NADONA/LTC Online: We Understand

CLINICAL INSIGHTS IN GERIATRICS (CIG) INTERACTIVE NEWSLETTER SERIES: SETTING THE STAGE:  STAGE-SPECIFIC TREATMENT OPTIONS FOR PATIENTS WITH MODERATE TO SEVERE ALZHEIMER'S DISEASE

As the US population ages, dementia syndromes such as Alzheimer’s disease (AD) are growing more prevalent. Roughly 60% to 80% of elderly patients with chronic dementia have AD, a progressive condition that leads to memory loss, personality changes, cognitive dysfunction, and functional impairment. The Practice Guidelines for the Treatment of Patients With Alzheimer’s Disease and Other Dementias, 2nd Edition (2007) and other related guidelines stress the importance of individualized and multimodal treatment plans. Recognizing symptomatology of AD at its various stages can help providers select appropriate therapies.

Continuing education is required to help primary care providers and other senior care clinicians ensure that patients are being evaluated and treated properly. Patients with dementia need to be stratified based on the severity of their disease and treated accordingly, but many providers do not know how long to treat AD since there is no established standard on the duration of treatment.



CLINICAL INSIGHTS IN GERIATRICS (CIG) INTERACTIVE NEWSLETTER SERIES:  MANAGING PAIN IN OLDER ADULTS WITH COGNITIVE IMPAIRMENT

A significant majority of older adults experience pain that may interfere with normal functioning. The ramifications of this extend far beyond the pain itself, increasing the risk of depression, care complexity, sleep problems, and hospitalization, as well as reducing patient quality of life and increasing overall costs. Numerous barriers interfere with the ability of clinicians to provide adequate pain management for seniors, including regulatory and reimbursement issues, patient comorbidities, concern about side effects, and the cognitive issues and dementia many of these patients experience.

Despite significant advances in drug development, pain remains inadequately managed in older adults. Furthermore, diagnosing and properly managing patients with cognitive impairment is even more challenging. Primary care providers and other senior care clinicians must be up-to-date on the most effective ways to assess and monitor pain in patients with cognitive impairment.

 

CLINICAL INSIGHTS IN GERIATRICS (CIG) INTERACTIVE NEWSLETTER SERIES:  SUCCESSFULLY DIAGNOSING AND MANAGING OVERACTIVE BLADDER IN OLDER ADULTS TO OPTIMIZE OUTCOMES

Overactive bladder (OAB) is the most common cause of urinary incontinence or loss of bladder control in adults and affects approximately 33 million Americans. While OAB affects people of all ages, the medical issue of OAB is of particular importance in the older adult population with prevalence greatly increasing in older individuals. The symptoms of OAB—urge urinary incontinence (UI), urgency, and urinary frequency—often lead to further medical and psychological problems and can have a devastating impact on quality of life.

Primary and long-term care physicians, pharmacists, nursing directors, physician assistants, and nurse practitioners have the opportunity to improve outcomes for older adults with OAB by more thoroughly identifying patients who suffer from OAB, by more consistently providing effective OAB treatment, and by increasing the use of strategies to promote patient adherence to OAB treatment recommendations. The goal of this continuing medical education activity is to expand the ability of primary care providers and other senior care clinicians to provide optimal care for older adults experiencing OAB, ultimately improving outcomes for the many older individuals who suffer from OAB.

 

 

CLINICAL INSIGHTS IN GERIATRICS (CIG) INTERACTIVE NEWSLETTER SERIES:  PAIN MANAGEMENT IN OLDER ADULTS:  IMPROVING ASSESSMENT AND TREATMENT

A significant majority of older adults experience pain that may interfere with normal functioning. The ramifications of this extend far beyond the pain itself, increasing the risk of depression, care complexity, sleep problems, and hospitalization, as well as reducing patient quality of life and increasing overall costs. Numerous barriers interfere with the ability of clinicians to provide adequate pain management for seniors, including regulatory and reimbursement issues, patient comorbidities, concern about side effects, and the cognitive issues and dementia many of these patients experience.

Despite significant advances in drug development, pain remains inadequately managed in older adults. Primary care providers and other senior care clinicians require education about the most recent guidelines for pain management in the older patient, opportunities to improve the treatment of pain, and new and emerging medications and nonpharmacologic approaches that can improve the assessment and management of pain in this growing population.


