Code status

-
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

-
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?

-
Is this subacute care?

Outsiders to expand acute care in the region

Personal care in Scotland

.
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

.
This looks interesting and new from the CAA

Helping Aging Drivers

New Canadian initiative

.
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 ?

.
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

.
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

.
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

.
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

_
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

-
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

-
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.
-


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.