Advance Care Planning in the Outpatient Geriatric Medicine Setting.

This article describes how to perform advance care planning in the outpatient geriatric medicine setting. The article defines advance care planning and discusses components of advance care planning, such as advance directives, do-not-resuscitate orders, and Physician Orders for Life-Sustaining Treatment. The article describes how to document advance care planning discussions in the clinic and bill Medicare and ways for clinicians to improve their skill at leading these conversations.

Multifractal analysis of nonlinear complexity of sacral skin blood flow oscillations in older adults.

The objective of this study was to investigate the relationship between cutaneous vasodilatory function and nonlinear complexity of blood flow oscillations (BFO) in older people. A non-painful fast local heating protocol was applied to the sacral skin in 20 older subjects with various vasodilatory functions. Laser Doppler flowmetry was used to measure skin blood oscillations.

Wavelet analysis of sacral skin blood flow oscillations to assess soft tissue viability in older adults.

The objective of this study was to investigate age-related changes of microvascular functions using wavelet analysis of blood flow oscillations (BFO), and to develop a new quantification method to present wavelet coefficients for studying the contribution of each blood flow control mechanism to the skin vasodilatory response. 20 older people between 65 and 85 years of age were recruited into the study. The heater temperature at the sacral skin was raised to 42 degrees C in 2 min and maintained at that temperature for the duration of the 50 minute heating period to induce a biphasic vasodilatory response: axon reflex mediated and nitric oxide mediated vasodilation.

Pressure ulcers and endothelial dysfunction: is there a link?

Pressure ulcers were first described in the medical literature in the mid-16th century. Today, in the 21st century, pressure ulcers continue to cause pain and suffering to patients and increase the cost of medical care. Researchers and clinicians have used significant time and money to develop prevention and treatment strategies for pressure ulcers.

Development and evaluation of a longitudinal Case Based Learning (CBL) experience for a geriatric medicine rotation.

The DWR Department of Geriatric Medicine at OUHSC and the OKC VA Medical Center began a mandatory third-year geriatric medicine clerkship in 2003. As part of the didactic sessions, the Department created a longitudinal Case-Based Learning (CBL) experience. The purpose of this paper is to describe the CBL experience, report student satisfaction with the CBL process, and discuss how students value CBL as a teaching method compared to other methods.

Health promotion in older adults. Prescribing exercise for the frail and home bound.

Some degree of physical activity is always preferable to a sedentary lifestyle. For home bound elderly, with limited mobility and strength, physical activity should be focused on "functional fitness," such as performing activities of daily living, transfers, and mobility. We examine the benefits of exercise for frail home bound elderly, potential barriers to exercise, and ways to initiate a physical activity program.

Effect of a mandatory geriatric medicine clerkship on third-year students.

A nationwide push has increased geriatric medicine instruction within medical school curricula. Some institutions have proceeded with an integrated 4-year curriculum while others have constructed discrete courses in the third or fourth year of medical school. This paper describes the impact of a new mandatory 4-week geriatric medicine clerkship on third-year students developed by the Donald W.

Minimizing physical restraints in acute care.

The use of restraints to protect patients and insure continuation of care is an accepted fact in today's medical practice. However over the last 20 years a growing body of evidence supports the idea that restraints are harmful and should be used as the last resort. Since 1987, federal law requires long term care facilities to be restraint free.