AD and DM

Article in the current issue of Neurology debunks the association

Diabetes is related to cerebral infarction but not to AD pathology in older persons

antibody to amyloid precursor protein

A team led by Dr. Emma Kidd at Cardiff University's Welsh School of Pharmacy made the discovery during research funded by the Alzheimer's Society, the UK's leading care and research charity for Alzheimer's disease and other types of dementia.

The results of the study show that it is possible to decrease production of a small protein called *-amyloid (A*), which is believed to be the main cause of the disease. Deposits of A* build up in the brain, preventing it from functioning properly.

Potential Alzheimer's Disease Treatment Discovered in Wales, UK

Testosterone and AD

In mice

Of Mice and Men Testosterone Helps Fight Alzheimer's Disease in Mice, but What About Humans?

Education and AD

Adequate cognitive reserve seems to be protective

Education -- the best pill of all for preventing Alzheimer's?

Cognitive training

It would be expected that cognitive training might help cognition ( and instrumental activities of daily living ) in older adults but its still reassuring to see it studied

Long-term Effects of Cognitive Training on Everyday Functional Outcomes in Older Adults

Canberra deaths

Final death toll in the Canberra outbreak is ten dead. It looks like it was influenza and an inquiry is being launched

Ten dead in nursing home flu outbreak

telephone surveillance

An example of technology enhancing independant living

Bergen program monitors seniors' well-being by phone

IMO reacts to proposed LTC changes

Irish Medical Organization president Dr Christine O'Malley reacts to the new LTC policy announced by Minister Harney last week.

Health Minister’s long-term care plans slammed by IMO President

Call for input on proposed LTC legislation

The Ontario Health Coalition has called for more input on the government's proposed legislation. Advocacy groups are concerned at the haste with which this is being pushed through.

Call for Seniors Input in Long Term Care Act

Information on LTC

Dept of Health and Human Services in the US has launched a new portal for information about LTC. Useful section on planning


National Clearinghouse for Long Term Care Information

Staff vaccination

What we already knew. What is very surprising is what passed for 'usual practice' ie 3.9% influenza vaccination of staff in the control group.

Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial

Nursing home owner acquited of abuse

Witnesses died before trial , a case of attrition

Nursing home owner acquitted of elder abuse

C Diff and Norwalk

I suppose the lesson here is not to always assume that all outbreak cases are 'only' Norwalk

C. difficile, Norwalk virus hit nursing home patients

biomarker for AD

A possible marker for the disease published in the Annals of Neurology

A step toward a breakthrough on Alzheimer's

Grand Rounds

An elegant history of Grand Rounds in today's New York Times , you may have to register ( free)

Many younger doctors did not know that grand rounds were once conducted with patients on stage.


Socratic Dialogue Gives Way to PowerPoint

LTC in Ireland

A boost for the elderly in Ireland as 1,200 new beds become available next year under what the government is calling 'Fair Deal'. A new payment mechanism will mean that seniors will pay up to 80% of their income for care. A spouse remaining at home will receive 200 euros a week

Harney unveils policy on nursing home care

bill 140

Bill 140, with proposed measures described by some as draconian, passes second reading (Ontario)

Media advisory - Government Announcement on Long-term Care Hearings Imminent: Coalitions Respond Across Ontario

Supportive living in Calgary

Three levels of care at this centre, independant, assisted living and 'memory' care

Seniors housing offers more selection, perks

phase II clinical trial

AL-108
Allon Receives Approval for Phase II Clinical Trial in Alzheimer's-Related Condition

Its all about the money, stupid

Story speaks for itself

lay-offs after court ruling to pay staff a decent wage

The Compass Group — a food-service company that claims on its corporate website it earns annual revenues of more than $27.2 billion and employs 400,000 people worldwide — said it can't afford the pay increases.


Jobs axed after pay doubles at Ottawa nursing home

Vitamin D

Mounting evidence for the vitamin of the day

Vitamin D Deficiency is Associated with Worse Cognitive Function and Low Mood in Older Adults

Rosiglitazone and AD

A phase III trial that will test the link between diabetes and AD

Caregivers of today

This study shows that children of aging parents born in the 50s and 60s are more committed to caring than their parents generation were. Another interesting finding was that as death approaches and when individual need is at its greatest there are fewer demands made of caregiving children.

Baby boomers value caring for aging parents more than earlier generation

World Aids Day

December 1st

40 million people worldwide and over 58,000 people in the UK are living with HIV. Globally only 1.3 million people have access to treatment

Take Action Today

Tamiflu®

It was only a matter of time I suppose, here is the Health Canada warning from today

New information regarding Tamiflu

Colin Powell

Dr Powell was a keynote speaker at the British Geriatrics Society Autumn meeting in Harrogate. His comments are summarized in the newsletter


BGS Newsletter Online

couple marry in nursing home

A man and woman both aged 24 were married in a nursing home in Ohio last Saturday so the groom's mother could attend the ceremony. Why not?

Young Couple Weds At Nursing Home

Fire

Fire at US nursing home kills 10

medical care of dementia

An editorial in the most recent Annals of Internal Medicine reflects on two studies published in the same edition that highlight dementia care making the following two points

1) dementia care has to focus more on the efforts of the caregiver, most patients who could live in a nursing home are living in their own home thanks to the work of the caregivier.

2) the office isn't the place to deliver coordinated care as the fee system does not support the activities required to coordinate and integrate ( ?and reward) appropriate care


Envisioning Better Approaches for Dementia Care

C Diff

In Ohio
Hospital rates 1.1-15.1 per 10,000 patient days
LTC 45-53 per 10,000 patient days

Integrated care

An example of integrated continuing care near Ottawa. Locals raised $1m for the project which combines LTC with supportive care apartments.

Deep River's new experiment -- senior living

Casa Verde

The coroner's report on the tragic deaths at a nursing home in Ontario in 2001 at the hands of another resident.

