subject that makes geriatric care its special impact in medicine. This book contains the most important subjects in Post-Acute and Long Term Geriatric Care and serves as an excellent clinical advisor to the clinician. It covers the most common problems and subjects with many references and is written in a practical way to the reader by using the "Do" parts. The book also gives the approach to the subject through the long experience in acute care; as well as post acute care of clinician with excellent capacities in clinical education. Therefore, I think that this book can contribute to the daily work of many clinicians in an open field.” - Professor Yitshal N.Berner, Head, Geriatric Medicine, Meir Medical Center, Kfar Saba

“The subject of post acute care is very important and is the subject that makes geriatric care its special impact in medicine. This book contains the most important subjects in Post-Acute and Long Term Geriatric Care and serves as an excellent clinical advisor to the clinician. It covers the most common problems and subjects with many references and is written in a practical way to the reader by using the "Do" parts. The book also gives the approach to the subject through the long experience in acute care; as well as post acute care of clinician with excellent capacities in clinical education. Therefore, I think that this book can contribute to the daily work of many clinicians in an open field.” - Professor Yitshal N.Berner, Head, Geriatric Medicine, Meir Medical Center, Kfar Saba

Introduction

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Chapter 1

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Cheng HY. What long-term care providers need to know. Clin Geriatr Med 2011;27:193–198.
Donelan K, DesRoches CM, Dittus RS, Buerhaus P. Perspectives of physicians and nurse practitioners on primary care practice. N Engl J Med 2013; 368:1898-1906.
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Iler C, Goering M, Ralley K, Zaccagnini M. Taking on the challenge of clinical teaching in LTCF. J Gerontol Nur 2011;37:32-38.
Johnson MA. Changing the Culture of Nursing Homes. The Physician's Role. Arch Intern Med. 2010;170:407-409.
Konetzka RT, Park J, Ellis R, Abbo E. Malpractice litigation and LTCF quality of care. Health Serv Res. 2013;48(6 Pt 1):1920-1938.
Mody L, Bradley SF, Huang SS. Keeping the “Home” in LTCF:  Implications for infection prevention. JAMA Intern Med. 2013;173:853-854.
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Saliba D, Buchanan J. Making the investment count: revision of the Minimum Data Set for LTCF, MDS 3.0. J Am Med Dir Assoc 2012;13:602-610.
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Stevenson DG, Spittal MJ, Studdert DM. Does litigation increase or decrease health care quality?: a national study of negligence claims against LTCF. Med Care. 2013;51:430-436.
Studdert DM, Spittal MJ, Mello MM, O'Malley J, Stevenson DJ. Relationship between quality of care and negligence litigation in LTCF. N Engl J Med 2011; 364:1243-1250.
Ziemba R, Perry TE, Takahashi B, Algase D. “That model is sooooo last millennium!” Residential long term care as a system, not a place. J Hous Elderly. 2008;23:261–280.

Chapter 2

Boling PA, Chandekar RV, Hungate B, Purvis M, Selby-Penczak R, Abbey LJ. Improving outcomes and lowering costs by applying advanced models of in-home care. Cleveland Clin J Medicine 2013;80: e-Suppl 1 e-S7-e-S14.
Chaudhry SI, Mattera JA, Curtis JP, Spertus JA, Herrin J, et al. Telemonitoring in patients with heart failure. N Engl J Med 2010; 363:2301–2309.
Edwards ST, Prentice JC, Simon SR, Pizer SD. Home-based primary fare and the risk of ambulatory care–sensitive condition hospitalization among older veterans with diabetes mellitus. JAMA Intern Med. 2014. doi:10.1001/jamainternmed.2014.4327.
Labson C, Sacco MM, Weissman DE, Gornet B, Innovative models of home-based palliative care. Cleveland Clin J Med 2013; 80: e-Suppl 1 e-S30-e-S35.

Chapter 3

Ahmed N, Tayor K, McDaniel Y, Dyer CB. The role of an acute care for the elderly unit in achieving hospital quality indicators while caring for frail hospitalized elders. Popul Health Manag 2012;15:236-240.
Ding YY, Anishenagaden J, Chong WF, Heng BH, Lim TK. Effectiveness of acute geriatric units in the real world: The case of short-term mortality among seniors hospitalized for pneumonia. Geriatr Gerontol 2012;7:211-217.
Ekdahl AW, Wirehn AB, Alwin J, Jaarsma T, Unosson M, et al. Costs and effects of an ambulatory geriatric unit (the AGe-FIT Study): a randomized controlled trial. J Am Med Dir Assoc. 2015 doi:10.1016/j.jamda.
Fox MT, Persaud M, Maimets I, O'Brien K, Brooks D et al. Effectiveness of acute geriatric unit care using acute care for elders components: a systematic review and meta-analysis. J Amer Geriatr Soc. 2012;60:2237-2245.


