tagging

what's interesting is the support from the comments. All is well in theory but if used to substitute care or if expectations and responsibilities are not clear there could be tears.

Charity supports dementia tagging

antipsychotics

sobering data from IMS.

The LTC and hospital culture that needs reforming. Medical and nursing staff need to know that neuroleptics don't work very well and are probably not safe. There are other safer interventions. Antipsychotics can be very useful in some patients ie psychoses and actual violent behaviour and that's really it......

A CBC News investigation into the increasing use of atypical anti-psychotics among the elderly

neuroleptics

not sure if I agree with his proposal to use benzodiazepines over neuroleptics in the eldery especially, surely a non-pharm approach is the ideal.......


Why are doctors still prescribing neuroleptics?

antipsychotics

Great variation in prescribing rates reported in this article 21% to 70%. Costly drugs of uncertain efficacy with potential harm. A metaphor for the so-called medical model that treats all dementia patients in the same fashion.

Nursing Homes Often Medicate Residents Without Psychosis

20 years on

OBRA 20 years later
An excellent resource from the Kaiser Family Foundation

New Resources and Briefing Explore Nursing Home Reform Twenty Years After Passage of Landmark Law

facility size

smaller is better. In this case a care centre in Nova Scotia wants to build smaller house or pods with a 10-15% increase in operating costs. The model is based on one of Evergreen's facilties in Oshkosh Wisconsin.

Smaller units the focus of new nursing home

incontinence

basic care .....again


Human rights complaint filed over seniors left in old diapers

judge lifts DNR order

patient makes dramatic recovery. Who has the final say now in Alberta?

Doctors, not judges, should control patient care: appeal

the move towards home care

in 20 years 4.2% to 3.6% adults in nursing homes in the US

Business Booming for Home-Care Franchises

refractive error in LTC

this seems so obvious yet........


Correcting Poor Vision In Nursing Home Residents May Decrease Symptoms Of Depression

falls in the UK

a third of fractured hips do not receive surgery by 48hours........
'Gaps' in elderly falls services

LTC accomodation rates in Nova Scotia

not very pretty
Long-term-care rates increase

Dr St Martin

9 physicians for 1350 LTC patients and growth at 4% a year in Sudbury Ontario

In search of a silver lining - Editorial (add your voice)

venous wound healing

a meta-analysis that was unable to demonstrate a significant difference between hydrocolloid, foam, hydrogel , alginate or low adherent dressing in venous ulcer healing.....

Dressings for venous leg ulcers: systematic review and meta-analysis

hip replacement

it certainly is..........The operation of the century: total hip replacement

EMR and osteoporosis

The first study to link improved osteoporosis management outcomes to the use of an EMR


Outreach Improves Osteoporosis Management after Fracture

sleep

A brief review article from today's New York Times on sleep. Problems seem to present after 60.....mostly causing secondary sleep disorders

The Elderly Always Sleep Worse, and Other Myths of Aging

aging in China

No system in place for older people. Traditionally families have cared for older relatives. This article from today's China Daily


Aging population 'a challenge'

Influenza A in Calgary LTC

Outbreak reveals early start to flu season

antipsychotics and dementia

More evidence........

observational study but the concerns aren't diminishing for these meds in dementia 22-29% vs 14%

Mortality Risk in Patients With Dementia Treated With Antipsychotics Versus Other Psychiatric Medications

feeding tubes

Review of a book on feeding tubes in last Saturdays's Jerusalem post. Geriatrician Mark Clarfield identifies absurd financial incentives in Israeli centres in relation to complex care and feeding tubes.

A completely unpalatable situation

reform of LTC in UK

“Our failure to support frail and vulnerable older people has been one of the unrecognised scandals of our time.."

“This move represents a bold first step at addressing one of the greatest social challenges facing the government. For too long this has been a no-go area for politicians since the Royal Commission on Long Term Care reported in 1999."

