Guest: Jeffrey Levine

Death certificates are essential to the creation of public health policies and determination of funding allocation. In addition, death certificates can bring public health epidemics to the forefront. Dr. Jeffrey Levine, clinical associate professor of medicine at New York Medical College, discusses how physicians can accurately report the immediate, intermediate and underlying causes of death. What medical-legal issues might be impacted by the accuracy or inaccuracy of death certificates? Dr. Eric Tangalos hosts.

Guests: William Hu, James J. Lah, Allan I. Levey

An estimated 5.4 million Americans of all ages had Alzheimer's Disease (AD) in 2012. This includes 5.2 million people age 65 and older and 200,000 individuals under age 65 who have younger-onset Alzheimer's. A paradigm shift in the diagnostic criteria for AD has occurred in the last year with new criteria and guidelines for managing AD having been updated, refined, and broadened compared with those published in 1984 by the Alzheimer's Association and the National Institute of Neurological Disorders and Stroke.

Join us as Drs. Lah, Hu and Levey discuss the new recommendations and guidelines for AD and emergent biomarkers/imaging as a critical adjunct to earlier identification and management of AD.

Estimated time to complete this activity: 1 hour

Guest: Gregory Zydiak

There are quite a few misconceptions about long term care and geriatric medicine. Many young physicians shy away from long term care medicine because they fear they won't be able to make enough money, or that they will burn out quickly. But Dr. Gregory Zydiak, medical director of a skilled nursing facility in Saint Louis, thinks the opposite is true. He believes long-term care medicine is a fruitful, rewarding and challenging career. Dr. Zydiak created a practical guide for a career in long-term care medicine, available here. Dr. Eric Tangalos hosts.

Guest: Matthew Wayne

What risks does polypharmacy pose for elderly patients, and how should physicians manage medications in the population of their patients over age 65? Dr. Matthew Wayne, assistant professor of medicine at University Hospitals Case Medical Center in Cleveland, discusses the typical symptoms that might indicate an adverse drug reaction, and suggests ways physicians can recognize these symptoms. What factors should physicians keep in mind when prescribing medications to a patient in their last few years of life? Dr. Eric Tangalos hosts.

Guest: Thiruvinva Dharmarajan

Patients in hospital settings are often screened and promptly treated for venous thromboembolism, or VTE, but perhaps less commonly in long-term care, even though these patients may be at risk. Dr. T.S. Dharmarajan, clinical director of the division of geriatrics at Montefiore Medical Center (North Division) in the Bronx, New York, discusses the medical conditions in long-term care that put patients at risk for VTE, and ways to assess patients for the condition. What anticoagulation medications and treatments may be used for treating VTE in long-term care? Should long-term care clinicians treat VTE as aggressively as hospitals often do, or are there other unique considerations clinicians should keep in mind for managing patients at risk for VTE in long-term care? Dr. Eric Tangalos hosts.  

Guest: William Smucker

Delirium often goes unrecognized, even though it is a common condition in long-term care facilities. How can we be vigilant to the symptoms that might suggest dementia? Are patients with dementia most susceptible to developing delirium? What other conditions or medications might put patients at risk for developing delirium? Host Dr. Eric Tangalos welcomes Dr. William Smucker, professor of family medicine at Northeastern Ohio Universities College of Medicine, to investigate preventative strategies physicians might use to prevent development of delirium, and how to best manage the condition.

Guest: Tena Alonzo

How can creating a more positive emotional experience for patients with dementia or Alzheimer's diminish behavior issues and improve quality of life? Tena Alonzo, director of research and co-director of the Palliative Care for Advanced Dementia program at Beatitudes Campus in Phoenix, discusses a common-sense approach to creating a comforting environment for those with dementia and Alzheimer's, which focuses on meeting each patient's unique needs. What simple steps can long-term care facilities and caregivers take to enhance the lives of patients with cognitive disorders? Dr. Eric Tangalos hosts.

Guest: Steven Handler

Because residents in long-term care facilities often have comorbidities, polypharmacy can be an issue. What are the most common types of adverse drug events that can occur among long-term care patients taking multiple medications? Dr. Steven Handler, assistant professor in the department of biomedical informatics and the department of geriatric medicine at the University of Pittsburgh School of Medicine, and the medical director for long-term care health information technology for the University of Pittsburgh Medical Center, says the current methods for monitoring medications in nursing homes are inadequate for protecting against adverse drug events, and suggests ways to improve medication safety in long-term care. What tools might help practitioners in long-term care better detect and prevent adverse drug events? Dr. Eric Tangalos hosts. 

