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ACE Units are general medical units specifically for older adults. These units typically have the following components:
Ahmed, N.N. & Pearce, S. E. (2010). Acute Care for the Elderly: A Literature Review. Population Health Management:13 (4): 219-225.
Ahmed, N., Taylor, K., McDaniel, Y., Dyer, C.B. (2012). The role of an acute care for the elderly unit in achieving hospital quality indicators while caring for frail hospitalized elders. Population Health Management: 15(4): 236-240.
Flood, K., MacLennan, P., McGrew, D. , et al.(2013). Effects of an Acute Care for Elders Unit on Costs and 30-Day Readmissions. Journal of the American Medical Association, 173(11):981-987.
Fox, M,T., Sidani, S., Persaud, M., Tregunno, D., Maimets, I., Brooks, D., & O'Brien, K. (2013). Acute Care for Elders Components of Acute Geriatric Unit Care: Systematic Descriptive Review. Journal of the American Geriatrics Society: 61(6): 939–946.
Landefeld, C.S., Palmer, R.M., Kresevic, D.M., Fortnsky, R.H., & Kowal, J. (1995). A Randomized Trial of Care in a Hospital Medical Unit Especially Designed to Improve the Functional Outcomes of Acutely Ill Older Patients. New England Journal of Medicine; 332:1338-1344.
Patients have the right to manage their own health care decisions, to accept or refuse medical treatment, and ultimately make advance directives. The Agency for Healthcare Research and Quality, in a 2011 report, noted that less than 33% of older adults have completed advance directives and often these advance directives are not part of the electronic medical record. Learn more about advance directives and tips on how to have discussions with older adults about these documents.
Advance Care Planning Handout
Agency for Healthcare Research and Quality (2011). Elders' preferences for end-of-life care are not captured by documentation in their medical records. Research Activities. https://archive.ahrq.gov/news/newsletters/research-activities/jun11/0611RA25.html
Crosby, J.T. (2015). Advance Care Planning Discussions: A step-by-step guide with verbal options. Annals of Long-Term Care (September): 28-32.
House, T. & Lach, H.W. (2014). Advance directives in hospitalized patients: A retrospective cohort study. The Journal for Nurse Practitioners 10 (7): 465-471.
Tulsky, J. (2015). Beydon advance directives, importance of communication skills at the end of life. Journal of American Medical Association 294(3):359-366.
Persons with Intellectual Development Disabilities (IDD) are aging at a rapid rate. Adults with intellectual disabilities have intellectual functional limitations that occur prior to the age of 18 years. Adults with developmental disabilities have functional limitations in 3 or more areas of life activity (self-care, language, mobility, self-direction, capacity for independent living). Constipation is a major medical conditions that commonly is seen among persons with IDD and may lead to serious complications.
Aging Persons with Intellectual Developmental Disorders (IDD): Constipation Handout
Health Guidelines for Adults with an Intellectual Disability. Available at: http://www.intellectualdisability.info/how-to../health-guidelines-for-adults-with-an-intellectual-disability#constipation
Lewis SJ, Heaton KW (1997). Stool Form Scale as a Useful Guide to Intestinal Transit Time. Scand. J. Gastroenterol. 32 (9): 920–4. doi:10.3109/00365529709011203.PMID 9299672
Office of Training and Professional Development (2011, October 15). The Fatal Four: Constipation: A Major Challenge that Impacts People with Developmental Disabilities. Division of Developmental Disabilities Services 4(9), pp 1-2.
Schalock, RL, Borthw9ck-Duff, SA, Bradley VJ, et al. (2010). Intellectual Disability: Definition, Classification and Systems of Supports. (11th ed). Washington DC: American Association on Intellectual and Developmental Disabilities.
Smith, MA, & Escude, CL (2015). Intellectual and Developmental Disabilities. The Clinical Advisor, February:49-58.
Comprehensive Geriatric Assessment (CGA) is a mainstay in the assessment, evaluation and development of a plan of care in older adults. Aging adults have several unique features including multi-comorbidities, diminishing physiologic reserves, aging organ systems which may influence functional independence and changing social-economic status. The comprehensive geriatric assessment is an overall biopsychosocial approach to meet the holistic needs of older adults.
Borenstein, JE, Aronow HU, Bolton LB, Dimalanta MI, Chan, E, Palmer K, Zhang, X, Rosen B, & Braunstein, GD. (2015). Identification and team-based interprofessional management of hospitalized vulnerable older adults. Nursing Outlook, on-line, 1-9. http://dx.doi.org/10.1016/j.outlook.2015.11.014.