Hung WW, Ross JS, Farber J, Siu AL. Evaluation of the Mobile Acute Care of the Elderly (MACE) Service. JAMA Intern Med. 2013;173:990-996.
Shepperd S, Doll H, Angus RM, Clarke MJ, Iliffe S et al. Admission avoidance hospital at home. Cochrane Database Syst Rev. 2008;4:CD007491.
Silvester KM, Mohammed MA, Harriman P, Girolami A, Downes TW. Timely care for frail older people referred to hospital improves efficiency and reduces mortality without the need for extra resources. Age Ageing 2014;43:472-477.


Somme D, Lazarovici C, Drame M, Blanc P, Lang PO et al. The geriatric patient: Use of acute geriatrics units in the emergency care of elderly patients in France. Arch Gerontol Geriat 2011;52:40-45.

Chapter 4

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Epstein RM, Korones DN, Quill TE. Withholding information from patients - when less is more. N Engl J Med 2010;362:380-381.
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Chapter 5

Headly A. Communication skills: a call for teaching to the test. Am J Med 2007;120:912-915.
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Lamas D, Rosenbaum L. Freedom from the tyranny of choice - teaching the end-of-life conversation. N Engl J Med 2012; 366:1655-1657.
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Chapter 6

Bowker LK, Price JD, Smith SC. Oxford handbook of geriatric medicine. 2nd ed, 2012, Oxford Univ Press, pp:654-661.
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Naik AD, Teal CR, Pavlik VN, Dyer CB, McCullough LB. Conceptual challenges and practical approaches to screening capacity for self-care and protection in vulnerable older adults. J Am Geriatr Soc 2008;56 Suppl 2:S266-270.
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Chapter 7

Braunwald E, Morrow DA. Unstable angina. Is it time for a requiem? Circulation 2013;127:2452-2457.
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Duffy MJ. Carcinoembryonic antigen as a marker for colorectal cancer: is it clinically useful? Clin Chem. 2001;47:624-630.
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Kim BJ, Lee KT, Moon TG, et al. How do we interpret an elevated carbohydrate antigen 19-9 level in asymptomatic subjects? Dig Liver Dis. 2009;41:364-369.
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Lazo M, Selvin E, Clark JM. Clinical implications of short-term variability in liver function test results. Ann Intern Med 2008;148:348-352.
Marks V. False-positive immunoassay results: a multicenter survey of erroneous immunoassay results from assays of 74 analytes in 10 donors from 66 laboratories in seven countries. Clin Chem. 2002;48:2008-2016.
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Steensma DP, Tefferi A. Anemia in the elderly: how should we define it, when does it matter, and what can be done? Mayo Clin Proc 2007;82:958-966.
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WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy. Geneva: World Health Organization; 2010.
Wolfe F, Pincus T. The level of inflammation in rheumatoid arthritis is determined early and remains stable over the longterm course of the illness. J Rheumatol 2001; 28:1817-1824.

Chapter 8

Batchvarov VN, Malik M, Camm AJ. Incorrect electrode cable connection during electrocardiographic recording. Europace 2007; 9:1081-1090.
Bonda RR, Finlava DD, Nugenta CD, Breenb C, Guldenringa D, Dayc MJ. The effects
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Chapter 9

Marshall EG, Clarke BS, Varatharasan N, Andrew MK. A long-term care-comprehensive geriatric assessment (LTC-CGA) tool: improving care for frail older adults? Can Geriatr J. 2015;18:2-10.
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Chapter 10