Casa Verde long-term care home inquest

hidden cameras

Medical director caught on camera....along with others

Hidden Cameras Lead To Nursing Home Arrests

Furor in the UK over NICE decision

The NICE has refused to support the use of cholinesterase in mild AD. Drug companies are considering an unprecedented court appeal. There have been widespread protests in the UK


Furore over who gets Alzheimer's drug in the UK

National report on LTC ( US)

Brown university researchers are assisting Newt Gingrich and John Kerrey in the upcoming report The National Commission for Quality Long-Term Care.Vincent Mor and Edward Allan Miller at the Center for Gerontology and Health Care Research at Brown University's report can be found at Out of the Shadows

Brown duo examines elder care

Future uncertain for older LTC homes in Ontario

Concerns over the future of LTC facilities in the province under the new legislation which targets older facilities. The Long Term Care Act will place a 10 year deadline on older facilities with uncertainty over continuity after this period.

Older long-term care homes under threat

Falls in nursing homes

National Center for Injury Prevention and Control spotlights falls in the elderly with some helpful provider and patient information.

Falls in Nursing Homes

not H5N1 in Australian nursing home

Nursing home illness 'not bird flu'

More OT less Rx

From Holland in today's BMJ



Therapy Beats Drugs For Dementia Sufferers'

Alzheimer's disease now in top 10

Now the 8th leading cause of death in LA county
16 deaths / 100,000

Alzheimer's now a top killer in L.A. County

Irish nursing home care

The Leas Cross report on Nursing Home care by Prof Desmond O'Neill who investigated 105 deaths at the home is critical of the lack of standards of care and low level of medical and nursing cover.


'Lessons to be learned from Leas Cross'


Summary of the O'Neill report recommendations

Influenza outbreak - down under

Flu claims another nursing home victim

week 44 activity

Canadian influenza activity map

European influenza activity

US influenza activity

World influenza activity

10 tips for caregivers

These seem useful

10 Tips to Keep a Family Caregiver from Losing Their Mind

Frailty

Recognition of frailty in the older patient should prompt the clinician to consider palliative-type interventions in a planned fashion. The authors talk of the prescence of 3 of 5 features as significant for frailty

loss of strength
weight loss
low levels of activity
poor endurance or fatigue
slowed performance


"There Are Things I Can't Do Anymore That I Wish I Could . . . "

tamiflu® concerns

From the FDA today

FDA Orders Caution Over the Use of Tamiflu

counselling delays placement

Who would have thought it?

Doesn't seem possible , nevertheless , even if it was true for a fraction of the 18 months deferred it would be worthwhile?

Counseling Alzheimer's Caregivers Postpones the Nursing Home

A case study

Winner of a AAAS Science Journalism Award Stacy Burling's case study of a patient with Alzheimer's disease is described as a 'superb route in to a harrowing subject' written in a beautiful counterpoint style.


Probing a Mind for a Cure

slideshow

Dr John DeVries

Calgary Geriatric Psychiatrist Dr John DeVries was honored Saturday night with the Canadian Academy of Geriatric Psychiatry Award for Lifetime Achievement in Geriatric Psychiatry in Canada

Psychiatrists Recognize for Outstanding Contributions to Mental Health at CPA Annual Conference

wrongful life

The case of a 92 year old woman in Florida who had a living will which expressed a wish to have a peaceful death who was resuscitated and lived for 9 days brought by her granddaughter.

'Death with dignity' on trial in Florida

Staffing mix

Ontario takes a page out of Alberta's book. It does work but it takes time and education. The new LPNs need lots of supervision. Overall this is probably not a good idea given the long term needs in the area and the need to retain 'good' people of all stripes. I would say that the allure to management is relatively short sighted and misses the major issue of the day, namely the human health resource crisis. We need to invest in good people now if we want to prevent sliding backwards.

Long-Term Care Facilities Lay Off RNs: Reductions Threaten Health & Safety of Residents

New LTC act in Ontario

Does more regulation make for better care? Do we have to be told? Do compliance reports and citations really benefit our residents as staff are distracted with the petty minutiae ? Is it evidence based?


Changes to long term care act needed

mobile dental unit

By the spring of 2000 in Alberta
Dentists - coming to a care facility near you

"Elder intimacy"

The article says it all


When love blossoms in the nursing home

Growth in seniors residences in Montreal

growing needs in St Laurent. One in four residents are over 65

2000 local seniors live in residences

statins and heart failure

Age and sex adjusted incidence of death and hospitalization were lower in treated groups ( hazards ratio 0.79 and 0.76 respectively)in this large cohort study.


Statin Therapy and Risks for Death and Hospitalization in Chronic Heart Failure

ADRs in the news

If it's not in the plan of care it makes it much more difficult to justify, especially if your home has previously recieved citations.


Nursing home patient given opiate overdose

Emergency room pressures

Every time there is a new announcement to replace or add LTC beds we should be told the ratio of beds to 1,000 seniors 75+ .This is public money which could be better spent building up community options ( I see that some money is going to Home Care)to promote care nearer the patients.......I cannot tell from this article if , in population terms, this is bringing Waterloo up to the plimsol line of other areas or not. Even if it isn't surely this would be an ideal opportunity to try something else? Responding to the insatiable appetite of emergency rooms with more LTC beds is short sighted in my opinion and not in the best interest of the system or the patient.

Funding gives hope of new long-term beds

risk of dementia in stroke

In this prospective study pre-stroke cognitive impairment was a significant risk factor for dementia (OR 12.4 95% CI 1.5-99)

Effect of a clinical stroke on the risk of dementia in a prospective cohort

Better than statins......

at last some good news, what other drug is this effective against heart disease.......?

Hazard ratio for 1-2 drinks a day = 0.38
p=0.04
nearly 9,000 subjects over 16 years
89 of the 106 MIs occured in men who abstained from alcohol or drank less than one drink a day.

Two Drinks Called Potent Addition to Heart-Healthy Lifestyle

good news for JAMDA

The Journal of the American Medical Directors Association (JAMDA), Official Journal of the American Medical Directors Association, published by Elsevier, has been accepted by Thomson Scientific (formerly ISI), for inclusion in the Science Citation Index ExpandedTM and Current Contents®/Clinical Medicine databases. JAMDA (published 9 times a year) offers coverage of the issues most important to healthcare professionals providing long-term care.

Journal of the American Medical Directors Association accepted into prestigious ISI Index

advocacy in Canada

CARP , the Canadian equivalent of AARP, is wading into the fray.....

Seniors group launches campaign to press politicians for health care reform

Nova Scotia

Accomodation charges going up by a dollar in Nova Scotia to $75.50. The 4,000 beds cost the government $326.0 million. Calgary Health Region , of comparable size, spent $165 million in 2005 on Continuing Care services. Accomodation charges are set by the province in Alberta and range from $42 to $48 a day.

