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