Well, until this is recognized as primarily an issue of health , nothing will change
......
King's Fund welcomes ‘historic move' on the future of long term care for millions of older people and their carers

edentulousness and dementia

more than simply forgetting to put in your teeth I suspect.......

Tooth loss, dementia may be linked, JADA study suggests

donepezil and agitation

small short study with no significant effect

Donepezil for the Treatment of Agitation in Alzheimer's Disease

another NSAID

This must be a record for time from approval to withdrawl

Withdrawal of Market Authorization for Prexige

dementia care

one scholar's perspective from observations of dementia care in the UK......more support for primary care physicians, couldn't agree more


Fulbright Scholar back from the U.K. with ideas for treating dementia

by the numbers

a fitter less disabled cohort with more money and care options according to this USA today article.

Fewer seniors live in nursing homes

OT

In todays BMJ a systematic review of 9 RCTs found that OT was an effective intervention after stroke improving performance and protecting against poor outcomes.


Occupational therapy for patients with problems in personal activities of daily living after stroke: systematic review of randomised trials

staffing

"86% of workers work short staffed between 1 and 20 times a month........'

Seniors getting 'assembly-line care' at facilities: CUPE

margins before care

Large Wall St investment firms have taken over thousands of homes in a worrying trend that is reflected in poorer care or so says this article in Sunday's New York Times...

At Many Homes, More Profit and Less Nursing

doctors orders

16% refusing to follow doctors orders, I thought it was more......

Study says elderly may dismiss doctors’ orders

zoledronic acid

another positive for hip fracture prevention

Zoledronic Acid and Clinical Fractures and Mortality after Hip Fracture

tai chi

falls reduced to 0.72 ( hazard ratio) after 16 weeks , mean age 69

A Randomized, Controlled Trial of tai chi for the Prevention of Falls: The Central Sydney tai chi Trial

adverse drug events

The rate of reporting was found to be disproportionate to the increase in drug prescriptions between 1998 and 2005 and safety withdrawls accounted for a small number.

Adverse drug events reported to FDA appear to have increased markedly

C difficile

Symptomless carriers of C. diff may pose infection risk to other patients

up to 50% of the LTC facility population in this study were asymptomatically shedding spores in their stool........

Falls

Patient with dementia sues facility after fall and fracture.
Of course I don't have the details but with a fall rate of 1.5 falls per resident per year this remains one of our most challenging clinical areas.

Patient with dementia sues nursing home after fall

Katrina deaths

Governor Refuses Blame in 35 Hurricane Deaths

LTC in Scotland and England

Still a confused story

The NHS - A Broken Trust

care worker killed in NH

Care worker in the UK stabbed to death at work in nursing home. Male resident arrested

Care worker stabbed to death at nursing home

androids

One possible solution for our staffing crunch

Androids to Lift Grandma

CMA poll

The CMA wakes up to Long Term Care. This poll published yesterday

Canadians Concerned Over Costs of Long-Term Care

The poll found:

- 55% were very or somewhat confident they would be able to cover long-
term care expenses and 43% were not;
- Most (37%) thought long-term care should be the top priority if
medicare were to be expanded, followed by home care (26%); prescription
drugs (18%); dental care (11%); and vision care (2%);
- Canadians were split evenly as to whether the government should cover a
portion of catastrophic drug expenses that exceed a certain amount of
income (40%), or 70% of all Canadians' prescription drug expenses
(40%). Only 16% said government should cover 100% of Canadians'
prescription drug expenses.
- 50% said governments should maintain 100% funding of doctor and
hospital services, even if individuals or their insurance would be
fully responsible for other services;
- 46% said governments should use existing funding to fund 70% of all
health care services including doctors' visits, hospital services, drug
coverage, home care and dental care, even if individuals or their
insurance would pay the difference.

Blue Water

Press release from the McGuinty government on LTC renewal in Ontario. 3,500 redeveloped beds a year in that province starting in 2008.