Long term care fees up $1 a day

'departure lounges'

The UK's charismatic Tory leader Mr Cameron's description of some care homes in an address to Age Concern today. Interestingly he distances himself from the Scottish policy on 'free' LTC but talks only in vague terms on his future government's policy on LTC. A partnership between the individual and government and the removal of any asset depleting policies.


David Cameron speech: Our aging population

LTC in Alberta : perspective from CUPE

CUPE publishes its survey of staff working in LTC. Results point to staffing and care issues which have not improved since the Auditor General's report. A particularly disturbing finding was that 49% of respondents felt that there was not enough time to meet resident's needs.


Union survey paints a bleak picture of seniors' care

Crisis in seniors' care (the survey)

LTC vs HC in Vermont

An interesting study from Vermont in 2002 found that residential LTC cost $120 a day in comparison to Home Care ( $80 a day). Since last year a new programme has paid caregivers $10 an hour up to 30 hours a week to provide care in the home. There is now 155 fewer LTC beds and 123 more Home Care clients than last year. Not sure this would have the same success in a centrally controlled system but it does recognize that resource that has no line ie the caregiver.


Vermont Program Allows Elderly Residents To Receive Home Health Care

NPs in LTC

Some work being done in Ontario


Examining The Nurse Practitioner Role in Long-Term Care: Evaluation of a Pilot Project in Canada

transatlantic LTC review from CEPS

From the Centre for European Studies an interesting review of LTC and spending.

Analysis: Cross atlantic exchange to advance long-term care

Ed Stelmach

A 2% limit on property tax for seniors and more trained staff for LTC. Tory leadership hopeful Ed Stelmach

Seniors a priority

geriatrics , the specialty

Apparently the third most popular specialty in the UK.

To manage not neccessarily to cure, this is geriatrics and LTC



Geriatrics Lags in Age of High-Tech Medicine

estrogen and emotion

A fascinating study presented at Neuroscience 2006 yesterday that suggests that older women on hormonal replacement have a greater emotional reaction to negative events. The amygdala is a site for estrogen activity and it is suggested that replacement sustains emotional reactivity in this area of the brain. Unfortunately ( or fortunately) there is no improved memory for such events.


Women on hormone therapy regain emotion response

flesh-eating outbreak

I guess it's possible......

Flesh-eating bacteria kills three in NZ

'bed blockers'

The use of offensive language in our nation's capital.........19% usage in Ottawa , here in Calgary more like 5%.

Senior 'bed blockers' crowding hospitals

atypical antipsychotics

More evidence.......

Drugs to Curb Agitation Are Said to Be Ineffective for Alzheimer’s

Abuse

Caught on camera in Quebec

Woman sues long-term care facility

LTC in Ireland: who is going to pay?

Isn't it time Ireland led the way on elder care?.....it can certainly afford to.

Nursing home Bill to limit grants for older people

end game

These Dutch researchers find that cachexia/dehydration (35%) is the most common final pathway in end stage dementia in the group surviving to total dependance. Cardiovascular ( 20.9%) and pulmonary complications (20.1%) were the next most common.

The natural endpoint of dementia: death from cachexia or dehydration following palliative care?

Robert and Rosalie Kane

Scholars in LTC


Experts on aging to address long-term care Oct. 24 at WUSTL's School of Social Work

decreased demand for LTC

In one area of the US there has been a decline in skilled nursing facility beds by 450 since 2003. The county executive for Albany county is proposing a 'single point of entry' model called 'long term care point of entry' to provide services to those individuals who wish to remain at home..sound familiar?

Breslin proposal taps care options

LTC centre delayed

A proposed LTC centre for High River, Alberta has been deferred due to high labour and construction costs. The centre is now due to open 2009. There is a planned increase in LTC beds as they move from the hospital with the addition of supportive living units.

Long-term care facility on hold
High labour and construction costs

Not guilty plea

The owners of St Rita's nursing home in the St Bernard Parish of New Orleans, Salvador and Mabel Mangano, pleaded not guilty to charges of negligent homicide in the deaths of 35 residents last year after the levees broke and flooded their home in 20 minutes.


Nursing home owners say not guilty in storm deaths

multivitamins and chronic disease

This conference review article concludes “Evidence is insufficient to prove the presence or absence of benefits from use of multivitamin and mineral supplements to prevent cancer and chronic disease.” The reviewers felt that the studies were not rigourous enough for them to make a clear statement of benefit or harm. Who is going to tell the 50% of American adults that take dietary supplements?

National Institutes of Health State-of-the-Science Conference Statement: Multivitamin/Mineral Supplements and Chronic Disease Prevention

http://www.ahrq.gov/downloads/pub/evidence/pdf/multivit/multivit.pdf

FTD video

Video taken at the 2005 Frontotemporal Dementia Caregiver Conference on November 11, 2005 in Philadelphia, PA. The speaker for this segment ... all » was Valerie T. Cotter, M.S.N., C.R.N.P., F.A.A.N.P., on the topic of Staging & Long Term Care
Frontotemporal Dementia - Staging & Long Term Care (Valerie Cotter)

death by hot water bottle

9%
Nursing home patient died from hot water bottle burns, inquest told

LTC announcements in Ontario

George Smitherman ( Minister of Health in Ontario) will announce the Long Term Care Homes Act 2006 today. This will include whistle blower protection, a resident's bill of rights, regulations limiting the use of temporary staff, 24 hour a day registered nursing care, more training and education for staff.


Nursing homes face tougher rules

LTC in Kingston

more money for LTC and Home Care in Kingston

McGuinty Government Improving Access To Long-Term Care Services In Kingston

quality improvement

CMS and several industry groups kicked off a participation drive today as part of "Advancing Excellence in America's nursing homes" The eight areas to choose from are
The eight areas are: reducing high-risk pressure ulcers; reducing use of physical restraints; improving pain management for short- and long-term residents; setting specific targets for quality improvement; assessing resident and family satisfaction; increasing staff retention; and making staff assignments more consistent.

Group kicks off initiative to improve long-term care

Abuse and neglect

A sad litany of events in this review article. Has nothing changed? Many issues can be traced back to staffing levels but surely its more than a supply issue?