Guest: Peter Winn

With palliative and hospice care, there is no one-size-fits-all approach. What differentiates these two types of care and how can physicians decide which approach to palliative or hospice care is best for each patient? Dr. Peter Winn, professor in the department of family medicine at Oklahoma University School of Medicine in Oklahoma City, discusses various types of care at the end of life, and outlines conditions that might require such care. What are some of the challenges to providing effective palliative and hospice care, and how can physicians best discuss realistic expectations with families and patients? Hosted by Dr. Eric Tangalos. 

Guest: David Smith

Nearly three-quarters of patients in long term care have some form of memory impairment or dementia. And while some forgetfulness is a normal part of the aging process, memory loss can also be overlooked as an early symptom of cognitive impairment. How can physicians distinguish between common memory loss and cognitive impairment? Dr. David Smith, professor of family medicine at the College of Medicine at Texas A&M University, College Station; and president of Geriatric Consultants of Central Texas in Brownwood, Texas, discusses the nuances of different forms of cognitive impairment, and emphasizes the importance of early diagnosis. What activities, medications, environments and other strategies can help physicians slow cognitive decline in these patients? Dr. Eric Tangalos hosts.

Guest: Alexandra Papaioannou

Millions of Americans have osteoporosis, but too often, a broken bone is the first indication of this common condition. What osteoporosis screening strategies can help diagnose osteoporosis in its early stages, and what treatment regimens are the most effective? Dr. Alexandra Papaioannou, professor in the department of medicine, and past-director of the division of geriatric medicine with a joint appointment in the division of rheumatology at McMaster University in Ontario, Canada, says it's important to target and prevent both falls and osteoporosis in tandem to reduce fractures. What are optimal amounts of calcium and vitamin D for older, less mobile patients? How can long term care facilities incorporate osteoporosis prevention into their screenings? Dr. Eric Tangalos hosts. 

Guest: William Schaffner

Which infectious diseases are most common at long term care facilities? If there is an infectious disease outbreak at a facility, how can we best protect residents? Dr. William Schaffner, president of the National Foundation for Infectious Diseases, as well as professor and chairman of the department of preventive medicine, and professor of medicine in the division of infectious diseases at Vanderbilt University School of Medicine in Nashville, Tennessee, stresses the importance of influenza and pneumococcal vaccinations for not only long-term care residents and staff, but also the residents' families. What strategies can help increase the vaccination success rates at long term care facilities? Dr. Eric Tangalos hosts. 

Guest: Alan Lazaroff

How different is the population of long term care facilities today than in decades past, and how will these new resident communities impact delivery of care? Dr. Alan Lazaroff, director of geriatric medicine at St. Anthony Hospitals Senior Health Centers, and president of Geriatric Medicine Associates in Denver, Colorado, talks about the changes long term care facilities have made to better serve the needs of shifting resident demographics, including flexible scheduling and activities. What challenges face nursing homes today that care for younger, sicker or shorter-term patients? Dr. Eric Tangalos hosts. 

Guest: James Galvin

Early detection of various conditions can help physicians better manage and treat their patients, and Alzheimer's is no exception. What early screening tests of cognitive impairment or dementia should be administered by primary care providers help detect when the disease process is beginning? Dr. James Galvin, professor in the departments of neurology and psychiatry at New York University Langone Medical Center in New York City, joins host Dr. Eric Tangalos to discuss the correlation between higher scores on cognitive impairment screening tests (such as the AD8 dementia screening test) and the presence of biomarkers for Alzheimer's. How effective is second stage confirmation of Alzheimer's with the use of biomarkers, and what role will biomarkers play in development of new therapies for this condition?

Guest: Frederick Wendt

As medication costs continue rising, what strategies can help long-term care facilities reduce drug expenditures, while still providing the best quality of care for patients? Fred Wendt, RPh, vice president of pharmacy services for Senior PharmaStrategies in Burleson, Texas, says one of the most significant pharmacy issues in long-term care is the Drug Enforcement Administration's current position on the nursing facility staff as agent of the physician, with regard to controlled substances. How is the role of the consultant pharmacist changing in long-term care? What programs can help long-term care facilities reign in drug costs, while maintaining high quality care for patients, particularly in the area of diabetes? Dr. Eric Tangalos hosts.