Aaron KJ, Sanders PW. Role of dietary salt and potassium intake in cardiovascular health and disease: a review of the evidence. Mayo Clin Proc. 2013;88:987-995.
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Ashraf MJ, Cook JR, Rothberg MB. Clinical utility of folic acid testing for patients with anemia or dementia. J Gen Intern Med 2008;23:824-826.
Aspray TJ, Bowring C, Fraser W, Gittoes N, Macdonald H et al. National Osteoporosis Society vitamin D guideline summary. Age Ageing 2014;43:592-595.
Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ et al. Evidence-based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group. J Am Med Dir Assoc. 2013 doi: 10.1016/ j.jamda.2013.05.021. [Epub ahead of print].
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Bjelakovic G, Gluud C. Vitamin and mineral supplement use in relation to all-cause mortality in the Iowa Women's Health Study: Comment on “Dietary Supplements and Mortality Rate in Older Women.” Arch Intern Med. 2011;171:1633-1634.
Bolland MJ, Avenell A, Baron JA, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: metaanalysis. BMJ 2010; 341:c3691.
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Brown RE, Kuk JL. Consequences of obesity and weight loss: a devil’s advocate position. Obes Rev. 2015;16:77-87.
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Dalen JE. Devries S. Diets to Prevent Coronary Heart Disease 1957-2013: What Have We Learned? Amer J Med 2014;127:364–369.
Dhamarajan TS, Ugalino JT, Kanagala M, Pitchumoni S, Norkus AP. Vitamin B12 status in hospitalized elderly from LTCF and the community. J Am Med Dir Assoc 2000;1:21-24.
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DiNicolantonio JJ, Niazi AK, SAdaf R, O’Keefe JH, Lucan SC, Lavie CJ. Dietary sodium restriction: take it with a grain of salt. A, J Med 2013;126: 951-955.
Djousse L, Gaziano JM. Breakfast cereals and risk of heart failure in the physicians' health study I. Arch Intern Med 2007;167:2080-2085.
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Ganguly R, Pierce GN. The toxicity of dietary trans fats. Food Chem Toxicol. 2015;78:170-176.
Halim SA, Newby LK. Review: Omega-3 fatty acid supplements provide no protective benefit in cardiovascular disease. Ann Intern Med 2012;157:Jc2-3.
Hayes KC, Pronczuk A. Replacing trans fat: the argument for palm oil with a cautionary note on interesterification. J Am Coll Nutr. 2010;29(3 Suppl):253S-284S.
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Heaney RP, Kopecky S, Maki KC, Hathcock J, Mackay D, Wallace TC. A review of calcium supplements and cardiovascular disease risk. Adv Nutr 2912;3:763-771.


Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911-1930.
Holick MF. Vitamin D is not as taoxic as was once thought: a historical and an up-to-date perspective. Mayo Clin Proc. 2015; 90: 561-564.
Jung SB, Nagaraja V, Kapur A, Eslick GD. Association between vitamin B12 deficiency and long-term use of acid-lowering agents: a systematic review and meta-analysis. Intern Med J 2015;45:409-416.
Kotchen TA, Cowley AW Jr., Frohlich ED. Salt in health and disease - a delicate balance. N Engl J Med 2013; 368:1229-1237.
Kwak SM, Myung S-W, Lee YJ, Seo HG, for the Korean Meta-analysis Study Group. Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and docosahexaenoic acid) in the secondary prevention of cardiovascular disease. A meta-analysis of randomized, double-blind, placebo-controlled trials. Arch Intern Med. 2012;172:686-694.
Lee JH, O’Keefe JH, Lavie CJ, Marchioli R, Harris WS. Omega-3 fatty acids for cardioprotection. Mayo Clin Proc 2008;83:324-332.
Liu J, Sui X, Lavie CJ, et al. Association of coffee consumption with all-cause and cardiovascular disease mortality. Mayo Clin Proc. 2013;88:1066-1074.
Lopez-Garcia E, van Dam RM, Li TY, Rodriguez-Artalejo F, Hu FB. The relationship of coffee consumption with mortality. Ann Intern Med 2008;148:904-914.
Lucas M, Mirzaei F, Okerke OI, Willet WC, O’Reilly EJ, Koenen K, Ascherio A. Coffee, Caffeine, and Risk of Depression Among Women. Arch Intern Med. 2011;171:1571-1578.
Mathus-Vliegen EM. Obesity and the elderly. J Clin Gastroenterol. 2012;46:533-544.
McAuley PA, Artero EG, Sui X, Lee D, Church TS, Lavie CJ, Myers JN, España-Romero V, Blair SN. The obesity paradox, cardiorespiratory fitness, and coronary heart disease. Mayo Clin Proc 2012;87:443-451.
Mitrou PN, Kipnis V, Thiébaut ACM, Reedy J, Subar AF, Wirfält E et al. Mediterranean dietary pattern and prediction of all-cause mortality in a US population. Results from the NIH-AARP diet and health study. Arch Intern Med. 2007;167:2461-2468.
Moyer VA on behalf of the U.S. Preventive Services Task Force. Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2013;158: doi:10.7326/0003-4819-158-9-201305070-00603.
Mozaffarian D, Jacobson MF, Greenstein JS. Food reformulations to reduce trans fatty acids. N Engl J Med 2010;362:2037-2039.
Mursu J, Robien K, Harnack LJ, Park K, Jacobs DR. Dietary supplements and mortality rate in oller women: The Iowa Women's Health Study. Arch Intern Med. 2011;171:1625-1633. N Engl J Med 2014;371:612-623.
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Chapter 34

al-Furaih TA, McElnay JC, Elborn JS, Rusk R, Scott MG, et al. Sublingual captopril-a pharmacokinetic and pharmacodynamic evaluation. Eur J Clin Pharmacol. 1991;40:393-398.
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Chapter 36

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