Residents in nursing homes are some of the most vulnerable and helpless citizens in the US, with nearly 1.7 million elderly and disabled persons residing in about 17,000 facilities. And as difficult as it is to believe in this day and age, there is indisputable evidence to show that many nursing home residents are being neglected and abused on a daily basis

Nursing Home Fraud Neglect & Abuse Much Too Common

faux resident

A student in gerontological studies programme at Miami university spends 12 weeks as a resident in a nursing home. She described the experience as 'indescribable, wonderful'

MU student spent 12 weeks living in a nursing home

Telephone medicine in LTC

From this months JAMDA.This article discusses the fact that nurses and physicians appreciate different aspects of telephone medicine in LTC. From two focus groups the researchers made the following QI recomendations

1) better nursing assessment and provision of patient information
2) minimization of nonurgent calls after hours
3) more decisive physician action (or explanation of inaction)
4) better physician familiarity with facility policies/logistics
5) better communication/paging system.

Considering how many care decisions are made over the phone this study should be broadly distributed and read!

Inter-disciplinary Focus Groups on Telephone Medicine: A Quality Improvement Initiative

Hospital food ( again)

No surprises here. I was intrigued by 23% of patients being too far from their food, I moved a couple of patients closer to the table on my last rounds.....

58 percent of older hospital patients have problems eating, 31 percent leave most of their meal

AMDA responds to Consumers Report

The American Medical Directors Association suggests that the prescence of a strong medical director on site has been associated with the following

- Reduced use of physical restraints by 50%;
- Reduced dehydration by 50%;
- Reduced rate of use of indwelling catheters by 29%;
- Increased treatment of depression by 12%;
- Increased residents with advance directives by 64%;
- Increased use of hearing aids for persons with hearing difficulty by 30%; and
- Reduced use of hospital services by 25%.

AMDA Responds to Consumer Reports Article on Nursing Homes

Long term acute care

? same as subacute care
Read more about this rehab unit in Northern California

Medical makeover: Rehab hospital switches focus to long-term acute patients

Al Wilke's blog

Read Dr Wilke's blog entry on nursing homes.......

Nursing Homes, Part of the "Shell Game"

delayed placement

Another study that demonstrates delay to placement ( three months) and improved quality of life in patients taking cholinesterase inhibitors.

Drug May Delay Nursing Home Placement for Dementia Patients

BNP

This could be a useful test in LTC in the setting of dyspnea and raised respiratory rate. The authors of this review article conclude that there is strong evidence that a low BNP level will exclude CHF in patients presenting to Emergency.


Natriuretic peptides in the diagnosis and management of heart failure

nimby in St John's

Don't you love it?

Posh St. John's neighbourhood nixes home for seniors

New Canadian Lipid Guidelines

Unfortunately not full text online yet that I can see. Published in the Canadian Journal of Cardiology September 2006, Volume 22, Number 11: 913-927. Not much about the elderly or LTC but they have expanded the Framingham table by 5 years up to 79, small steps...

Canadian Cardiovascular Society position statement – Recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease

quake zone

More needs to be done for older patients living in the earthquake zone of Kashmir ( 2005)it was announced at a 3 day conference in Muzaffarabad ( capital city of the state of Azad Kashmir) by a representative of HelpAge International.


‘Geriatric, palliative care received less attention in quake hit zone’

Campus of care

Fraser Health to control 90 LTC beds

Care home gets nod

minimum staffing levels

The Ontario government is promising to release a new Long Term Care Act in the fall to the legislature. According to SEIU Local 1.on there will be no reference to minimum staffing levels. A report will be released on Friday

Ontario Nursing Home Residents Deserve a Guaranteed Amount of Care Hours

Staying in bed

Is it bad for patients to stay in bed in LTC? Who gets to decide? Baycrest and U of T are collaborating in a research project to find out.


Study takes a look at patients in continuing care

Measurement of care

Dr Chappell in Victoria is leading a group of investigators using new easy to use measures for care of older people with dementia in LTC

An ongoing study seeks ways to improve dementia care in British Columbia

Home Care in Hamilton

Deficits and waiting lists in Hamilton.
9% increase in people receiving home care this year and a 18% increase in clients post acute care
20 out of 42 CCACs are projecting deficits
Hamilton CCAC has 11,000 clients a month and will soon merge with five neighbouring CCACs

Home-care service cuts would be 'disaster' for seniors

Driving cessation

A Canadian study on driving cessation in the context of dementia/cognitive impairment led by Dr Hermann out of Sunnybrook looks at 3 years of data in todays CMAJ. Agitation, apathy and hallucinations were all predictors of driving cessation. However no easy solution is suggested to assist the family and family physician in counselling regarding cessation of driving in early dementia.

Predictors of driving cessation in mild-to-moderate dementia

pre-MCI : what next?

What do I tell patients now? A study out of Dartmouth

Seniors who feel their 'mind is going' could very well be right

hospital food ( in Glasgow anyway)

Confused, sick, starving … old

Ageism in the health service

A study and editorial in today's BMJ regarding the undertreatment of strokes and TIAs on the basis of age and in light of clear benefit. As Professor John Young (Academic Unit of Elderly Care and Rehabilitation, St Luke’s Hospital, Bradford, UK) states in his editorial

Whenever a clinical stone is turned over, ageism is revealed, he says. For example, in cancer services, coronary care units, prevention of vascular disease, and in mental health services. To this list, we must now add the management of transient ischaemic attacks and minor strokes.

AGEISM ENDEMIC IN HEALTH SERVICES

Green House Project

Hear Dr William Thomas ( founder of the Eden Alternative) talk about his latest project , the Green House project. Smaller more resident orientated housing for LTC. In this brief sound clip he talks about reducing the use of wheelchairs in one centre from 70% to 30%. Smaller housing means better privacy and dignity.

A Different Kind of Nursing Home

ADRs

From this weeks JAMA. A one hour educational intervention resulted in a ten fold increase in reporting of adverse drug reactions in 1,400 physicians in Portugal. A significant difference in the intervention group was sustained at one year.

