Enhancing Advance Care Planning Communication: An Interactive Workshop With Role-Play for Students and Primary Care Clinicians.

Introduction: Increased clinician training on advance care planning (ACP) is needed. Common barriers to ACP include perceived lack of confidence, skills, and knowledge necessary to engage in these discussions. Furthermore, many clinicians feel inadequately trained in prognostication.

Handing Off the Older Patient: Improved Documentation of Geriatric Assessment in Transitions of Care.

Objectives: To improve assessment and documentation of function, cognition, and advance care planning (ACP) in admission and discharge notes on an Acute Care of the Elderly (ACE) unit.

Design: Continuous quality improvement intervention with episodic data review.

Setting: ACE unit of an 866-bed academic tertiary hospital.

Unintentional Weight Loss in Older Adults: A Geriatric Interprofessional Simulation Case Series for Health Care Providers.

Introduction: Interprofessional teams can provide better care and management of complex geriatric patients. Unintentional weight loss in older patients can lead to significant morbidity and mortality and functional decline. This simulation curriculum focuses on teaching learners from all health care professions how to use the Carolina Geriatrics Workforce Enhancement Program unintentional weight loss tool and flowchart (T&F) to identify, diagnose, and create a plan of care for weight loss in geriatric patients.

Definition and recommendations for advance care planning: an international consensus supported by the European Association for Palliative Care.

Advance care planning (ACP) is increasingly implemented in oncology and beyond, but a definition of ACP and recommendations concerning its use are lacking. We used a formal Delphi consensus process to help develop a definition of ACP and provide recommendations for its application. Of the 109 experts (82 from Europe, 16 from North America, and 11 from Australia) who rated the ACP definitions and its 41 recommendations, agreement for each definition or recommendation was between 68-100%.

Discussing physician-assisted dying: physicians' experiences in the United States and the Netherlands.

Purpose Of The Study: This study aims to further our understanding of the experiences of physicians when discussing physician-assisted dying (PAD) within the context of doctor-patient relationships in various sociolegal settings. Although patients bring up PAD in diverse settings, little is known about how physicians experience these discussions, and such experiences have not been directly compared across countries.

Design And Methods: A total of 36 physicians in the Netherlands and the United States (including Oregon) were interviewed using individual semistructured interview guides.

Approaches to suffering at the end of life: the use of sedation in the USA and Netherlands.

Background: Studies describing physicians' experiences with sedation at the end of life are indispensible for informed palliative care practice, but they are scarce. We describe the accounts of physicians from the USA and the Netherlands, two countries with different regulations on end-of-life decisions regarding their use of sedation.

Methods: Qualitative face-to-face interviews were held in 2007-2008 with 36 physicians (18 from the Netherlands, 18 from the USA), including primary care physicians and specialists.

Gynecologic care of elderly women.

Evaluation and management strategies for addressing abnormal bleeding, discharge, urinary symptoms, and sexuality amongst elderly women are presented.

Perceived needs for geriatric education by medical students, internal medicine residents and faculty.

Context: Traditional methods of setting curricular guidelines using experts or consensus panels may miss important areas of knowledge, skills, and attitudes that need to be addressed in the training of medical students and residents.

Objective: To seek input from medical students and internal medicine residents ("trainees") on their perception of their needs for training in Geriatrics.

Design: Two assessment methods were used (1) focus groups with students and residents were conducted by professional facilitators and the transcripts analyzed for areas of agreement and divergence and (2) geriatric medicine experts and ward attendings were surveyed to examine training gaps raised by trainees during Geriatric Guest Attending Rounds.

Potentially modifiable resident characteristics that are associated with physical or verbal aggression among nursing home residents with dementia.

Background: Physical aggression by nursing home residents is a burden to residents and staff. The identification of modifiable correlates would facilitate developing preventive strategies. The objectives of the study were to determine potentially modifiable resident characteristics that are associated with physical aggression and to correlate these characteristics with verbal aggression.

Nursing home practitioner survey of diagnostic criteria for urinary tract infections.

Objectives: To identify clinical and laboratory criteria used by nursing home practitioners for diagnosis and treatment of urinary tract infections (UTIs) in nursing home residents. To determine practitioner knowledge of the most commonly used consensus criteria (i.e.

Timing in the communication of pain among nursing home residents, nursing staff, and clinicians.

Background: The management of nursing home (NH) residents' pain requires adequate nursing assessment and clinician knowledge of pain therapies. However, the timely communication of pain from residents to nurses and from nurses to clinicians is equally necessary. Using a 4-step model (nursing assessment of pain, notification of clinicians regarding pain assessment, clinicians' assessment of pain and intervention), and nursing reassessment following an intervention, we describe the timing with which each of these steps occur.

Older person's preferences for home vs hospital care in the treatment of acute illness.

Background: Although the home is expanding as a potential site for acute illness treatment, little is known about patients' preferences for home vs the hospital.

Objective: To determine older persons' preferences for home or hospital as a treatment site for acute illness and factors associated with preference.

Methods: Two hundred forty-six community-dwelling persons aged 65 years or older hospitalized with congestive heart failure, chronic obstructive pulmonary disease, or pneumonia were identified in 2 urban teaching hospitals and received telephone interviews 2 months after hospitalization.

Older persons' perceptions of home and hospital as sites of treatment for acute illness.

Purpose: Home care is increasingly being used as a substitute for hospital care. This study examined older patients' perceptions of the home and of the hospital as treatment sites for acute illness and the patient characteristics that are associated with these perceptions.

Subjects And Methods: A series of questions derived from open-ended interviews supplemented by literature review were administered by telephone in a cross-sectional, descriptive study to community-dwelling persons age 65 years or older who had been hospitalized 2 months earlier with congestive heart failure, chronic obstructive pulmonary disease, or pneumonia.

Older persons' preferences for site of terminal care.

Background: Little is known about patients' preferences for site of terminal care.

Objective: To describe older persons' preferences for home or hospital as the site of terminal care and to explore potential reasons for their preferences.

Design: Cross-sectional quantitative and qualitative interviews.

Who dies at home? Determinants of site of death for community-based long-term care patients.

Objective: To determine characteristics associated with site of death in a cohort of long-term homecare patients.

Design: Cohort study.

Setting: Community-based long-term care program.

Older persons' preferences for site of treatment in acute illness.

Objective: To explore how older persons form preferences for site of medical care by examining their perceptions of home care and hospital care.

Design: Qualitative analysis of in-depth interviews using the constant comparative method.

Setting: Respondents' homes.

Physician responsibility in driver assessment.

This study describes the present physician practice of counseling patients about driving and reporting potentially unsafe drivers. A survey was sent to all licensed general practitioners, internists, ophthalmologists, neurologists, and neurosurgeons in Connecticut. Fifty-nine percent (2,049/3,450) of eligible physicians responded to the questionnaire.

Psychomotor mobility and the elderly driver.

In summary, declines in motor ability and reaction time are noted with aging, although the effect of these changes on actual driving performance needs further elucidation. It may be possible to compensate partially for some of these declines through physical and behavioral training. Attention to the physical, cognitive, and sensory capacities of older individuals in the design of vehicles and roadways also may be beneficial.

A simple procedure for general screening for functional disability in elderly patients.

We propose a short, simple approach that can be used by general internists to routinely screen the functional status of elderly patients in office practice. The approach relies on checking a limited number of targets that are commonly dysfunctional but often unappreciated when conventional histories and physical examinations are done for elderly patients. The new focus is on carefully selected tests of vision, hearing, arm and leg function, urinary incontinence, mental status, instrumental and basic activities of daily living, environmental hazards, and social support systems.