Guests: Christine Dunford, Mary O'Hara

Although we remain limited in our options for treating patients with memory loss and Alzheimer's, there are a variety of non-pharmacologic treatments that are showing some promise. Mary O'Hara, social worker at Cognitive Neurology and Alzheimer's Disease Center at Northwestern University Feinberg School of Medicine, and Christine Dunford, cultural anthropologist, ensemble member of Chicago's Lookingglass Theatre, and founding teaching artist with the Chicago Arts Partners in Education (CAPE) program, facilitate an improvisational acting workshop called the Memory Ensemble for patients with Alzheimer's and memory loss. One of improv's principles emphasizes being "in the moment," which can be particularly therapeutic for patients with memory loss. How has the Memory Ensemble program been designed to be both challenging and supportive, and what are some of the program's benefits? What other types of creative programs might have a similar effect on improving the quality of life, as well as building confidence and coping mechanisms for these patients? Hosted by Dr. Eric Tangalos.

Guest: Laurie Jacobs

Patients who have recently had orthopedic and other types of general surgery, those who have recently had a stroke, and those with an ongoing medical condition (such as heart disease) are at most risk for developing venous thromboembolic disease. Do most long-term care facilities screen for this condition among these patient populations, and when should physicians initiate prophylactic care? Dr. Laurie Jacobs, professor of clinical medicine and vice chairman of clinical and educational programs in the department of medicine at Albert Einstein College of Medicine and Montefiore Medical Center, and director of the Resnick Gerontology Center at Albert Einstein College of Medicine in Bronx, New York, discusses ways to reduce the risk of developing venous thromboembolism among long-term care patients. What is on the horizon in terms of new therapies? Hosted by Dr. Eric Tangalos.

Guest: Bruce Troen

Vitamin D deficiency has been receiving a deluge of media coverage lately, and physicians are likely to hear many related questions from patients, especially long-term care residents and their families. What are the latest developments in vitamin D research, and how can adequate vitamin D levels help prevent falls among our older patients? Even more fundamentally, how do we define vitamin D insufficiency and deficiency? Dr. Bruce Troen, professor of medicine, research scientist at the Geriatric Research, Education, and Clinical Center, and director of the molecular gerontology program at the University of Miami Miller School of Medicine in Miami, Florida, describes the crucial role that vitamin D plays throughout the body, beyond its well-known role in the musculoskeletal system. How common is vitamin D insufficiency among geriatric and nursing home residents? What is the best regimen and dosage to overcome vitamin D insufficiency or deficiency? When should calcium be supplemented to help prevent fractures? Tune in to hear host Dr. Eric Tangalos and this week's guest sift through the latest information on vitamin D.

Guest: Hosam Kamel

Heart failure is a common reason for hospitalization among older adults and long-term care patients. What strategies can help prevent a recurrence of heart failure, and what types of monitoring for exacerbations are most effective in prevention? How can physicians individualize therapy in this population? How crucial are blood pressure and hypertension control in managing patients with heart failure? Dr. Hosam Kamel, director of geriatrics and extended care, at St. Joseph’s Mercy Health Center in Hot Springs, Arkansas and associate clinical professor of geriatrics at the department of geriatrics at the University of Arkansas for Medical Sciences, discusses the goals of managing patients with heart failure in long-term care, and offers pragmatic advice for physicians in managing patients with heart failure. Dr. Eric Tangalos hosts.

Guest: Jay Luxenberg

It can be challenging for caregivers to diagnose depression in long-term care medicine, even though depression in facilities such as nursing homes and assisted living facilities is common. How can long-term care physicians recognize the early signs and symptoms of depression, and determine when pharmacologic or other forms of therapy are most appropriate? What quantitative screening tests and management tools are helpful for physicians to use in diagnosing and treating depression? Dr. Jay Luxenberg, director of medical services at the Jewish Home in San Francisco, and clinical professor in the School of Medicine at the University of California, San Francisco, weighs the options of antidepressant therapy versus other non-pharmacologic treatments for patients with depression in long-term care facilities. What evidence demonstrates the efficacy of bright light therapy, family involvement and other activities in improving the symptoms of depression? Dr. Eric Tangalos hosts. 