McGuinty Government Moving Forward on Redevelopment of Blue Water Rest Home

elder abuse

and so it goes on......a report out of the UK from a joint committee of MPs and peers

Elderly 'are being denied human rights'

Mexican nursing homes

This might be a choice for some

Mexican Nursing Homes Attract U.S. Residents

donepezil in severe AD

Dr Sandra Black and colleagues from Sunnybrook conduct a 24 week randomized double blind trial to test the efficacy of donepezil in severe AD ( mean MMSE around 7). Findings suggest modest benefit for cognition and global function. Patients had severe AD but were community dwelling and were also naive to the treatment intervention, perhaps this drug provides a 'once only' benefit in AD?

Donepezil preserves cognition and global function in patients with severe Alzheimer disease

resuscitation

failure to resuscitate in Illinois


Nursing home pays fine for not trying to resuscitate resident

Flu down under

Flu victims better off in nursing homes: AMA

St Rita's

Trial starts today. Owners did not obey mandatory evacuation order. 35 deaths
Katrina was responsible for 1,400 deaths in August 2005


Trial to Open for Owners of Nursing Home

omeprazole and esomeprazole risk ?

something new to worry about

Health Canada reviewing new safety information on cardiac events in patients taking Losec (omeprazole) or Nexium (esomeprazole)

glaucoma

Could we soon be treating glaucoma with dementia Rx?

Glaucoma Could Be Treated With Alzheimer's Drugs, New Study

H2 antagonists and cognitive impairment

2.5 x more common in African Americans ?


Cognitive impairment link found in older adults taking popular stomach acid medications

raw food allowance

Well , this must be a good thing

McGuinty Government Ensuring High Quality Nutrition For Long-Term Care Residents

MMSE

a poignant poem

Memory for MMSE

hip protectors

Some bad news.....interesting study with patients acting as their own controls wearing only one hip protector was terminated after 20 months due to lack of efficacy


Efficacy of a Hip Protector to Prevent Hip Fracture in Nursing Home Residents

Oscar the cat

a cat from Rhode Island who predicts death in the nursing home

Oscar the Cat Predicts Patients' Deaths

the allure of Home Care (at last)

99% of low income seniors and disabled in Tennessee reside in nursing homes, the highest in the US. In Oregon ,on the other hand the 22% of its Medicaid clients live in institutions.

Nursing homes vs. home care — it's a national issue

standards in Hamilton

Restraint use was a common issue.
Facilities blame staffing levels.

Not good enough Majority of area long-term care homes failed at least one government standard

the 60s again

nursing homes for the kool-aid acid test generation........


The future of nursing home design — far out

Culture change

or 'deep system change'

refers to the transformation of nursing homes from an "acute care" medical model to a "consumer-directed" model. It commonly refers to techniques associated with consumer-directed care, a more home-like environment, flexibility in sleep and dining schedules; as well as autonomy in personal choices for the residents and a less bureaucratic organizational approach.

in this study , fewer citations, better quality of care and operating margins.........

Preliminary Research Supports Nursing Home Culture Change Movement
New Study Suggests Better Quality of Care and Profitability Outcomes

dementia in Scotland

Mental Welfare commission finds dementia care lacking in Scotland

Concern over 'poor' dementia care

first available bed

$300 a day for refusing to take first available bed in Dundas. The ethics are pretty obvious until you question the process for successful placement in the more desirable centres.

Hospitals threaten to bill seniors who refuse long-term care

LTC in Quebec

The ombudsman's report , 300 pages long, lists a catalogue of issues in regard to the care of seniors especially in LTC. It is estimated that the population of seniors in Quebec will be 27% by 2030.

Seniors deserve better care

NPs

Is this the future?

Canadian context may differ with fewer geriatricians providing primary care and more involvement of family physicians in institutional care. Nevertheless an interesting article in the climate of 'lowering' professional standards in LTC

The Right Cure For Ailing Elder Care?

queue jumping in Nova Scotia

The most astounding statistic in this article is the fact that 28% of the Nova Scotia's population will be 65+ in 20 years.

