November 20, 2024
There are many controversies and thought-provoking topics in post-acute and long-term care (PALTC), and the most recent issue of Caring for the Ages addressed some of these. PALTalk with Caring host Karl Steinberg, MD, HMDC, CMD, sat down with editor-in-chief Elizabeth Galik, PhD, CRNP, and senior contributing writer Joanne Kaldy to discuss some of these topics. They also took a few minutes to celebrate the 25th anniversary of Caring.
Among the insights on When a Patient or Caregiver Asks for a Drug by Name, What Should Practitioners Do?:
- Clinicians are generally prepared to talk with patients and families about medication choices and why a medication advertised on TV might or might not be a viable choice for them or their loved one. Ms. Kaldy, who authored the article, said, “Most practitioners I talked to said that, as a rule, people are very accepting of the advice and guidance of their clinician. These conversations are most productive when there is a mutually trusting relationship.”
- At least one study has found that fewer than 1/3 of the drugs most frequently featured in TV ads were rated as having high therapeutic value. This suggests the need to include patients and families in educational efforts about care and treatments for common conditions seen in older adults. Ms. Kaldy said, “When they have accurate information from trusted sources, they're more likely to make good choices and follow the guidance of their clinicians.”
- Dr. Galik observed, “When a patient or a family member comes to discuss with the practitioner about a new drug that they've seen advertised, it opens up an opportunity not only to talk about that medicine but to talk about polypharmacy as well and some of the dangers associated with that.”
Talking about Controversies in Aging: Anticonvulsants for Management of Agitation in Dementia, Dr. Galik noted:
- There are potential adverse effects for these medicines, including GI symptoms such as nausea and vomiting. Patients with more advanced dementia often start losing weight because they're not eating, and they might not be able to tell anyone. Clinicians need to weigh the benefits of these medications with the possible side effects. “I always warn students that if they’re going to prescribe these medications, the patient has to be able to tolerate the blood tests and be appropriately monitored for side effects,” she said.
- It is important to teach the staff and families what to look for. Because they know the patient so well, they may notice subtle changes or issues.
- “I hope the article will give our prescriber listeners and readers some pause before ordering an anticonvulsant indiscriminately for behavioral expressions and dementia,” said Dr. Galik.
Dr. Galik also talked about her Caring Collaborative column, What Is Special About Dementia Special Care:
- “I think staff training, having appropriate staff-to-resident ratios, having staff who have experience working with individuals with dementia, and maybe an environment that is dementia-friendly all can go a long way in making care better. The challenge is how we label it. Just because you call something dementia special care doesn't necessarily mean it includes those components,” she said.
- There is no standard definition of dementia special care, also known as memory care. However, dementia special care is marketed as “providing supportive physical environments and social models of care with trained staff to support the care of individuals living with dementia.”
- The majority of states allow assisted living communities to self-designate memory care services, and these can cost up to 40% more than general assisted living communities, which is already expensive. “I think we have to consider the cost-benefit ratio of this care, and that research really hasn't been done,” she said. However, some potential benefits include a decreased risk of hospitalization and nursing home admission.
- One state-based study of dementia special care units in assisted living indicated that residents in these units had the “same number of or fewer medical comorbidities and more severe cognitive impairment than their peers in general AL communities.” Additionally, this study found no differences in the discharge of residents living with dementia to nursing homes. However, a national study found that residents in dementia special care units had a decreased risk of hospitalization and nursing home admission.
Drs. Steinberg and Galik and Ms. Kaldy also shared some memories about the magazine and discussed the article We’re Celebrating Our 25th Anniversary! Dr. Steinberg said, “When I got my first issue of Caring around the turn of the century, I was immediately enthralled. There wasn't at that time and still isn't any publication that is more directly relevant to my day-to-day work than Caring; and I started reading it cover to cover pretty much every issue and still do.”
Ms. Kaldy, who has written for Caring since its inception, said, “I have had the opportunity to speak with so many great experts and leaders in the field. For instance, I got to talk to Mark Beers, the father of the Beers Criteria, shortly before he passed away. People like him were rock stars to me, and it has been such an honor to talk with and write about them.”
Dr. Galik noted that she has been a faithful reader of Caring for 20 years. She said, “One of my favorite parts of Caring is getting to know some of the PALTmed members a little bit better, as well as the people who write for us. That’s been a lot of fun. It’s so nice to get emails from readers. It’s rewarding to know people are reading and enjoying the publication and that we are having an impact.” She added, “I've tried to bring forth the interdisciplinary team in Caring and stay true to the focus of PALTC medicine while getting a little creative with special issues.”
Listen to the full podcast here.