Guest: Douglas Berkey

A patient's mouth can literally serve as a window to their overall health. Systemic conditions that are common among many older patients, such as diabetes, often have oral manifestations. What are some of the symptoms to look for, and how can we promote and preserve the oral health of vulnerable patients? Dr. Douglas Berkey, professor at the University of Colorado Schools of Dental Medicine and Public Health, where he also serves as co-director of the Center on Aging, discusses some of the most common oral health problems among elderly and long-term care residents, including oral abscesses and periodontal disease, and suggests a proactive approach to dental care for these patients. Dr. Eric Tangalos hosts.

Guest: Herbert Sier

What are some of the unique issues related to patients with Parkinson's in long-term care, and how can all long-term care team members assess and manage the condition? Dr. Herbert Sier, associate chief of geriatrics and assistant professor of medicine at Northwestern University Feinberg School of Medicine, and vice president of medical affairs at the nonprofit community organization, CJE Senior Life, in Chicago, Illinois, joins host Dr. Eric Tangalos to discuss ways physicians can preserve and improve mobility for Parkinson's patients, while providing for appropriate psychological care as well. Hosted by Dr. Eric Tangalos.

Guest: Debra Bakerjian

What strengths do physicians and nurse practitioners contribute to the long-term care interdisciplinary team, and what are the keys to a strong collaborative practice? What types of state and specific nursing home regulations impact nurse practitioners in long-term care? Nurse practitioner Dr. Debra Bakerjian, postdoctoral fellow at Betty Irene Moore School of Nursing at University of California Davis, joins host Dr. Eric Tangalos to discuss the impact of supervisory regulations on collaborative practices, and how changes might be made to regulations to improve patient care. Also, what's the job growth outlook for nurse practitioners in long-term care? 

Guest: Dennis McCullough

Dr. Dennis McCullough embodies the Tibetan wisdom 'make haste slowly.' How can we navigate caring for our elders with compassion and understanding? Dr. Dennis McCullough has been an in the-trenches family doc and geriatrician for 30 years. He serves as a faculty member in the department of community and family medicine at Dartmouth Medical School. He is author of the book My Mother, Your Mother: Embracing 'Slow Medicine,' the Compassionate Approach to Caring for Your Loved Ones. What exactly is slow medicine? Tune in for host Dr. Leslie Lundt's conversation with Dr. McCullough to find out.

Guest: Lisa Gibbs

Dr. Lisa Gibbs, associate professor in the department of family medicine at the University of California, Irvine School of Medicine, describes the different types of elder abuse and who is most vulnerable. She explains how physicians evaluate mental capacity and the difference between capacity and competency. She also discusses the latest research in elder abuse. Hosted by Susan Dolan.

Guest: Joseph Ouslander

What are the most essential elements of ensuring safe transitions of care when a patient is discharged from a hospital into a skilled nursing facility, and vice-versa?  Dr. Joseph Ouslander, professor of clinical biomedical science and associate dean for geriatric programs at the Charles E. Schmidt College of Biomedical Science, and professor at the Christine E. Lynn College of Nursing of Florida Atlantic University in Boca Raton, Florida, recommends some of the clinical tools he uses to encourage smoother and safer transitions of care to and from long-term care facilities. How can better communication between physicians and adherence to transfer document checklists reduce hospital readmissions? Dr. Eric Tangalos hosts.

Guest: William Hall

Dr. William Hall, director of the Center for Healthy Aging at Highland Hospital in Rochester, New York, discusses with host Dr. Maurice Pickard the unprecedented increase in members of our population age 85 and older, and the role this may play in exceptional longevity. We know more today than we ever have before about disease factors that cause disability and frailty, such as depression, neuromuscular stability, cognitive status and urinary incontinence. How will these factors help to support older patients?

Guest: William Thomas

Why are conventional emergency departments less than ideal environments for older patients, and how can EDs be acclimated for seniors? Dr. William Thomas, geriatrician and professor of aging studies at the Erickson School at the University of Maryland, describes to host Dr. Lee Freedman the philosophy behind the nation's first ED designed specifically for older patients, at Holy Cross Hospital in Silver Springs, Maryland. How do staffing and design changes, as well as new screening methods, help physicians better care for older patients? Is this model cost-effective and efficient enough for other hospitals to emulate?

Guest: Paul Drinka

Multi-drug resistant organisms (MRDOs), such as Methicillin-resistant Staphylococcus aureus (MRSA), due to antibiotic use are of significant concern. Not only hospitals, but also long-term care facilities, are particularly susceptible to the impact of antibiotic resistance. Dr. Paul Drinka, clinical professor of internal medicine and geriatrics at University of Wisconsin-Madison and the Medical College of Wisconsin-Milwaukee, tells us that one evidence-based approach is to maintain a database of the MRDOs that will help identify clustering of a specific isolate and document a facility's resistance problem, which can then be addressed more precisely. What other specific steps might facilities take to prevent unnecessary use of antibiotics and therefore limit resistance? Dr. Eric Tangalos hosts.

