Prioritizing geriatrics in medical education improves care for all.

Within the United States, there is a deficit of Geriatricians providing care for older adults, and this deficit will only grow as the population continues to age, meaning all clinicians, particularly Internal Medicine (IM) and Family Medicine (FM) trained physicians, will provide the bulk of primary care for older adults. However, geriatric training requirements for clinicians fall short, and in the case of IM were reduced as of 2022). Serving as a call to action, this article provides insight on ways to enhance geriatric education for all graduate medical trainees, utilizing both conventional teaching and newer, non-traditional media, such as national online journal clubs, podcasts, and online teaching curricula, as well as expanding sites of training to include evidence-based models of care, such as the Program of All-Inclusive Care for the Elderly (PACE).

Eating Problems in Advanced Dementia: Navigating Difficult Conversations.

Introduction: The majority of older adults with advanced dementia (AD) develop difficulties with eating and swallowing, often prompting concerns about nutrition and quality of life. Employing a palliative approach requires providers to attain skills in addressing symptoms and communicating with family caregivers about the trajectory of AD and associated dysphagia, as well as to elicit goals of care. Research suggests internal medicine (IM) residents often perceive minimal education during training addressing skills needed to care for patients with AD.

Rationing Limited Healthcare Resources in the COVID-19 Era and Beyond: Ethical Considerations Regarding Older Adults.

Coronavirus disease 2019 (COVID-19) continues to impact older adults disproportionately with respect to serious consequences ranging from severe illness and hospitalization to increased mortality risk. Concurrently, concerns about potential shortages of healthcare professionals and health supplies to address these issues have focused attention on how these resources are ultimately allocated and used. Some strategies, for example, misguidedly use age as an arbitrary criterion that disfavors older adults in resource allocation decisions.

AGS Position Statement: Resource Allocation Strategies and Age-Related Considerations in the COVID-19 Era and Beyond.

Coronavirus disease 2019 (COVID-19) continues to impact older adults disproportionately, from severe illness and hospitalization to increased mortality risk. Concurrently, concerns about potential shortages of healthcare professionals and health supplies to address these needs have focused attention on how resources are ultimately allocated and used. Some strategies misguidedly use age as an arbitrary criterion, inappropriately disfavoring older adults.

Speech-Language Pathologists' Views About Aspiration Risk and Comfort Feeding in Advanced Dementia.

Background: Speech-language pathologists (SLPs) are often called upon to assess swallowing function for older adults with advanced dementia at high risk of aspiration and make recommendations about whether the patient can safely continue oral nutrition.

Objective: To describe the circumstances under which SLPs recommend oral nutritional intake for these patients.

Methods: A mail survey of a national probability sample of SLPs (n = 731).

Advance Directives and Care Received by Older Nursing Home Residents.

Background: Research shows variable success as to whether care provided aligns with individual patient preferences as reflected in their advance directives (AD).

Objective: We aimed to study AD status and subsequent care received in older nursing home (NH) residents deemed at risk for infections and care transitions: those with a urinary catheter (UC), feeding tube (FT), or both. Design/participants/measurements: A subgroup analysis of a prospective cohort of 90 residents with a UC and/or FT from 15 NHs in southeast Michigan.

Enhancing provider knowledge and patient screening for palliative care needs in chronic multimorbid patients receiving home-based primary care.

This article describes a pilot model to increase palliative care (PC) knowledge and collaboration among providers and to systematically identify chronic multimorbid home care patients who would benefit from focused discussion of potential PC needs. Thirty health care providers from a home-based primary care team attended interdisciplinary trainings. The Palliative Performance Scale (PPS) tool was used to trigger discussions of potential palliative needs at team rounds for patients who scored below a cutoff point on the tool.

Internal medicine house officers' attitudes and experience with patients who overstep patient-physician boundaries.

Maintenance of appropriate social boundaries is an essential aspect of patient care. Given limited clinical experience, house officers may be especially vulnerable to such transgressions. We studied the frequency of patients' transgressions of boundaries and house officer responses to these transgressions.

Perceptions and attitudes about hospice and palliative care among community-dwelling older adults.

It is expected that the American geriatric population will have an increased need for hospice and palliative care services over the next few decades. We surveyed 187 community dwelling older adults about several aspects related to end-of-life (EOL) care. Participants were much more familiar with the term hospice than palliative care.

Management of bleeding associated with malignant wounds.

Bleeding malignant wounds in palliative care patients can be anxiety-provoking for patients, their caregivers, and healthcare providers, and can be difficult to manage. We present the case of a 60-year-old man with a bleeding neck wound due to squamous cell carcinoma of the hypopharynx admitted to our inpatient palliative care unit. Management of bleeding included local wound care measures and psychosocial support for the patient and his wife.

Self-perceived competence among medical residents in skills needed to care for patients with advanced dementia versus metastatic cancer.

To examine medical residents' perceived competence in caring for patients with dementia we conducted an online survey of all 120 second, third and fourth-year residents in Internal Medicine, Medicine/Pediatrics, and Family Medicine at University of Michigan. A structured survey elicited residents' training, experience, confidence, and perceived career needs for skills in estimating prognosis, symptom management, and communication in caring for patients with dementia, compared to patients with metastatic cancer. Among the 61 (51 %) respondents, a majority report lower confidence in assessing prognosis and eliciting treatment wishes in patients with dementia (vs.

A call for guidance in the use of left ventricular assist devices in older adults.

Left ventricular assist devices (LVADs) are approved as "destination therapy" (permanent use without plans for transplantation) in individuals with advanced heart failure who are not candidates for a cardiac transplant; as such, these devices are increasingly being used in older adults. Although LVADs have been shown to increase quality of life and survival, the associated treatment burdens and complications deserve careful consideration. The current study illustrates myriad clinical challenges that can arise during long-term mechanical support using an older adult case history.

Antimicrobial use at the end of life among hospitalized patients with advanced cancer.

Background: We sought to evaluate antimicrobial use among patients with advanced cancer.

Methods: Retrospective review of patients experiencing cancer-related death while hospitalized.

Results: Among 145 patients, 126 (86.

Tube feeding in patients with advanced dementia: knowledge and practice of speech-language pathologists.

Context: Speech-language pathologists (SLP) are often called on to evaluate eating difficulties in patients with dementia.

Objectives: To assess factors associated with SLPs' knowledge and recommendations about feeding tubes in patients with advanced dementia.

Methods: A mail survey was administered to a probability sample of 1500 SLPs from the American Speech-Language-Hearing Association mailing list; 731 usable surveys were received (response rate=53.

Antimicrobial use among patients receiving palliative care consultation.

Background: We sought to characterize antimicrobial use among patients receiving palliative care consultation.

Methods: Retrospective review of patients seen by the Palliative Care Service at the University of Michigan Health System from January 2008 to May 2008.

Results: Of 131 patients seen in consultation, 70 received antimicrobials.

Tube feeding in advanced dementia: an exploratory survey of physician knowledge.

The administration of artificial nutrition by means of a percutaneous endoscopic gastrostomy (PEG) tube in older persons in the advanced stages of dementia is commonplace, yet the treatment is associated with significant treatment burdens and unclear benefits in this population. In addition, there is wide and unexplained geographic variability in the use of PEG in advanced dementia, which may stem partly from physicians' lack of understanding about its indications, risks, benefits, and effect on quality of life in advanced dementia. This study was a mail survey undertaken to assess physician knowledge regarding tube feeding in advanced dementia and explore whether certification in geriatrics or other physician characteristics are associated with physician knowledge.