Dyer, C.B., & Ostwald, S. (2011). Ageing and health: Managing co-morbidities and functional disability in older people. In E. Stuart-Hamilton (Ed.), An introduction to gerontology (pp. 87-125). Cambridge, UK: Cambridge University Press.
Flood, KL, MacLennan, PA, McGrew, D, Green, D, Dodd, C, & Brown, CJ (2013). Effects of an acute care for elders unit on costs and 30-day readmissions. JAMA Internal Medicine, 173(11), 981-987.
Interprofessional Education Collaborative (2011). Core Competencies for Interprofessional Collaborative Practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.
Ward, K.T., & Reuben, D.B. (2012). Up To Date. Comprehensive Geriatric Assessment. Retrieved from http://www.uptodate.com/contents/comprehensive-geriatric-assessment.
World Health Organization (WHO). (2010). Framework for Action on Interprofessional Education & Collaborative Practice. Geneva: World Health Organization. Retrieved September 17, 2013 from https://www.who.int/publications/i/item/framework-for-action-on-interprofessional-education-collaborative-practice.
Blume, S.W., & Curtis, J.R. (2011). Medical costs of osteoporosis in the elderly Medicare population. Osteoporosis International, 22, 1835-1844.
Cauley, J. (2013). Public Health Impact of Osteoporosis. Journal of Gerontology: Medical Sciences. Doi: 10.1093/Gerona/glt093. E-pub ahead of print.
Carey, J.J. (2005). What is a 'failure' of bisphosphonate therapy for osteoporosis? Cleveland Clinic Journal of Medicine; 72:1033-1039.
Chodzko-Zajko, W.J., Proctor, D.N., Singh, M.A., Minson, C.T., Nigg, C.R., Salem, G.J., and Skinner, J.S. (2009). Exercise and physical activity for older adults. American College of Sports Medicine Science Exercise, 4, 1510-1530.
Holick, M. (2006). High Prevalence of Vitamin D Inadequacy and Implications for Health. Mayo Clinic Procedures; 81:353-373.
National Osteoporosis Foundation. (2011). Clinician's Guide to Prevention and Treatment of Osteoporosis. Retrieved from http://www.nof.org/professionals/clinical-guidelines
National Institutes of Health (2000). Osteoporosis prevention, diagnosis, and therapy. NIH Consensus Statement 17(1):1e36. Retrieved from http://consensus.nih.gov/2000/2000Osteoporosis111
The National Osteoporosis Foundation (2012). Fast Facts. Retrieved from www.nof.org
Sweet, M.G., Sweet, J.M., Jeremiah, M.P., and Galazka, S.S. (2009). Diagnosis and Treatment of Osteoporosis. Journal of American Family Physician, 79,193-200.
Pain Management Handout
Bosilkovska, M., Walder, B., Besson, M., Daali, Y., & Desmeules, J. (2012). Analgesics in Patients with Hepatic Impairment. Drugs, 72(12), 1645-1669.
Delgado-Guay, M., & Bruera, E. (2008). Management of pain in the older person with cancer: Part 1: Pathophysiology, Pharmacokinetics, and Assessment. Oncology, 22, 56-61.
Fallon, M., Cherny, N., & Hanks, G. (2011). Opioid analgesic therapy. In G. Hanks, N. I. Cherny, N. A. Christakis, M. Fallon, S. Kaasa, & R. K. Portenoy, Oxford Textbook of Palliative Medicine (pp. 661-698). New York: Oxford University Press.
International Association for the Study of Pain. (2006). Pain: Clinical Updates; Older People's Pain.
Johnson, S. J. (2007, November 30). Opioid Safety in Patients with Renal or Hepatic Dysfunction. Retrieved from Pain Treatment Topics: www.Pain-Topics.org
Mercadante, S., & Arcuri, E. (2007). Pharmacological Management of Cancer Pain in the Elderly. Drugs Aging, 24, 761-776.
Pergolizzi, J., Boger, R., Budd, K., Dahan, A., Erdine, S., Hans, G., . . . Sacerdote, P. (2008). Opioids and the Management of Chronic Severe Pain in the Elderly: Consensus Statement of an International Expert Panel with Focus on the Six Clinically Most Often Used World Health Organization step III Opioids. Pain Practice, 8(4), 287-313.
Portenoy, R. (2012, February). Pain. Retrieved from The Merck Manual Online: http://www.merckmanuals.com/professional/neurologic_disorders/pain/overview_of_pain
Rastogi, R., & Meek, B. (2013). Management of chronic pain in elderly, frail patients: finding a suitable, personalized method of control. Clinical Interventions in Aging, 8, 37-48.
Schmader, K. E., Baron, R., Haanpaa, M. L., Mayer, J., O'Connor, A. B., Rice, A., & Stacey, B. (2010). Treatment Considerations for Elderly and Frail Patients with Neuropathic Pain. Mayo Clin Proc, 85(3), S26-S32.
