Malnutrition in the nursing home.

Purpose Of Review: Malnutrition in the nursing home is increasingly recognized as a major international research priority, given the expanding geriatric populations, serious consequences, and challenges conducting research in nursing homes. This review examines the recent literature and suggests implications for research and practice.

Recent Findings: Across the recent studies, approximately 20% of nursing home residents had some form of malnutrition.

Combining quality improvement and geriatrics training: the nursing home polypharmacy outcomes project.

To examine sustained effects of an educational intervention, the authors repeated a successful quality improvement (QI) project on medication safety and cost effectiveness. In October 2007 and August 2008, the facility leadership and geriatrics faculty identified all patients receiving nine or more medications (polypharmacy cohort) in a 170-bed teaching nursing home. They then taught Geriatric Medicine fellows (n = 12 in 2007, 11 in 2008) to (a) systematically collect medication data; (b) generate medication recommendations (stop, taper, or continue) based on expert criteria (Beers criteria) or drug-drug interaction programs; (c) discuss recommendations with patients' attending physicians; and (d) implement approved recommendations.

"You're being paged!" outcomes of a nursing home on-call role-playing and longitudinal curriculum.

Effectively handling telephone calls about nursing home (NH) residents is an important skill for healthcare professionals, but little formal training is typically provided. The objective of the current study was to describe and evaluate the effectiveness of a novel structured role-playing didactic session followed by an on-call NH longitudinal clinical experience. The effectiveness of the structured role-playing didactic session was compared in different learners, including geriatric medicine fellows (n = 10), family medicine residents and faculty (n = 14), nurse practitioner students (n = 31), and other learners (n = 7).

Factors associated with weight loss, low BMI, and malnutrition among nursing home patients: a systematic review of the literature.

Background: Weight loss and poor nutrition are important quality measures in long term care. Long term care professionals need to identify factors associated with weight loss and poor nutrition to target high-risk patients.

Methods: The authors systematically searched Medline and CINAHL databases and included English language studies with more than 100 subjects analyzed, published after January 1, 1990, with data on factors associated with at least one of the following: weight loss, low body mass index (BMI), low Mini-Nutritional Assessment (MNA) score, or other standard measure of malnutrition.

Prevalence and measures of nutritional compromise among nursing home patients: weight loss, low body mass index, malnutrition, and feeding dependency, a systematic review of the literature.

Weight loss and poor nutrition have been important considerations in measuring quality of nursing home care since 1987. Our purpose was to examine, synthesize, and provide a systematic review of the current literature on the prevalence and definitions of nutritional problems in nursing home residents. In the fall of 2011, we performed MEDLINE searches of English-language articles published after January 1, 1990.

Reducing cost by reducing polypharmacy: the polypharmacy outcomes project.

Objective: To examine the effect of intervention by geriatric medicine fellows and a geriatrician on medication cost among long term care residents with polypharmacy.

Design: Interventional study.

Setting: A single hospital-affiliated long term care facility.

Outcomes of polypharmacy in nursing home residents.

This article provides a comprehensive review of the outcomes of polypharmacy in nursing homes. Our review had some limitations. First, we only included studies beginning in 1990, and significant earlier studies are not included.

Factors associated with polypharmacy in nursing home residents.

The prevalence of polypharmacy is very high in the nursing home setting. In this comprehensive review, we describe the many demographic, functional status, chronic disease, and healthcare financing factors associated with polypharmacy in nursing home patients. Recognition of the factors associated with polypharmacy is the first step for practitioners.

Medical School Hotline: Developing communication skills for leading family meetings.

Good clinician-family communication is essential for the provision of high-quality patient care. Families rate the communication skills of clinicians as critical clinical skills. However, there has been no structured training of fellow communication skills while leading family meetings in the University of Hawai'i Geriatric Medicine Fellowship Program.

Physician intervention for medication reduction in a nursing home: the polypharmacy outcomes project.

Objective: To examine the effects of a medication review project by geriatricians and geriatric medicine fellows on polypharmacy in a teaching nursing home.

Design: Quality improvement intervention study

Setting: Long-term care facility in Honolulu, HI PARTICIPANTS: Seventy-four patients with the Minimum Data Set quality indicator criteria of polypharmacy (9 or more medications).

Intervention: Geriatric medicine fellows and faculty reviewed each patient's medication list, consulted the updated Beers Criteria and Epocrates online drug-drug interaction program, and recommended medication changes to the patients' primary care physicians.

Weight loss in patients with Alzheimer's disease.

Weight loss occurs frequently in patients with Alzheimer's disease (AD). This article will review why weight loss is so important in AD patients and what the ramifications are. This includes not only the negative effects of weight loss but possible benefits of weight gain.

Excessive sweepstakes participation in patients with dementia in Hawai'i: a case series.

We report a case series of 11 patients with excessive sweepstakes participation on initial geriatric consultation in Honolulu. Ten of these patients had dementia, mostly Alzheimer's disease, with Folstein MiniMental Status Exam scores ranging from 17-29/30. Money lost ranged from 6,600 dollars to 200,000-400,000 dollars.