An Educational Intervention to Improve Physician Reporting of Adverse Drug Reactions

Smart beds

This story from Singapore where a smart bed has been developed that will trigger staff to attend to residents who are in imminent danger of falling from bed

No more falling off beds

Geriatrician shortage

September JAGS article from Canadian geriatrician Dr Laura Diachun describes the current and projected shortage in her area ( 200 geriatricians for the entire country , approximately a third of the current requirements at 1.25 physicians per 10,000 65+)


Boomers face critical shortage of geriatricians when they reach old age: study

Cholinesterase inhibitors

The debate in the UK continues in this BMJ commentary from Friday. Too little evidence of efficacy too many resources spent in specialty memory clinics, not enough care throughout the disease.


Role of cholinesterase inhibitors in dementia care needs rethinking

Risk factor for LTC?

This recent study in the Journal of Gerontology:Medical Sciences gives persistent difficulty with bathing requiring assistance a 77% increased risk of nursing home admission.

Bathing a marker for nursing home

Nursing homes in China

Some 140 million Chinese people are aged 60 or older ( this is the same proportion of seniors as in the whole of Europe). In this article in the Shanghai Daily a senior kindergarten is proposed which offers 'non-secluded' care in Shijiazhuang, capital city of north China's Hebei Province.


"Senior kindergartens" provide care elderly close to home

Incompetence in Cambridge

More of the same.......


MP calls for probe into nursing home

AARP paper

This was published in 2002 by AARP and provides an excellent summary of how chronic care is evolving in the US away from nursing homes into the community.

Before the Boom:Trends in Long-Term Supportive Services for Older Americans with Disabilities

Aggression

A recent cross sectional study in the Archives of Internal Medicine using MDS data of 100,000 LTC residents found that the prescence of depression, constipation, delusions and hallucinations were all associated with physical aggression. (7% of residents had been physically aggressive in the previous week). Treatment of the underlying cause would seem to be the best course if causality is agreed.

Potentially Modifiable Resident Characteristics That Are Associated With Physical or Verbal Aggression Among Nursing Home Residents With Dementia

primary care

An excellent review in tomorrows NEJM

It has been estimated that it would take 10.6 hours per working day to deliver all recommended care for patients with chronic conditions, plus 7.4 hours per day to provide evidence-based preventive care, to an average panel of 2500 patients (the mean U.S. panel size is 2300).4

Primary Care — Will It Survive?

a placement issue

Apparent murder-suicide in a BC hospital as a woman with Alzheimers disease awaited placement to LTC. Is the idea of placement that bad?

Elderly couple in murder-suicide at B.C. hospital

Memantine

A letter in the CMAJ from Drs Gauthier and Herrman describing their current Lundbeck sponsored study on the possible anti-psychotic sparing properties of this NMDA receptor antagonist. The only province convinced of the benefit of this drug to date has been Quebec.

Use of memantine to treat Alzheimer's disease

Rosetta stone

New guidelines that describe a common set of standards and tests for cognitive impairment in stroke and dementia are published in yesterday's issue of Stroke.

Is it Alzheimer's or is it a stroke?

National Institute of Neurological Disorders and Stroke–Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards

Bedsores

An interesting review article of nearly 60 randomized control trials on bedsores from the last 30 years conducted by Canadian geriatricians Paula Rochon and Madhuri Reddy published in JAMA. They conclude that there is a lack of well designed studies and that the usual preventative interventions such as off loading, repositioning, optimizing nutritional status appear to be appropriate.

JAMA

Canada.com

More bad news for caregivers

A new study today from Metlife Mature Market Institute ( a disinterested entity in the LTC insurance industry I'm sure ;-) reveals that caregivers suffer financially and physically from caring for patients with Alzheimers. For an individual with Alzheimer's disease or a related disorder, the total average cost of services annually,considering paid and unpaid care, was $77,447,compared to $59,088 for a person with serious physical problems. and that Alzheimer's caregivers indicate that caregiving has caused theirhealth to worsen 45% more often than other caregivers

Alzheimer's Caregivers Report More Stress, Higher Costs And A Greater Commitment Of Time, According To New MetLife Mature Market Institute Study

Vancouver coastal services

A quick summary in today's North Shore News on community care services for seniors in North and West Vancouver

Community care programs varied

hospice in LTC

A new study from Brown Medical School has shown that admission to hospice significantly reduces hospitalizations at the end of life. Some 80% of nursing homes in the US have arrangements to provide hospice care.

Nursing-Home Hospice Care Reduces End-of-Life Hospitalizations

Nursing home evacuations

Report from Dept of Health and Human Services in the US has concluded that the majority of residents who were moved during last years hurricanes along the Gulf coast suffered more than those that were not moved according to a NY Times article today. The entire evacuation process was inadequate from how much food and water to bring to which route to take. Perfectly legal emergency plans were flawed.

Report Calls for Tighter Rules in Nursing Home Evacuations

850 waiting for LTC in Ottawa

According to MPP Lisa Macleod in today's Ottawa Sun


MPP calls for long-term care

Geriatric 1927

The hottest video blog on 'You Tube' from an unlikely senior who remains anonymous somewhere in the middle of England..........nine short videos to date........fascinating

Geriatric 1927

Diagnosis of dementia

A review in the September issue of the Journal of Geriatric Psychiatry and Neurology by leading authors on the determination of the diagnosis of dementia in preparatation for the next edition of DSM (V).
For instance Barry Reisberg suggests that we no longer consider AD as a diagnosis of exclusion,that we abandon the dichotomy of pre-senile and senile dementia and that there should be more clinical description of the disease.

Modern Diagnostic Approaches in Dementia: On the Cusp of Change

culture change in LTC

Another article on the so-called culture change in some centres that is putting residents at the centre of care.


Culture change is on the horizon for long-term health care

Terminal sedation

An editorial piece in yesterdays New York Times that discusses 'double effect'


The Fuzzy Gray Place in the Killing Zone

Managed Death in PACE

An interesting article from the most recent issue of JAMDA that describes the introduction of a documentation tool around health care wishes in a 'pathway' format to a PACE programme. Post introduction there was less invasive interventions, greater compliance with advance directives and fewer deaths in hospital.

Managed Death in a PACE: Pathways in Present and Advance Directives

Urinary incontinence and quality of life

An article in JAGS that looked at MDS data from all nursing homes in 5 states between 1994 and 1996 and was able to show decreased quality of life measures with UI regardless of cognitive function or functional competence.


The Effect of Urinary Incontinence on Quality of Life in Older Nursing Home Residents

Nursing Home Guide

The excellent Consumer Reports guide to nursing homes in the US. For-profits and chains not performing as well as the not-for-profits and the smaller independant homes.


