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Dementia - Depression, Acute Behavioral Change, and Decision Making Capacity New!
Dementia and associated disorders have increased prevalence with age. Dementia is often associated with other treatable disorders such as depression and delirium. Both are often misdiagnosed and inappropriately managed, thus contributing to the complexity of care, unnecessary service utilization and poor quality of life.
Clinicians have reported not being prepared to diagnoses and manage those conditions. Diagnosis and management of depression in dementia evaluation for acute change in behavior and determining decision-making capacity are critical in the management of elderly with chronic illness. Knowledge of signs and symptoms, familiarity with the available methods and tools to assess these conditions will allow clinicians to play an important role in providing education, psychosocial support, and referrals for the identified problems, among others, for patients and caregivers. It will also allow clinicians to manage their other chronic illness more effectively. The series of cases presented here will provide an opportunity to manage several virtual older patients and receive feedback and guidance as to the appropriate course of action.
Release Date: November 16, 2011 |
1.5 |
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Pain Management in Long Term Care Settings New!
Management of pain is often challenging in the nursing home, particularly because many residents have some type of cognitive impairment that keeps them from readily self-reporting pain. In addition, myths such as the belief that pain should be expected in older adults and fears about potential addiction prevents many older adults and their family members from asking for pain medication. Similar concerns and beliefs by nurses and physicians may also contribute to poor pain management and resident suffering. Nursing homes need to establish a comprehensive program that creates a systematic approach to pain management. A good pain management program needs to be resident focused and include pain assessment, interventions/treatments, monitoring, quality improvement and education for patients, families and staff. By establishing a systematic and comprehensive program, nursing homes can ensure that residents have their pain goals met and do not suffer needlessly.
Release Date: September 22, 2011 |
1.5 |
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Urinary Incontinence (UI) New!
Urinary incontinence (UI) is a common and treatable problem, especially in women and the elderly. The prevalence of UI increases with age, but it is not a part of normal aging. In women over age 60 years the prevalence of UI ranges from 15% to 43%. In contrast, the prevalence of UI in men at all ages, ranges from 1.6% to 24%. Despite this, UI remains under diagnosed and underreported with only 32% of primary care physicians routinely asking all of their patients about UI, and 50%-75% of incontinent community-dwelling patients never describing their symptoms to physicians.
Release Date: July 8, 2011 |
1.25 |
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Palliative Care – Words Matter -- Effective Communication About Goals of Care and Treatment Limitations New!
Establishing patient-centered goals of care and treatment limitations is an important component of care in patients facing advanced illness. At the same time, communication during serious illness can be difficult for patients as well as providers. Research has demonstrated that the ethical ideal for decision making, involving shared decision making between an informed patient and a physician knowledgeable in both the patient's values and achievable treatment outcomes, is far from the norm in clinical practice. Improving communication about goals of care and treatment limitations requires that providers and patients (or their surrogates) develop a shared understanding of desired and achievable outcomes, which can be accomplished by incorporating key principles and a step-wise approach to the goals of care discussion. This approach leads to high levels of patient satisfaction as well as treatment decisions that truly reflect the patient's goals.
Release Date: May 9, 2011 |
1.25 |
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Office-Based Geriatric Assessment New!
Comprehensive geriatric assessment is a method of screening for and diagnosing physical, psychosocial and functional impairments among older adults. Assessments are made to develop a comprehensive plan for prevention, treatment and rehabilitation. The approach often employs interdisciplinary teams and standardized instruments for assessment. The value of comprehensive geriatric assessment has been assessed in a variety of settings (inpatient, outpatient and at home) and models (primary and consultative care). Certain types of assessment programs can reduce mortality and improve patients' physical and cognitive function at no additional cost compared to usual care. Components of comprehensive geriatric assessment usually include medical, cognitive, affective, functional, social support, economic, environmental, advance directives, prevention, prognosis and patients goals an preferences. One can conduct such comprehensive assessment in the office setting by: 1) asking patients to complete a comprehensive questionnaire prior to the visit 2) functional assessment by observation 3) performing a directed medical history and physical examination and 4) establishing agreement on a plan of action.