Health to review nursing-home placement rules

antipsychotics

Another study questioning the safety of antipsychotics in the elderly especially in LTC. A matched cohort study of over 25,000 patients provides some evidence that traditional antipsychotics are worse than atypicals and atypicals are worse than no drug treatment.
Full text is available at the Annals of Internal Medicine website


Antipsychotics increase death risk among seniors

BMA in NI

When will it be accepted that personal care is health care? Scotland accepted the reccomendations of the 1999 Royal Commission ( With Respect to Old Age) while Mr Blair's government continued to empty pensioners purses and ignored its findings.


BMA Northern Ireland supports free personal and nursing care for patients.

The New Yorker

An entertaining article from a recent publication

The Way We Age Now
Medicine has increased the ranks of the elderly. Can it make old age any easier?

caregiving in Nova Scotia

Caregivers strategy being planned by the Dept of Health for the next 10 years

Family values: more and more Nova Scotians are looking after aging family members at home

Avandia

The news isn't good from this metaanalysis published in last weeks NEJM

Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes

Home Care cap removed in Alberta

The cap on individual Home Care has been removed after 15 years at the same level

Province ends freeze on funding for home care

LTC in Quebec

A commentary on the 2100 proposed bed closures in Montreal from Dr Brian Gore, medical director at Maimonides Geriatric Centre in Montreal.

Health care for seniors must become a Quebec priority

new nursing positions in Ontario's LTC sector

1,200 more nurses for long-term care

euthanasia in Holland

An article from todays NEJM. Euthanasia and physician assisted suicide declined during the study period , possibly due to increased use of other end of life measures such as palliative sedation.

End-of-Life Practices in the Netherlands under the Euthanasia Act

dignified care of older people

less blame, a whole systems approach and better medical care

(4) Major change needed to achieve dignified care for older people

PPIs and pneumonia

A new study by Dr Gau and colleageus in Ohio found no significant difference in risk between hospitalized patients treated with PPIs and those that were non-users

AGS: Proton Pump Inhibitors Don't Add Pneumonia Risk to Older Adults

zoledronic acid

how did the ethics board approve a placebo in this study? Anyway a 70% decrease in vertebral fractures is impressive over 3 years and , for a change, resource-light for those of us working in LTC

Once-Yearly Zoledronic Acid for Treatment of Postmenopausal Osteoporosis

drug burden

An interesting study in Archives that links drug burden with poorer physical and cognitive performance in older patients. The chief offenders were sedatives and anticholinergic drugs. See abstract below


A Drug Burden Index to Define the Functional Burden of Medications in Older People

Holy Cross closed

Holy Cross nursing home shut by CHR

smoking

not before time, some might say
Nursing-home smokers get tough love from premier

fraud

Democratic hopeful Barrack Obama calls for investigation into LTC insurance fraud ( 1 in 4 claims in California were denied in 2005)

Barack Obama Renews His Call for Investigation into Long-Term Care Abuse During Community Meeting on Health Care in Iowa

chronic disease management and COPD

A systematic review finds in favour of chronic disease management interventions for hospitalization and unscheduled visits but no effect on mortality.


Systematic Review of the Chronic Care Model in Chronic Obstructive Pulmonary Disease Prevention and Management

Nova Scotia

new beds
The government has promised 832 beds by 2010

Northside, Sydney get 64 nursing home beds

Interview with Dr Robert Kane

Well known geriatrician and recent co-author of It Shouldn’t Be This Way: The Failure of Long-Term Care is interviewed by some older bloggers

Dr. Kane Answers Your Questions About Long-Term Care

alleged abuse in an Ottawa home

A reminder to document all bruising.