Nursing Home Guide

Equal choice

New legislation passed in Massachusetts yesterday will give seniors in that state equal access to Home Care and Nursing Home Care. The state currently spends only 25% of its long term care budget on Home Care. Some states that have moved towards greater Home Care spend up to 50%


Home care bill signed

LTC meets the Sopranos

Nursing home protection racket

Medical Directors in LTC

Read Chris Frank's study in the June edition of the Canadian Family Physician.

82.7% of respondents felt that there was a serious shortage of physicians to work in LTC.

Medical directors of long-term care facilities

Assisted suicide attempt in LTC

B.C. doctor accused of helping a patient in a bid to commit suicide

personal protective equipment

A discouraging study and commentary by John Conly on personal protective equipment in this weeks CMAJ.

Personal protective equipment for preventing respiratory infections: What have we really learned?

antipsychotics: more smoke

Further evidence from Lilly (the makers of Zyprexa) on the adverse effects of antipsychotic medications in the elderly from the Journal of Clinial Psychiatry . Six studies were examined for mortality , CVAEs and other adverse effects in the use of olanzapine, risperidone and conventional anti-psychotics . Mortality was found to be significantly higher in olanzapine treated patients (3.5%)than in placebo treated patients ( 1.5%) There was no difference in crude mortality between olanzapine and risperidone and conventional anti-psychotics.

A Review of Treatment-Emergent Adverse Events During Olanzapine Clinical Trials in Elderly Patients With Dementia.

Exercise and constipation

This study published yesterday in BMC Geriatrics failed to show that moderate intensity exercise improved habitual physical activity or constipation for the 22% of residents diagnosed with this problem after 6 months


Effects of resistance and functional-skills training on habitual activity and
constipation among older adults living in long-term care facilities: a randomized
controlled trial

LTC in UK

The fall out from the Panorama special continues. In this article from yesterdays Observer a new model of funding is proposed which will guarantee minimum levels of care. In the UK today it costs families 24,000 GBP for a year of care, the same as school fees at Eton College.

Growing concern over provision of long-term care sparks campaign

nursing home acquired pneumonia

A recent update on treatment options from Dr Mylotte

NHAP

Pressure mounts in UK for changes to LTC

Lack of clarity around medical vs social need in chronic care.

Pressure on for long term care rule rejig

heat related nursing home deaths

+30 temperatures in Europe claim the lives of 3 LTC residents in Amsterdam

Heat blamed in deaths of three nursing home residents

Ontario LTC physicians conference in October

Geriatric Medicine for the Practising Physician

The heat

warm in Fremont


Heat forces evacuation of residents at Fremont nursing home

A sign of things to come?

A western Mantiban nursing home has been forced to transfer 10 residents due to staffing shortages to other facilities. At one stage recently there was 7 unfilled shifts at the 50 bed personal care home in the town of Virden in the Assiniboine Regional Health Authority


Staff shortage forces nursing home residents to move

The cost of LTC

A nice summary of the cost burden on individuals requiring LTC in the UK

Families’ fees nightmare is likely to be very long-term

Med errors

The Institute of Medicine's latest missive on medication errors

Medication Errors Injure 1.5 million Americans a Year

Singapore readiness exercises

Nursing homes and hospitals prepare for pandemic influenza in Singapore. This story describes how one nursing home ( Lions Home for the Elders at Toa Payoh Rise)is using role playing to teach residents staff and families.


Nursing Home does it with role playing

Access to care for immigrant families

A recent study in BC has revealed issues with immigrant communities and care of the elderly. Assumptions regarding care within families are often erroneous with more families unable to care for their own at home. Care providers need to better understand what the current norms are and how to overcome barriers to care for these families. Misunderstandings on both sides abound with the patient in the middle of it all.


Barriers to Access to Care for Ethnic Minority Seniors

There are many reasons for their lack of understanding of the system
-their recent arrival in BC,
-lack of communication between family physicians and the health
authority,
-inability to find a family physician who speaks their language,
-lack of knowledge about the availability of interpreters,
-scarcity of interpretation services and translated materials,
-insufficient English language skills to use the telephone or public
transportation,
-reliance on family members for transportation and interpretation,
-restrictions on movement outside the home due to childcare
responsibilities and/or cultural mores, and
-lack of access to the internet.

Katrina

Palliative care or mercy killing? The attorney general of Louisiana has charged Dr Pou and her nurse colleagues with murder.

Louisiana Doctor Said to Have Faced Chaos

Caregivers and gender

Genworth Financial in the US reports on LTC yesterday. They state that women have a 60% greater chance of entering LTC and that women experience significant financial hardships in their roles as unpaid caregivers. With the first of America's 77 million bababy boomers turning 60 this year there is a need to consider LTC and wellness. Key findings include estimates of 23 million unpaid caregivers ( 70% of whom are women) , 19% of caregivers provide 'constant care' of at least 40 hours a week ( of those 80% are women) and women aged 65 and older have a 44% chance of entering a nursing home compared to 27% of men.

Women Bear Greater Share of Long Term Care Risks and Costs According to Genworth Financial Study

Transfers to hospital

Could be cut by a third?? Article in todays Boston Globe

Nursing Homes seed deficient on basic care

Code status

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Dr Brechtelsbauer discusses code status in this months 'Caring for the Ages'

Determining a New Patient's Code Status

AMDA

The American Medical Directors Association has spruced up its web site..........http://www.amda.com/index.cfm

Parkinsons

Only specialists should diagnose Parkinsons disease........according to NICE, oh really?

Considering drug cost

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A very elegant essay on the need to consider cost of therapy in the development of new clinical practice guidelines from Drs Johnson and Edwards from last weeks CMAJ

Evidence and advocacy: Are all things considered?

Dehydration

A useful review on hydration in the elderly and its importance to health outcomes. In a study done by the author of this article, 31% of the LTC residents she followed over six months were dehydrated. In a different study found that 48% of older adults admitted from Emergency Departments had laboratory values indicative of dehydration.

Study finds hydration lacking in older adults

When to consider LTC?

Barry Goldlist writes on long term care in today's Globe and Mail

When to consider Long Term Care?

Dental care for seniors : the gaps

A thoughtful review of dental care by Dr. MacEntee a professor in the division of prosthodontics and dental geriatrics, department of oral health sciences, faculty of dentistry, University of British Columbia, Vancouver.