Guest: Ken Brummel-Smith

Are you certain the prescribed medication is helping your elderly patient? Dr. Ken Brummel-Smith, professor in the department of geriatrics at Florida State University College of Medicine, talks with host Dr. Bill Rutenberg about reducing polypharmacy in the elderly. What questions should you ask yourself before prescribing a drug to an elderly patient? How does the patient’s age, adherence and side effects relate to your prescribing decision? Is there a framework you can use to help make these difficult prescribing decisions? Join us to learn more.

Guest: Freddi Segal-Gidan

Dr. Segal-Gidan, assistant clinical professor at the University of Southern California's Keck School of Medicine, discusses the role of the physician assistants in geriatric medicine with host Lisa Dandrea Lenell. Dr. Segal-Gidan also describes the nuances of providing care to elderly patients suffering from Alzheimer's disease, Parkinson's disease, and stroke complications in a public hospital setting.

Guest: Lisa Gibbs

How is self-neglect defined and how prevalent is it in the elderly population? Dr. Lisa Gibbs, professor in the department of family medicine at the University of California, Irvine School of Medicine, defines self-neglect and explains why it is a geriatric syndrome. She describes how to conduct a comprehensive assessment for self neglect, and discusses the relevant research. Hosted by Susan Dolan.

Guest: Dan Osterweil

Telehealth refers to the constantly evolving tools and technologies used to care for patients remotely. These technologies can be applied in many types of clinics, including long-term care facilities, to improve patient access to care and reduce healthcare costs. Dr. Dan Osterweil, clinical professor in the department of geriatrics at the David Geffen School of Medicine at University of California Los Angeles, and medical director for Silverado Senior Living in Calabasas, California, joins host Dr. Eric Tangalos to discuss some of the current practical applications of telehealth, ways to overcome barriers to implementation and the future outlook for remote care. How can telehealth be particularly beneficial  to long-term care patients and providers? What are some of the limitations to the use of telemedicine while managing elderly patients? Can telehealth effectively replace in-person exams, are the technologies best utilized in monitoring or consulting situations?

Guest: Dennis McCullough

In the later stages of life, patient care often requires a different approach. How can a physician help geriatric patients and their loved ones through the last stations of life: decline, prelude to dying, dying and grieving?  Dr. Dennis McCullough, associate professor of community and family medicine at Dartmouth School of Medicine and practicing geriatrician for 30 years, joins host Dr. Leslie Lundt to explain ‘slow medicine.' Dr. McCullough discusses a forward approach to planning, understanding a patient's comfort with risk vs. safety, as well as building and using a team.

Guest: Steven N. Austad

The bowhead whale is the longest-living mammal on Earth. Its lifespan can exceed 200 years. What can we learn about fostering human longevity from the extraordinarily long-living animals in what author Dr. Steven Austad calls "Methuselah’s Zoo" (so named for Methuselah, the oldest figure in the Bible, said to have lived for 969 years)? Dr. Austad, professor of cellular and structural biology at the Barshop Institute for Longevity and Aging Studies at the University of Texas Health Science Center, talks to host Dr. Mary Leuchars.

Guest: Alan Abrams

As our older patient population grows more diverse, it will become increasingly important to understand how to best communicate with patients, and their families, about values and expectations. In addition, teams of medical providers come from different backgrounds, so good dialogue within the team is crucial to providing quality care to patients. What should we keep in mind when caring for our older patients, who may be from cultures than our own? Dr. Alan Abrams, assistant professor of medicine at Harvard Medical School, emphasizes that the skills of ethnogeriatric communication are learnable, teachable and paramount to medicine. Dr. Eric Tangalos hosts.

Guest: Barbara Resnick

How is interdisciplinary collaboration of crucial importance in long term care medicine, and how can a team of health care providers communicate most effectively? What are some of the challenges presented by interdisciplinary collaboration? Dr. Barbara Resnick, professor in the department of organizational systems and adult health at the University of Maryland School of Nursing, discusses collaboration in geriatric and long term care medicine with host Dr. Eric Tangalos.