Nursing home residents abused

the cost of the pandemic

GDP expected to drop by 5.5% or three quarters of a trillion dollars with the influenza pandemic

Study: Flu outbreak in U.S. could spark recession

online meds

Pills bought online likely killed B.C. woman

Duragesic

watch out!
Nursing home resident suffered narcotic overdose, suit claims

wandering

An interesting literature review on WANDA

A systematic literature review of the effectiveness of non-pharmacological interventions to prevent wandering in dementia and evaluation of the ethical implications and acceptability of their use

drop in nursing home deaths

A story out of Saskatoon of a fall in LTC deaths resulting in an acute care log jam

Backlog of patients costly for health region

pain in the older patient

A report released yesterday described 2 out of 5 residents of nursing homes surveyed in the UK were in constant pain. The report from the Patients Association is called Pain in Older People - A Hidden Problem

Care-home residents suffering in silence

fire in Russian nursing home

Inferno at nursing home in Russia kills at least 62 people

DNR

seems incredible by today's standards

The Knucklehead of the Day award

pain

Evelyn Williams and colleagues at Sunnybrook and their work on managing pain in LTC

Reducing chronic pain for residents in long term care

weekend MIs

don't get sick on the weekend. A small but significant difference in mortality compared to weekday admissions.

Weekend versus Weekday Admission and Mortality from Myocardial Infarction

under diagnosis and treatment

minority populations often underrecognize Alzheimer's disease according to this survey out of Florida

Alzheimer's in minorities often goes untreated

senior's housing

A blog entry on seniors housing. Co-housing, common areas, Green House model etc

The brave new world of senior housing

Down's syndrome

hand in hand with age

A cruel, dual blow for special patients

music therapy

an interview with a music therapist working with dementia patients

Music and mental life: the state of art therapy today

residents moved out of centre

City seniors face ouster

side rails

Two stories today on side rails. One a report on an entrapment involving a siderail and the other an article in JAGS reporting on the success of an intervention to reduce side rail use in nursing homes.


Suffocation at nursing home under inquiry

Consequences of an Intervention to Reduce Restrictive Side Rail Use in Nursing Homes

Dr Muriel Gillick

This well known physician writes a wonderful blog

Perspectives On Aging

end of life in dementia

a useful little page for families dealing with end stage disease from the Mayo Clinic

Anticipating end-of-life needs of people with Alzheimer's disease

Sir William Osler

written by a former resident of the town of Osler SK

Sir William Osler and Long Term Care

morphine and end of life care

An editorial from Dr Claud Regnard in today's BMJ dispels some myths associated with the use of morphine as a drug that hastens death. The double effect card has been overplayed.

Using morphine to hasten death is a myth, says doctor

C diff outbreak

Toronto is experiencing a C diff outbreak that has been linked to the same strain that Quebec experienced claiming 2,000 lives.

C. difficile strikes southern Ontario; one case linked to Quebec outbreak

Carewest news

Carewest looking to be involved in long term care

George Melly

Jazz legend suffering from dementia

in the lab

blocking the enzyme casein kinase in mice reversed beta amyloid production but not without significant side effects

New therapeutic target for Alzheimer's could lead to drugs without side effects

Victoria, not so old

17% of Greater Victoria is 65+ but Saskatchewan has the greater number of seniors at 14.9% of its population and Newfoundland Labrador has the highest median age at 41.3

The  of Victoria

out of state placement

We think we have problems with available beds. Hawaii to Ohio....

Queen's patients sent to Ohio nursing homes

developmentally disabled and LTC

In Ontario and other provinces options are shrinking for these adults who are ending up in LTC. The costs can be half of a group home or residential centre. The appropriateness of LTC placement is being questioned by advocates and families in this article

Nowhere else to go

abuse

This is a challenging one to explain.
Duct tape in the wrong place is worthy of headlines while staffing shortages and chronically insufficient personal care hours are relegated until, of course, consequent events arise, this is health.

Elderly nursing home resident has mouth taped shut by nurses

geriatrician supply

geriatricians are the lowest paid physicians per hour worked..........

Growing old

delirium and dementia

A Boston Globe article that interviews Sharon Inouye on the relationship between these two conditions with a view to prevention.

An end's beginning
More than half of all elderly hospitalized patients suffer severe confusion. Many ultimately decline into dementia. Are there common triggers to both?

panorama follow up on nursing homes in the UK

12 years ago the Law Commission proposed legislation which would protect older people from abuse and neglect but so far, governments have refused to implement it.

