Advances in Long Term Care Medicine

Host: Matt Birnholz, MD

Guest: William Short, MD

Since the discovery of HIV more than 3 decades ago, there has been progress in the treatment of the disease. However, there remains a significant need to continue providing adults living with HIV and their physicians with treatment options. The last few years have seen the development of additional treatment options, including fixed-dose combination therapies. Dr. William Short, Associate Professor at Perelman School of Medicine at the University of Pennsylvania in Philadelphia, joins Dr. Matt Birnholz to discuss the considerations in treatment options for adults living with HIV-1, highlighting PREZCOBIX® (darunavir 800 mg/cobicistat 150 mg), one of the treatments in the space. Download and listen today. For more information on PREZCOBIX®, please visit www.PREZCOBIX.com/hcp. This promotional program is sponsored by Janssen Therapeutics, Division of Janssen Products, LP.

Guest: Thiruvinva Dharmarajan, MD FACP AGSF

Host: Eric Tangalos, MD

Patients in hospital settings are often screened and promptly treated for venous thromboembolism, or VTE, but perhaps less commonly in long-term care, even though these patients may be at risk. Dr. T.S. Dharmarajan, clinical director of the division of geriatrics at Montefiore Medical Center (North Division) in the Bronx, New York, discusses the medical conditions in long-term care that put patients at risk for VTE, and ways to assess patients for the condition. What anticoagulation medications and treatments may be used for treating VTE in long-term care? Should long-term care clinicians treat VTE as aggressively as hospitals often do, or are there other unique considerations clinicians should keep in mind for managing patients at risk for VTE in long-term care? Dr. Eric Tangalos hosts.  

Host: Eric Tangalos, MD

Guest: Tena Alonzo, MA

How can creating a more positive emotional experience for patients with dementia or Alzheimer's diminish behavior issues and improve quality of life? Tena Alonzo, director of research and co-director of the Palliative Care for Advanced Dementia program at Beatitudes Campus in Phoenix, discusses a common-sense approach to creating a comforting environment for those with dementia and Alzheimer's, which focuses on meeting each patient's unique needs. What simple steps can long-term care facilities and caregivers take to enhance the lives of patients with cognitive disorders? Dr. Eric Tangalos hosts.

Guest: Robert Kane, MD

Host: Eric Tangalos, MD

Deciding between assisted living facilities or nursing homes can be daunting for patients and families. How can healthcare professionals discuss long-term care expectations with patients and families and help with the selection process? Dr. Robert Kane, Minnesota Chair in Long-term Care and Aging at the University of Minnesota School of Public Health and director of the University of Minnesota's Center on Aging, discusses the genesis and evolution of assisted living facilities and nursing homes. What are some of the common precursors to patients and families deciding it is time to choose long-term care, and how can they determine which type of care is best?  Dr. Eric Tangalos hosts.

 

Guest: Steven Levenson, MD, CMD

Host: Eric Tangalos, MD

As healthcare reform evolves, so too do the public policies governing long-term care facilities. How can healthcare professionals stay up-to-date with the latest changes in federal and state regulations? What are the differences between regulations governing assisted living versus skilled care environments? How successful have regulations been at facilitating better quality of care in skilled care and assisted living? Dr. Steven Levenson, medical director of six long-term care facilities in Maryland and past-president of AMDA, says that having a "watchful eye" over long-term care facilities is generally useful in promoting quality of care, but laments the fact that there are some inconsistencies in the ways regulations are applied and implemented. How can healthcare providers aim towards regulatory compliance and better patient care, without getting bogged down with seemingly overwhelming details? Dr. Eric Tangalos hosts.

Guest: Matthew Wayne, MD, CMD

Host: Eric Tangalos, MD

Regulations regarding nurses as prescribing agents of physicians in long-term care facilities are more restrictive than in the hospital setting, because controlled substance licenses are not currently approved for nursing homes in most states. These restrictions can make it challenging for long-term care patients to receive timely access to narcotics. Dr. Matthew Wayne, medical director, geriatric medicine, University Hospital Richmond Medical Center in Richmond Heights, Ohio, and assistant professor of medicine at University Hospitals Case Medical Center in Cleveland, suggests revisions to some provisions of the Controlled Substances Act in order to ensure long-term care patients have access to pain medications when they need them the most. What hurdles are the most significant impediments to improving patient care with appropriate access to narcotics, and how can medical professionals best navigate the waters until revisions are made to the current law? Dr. Eric Tangalos hosts.

Host: Eric Tangalos, MD

Guest: Steven Handler, MD, PhD, CMD

Because residents in long-term care facilities often have comorbidities, polypharmacy can be an issue. What are the most common types of adverse drug events that can occur among long-term care patients taking multiple medications? Dr. Steven Handler, assistant professor in the department of biomedical informatics and the department of geriatric medicine at the University of Pittsburgh School of Medicine, and the medical director for long-term care health information technology for the University of Pittsburgh Medical Center, says the current methods for monitoring medications in nursing homes are inadequate for protecting against adverse drug events, and suggests ways to improve medication safety in long-term care. What tools might help practitioners in long-term care better detect and prevent adverse drug events? Dr. Eric Tangalos hosts.

Guest: Peter Winn, MD, CMD

Host: Eric Tangalos, MD

With palliative and hospice care, there is no one-size-fits-all approach. What differentiates these two types of care and how can physicians decide which approach to palliative or hospice care is best for each patient? Dr. Peter Winn, professor in the department of family medicine at Oklahoma University School of Medicine in Oklahoma City, discusses various types of care at the end of life, and outlines conditions that might require such care. What are some of the challenges to providing effective palliative and hospice care, and how can physicians best discuss realistic expectations with families and patients? Hosted by Dr. Eric Tangalos. 

Guest: Karl Steinberg, MD, CMD

Host: Eric Tangalos, MD

"Advance directive" is an umbrella term that encompasses end-of-life documents, including a living will and durable power of attorney for healthcare. Such documents can be scary for many patients, and as such, advance directives are not very common among the general US population. Yet these documents can be powerful tools in ensuring patients receive the type of care they desire. What do physicians need to know about advance directives in caring for patients at the end of life? Dr. Karl Steinberg, associate medical director for skilled nursing care at Scripps Coastal Medical Center in Vista, California, discusses variations, misconceptions and confusion surrounding advance directives, and says there is room for improvement. Many states have enacted Physician Orders for Life Sustaining Treatment (POLST) programs to address end-of-life care issues. What do these programs involve, and how effective are such programs in alleviating confusion with end-of-life care? Dr. Eric Tangalos hosts.

Guest: David Smith, MD, CMD

Host: Eric Tangalos, MD

Nearly three-quarters of patients in long term care have some form of memory impairment or dementia. And while some forgetfulness is a normal part of the aging process, memory loss can also be overlooked as an early symptom of cognitive impairment. How can physicians distinguish between common memory loss and cognitive impairment? Dr. David Smith, professor of family medicine at the College of Medicine at Texas A&M University, College Station; and president of Geriatric Consultants of Central Texas in Brownwood, Texas, discusses the nuances of different forms of cognitive impairment, and emphasizes the importance of early diagnosis. What activities, medications, environments and other strategies can help physicians slow cognitive decline in these patients? Dr. Eric Tangalos hosts.