Guest: Susan Levy

When patients are admitted to long term care facilities, it's crucial to conduct a health screening and identify a preventative patient health plan in order to preserve their well-being. What are some of the areas to pay particular attention to when screening a new patient at a long term care facility? What is the role of the family in creating a health maintenance plan? How might an individualized health maintenance plan differ from standard guidelines? Dr. Susan Levy, vice president of medical affairs and medical director at Levindale Hebrew Geriatric Center and Hospital in Baltimore, discusses these and other questions about health maintenance with host Dr. Eric Tangalos.

Guest: David Thomas

How common are pressure ulcers in hospitals, nursing homes and other long-term care facilities? What clinical situations put patients at risk for developing pressure ulcers, and how are these wounds diagnosed? Dr. David Thomas, professor of internal medicine and geriatric medicine at Saint Louis University Health Sciences Center, joins host Dr. Eric Tangalos to review strategies for managing pressure ulcers.

Guest: Alva (Buzz) Baker

Among older patients, who is most at risk for developing dementia? How can a team of caregivers at a nursing home best assess dementia, and what are some of the causes of this condition? How can activity programs help to decrease the cognitive decline of residents at long-term care facilities? Host Dr. Eric Tangalos discusses these and other questions about dementia with Dr. Alva Baker, faculty member of the division of geriatric psychiatry and neuropsychiatry at Johns Hopkins University School of Medicine.

Guest: John Morley

Weight loss, especially among older patients, can be a key indicator of other health problems. How much weight loss is safe, and at what point should physicians address any potential underlying causes of weight loss, including nutritional deficiencies? What are the most common symptoms of dehydration, which can be even more challenging to recognize than nutritional deficits? Join host Dr. Eric Tangalos as he reviews these and other questions with Dr. John Morley, the Dammert Professor of Gerontology at Saint Louis University Medical Center.

Guest: Cari Levy

A growing number of young physicians are choosing to work in long term care medicine— a specialty in which high job satisfaction is generally reported. Dr. Cari Levy, assistant professor and director of palliative care at the Denver Veterans' Affairs Medical Center, tells host Dr. Eric Tangalos what she finds most appealing about working in long term care medicine. They take a wide-angle look at the field, from how physicians working in long term care facilities stay connected to a network of fellow geriatricians, to the financial viability of the specialty.

Guest: Karen Leible

Does the 'culture change' model at long term care facilities involve a simple re-design of aesthetics, or does this model encourage an entirely different way of structuring long term care? How challenging is it to implement a culture change, or patient-centered model, especially at facilities that have operated under a traditional model for decades? Dr. Karen Leible, chief clinical officer for Pinon Management, a long term care management and consulting firm in Colorado, discusses these questions and more with host Dr. Eric Tangalos. How can culture change help to empower patients?

Guest: Charles Cefalu

What are the various types of anemia found in long-term care settings, and which types are the most common? What are some of the underlying causes of both chronic and acute anemia? Dr. Charles Cefalu, clinical professor and chief of the section of geriatric medicine at Louisiana State University Health Sciences Center, talks about how physicians can be alert to symptoms of anemia, which are often non-specific. What is the relationship between falling and anemia? Dr. Eric Tangalos hosts.

Guest: Paul Katz

How can we address the shortage of physicians in nursing homes, and how does this relate to the broader issue of dwindling primary care physicians nationwide? Dr. Eric Tangalos addresses this topic with Dr. Paul Katz, professor of medicine at the University of Rochester School of Medicine and Dentistry in upstate New York. What are the advantages to working as a physician in a nursing home? Will a nursing home specialist model be likely in the near future?

Guest: Charles Crecelius

There are many different types of long term care facilities, including nursing homes, skilled nursing facilities and assisted living facilities. Dr. Charles Crecelius, clinical instructor of internal medicine and geriatrics at Washington University School of Medicine in St. Louis, explains the services these different facilities provide, and offers some suggestions to physicians about ways to assess long-term care facilities. Dr. Eric Tangalos hosts. You can visit Medicare's Nursing Home Compare website here.

Guest: David Dosa

Long-term care facilities that include pets as residents are finding that fuzzy friends offer not only companionship to their human residents, but also comfort at the end of life. Dr. David Dosa, geriatrician and health services researcher at Brown University in Providence, Rhode Island, and author of Making Rounds with Oscar: The Extraordinary Gift of an Ordinary Cat, shares his stories about a nursing home cat named Oscar with an uncanny ability to sense when patients are nearing the end of life. What can Oscar teach us about compassionate palliative and hospice care? How prevalent are animal programs at long-term care facilities, and what other benefits do pets offer to residents? How do animal programs fit in with culture change in long-term care? Dr. Eric Tangalos hosts. 