Missing Links in Oral Health Care for Frail Elderly People

Long term acute care?

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Is this subacute care?

Outsiders to expand acute care in the region

Personal care in Scotland

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From an article in the Scotsman.
Problems with free personal care for the elderly in Scotland were uncovered as it was found that councils differ in how need is assessed. The cost of free personal and nursing care has risen from 107 million British pounds to 153 in the last financial year. Scotland has provided free personal care since the publication of a Royal Commission report in 1999 called 'With respect to Old Age'

Fresh Blow to Free Personal Care System

Pandemic planning checklist for LTC

Useful checklist from Health & Human Services in the US

Long Term Care and Other Residential Facilities Pandemic Influenza Planning Checklist

Interactive website for older Canadian drivers

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This looks interesting and new from the CAA

Helping Aging Drivers

New Canadian initiative

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The National Initiative for the Care of the Elderly(NICE). (Not to be confused with the other NICE National Institute for Health and Clinical Excellence in the UK.

Their stated goal The overarching goal will be the dissemination of research and best practices for the care of older adults

Launched last week Wednesday June 16 2006

National Initiative for the Care of the Elderly

Poor standards everywhere ?

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A tendering process has revealed poor standards of care in Irish nursing homes.

Poor nursing home standards revealed

Pressure sores on the rise

Data out of the US from the Agency for Healthcare Research and Quality reveals a 63% rise in the number of pressure ulcers in hospital patients from 1993 to 2003. Some interesting data on the 455,000 cases can be found in a statistical brief linked below

Hospitalizations related to pressure sores , 2003

Staffing diversity

A story out of the US highlighting the dependence of many homes on immigrant workers who add to the cultural diversity of the workforce. A nurse from the Philippines describes how she can earn $23 an hour compared to $120 a month in her home country.

Care of aging Americans often in immigrants' hands

Oral supplements

Editorial and article in the current issue of JAGS on the problem of oral supplements in nursing homes. Weight loss and malnutrition are common problems in LTC and often the only intervention is oral supplements. It was found in this study and in past studies that a significant number of oral supplements were not being given as prescribed. There was also issues regarding the time spent by staff when supplements were being given. Other issues around oral supplementation included a lack of investigation as to the cause of the weight loss, inadequate staffing in many centres, interference with appetite and inadequate caloric intake despite oral supplementation.



DOI:10.1111/j.1532-5415.2006.00740.x

Happines and age

In all, a statistical analysis of the results show, people in the older group reported a current level of happiness for themselves that was significantly higher than the self-rating made by the younger group's members. And yet, participants of all ages thought that the average 30-year-old would be happier than the average 70-year-old, and that happiness would decline with age.


Hope I Die Before I Get Old?

Man found dead in nursing home

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Yes, nothing startling about that you might say.......except that he was undiscovered for 3 days.


Man lay dead for days at nursing home

Nursing home violence

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Stabbing in a Japanese nursing home

Elderly man stabs fellow nursing home resident in bath squabble

COX-2

Health Canada's final report on the cardiovascular risks of COX-2 selective non-steroidal anti-inflammatory drugs. They state that long term use of the COX-2 selective drugs are associated with increased risk of cardiovascular events when compared to placebo. They recommend the labeling of _all_ NSAIDs to reflect cardiovascular risk but that no data exists to rank such risk.

Report on the Cardiovascular Risks Associated with COX-2 Selective Non-Steroidal Anti-Inflammatory Drugs

New York

One third of US Medicaid's personal care dollars were spent in New York in 2004.
Medicaid, originally intended to help the poor and disabled, is now increasingly used by the middle class; aggressive elder law attorneys are helping New Yorkers shelter assets and disavow family responsibilities in order to get the state to pay for care that patients and their families could afford on their own.


Long Term Care's perfect storm

Moving out of LTC

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A story in the San Francisco Chronicle that captures a trend in the US with seniors choosing assisted living over LTC and moving out of institutional care. There is an ongoing need to refine admitting and discharge processes across care streams. A possible role that a community based case manager could fulfill??


Seniors Moving Out of Nursing Home System

START programme

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A story from the Edmonton journal on the START programme at the Glenrose under the medical direction of Dr Darryl Rolfson. The programme ( short term assessment and rehabilitation treatment) is aimed at supporting frail seniors in the community to live as independently as possible and avoid admissions to LTC.


Glenrose programme keeps seniors active

Muslims and LTC

Is the placing of a Muslim patient in a nursing home a violation of religious principles? The debate is explored in today's New York Times. Some say that modern teaching needs to reflect the current reality for many Muslims and caring for older relatives and family.




Muslims Seek To Reconcile Need for Nursing Home Care With Religious Teachings

Canadian Healthcare Association merges

Two leading national health organizations announce amalgamation. The Canadian Assocition for Community Care and the Canadian Healthcare Association will become the Canadian Healthcare Association. The CACC was formed in 1995 following the merger of HomeSupport Canada and the Canadian Long Term Care Associaion. The 75 year old CHA is the federation of provincial and territorial hosptial and health organizations across Canada. The CHA is a leader in developing and advocating for health policy solutions that meet the needs of Canadians.


Leading national health organizations announce amalgamation

the generalist

In praise of the generalist

Generalism versus subspecialization: Changes necessary in medical education

antipsychotic drugs

Editorial in this weeks BMJ commenting on the CATIE study(NEJM 2005;353:1209)that suggested that older anti-psychotics still have a therapeutic role if one looks at efficacy , safety and cost.

Are older antipsychotic drugs obsolete?

Culture change in LTC

Commentary in the Star Tribune Minneapolis-St Paul referring to the change underway in LTC housing. The future is predicted to be smaller more home like settings with a client focus and an emphasis on hospitality. The article states that 250 of the 16,000 nursing homes in the US have adopted this new model


Culture Change in LTC

Blood glucose testing in LTC

Protocol out of Oregon that provides a guide to the level of blood glucose monitoring in nursing homes published online in JAGS. The protocol is congruent with AMDA guidelines but unfortunately for Canadians is in imperial units!

