SHC Medical Partners

Reduced Pneumonia Risk in Advanced Dementia Patients on Careful Hand Feeding

Another study just published in JAMDA has confirmed that among patients with advanced dementia, nasogastric feeding tubes do not result in increased survival when compared to patients being fed by careful handfeeding. Most importantly, in this study of more than 700 patients admitted to two geriatric convalescent units, among patients that were fed with the help of feeding tubes, the risk of pneumonia was 1.4 times higher than others.

This study provides us with another reason to be very cautious and thoughtful, when considering feeding options for patients with advance dementia. More often than not, nasogastric feeding or other kind …

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Risks of Gabapentin for Older People

This important study just published in the Journal of the American Medical Association focuses on the risks of gabapentin among hospitalized patients who require surgery. Among older patients, researchers found that gabapentin use was associated with multiple risks including delirium, pneumonia, and an increase in antipsychotic use. This study validates that gabapentin continues to be a very high risk medication among older people.

In the context of frail and older nursing home residents, it is very important that we question the need of the use of gabapentin and that we optimize and discontinue it when possible. Specifically, among patients who …

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Atrial Fibrillation in the Golden Years

Atrial fibrillation (AF) is not just a cardiac rhythm problem that leads to serious harm through heart failure or strokes etc. It has been known for a while that the disorder is associated with many other cardiac and non-cardiac symptoms that impact quality of life. This editorial provides a summary of a recent study that was published in the Journal of the American Geriatrics Society, in which researchers used surveys to assess the quality of life impact of AF. As the editorial points out, AF may result in many cardiac but more importantly, non-specific symptoms (e.g., fatigue, dizziness etc.), …

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Challenges of Recognizing and Managing Sepsis in Long-Term Care Settings

The Centers for Disease Control and Prevention (CDC) is urging long-term care clinicians and staff members to be on the lookout for signs of sepsis in residents. Heather Jones, DNP, NP-C, a long-term care consultant with the CDC’s Division of Healthcare Quality Promotion recently published an insightful blog on the challenges of recognizing and managing sepsis in long-term care settings.

She reminds that sepsis is an overwhelming response to infection that requires immediate intervention. It disproportionately affects frail seniors, including those living in nursing homes, but remains challenging to diagnose and treat in those settings. She writes, “Sepsis develops quickly …

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The Gift of Advance Care Planning

Advance Care Planning, Ongoing Care Planning, Dynamic Care Planning … no matter what you want to call it, and how and when you do it … this proactive, transparent and open conversation that promotes shared decision-making between clinicians and their patients and families is one of the most impactful, gratifying and meaningful activities in healthcare.This article from the Journal of the American Medical Association (September 2022) shares how pivotal such a communication is for the patients and their families. The example here, provides excellent guidance and advise on how to carry out very sensitive conversation about end of life …

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Task Force Guidelines on Statin Use for the Primary Prevention of Cardiovascular Disease

The US Preventative Services Task Force (USPSTF) has updated its guidelines on the benefits and use of statins for primary prevention of cardiovascular disease.

Use of statins for primary prevention has always been a topic that has raised debates among the clinical and research communities. These current guidelines, though, help settle some of the debate, but by no means will put them to rest.

Here are the summary recommendations:

1.  Clinicians prescribe a statin for the primary prevention of CVD for adults aged 40 to 75 years who have one or more CVD risk factors (i.e., dyslipidemia, diabetes, hypertension, or …

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Perils of Polypharmacy for Older Adults with Psychiatric Diagnoses

More evidence continues to accumulate on the perils of polypharmacy among older people. This study from inpatient populations in China, again confirm that older patients with psychiatric diagnoses are at a high risk of polypharmacy, and also psych drug-to-drug interactions. As patients accumulate diagnoses and more drugs, risks for interactions and adverse reactions increase. In this study the most common interactions were found to be among lorazepam and olanzapine.
For our frail and older patients in the post-acute settings, this article emphasizes for us to continue to review medications that are being utilized by older patients and continue to
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The Complexities of Diabetes Management

Improving diabetes management is critical and can improve patient quality of life and prevent avoidable hospitalizations.

Given multiple comorbidities, varying eating habits, dependency on ADLs etc., diabetes management is complicated among those with frailty. Also more complexity is added due to several categories available for oral treatment of diabetes.

Following are two good articles plus some pearls of diabetes management. Those of you who are new to complex care delivery will benefit from an in-depth review of these resources. I promise that you will feel many folds more comfortable making decisions related to hyper and hypoglycemia, among older and frail

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