 

CLINICAL INSIGHTS IN GERIATRICS (CIG) INTERACTIVE NEWSLETTER SERIES:  IMPROVING CHRONIC CONSTIPATION MANAGEMENT FOR OLDER ADULTS THROUGH A COMPREHENSIVE APPROACH

Chronic constipation in older adults can dramatically impact quality of life and lead to serious medical problems. The estimated prevalence of chronic constipation in the U.S. is between 2 and 27%, but increases to 40% among people over 65 years of age. Older adults are at particular risk due to additional chronic disease burdens, immobility, and/or functional limitations.

Effective management of chronic constipation requires a combination of provider and patient education, lifestyle and/or pharmacologic modifications, and the judicious use of pharmacologic and non-pharmacologic therapies.

This interactive newsletter will describe a comprehensive approach to care and outline considerations for tailoring treatment for individual patients. With an improved understanding of the condition and its management, primary, geriatric, and long-term care providers can help lessen the burden of chronic constipation and significantly improve the lives of the older adults in their care.

 

 

CLINICAL INSIGHTS IN GERIATRICS (CIG) INTERACTIVE NEWSLETTER SERIES:  BARRIERS TO EFFECTIVELY MANAGING CHRONIC CONSTIPATION IN OLDER ADULTS

Chronic constipation can dramatically impact quality of life and lead to serious medical problems. Older adults are at particular risk due to additional chronic disease burdens, immobility, and/or functional limitations. Recognizing chronic constipation can be a challenge, mainly because there is a significant disconnect between patient and clinician perceptions of constipation. Effective management of chronic constipation requires a combination of patient and provider education, lifestyle and/or pharmacologic modifications, and the judicious use of pharmacologic and non-pharmacologic therapies.

This interactive newsletter will examine considerations for patient evaluation and assessment and explore common barriers that can hinder management. With an improved understanding of the condition and its management, primary, geriatric, and long-term care providers can help lessen the burden of chronic constipation and significantly improve the lives of the older adults in their care.

 

 

CLINICAL INSIGHTS IN GERIATRICS:  ANEMIA OF CHRONIC KIDNEY DISEASE IN OLDER PATIENT POPULATION:  SELECTING THE APPROPRIATE TREATMENT

The treatment of related anemia of chronic kidney disease (CKD) in older adults remains a major clinical challenge. Anemia is a common finding in older adults. Although anemia is often asymptomatic, even mild untreated anemia can lead to adverse outcomes, such as hospitalization, disability, and death. In order to effectively manage these patients, primary care providers and other senior care clinicians need to be competent in the appropriate recognition and differential diagnosis of anemia, as well as the evidence-based strategies for treating anemia, especially in those with anemia of CKD.

Despite the benefits of therapy, anemia of CKD often is not treated. This may be because clinicians are not aware of the consequences of anemia or do not view it as a threatening condition. Once therapy is started, appropriate monitoring ensures that therapy with an erythropoiesis-stimulating agent (ESA) is safe and effective. Data has shown that clinicians may be unaware not only of appropriate hemoglobin goals, but recommended timing for obtaining ESA hemoglobin levels. Anemia may lead to decreased functionality and quality of life in older patients. Because of its high prevalence and negative impact on older adults, continuing education in this area is essential for clinicians who serve this population.  

 

 

 

Partnership for Patients - National Priorities Partnership
PATIENT SAFETY WEBINAR SERIES

Webinar 1: Introduction to the Patient Safety Initiative & Standout Stories
 

Watch the recording

Overview  

This session provided an overview of the Partnership for Patients initiative and set the context for the series of webinars to follow. It will include “stand out stories” focusing on the two goal areas of all cause harm and readmissions. It will also set-up key crosscutting themes (e.g. reliability, communications, hand-offs, overuse) that will be interwoven throughout the webinars.

Meeting Objectives 

  • Introduce the Patient Safety Webinar Series and the cross-cutting themes (e.g., communication, culture of safety, and organizational leadership) that connect the series.
  • Discuss the Partnership for Patients’ purpose and specific goals:
    - Reducing preventable hospital-acquired conditions by 40% by the end of 2013.
    - Decreasing preventable complications during care transitions to result in a 20% decrease in hospital readmissions by the end of 2013.
  • Provide an opportunity for thought leaders to share “stand out” stories and strategies for overcoming barriers to implementation of successful patient safety models.