Guest: Steven Levenson

As healthcare reform evolves, so too do the public policies governing long-term care facilities. How can healthcare professionals stay up-to-date with the latest changes in federal and state regulations? What are the differences between regulations governing assisted living versus skilled care environments? How successful have regulations been at facilitating better quality of care in skilled care and assisted living? Dr. Steven Levenson, medical director of six long-term care facilities in Maryland and past-president of AMDA, says that having a "watchful eye" over long-term care facilities is generally useful in promoting quality of care, but laments the fact that there are some inconsistencies in the ways regulations are applied and implemented. How can healthcare providers aim towards regulatory compliance and better patient care, without getting bogged down with seemingly overwhelming details? Dr. Eric Tangalos hosts.

Guest: Matthew Wayne

Regulations regarding nurses as prescribing agents of physicians in long-term care facilities are more restrictive than in the hospital setting, because controlled substance licenses are not currently approved for nursing homes in most states. These restrictions can make it challenging for long-term care patients to receive timely access to narcotics. Dr. Matthew Wayne, medical director, geriatric medicine, University Hospital Richmond Medical Center in Richmond Heights, Ohio, and assistant professor of medicine at University Hospitals Case Medical Center in Cleveland, suggests revisions to some provisions of the Controlled Substances Act in order to ensure long-term care patients have access to pain medications when they need them the most. What hurdles are the most significant impediments to improving patient care with appropriate access to narcotics, and how can medical professionals best navigate the waters until revisions are made to the current law? Dr. Eric Tangalos hosts.

Guest: Ken Brummel-Smith

Alzheimer's patients display many special personal needs beyond the physical care of their disease. How can doctors and caretakers work through the challenges posed by cognitive disability? Dr. Ken Brummel-Smith, professor and chair of geriatrics at Florida State University College of Medicine, explores the social and psychological needs of Alzheimer's patients with host Dr. Bill Rutenberg. Like all of us, they desire respect, dignity, and the best feasible quality of life.

Guests: Tim Fox, Mimi Jacobs

As people are living longer than ever before with a variety of chronic conditions, modified physical activity can help older patients regain or retain functionality. Indeed, physical therapy is also essential to the recovery of patients who have undergone elective or emergency surgeries. What distinguishes therapeutic exercise from physical activity, and how can exercise programs be tailored to meet the various needs of long-term care residents? How can we effectively "dose" therapeutic exercise, setting up an effective care plan that residents can adhere to? Dr. Tim Fox, founder and executive director of Fox Rehabilitation in Cherry Hill, New Jersey, and Mimi Jacobs, founding executive director of the non-profit Fox GERI: Geriatric Education & Research Institute, advocate for the benefits of therapeutic exercise in improving quality of life for all patients. Hosted by Dr. Eric Tangalos.

Guest: Ken Brummel-Smith

Eighty million Americans will be above age 65 by the year 2030. This projection offers clear warning that our health care system needs more specialists in geriatric medicine. So, how does the practice of geriatrics compare to internal medicine? How can our policies encourage an influx of geriatricians? Host Dr. Bill Rutenberg talks with Dr. Ken Brummel-Smith, professor of geriatrics at Florida State University College of Medicine.

This article is from the issue dated April 1, 2010. Data from a national study showed that more than one quarter of older adults who died between 2000 and 2006 required decision making at the end of life but lacked decision-making capacity.

This article is from the issue dated February 11, 2010. The author writes that she and her mother and were on vacation in New York when they got a call from her aunt and uncle, both psychiatrists, in Portland, Oregon. The author's 90-year-old, demented paternal grandmother seemed to be having a stroke. They wanted to know whether they should take her to the emergency room.

This Clinical Implications of Basic Research article is from the issue dated December 31, 2009. Recent discoveries in the research on aging suggest that modern science is more adept at keeping aging at bay — at least temporarily and thus far only in worms, flies, and rodents  — than at halting it completely. A recent study has identified ribosomal protein S6 kinase 1 (S6K1) as a molecular player in the aging game.