Elderly at risk in nursing homes


Elderly suffer from neglect, cruelty and abuse

coffee and AD

what next?

Drink coffee to stave off Alzheimer’s

anesthesia and AD

Cognitive changes post-op and the results of this laboratory study may mean more precision with anesthetic agents in the elderly


Alzheimer's Society comment on anaesthetics and AD

smart homes

It will be interesting to see the results of testing

A 'smart house' for people with dementia

vitamin D and falls

Interesting little study in this month's JAGS that demonstrates possible reduced falls with higher doses of vitamin D.

A Higher Dose of Vitamin D Reduces the Risk of Falls in Nursing Home Residents: A Randomized, Multiple-Dose Study

loneliness

One must ask , what came first?

Loneliness linked to Alzheimer's

looming crisis in availability in the UK

on the flip side this should drive patient centred care in the home....

Long-term care and dementia services: an impending crisis

SSRIs and #

Article from last weeks Archives of Internal Medicine. I suppose the only consolation is that it was a small group and that all depressed patients with fractures were treated with SSRIs which would leave the door open for depression as a possible variable.


Effect of Selective Serotonin Reuptake Inhibitors on the Risk of Fracture

Bill 140

CUPE call for increase in hours ( 2.04 in 2000)through minimum standard ( Alberta 3.5 hours a day)

CUPE says experiments with long-term care must stop

Multivitamins/minerals & infection

No surprise here.

Effect of Multivitamin and Mineral Supplementation on Episodes of Infection in Nursing Home Residents: A Randomized, Placebo-Controlled Study

working together

An article from yesterday's NYT by Ira Rosofsky that proposes cooperative housing and pooled resources as a viable alternative to the inevitable nursing home option. As most admissions to LTC are basically unplanned this would require some advance thought and ingenuity.

Escape From the Nursing Home

Genetics & AD

At last

Study Links Gene to Alzheimer's Risk

Bill140

Hearings started yesterday
Nursing home bill means less care: critics

Delirium

An upcoming review in the Journal of Gerontology: Medical Sciences ( January 2007) examines the relationship between delirium and dementia. This news article interviews the doyen of dementia Dr Sharon Inouye and summarizes some of the key questions asked by researchers of delirium.

Relationship Between Delirium and Dementia

hemorrhagic stroke

Article in Neurology that finds a quintupling of the rate of hemorrhagic stroke over a period of 10 years. The rate for patients over 80 went from 2.5/100,000 to 45.9/100,000.During the same period in the US the use of warfarin quadrupled.

Drug linked to rise in brain hemorrhages

The increasing incidence of anticoagulant-associated intracerebral hemorrhage

education and AD

So much for an education. Looks like it is less independantly associated than previously thought......

Higher Education Linked to Faster Mental Decline

Day care for seniors

If anyone has more information on this.....let me know

Calgary Daycare For Seniors Operational

SARS

4 years on and Justice Campbell releases his third and final report on the SARS outbreak in Ontario

McGuinty Government Committed to Applying Lessons Learned From SARS


MCGUINTY GOVERNMENT COMMITTED TO APPLYING LESSONS LEARNED FROM SARS

falls becoming more hazardous

CDC reports that falls are becoming more lethal for the older patient in this Consumer Reports article

The rate of fatal falls grew from 23.7 for every 100,000 persons 65 and older in 1993 to 36.8 in 2003, according to the report. The fatal fall rate for men was about 50 percent higher than for women.

New report on falls highlights risks to elderly

65

At 65 you can expect to live 17-20 years according to Stats Canada. However 43% of those aged 65 and older can expect to live 3-4 years in a long term care centre. Quid pro quo.

Seniors enjoy longer life: Stats Canada

LTC in PEI

At last a change in the asset testing for accomodation charges that will spare islanders the prospect of depleting their assets to pay for LTC

Seniors in long-term care covered by new rules: minister