Yennurajalingam, S., Braiteh, F., & Bruera, E. (2005). Pain and Terminal Delirium Research in the Elderly. Clinics in Geriatric Medicine, 21, 93-119.
Zeppetella, G. (2011). Breakthrough Pain. In G. Hanks, N. I. Cherny, N. A. Christakis, M. Fallon, S. Kaasa, & R. K. Portenoy, Oxford Textbook of Palliative Medicine (p. 655). New York: Oxford University Press.
Prescription Drug Misuse among Older Adults
Prescription Drug Misuse Handout
Culberson, J.W., Ticker, R.L., Burnett, J., Marcus, M.T, Pickens, S.L., & Dyer, C. B. (2011). Prescription medication use among self-neglecting elderly. Journal of Addictions Nursing, 221), 63-68.
Culberson, J.W., & Ziska, M. (2008). Prescription drug misuse/abuse in the elderly. Geriatrics, 63(9), 22-31.
Grohol, J. M.A. (2010). Top 25 Psychiatric Prescriptions for 2009. Retrieved September 26, 2013, from http://psychcentral.com/lib/top-25-psychiatric-prescriptions-for-2009/0003170
Institute of Medicine. (2012a). The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? In J. Eden, K. Maslow, M. Le & D. Blazer (Eds.), Committee on the Mental Health Workforce for Geriatric Populations Board on Health Care Services. Washington, DC: Institute of Medicine, The National Academies Press.
Institute of Medicine. (2012b). The mental health and substance use workforce for older adults In whose hands? Washington, DC: National Academy of Sciences.
Kalapatapu, Raj K., & Sullivan, Maria A. (2010). Prescription Use Disorders in Older Adults. American Journal on Addictions, 19(6), 515-522. doi: 10.1111/j.1521-0391.2010.00080.x
Kan, C. C., Hilberink, S. R., & Breteler, M. H. (2004). Determination of the main risk factors for benzodiazepine dependence using a multivariate and multidimensional approach. Comprehensive psychiatry, 45(2), 88-94.
Laqueille, X., Dervaux, A., El Omari, F., Kanit, M., & Bayle, F.J. (2005). Methylphenidate effective in treating amphetamine abusers with no other psychiatric disorder. European Psychiatry, 20(5-6), 456-457.
Manchikanti, L. (2006). Prescription Drug Abuse: What is Being Done to Address This New Drug Epidemic? Testimony Before the Subcommittee on Criminal Justice, Drug Policy and Human Resources. Pain Physician, 9, 287-321A.
Maxwell, Jane Carlisle. (2011). The prescription drug epidemic in the United States: A perfect storm. Drug and alcohol review, 30(3), 264-270. doi: 10.1111/j.1465-3362.2011.00291.x
National Institute on Aging. (2013). Alcohol use in older people. Retrieved from http://www.nia.nih.gov/health/publication/alcohol-use-older-people
Simoni-Wastila, L., & Yang, H. K. (2006). Psychoactive drug abuse in older adults. American Journal of Geriatric Pharmacotherapy, 4, 380-394.
Wu, Li-Tzy, & Blazer, Dan G. (2011). Illicit and Nonmedical Drug Use Among Older Adults: A Review. Journal of Aging and Health, 23(3), 481-504.
Primary hyperparathyroidism (PHPT) is characterized by elevated plasma levels of parathyroid hormone (PTH) and calcium with reduced plasma phosphate. PHPT is the third most frequently diagnosed endocrine disorder. It is a silent health problem in the elderly until it becomes apparent with cognitive and physical consequences, for example, mental status change, severe constipation, and fracture.
Adami, S., Marcocci, C., & Gatti, D.. Epidemiology of primary hyperparathyroidism in Europe. Journal of Bone and Mineral Research 2002;Suppl 2:N18-23.
Bilezikian, J., Khan, A., Potts, T. Jr, (2009). Third International Workshop Asymptomatic Primary Hyperthyroidism. Guidelines for the management of asymptomatic primary hyperparathyroidism: Summary statement. Journal of Clinical Endocrinology & Metabolism; 94:335-339.
Kim, L., Whittier Krause, M., & Kantorovich. (2012). Primary Hyperparathyroidism. Medscape Reference Drugs, Diseases & Procedures. Retrieved from http://emedicine.medscape.com/article/127351-overview#aw2aab6b4
PACE Program Handout
Casiano A. A Model of Care for Individuals with Multiple Chronic Conditions. Annals of Long Term Care. 2015:41-45.
Hirth V, Baskins J, Dever-Bumba M. Program of all0inclusive care (PACE): past, present and future. Journal of American Medical Director Association. 2009; 10(3): 155-160.
