Cardiac Resuscitation Procedures in US Nursing Facilities: Time to Reevaluate the Standard of Care?

Although the use of automated external defibrillators (AEDs) in out-of-hospital cardiac arrest (OHCA) response has become the standard of care in many community settings over the past 20+ years, the adoption of AEDs in US nursing facilities is variable and the current number of facilities with AEDs is unknown. Recent research into the use of AEDs as part of cardiopulmonary resuscitation (CPR) procedures for nursing facility residents with sudden cardiac arrest demonstrates improved outcomes in the limited cohort with witnessed arrests, early bystander CPR, and an initial amenable rhythm, shocked with an AED before the arrival of Emergency Medical Services (EMS) personnel. This article reviews data about outcomes of CPR in older adults and nursing facility settings and proposes that standard procedures for CPR attempts in US nursing facilities should be reevaluated and continue to evolve, commensurate with the evidence and community standards.

Management of Chronic Pain in Nursing Homes: Navigating Challenges to Improve Person-Centered Care.

Despite the dynamic demands in the nursing home (NH), a definitive approach to managing chronic pain in older adults has yet to be established. Due to concerns for potential adverse pharmacologic effects, balancing appropriate pain management is a challenge among NH residents. The challenges encompass but are not limited to medical complexities, functional disabilities, and physical frailty.

DEA enforcement in long-term care: is a collaborative correction feasible?

The prescribing and dispensing of controlled substances within long-term care facilities is an important and complex issue from both the clinical and the public policy perspectives. This article reviews the regulatory background and clinical concerns regarding the enforcement of the Controlled Substances Act by the Drug Enforcement Administration within the institutional pharmacies serving long-term care facilities. The article argues that the processes implemented since 2009 in response to concerns about Drug Enforcement Administration enforcement are suboptimal at many levels.

Perspectives on the future of geriatric medicine.

The following comments were presented to the 20th anniversary celebration of the geriatric medicine fellowship training program at the Baylor College of Medicine in the Texas Medical Center, Houston, Texas, on June 24, 2005. The author, who was the first graduate of the geriatric medicine training program at Baylor, proposes that geriatrics is at a critical juncture and that the voice and identity of geriatric medicine should be that of advocacy for our patients, and that in such a role geriatric medicine is well suited to become the "soul of medicine." She encourages all geriatricians to read the report of the Task Force on the Future of Geriatric Medicine and to look for opportunities to personally be involved in implementing the recommendations.