Speakers  

  • Don Berwick, Administrator, Centers for Medicare and Medicaid Services (CMS)
  • Joe McCannon, Senior Advisor, Office of the Administrator, CMS
  • John Toussaint, MD, President and Chief Executive Officer, ThedaCare
  • Gary Kaplan, MD, FACP, Chief Executive Officer, Virginia Mason Medical Center

Moderators   

Key Audiences  

  • Hospital leaders
  • Clinicians
  • Healthcare providers across all settings
  • Consumer groups and patient organizations
  • Healthcare purchasers
  • Health plans

 

 

 

Related Information

 

 

Webinar 1: Introduction to the Patient Safety Initiative & Standout Stories
Featured Speaker Bios
Presentation Slides
Webinar Summary

 

 

 

NQF and Safety

NQF’s mission is to improve the quality of healthcare. Patient safety is central to achieving our mission.

Check out NQF's Profile on Patient Safety. 

 

 

Partnership for Patients - National Priorities Partnership
PATIENT SAFETY WEBINAR SERIES

Webinar 2: Reducing Readmissions through Care Transitions

 

Watch the recording

Overview 

 

This webinar will discuss the goal of decreasing preventable complications, during a transition from one care setting to another, thereby reducing hospital readmissions by 20%.  

Meeting Objectives 

 

  • Provide an opportunity for thought leaders in the field of patient safety to share best practices, success stories, and strategies for getting started.
  • Identify key barriers to widespread adoption of successful models and programs that improve care transitions, and corresponding policy drivers that could accelerate progress nationally.
  • Provide examples of public-private partnerships working to address barriers at the policy and/or implementation levels.

 

Speakers 

 

  • Mary Naylor, PhD, RN, Professor in Gerontology, University of Pennsylvania School of Nursing
  • Eric Coleman, MD, MPH, Chief Medical Officer, University of Colorado Health Sciences Center

 

Moderators 

Panelists: 

 

  • Robyn Golden, LCSW, Director of Older Adult Programs, Rush University Medical Center
  • Traci Cornelius, MSW, Care Transitions Coach, Riverside County Regional Medical Center

 

Partnership for Patients - National Priorities Partnership
PATIENT SAFETY WEBINAR SERIES

Webinar 3: Preventing Adverse Drug Events in Your Organization 

 

 

Watch the Recording 

Overview 

This webinar featured key thought leaders and experts in the pharmaceutical field. They discussed the role of adverse drug events in improving patient safety, and highlighted best practices and success stories.

Meeting Objectives 

  • Provide an opportunity for thought leaders in the field of adverse drug events to share best practices, success stories, and strategies for getting started
  • Generate action in organizations and communities nationwide
  • Provide examples of public-private partnerships working collaboratively to achieve results

Speaker  

Michael Cohen, MS, ScD, RPh, President, Institute for Safe Practices

Moderators 

Bernie Rosof, MD, Senior Vice President, North Shore-LIJ Health System (NPP Co-Chair)

Panelists: 

  • Steven Meisel, PharmD, Director of Patient Safety, Fairview Health Services
  • David Bates, MD, MSc, Chief Quality Officer, Brigham and Women’s Hospital
  • Bob Galvin, MD, MBA, Chief Executive Officer, Equity Healthcare, The Blackstone Group  

 

 

 

 

 

 

Overcoming Clinical Challenges in Parkinson’s Disease 

This online activity with faculty Q&A will provide important information on the treatment and management of patients with PD: 

  • Identify features of early PD

  • Adjust treatment based on disease stage and clinical manifestations

  • Review the various classes of drugs used to treat PD

  • Manage treatment-related side effects and psychiatric complications

  • Discuss unmet needs and ongoing research

 

 

Reduce the Risk of Stroke in Seniors with Atrial Fibrillation

Approximately 2.2 million people in the United States have been diagnosed with atrial fibrillation (AF), the most common cardiac arrhythmia, and the risk for stroke in these patients is substantial. In older adults, AF leads to 25% of all strokes. Guidelines for the management of patients with AF emphasize risk assessment to determine which patients are likely to benefit from anticoagulant therapy. Long-term anticoagulation is recommended for all AF patients who have risk factors for thromboembolism. Many older adults with AF receive inadequate risk assessment, however, and anticoagulation therapy is often not initiated or optimized.

Senior care clinicians play an important role in ensuring that older adults with AF benefit from optimal anticoagulant therapy to prevent stroke. This activity seeks to enhance clinicians' abilities to determine when the risk for stroke in elderly patients with AF exceeds the risk for anticoagulation-associated bleeding, to identify optimal anticoagulant agents, and to maintain the ideal therapeutic range for therapy for each patient. Emerging anticoagulants and their unique characteristics will also be discussed. Because of the serious and immediate consequences of strokes, effective preventive treatment is of the utmost importance in reducing disability and improving survival in elderly patients with AF.