Release Date: May 9, 2011 |
1.0 |
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Atrial Fibrillation Management
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, occurring in 1–2% of the general population. Its prevalence is estimated to at least double in the next 50 years as the population ages. AF confers a 5-fold risk of stroke, and one in five of all strokes is attributed to this arrhythmia. Ischemic strokes in association with AF are often fatal, and those patients who survive are left more disabled by their stroke and more likely to suffer a recurrence than patients with other causes of stroke. In consequence, the risk of death from AF-related stroke is doubled and the cost of care is increased 1.5-fold. Appropriate management of the AF patient has been shown to reduce the related morbidity and mortality.
Release Date: February 4, 2011 |
1.25 |
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Management of Congestive Heart Failure (CHF)
Heart failure is increasing in both incidence and prevalence with roughly 5 million people in the United States having this disorder. This is partially a result of decreased mortality from myocardial infarction as a result of improved treatment, as well as improved treatment of the heart failure itself leading to prolonged survival. Heart failure is a major cause of sudden cardiac death with more than half of the deaths due to heart failure are from sudden cardiac death. The second leading cause of death in heart failur patients is due to progressive heart failure. The most important preexisting condition and the best predictor of sudden death is left ventricular dysfunction, the underlying cause of heart failure.Congestive heart failure is one of the top conditions leading to hospitalization among the elderly. It is important that physicians recognize and treat heart failure with knowledge of therapies that minimize mortality and morbidity.
Release Date: January 13, 2011 |
1.50 |
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The Assessment of Falls in the Office Setting
As one ages the possibility of injuring oneself due to falling become an increasing concern to both patients and family members. Health care providers also need to be aware of this not uncommon occurrence since the overall population is aging and will result in an increased incidence of falling.
Release Date: January 6, 2011 |
1.25 |
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Managing COPD in Older Adults: Using Spirometry and Bronchodilators
Spirometry is the most commonly performed pulmonary function test (PFT). It is a relatively simple test that can be performed at the bedside, in a physician's office, or in a pulmonary laboratory. It is usually the first test performed to evaluate a potential problem with the lungs function as it helps to narrow the differential diagnosis of dyspnea. Indications for spirometry include an abnormal chest radiograph, arterial blood gas analysis, symptomatic patients with a history of smoking, family history of lung disease, or other abnormal diagnostic pulmonary test result. Regular spirometry tests be performed over time on patients with chronic respiratory ailments including COPD to evaluate rates of decline in lung function. It is also used to evaluate the efficacy of bronchodilator inhalers and help to guide therapy.
Release Date: November 1, 2010 |
0.25 |
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Osteoporosis: An Overview
Osteoporosis is a disease in which bones become fragile and more likely to break. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. These broken bones, also known as fractures, occur typically in the hip, spine, and wrist.
Release Date: September 1, 2010 |
1.00 |
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Treatment of Asthma and Chronic Obstructive Pulmonary Disease
Shawkat Dhanani, MD, MPHChronic Obstructive Pulmonary Disease (COPD) is a frequently encountered problem among primary care physicians managing older adults and geriatric patients. The prevalence of COPD has been increasing and although it can be treated, it cannot be cured, which results in it having a significant impact on healthcare.
Release Date: July 12, 2010 |
1.25 |
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Anticoagulation in the Elderly: Prevention and Management of Venous Thromboembolism
Howard A. Liebman, M.D.Thromboembolism is an enormous problem across the spectrum of medicine. In the US and Europe over 600,000 people will suffer a venous thromboembolism, and nearly 20% will die as a result. The incidence of arterial and venous thromboembolism (VTE) is highly age dependent, contributing significant morbidity and mortality to an aging population.
Release Date: May 1, 2010 |
1.50 |
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Chronic Kidney Disease in the Elderly
Phuong-Chi Pham, MDCKD is an increasingly prevalent problem resulting at least partially from the increased prevalence of diabetes. These trends are expected to continue, which makes it especially important that primary care physicians are up to date on recognizing and managing CKD.
Release Date: May 1, 2010 |
1.25 |
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Stroke Prevention and Management
Stanley N. Cohen, M.D.A gap exists between the increased prevalence of stroke in the elderly and appropriate prevention and treatment measures practiced in the community.
Release Date: May 1, 2010 |
1.25 |
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Discover SCAN educational offerings where you can earn CME credits and ensure you get the latest in geriatric-care information to better serve your patients.
Utilizing the 2008 California Guideline for Alzheimer’s Disease Management in a Managed Care Environment
Carol Hahn, MSN, RN, ONC
Director Professional Training
Alzheimer’s Association California Southland Chapter