Development of a Protocol for Capillary Blood Glucose Testing in Nursing Home and Rehabilitation Settings

Irish nursing homes

The Tanaiste Mary Harney launched a document 'National Quality Care for Nursing Homes' on behalf of Excellence Ireland Quality Association on May 25 2006. The Irish government is working on a new Health Bill which will provide for the establishment of a Health Information and Quality Authority and has struck a working group to develop standards for residential care settings for older people. Sound familiar?


Tanaiste launches National Quality Care for Nursing Homes' developed by Excellence Ireland Quality association ( EIQA)

Nursing home acquired pneumonia

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Dr Mark Loeb and colleagues at McMaster have published a randomized controlled trial using a clinical pathway for pneumonia in the nursing home. They found that mortality rates , health related quality of life measures and functional outcomes were not significantly different between clinical pathway group and the usual care group. Transfers to hospital, however, were halved in the clinical pathway group ( mean reduction in hospitalize was 12% after adjusting for clustering of residents). They suggest a saving of $1,016 per resident treated

Effect of Clinical Pathway to Reduce hospitalize in Nursing Home Residents With Pneumonia

Capacity and the frail elderly

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Ken Rockwood's wonderful editorial in this weeks CMAJ exploring the challenges in caring for the frail elderly with reduced capacity. He suggests among other things that we need to create better environments and processes ( especially in hospitals) that don't undermine our older patients autonomy when they are sick and need our help. He also issues a call for a renewed look at our professionalism.
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Capacity , population aging and professionalism

time management

A useful article on how physicians can manage their time more effectively in this weeks Medical Post


Patient-ly waiting

Seroquel

Class action suit against Astrazeneca the manufacturers of Seroquel

MONTREAL, June 1 /CNW Telbec/ - Mr. François-Luc Lavallée, a 48 year-old citizen of Bois-des-Fillions, Québec, is the representative Plaintiff in a national class action claiming more than $100,000,000 in damages and interest on behalf of the entire plaintiff class from the multi-national company AstraZeneca. Mr. Lavallee has issued a claim by way of a class action on behalf of all citizens, in Canada, who took the antipsychotic medication Seroquel(R). Seroquel(R) is prescribed for various mental health problems such as schizophrenia and bi-polar disorder.

Mr. Lavallée alleges having developed, among other problems, Type II diabetes after having used this medication and he alleges AstraZeneca has failed to inform the public, health authorities and patients of the serious health risks associated with this medication.

Seroquel(R) has been prescribed to more than 8 million people across the globe. This drug is a sales leader in the atypical antipsychotic pharmaceutical market in the United States and in Canada. The plaintiff class is estimated at thousands of persons. Many legal actions have been filed in the United States and in Canada, namely in Alberta, and British Columbia alleging similar claims.

Mr. Lavallée is represented by Lauzon Bélanger, a prominent class action firm in Canada, which works in close collaboration with McNally Cuming Raymaker who represents claimants from Alberta, and British Columbia, as well as Roy Elliott Kim O'Connor who represents class members in Ontario.

All persons interested by this class action request may consult the complete text of the motion on Lauzon Bélanger's Web site at www.lauzonbelanger.qc.ca or contact the firm's Member Services by e-mail to serviceauxmembres@lauzonbelanger.qc.ca or by phone at 514-287-1000 or 1-800-287-8587.

For Ontario inquiries, please contact REKO LLP at www.reko.ca , by e-mail to info@reko.ca or by phone at 416-362-1989.

In Western Canada, please contact McNally Cuming Raymaker, at www.mcnallycuming.com, by e-mail to rfogel@mcnallycuming.com, or by phone at 1-800-682-2480.

/CONTACT: Anna Vetere, director, Lauzon Bélanger inc., (514) 287-1000, 1-800-287-8587

(END) Dow Jones Newswires

Physician shortages

Not much better south of the border. Shortages are being experienced in many communities. Retirement rate by 2020 will be 22,000 physicians a year ( currently around 9,000). To compound the problem a new generation of physicians are reportedly 10% less productive working less slavish hours.

A doctor shortage threatens to set off healthcare crisis

Sexual assault in nursing home

An 18 month sentence was handed down in Calgary after a caregiver pleaded guilty to sexually assaulting an 86 year old resident of a long term care centre. The caregiver was a physician in his native Peru and worked as care aide in a Calgary facility.


Caregiver jailed for senior sex assault

Extendicare plans

Extendicare plans to split off its Assisted Living business in the US into a public company which will make it the fifth largest provider of assisted living in the US

Extendicare bucks trend

Respite care : one solution

Respite care

Adults can check in their aging parents for anywhere from three days to several months at the Griffith McConnell Residence for seniors in Cote St. Luc.

Accomodation costs between $57 and $150 a day inclusive of care

The short-term stay program there fills a much-needed niche in services to caregivers and care recipients, said Elizabeth Ball, a social worker at Centre de sante et de services sociaux Cavendish (CSSS Cavendish), which was formerly CLSC Rene Cassin and serves Cote St. Luc, N.D.G. and Montreal West.

Pandemic portal

Pandemic influenza portal at Health Canada with latest news on avian influenza, travel ehealth advisories and links to the Public Health Agency of Canada.

Pandemic influenza

New Canadian guidelines for Seniors Mental Health

Dr Conn and Leclair from Toronto have completed the Canadian Coalition for Seniors' Mental Health guidelines for the management of the following conditions
-delirium
-depression
-suicide
-mental health issues in LTC Homes (sic)

Canadian guidelines for Seniors Mental Health

Ambulance transfers

Election ( June 13) promises in Nova Scotia. NDP will eliminate the cost of ambulance transfers to hospital ( $120) and to other nursing homes ($600). They cite discriminatory policy that places seniors in homes many km from family. The cost of transfer to a closer facility when a bed becomes available is borne by the patient.

Nova Scotia election promises

Alternative therapies in the UK

Commentary in yesterday's Times regarding alternative therapies and public funding. Are patients really turning to alternative therapies because GPs only have seven minutes a consultation?

Alternative thinking

Toronto nursing home deaths

Toronto nursing home mystery illness death toll now 16

Drug Spending in Canada

Drug Spending in Canada

Total drug expenditure per person for 2005 was $770 an increase of 10% on the previous year

Public Reporting on LTC in Ontario

Public Reporting on Long Term Care in Ontario

How reporting is working in Ontario

New Continuing Care Standards

New Continuing Care Standards in Alberta

New standards for care in Alberta announced May 5