Guest: Paul Sanders

At the American Medical Association's 2009 House of Delegates meeting President Obama discussed the need to re-emphasize primary care, determine the most appropriate physician reimbursement rates and reduce re-hospitalizations. How will each of these aspects of healthcare reform impact long term care medicine? Dr. Paul Sanders, family physician and corporate medical director, discusses these issues with host Dr. Eric Tangalos.

Guest: Lisa A. Jackson

Do influenza vaccines for the elderly really make a difference?  Dr. Lisa Jackson, research professor of epidemiology at the University of Washington and senior investigator at The Center for Health Studies in Seattle, Washington calls into question previous documentation of reducing deaths and hospitalizations in the elderly from flu vaccination. This is based on a fundamental difference between the kinds of people who get vaccines and those who do not. Join host Dr. Maurice Pickard to learn more.

Guest: Samuel Gandy

What medications are approved for the treatment of Alzheimer's disease? Dr. Samuel Gandy, professor and director of the Farber institute for neurosciences at Thomas Jefferson University, discusses state of the art pharmacologic treatments for Alzheimer's disease with host Dr. Lee Freedman. What are the benefits to each medication, and how can physicians prevent side effects from these medications? How do diet and lifestyle influence the condition?

Guest: Jeffrey Kaye

Our best evidence suggests that nursing homes and other assisted-living facilities will likely not be able to keep up with the demands of our rapidly aging population, which today stands at more than 40 million, a number that is expected to more than double by 2050. As a result, a premium is being placed on new remote monitoring devices that allow medical professionals to track patients for medical data from the comfort of patients' own homes, thereby allowing more elderly patients to live independently for longer. Dr. Jeffrey Kaye, professor of neurology and biomedical engineering, and director of the Oregon Center for Aging and Technology at Oregon Health and Science University, joins host Dr. Danny Petrasek to project where recent advances in these technologies will guide us over the next several years.

Guest: Jeffrey Kaye

Dr. Jeffrey Kaye, professor of neurology and biomedical engineering, and director of the Oregon Center for Aging and Technology at Oregon Health and Science University, provides his perspective on where recent advances in technology will guide health care for the elderly over the next several years. Dr. Danny Petrasek hosts.

Guest: John Trojanowski

Dr. Trojanowski discusses how to differentiate the types of dementia and how making these distinctions can lead to different approaches in terms of management.

Guest: John Trojanowski

Dr. Trojanowski discusses the implications of our aging population in terms of the future burden of Alzheimer's disease: financial and human costs. He then reviews newer directions for the prevention and treatment of this possible epidemic.

Guest: Charlene Harrington

Professor and RN, Charlene Harrington discusses with host Dr. Bill Rutenberg the recently launched UCSF demonstration project to design and test nursing interventions to improve quality of care in nursing homes. A focus of the study is to "refine a practice model to transform the nursing home care, based on peer-reviewed research into what works and what does not." Another goal of the study is to "translate the findings from the current research into practical changes on a national scale."

Guest: Charlene Harrington

Professor and RN Charlene Harrington discuss the Future of Nursing Homes with host, Dr. Bill Rutenberg. What policies are vital to keep nursing homes up to snuff so they’re ready for the aging population? They also discuss the development of and usefulness of Nursing Home Consumer Information System, Reimbursement policies, and Regulation required in the nursing home industry.

Guest: Audrey Ignatoff

In this segment medical sociologist Audrey Ignatoff talks about the difficult task of following a medication regimen for a senior on many concurrent medications.

Guest: Peter Reed

Dr. Reed describes the services and support that the Alzheimer's Association offers to patients, families, and physicians.

Guest: Bill Thies

Dr. Thies discusses the background of Alzheimer's Disease including factors associated with the disease and signs and symptoms.

Guest: Jennifer Lynch

Dr. Jennifer Lynch identifies common causes of insomnia in the elderly.

Guest: Lisa Baron

Mrs. Baron and Mrs. Osiek talk about the mission of Memory Care Home Solutions, including their training and referral services for caregivers, and the positive impacts this has for Alzheimer's patients at home with their families.

Guest: Lisa Baron

Mrs. Baron and Mrs. Osiek extend their talk about the mission of Memory Care Home Solutions, including the achievements and challenges in training caregivers for delivering at-home assistance for patients with advanced Alzheimer's disease.

Guest: Suzanne Griffel

Dr. Pickard and Rabbi Griffel discuss the issues, challenges and needs for end of life discussions and preparations.

Guest: Christopher Marash

Dr. Marash discusses the origin and prevalence of depression in the elderly as well as the latest treatment options and management techniques.