Development of a Hybrid Simulated Patient Experience to Practice Care of the Dying Older Adult.

Introduction: Care of the dying older adult includes critical skills that emerging physicians should master but are not consistently taught. Simulation has been shown to be an excellent tool for teaching these skills in a standardized fashion. Simulation allows direct observation to assess and provide learner feedback.

Development of an ambulatory geriatrics knowledge examination for internal medicine residents.

Background: The number of older adults needing primary care exceeds the capacity of trained geriatricians to accommodate them. All physicians should have basic knowledge of optimal outpatient care of older adults to enhance the capacity of the system to serve this patient group. To date, there is no knowledge-assessment tool that focuses specifically on geriatric ambulatory care.

Palliative Access Through Care at Home: experiences with an urban, geriatric home palliative care program.

The aging of the U.S. population has resulted in a large number of persons with multiple, chronic illnesses and gradual functional decline.

Integrating palliative medicine into the care of persons with advanced dementia: identifying appropriate medication use.

Objectives: To evaluate the feasibility of developing consensus recommendations for appropriate prescribing for patients with advanced dementia using a new conceptual framework and to determine the frequency of inappropriate medication use based on these recommendations in a small sample of patients with advanced dementia.

Design: Medication data were obtained using chart review. Recommendations for appropriate prescribing were achieved using a modified Delphi consensus panel.

Patients dying with dementia: experience at the end of life and impact of hospice care.

To evaluate the impact hospice enrollment has on the terminal care of patients with dementia and describe the symptom burden these patients experience, caregivers of dementia decedents were assessed in a mortality follow-back survey. Patients had been managed through academic outpatient geriatric clinics in Chicago, IL. A total of 135 family members or other knowledgeable informants of persons who had died with dementia were queried about the patient's preferred location of death, location of death, satisfaction with patient care, and assessment of patient's pain and most bothersome symptom.

Management of noncancer pain in community-dwelling persons with dementia.

Objectives: To explore the pharmacological treatment of noncancer pain in persons with dementia and identify predictors associated with insufficient analgesia.

Design: Cross-sectional analysis of an observational cohort study.

Setting: Academic outpatient geriatric clinic in Chicago, Illinois.

To what extent do geriatricians document the most bothersome symptoms of patients with advanced dementia?

Objectives: To assess whether geriatricians documented the bothersome symptoms of patients with advanced dementia, proxy reports of the most-bothersome symptoms affecting those patients (as elicited in research interviews) were compared with what geriatricians who had seen those patients in a proximate clinic visit documented in the medical record.

Design: Retrospective chart review.

Setting: Outpatient geriatrics clinic at the University of Chicago.

Factors associated with self- and caregiver report of pain among community-dwelling persons with dementia.

Background: Among cognitively intact patients, self- and caregiver report of patient pain has been associated with worse psychological health for both the patient and caregiver. Little existing research examines factors associated with patient self-report of pain and caregiver report of patient pain among community-dwelling persons with dementia.

Objective: To identify patient and caregiver factors associated with self- and caregiver report of patient pain among community-dwelling persons with dementia.

A brief history and lessons learned from twin efforts to transform medicine.

In this article, we consider the intersection between the fields of geriatrics and palliative medicine in the United States. Although geriatrics and palliative medicine have sometimes used different strategies to address the same challenges, they have created opportunities where both fields can learn from the experiences of the other. One specialty may be able to learn from issues already dealt with by the other.

Pain in community-dwelling persons with dementia: frequency, intensity, and congruence between patient and caregiver report.

To better understand the pain experience of persons with dementia and to describe what factors are related to congruence of pain reports within patient-caregiver dyads, a cohort study enrolled patient-caregiver dyads at a primary care geriatrics clinic. Thirty-two percent of persons with dementia self-report pain "right now." Of these, 65% report slight/mild pain, 27% moderate pain, and 8% severe pain or greater.

Barriers to excellent end-of-life care for patients with dementia.

While great strides have been made recently in improving end-of-life care in the United States, people with dementia often die with inadequate pain control, with feeding tubes in place, and without the benefits of hospice care. In this paper, we discuss the most important and persistent challenges to providing excellent end-of-life care for patients with dementia, including dementia not being viewed as a terminal illness; the nature of the course and treatment decisions in advanced dementia; assessment and management of symptoms; the caregiver experience and bereavement; and health systems issues. We suggest approaches for overcoming these barriers in the domains of education, clinical practice, and public policy.

Barriers to limiting the practice of feeding tube placement in advanced dementia.

Objective: In advanced dementia, many difficult decisions may arise as the disease progresses, including whether to use feeding by tube. Several recent articles question the benefit of percutaneous endoscopic gastrostomy (PEG) tube placement in persons with advanced dementia. However, patients with advanced dementia are still referred for PEG tubes.

Palliative Excellence in Alzheimer Care Efforts (PEACE): a program description.

Hospice is the standard method for providing quality end-of-life care in the United States. However, studies reveal that persons with dementia are infrequently referred to hospice, that barriers exist to increasing hospice utilization in this population, and that patients with dementia would benefit from hospice or hospice-like services earlier in the disease course. The Palliative Excellence in Alzheimer Care Efforts (PEACE) program responds to these deficiencies, striving to improve end-of-life care of persons with dementia and to integrate palliative care into the primary care of patients with dementia throughout the course of the illness.

Predictors of emergency medical services utilization by elders.

Objective: Elders (age > or = 65 years) frequently use emergency medical services (EMS) for care. Understanding reasons for EMS use by elders may allow better management of EMS demand. To the best of the authors' knowledge, no studies have identified patient characteristics associated with EMS use by elders.