Meret-Hanke L. Effects of the Program of All-Inclusive Care for the Elderly on hospital use. Gerontologist. 2011; 51(6):774-785.
Segelman M, Szydlowski J, Kinosian B, et al. Hospitalizations in the Program of All-Inclusive Care for the Elderly. Journal of the American Geriatric Society. 2014; 62(2):320-324.
Age-related changes in sleep physiology, multi-morbidity and sedentary lifestyles make older adults vulnerable to sleep disturbances. As older adults age, there are changes to total sleep time, time spent in deep sleep and altered sleep patterns. Sleep physiology changes with increased nocturnal awakenings and daytime napping. Research has shown older adults spend more time in bed without good sleep efficacy. Late life insomnia often occurs due to secondary causes such as medical conditions, medications, neuropsychiatric illnesses.
Flaherty, J. (2008). Insomnia among Hospitalized Older Patients. Clinics in Geriatrics Medicine:24:51-67.
Kamel, N.S., & Gammack, J.K. (2006). Insomnia in the elderly: Cause, Approach and Treatment. The American Journal of Medicine 119, 463-469.
Martin, J.L., Alam, T., & Alessi, C.A. (2007). Sleep Disorders. In R. J. Ham, P.D. Sloan, G.A. Warshaw, M.A Bernard & E. Flaherty (Eds). Primary Care Geriatrics: A Case-Based Approach (5th Ed). New York: Mosby Elsevier: pp. 391-400.
Subramanian, S. & Surani, S. (2007). Sleep disorders in the elderly. Geriatrics, 62(12):10-32.
This current generation of older adults in the United States has the highest smoking rate of any generation. Smoking is the most preventable cause of disease and death in the United States. Smoking is a strong risk factor for premature mortality in older age and smoking cessation is beneficial at any age. Smoking can interfere with the effectiveness of many medications. Older adults who smoke have been shown to be more successful at quitting than younger smokers.
Boyd, N. R. (1996). Smoking cessation: A four-step plan to help older patients quit. Geriatrics, 51(11), 52-57.
Centers for Medicare & Medicaid Services. (2012). Tobacco Use Cessation Counseling Services. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/smoking.pdf
Gellert, C., Schöttker, B., & Brenner, H. (2012). Smoking and all-cause mortality in older people: Systematic review and meta-analysis. Archives of Internal Medicine, 172(11), 837-844. Retrieved from SCOPUS database.
Jones, S.J., Gardner, C.L., Cleveland, K.K. (2014). Development of a smoking cessation algorithm for primary care providers. The Journal for Nurse Practitioner,10 (2):120-127.
Nicita-Mauro, V., Maltese, G., Nicita-Mauro, C., Lasco, A., & Basile, G. (2010). Nonsmoking for successful aging: Therapeutic perspectives. Current Pharmaceutical Design, 16(7), 775-782. Retrieved from SCOPUS database.
The American Lung Association, (2010). Smoking and older adults. Retrieved from: http://www.lung.org/stop-smoking/about-smoking/facts-figures/smoking-and-older-adults.html
Zoorob, R. J., Kihlberg, C. J., & Taylor, S. E. (2011). Aging and disease prevention. Clinics in Geriatric Medicine, 27(4), 523-539. Retrieved from SCOPUS database.
Syncope is one of the most common causes of emergency visits by an older adult. Thirty-five percent of older adults 65 years or older experiences syncope every year and the number increases to 45% for those 85 years or older. Syncope can be defined as an abrupt and transient loss of consciousness associated with absence of postural tone, followed by complete and usually rapid spontaneous recovery. It is often benign and self-limited; however, it may also indicate multiple underlying disease process.
Kenny, RA, O’Shea, D, Walker, HF. (2002). Impact of a dedicated syncope and falls facility for older adults on emergency beds. Age and Ageing, 31: 272-275.
Olshansky, B, Ganze, LE, Yeon, SB, Hockberger, RS. (2014). Evaluation of syncope in adults.UpToDate. http://www.uptodate.com
Cheitlin, MD. (2003). Cardiovascular physiology-changes with aging. American Journal of Geriatric Cardiology, 12(1): 9-13.
One of the greatest aging myths is that urinary incontinence (UI) is part of normal aging, when, in fact, it is not. UI is defined as the involuntary passage of urine. Older adults are often embarrassed by this problem and are reluctant to discuss this issue with their clinician.
The diagnosis and management of UI can be successfully achieved in the primary care setting and in consultation with an urologist (surgical interventions). It is highly treatable and even curable in many instances.
Alhasso, M. & N'Dow, G. (2008). Serotonin and noradrenaline reuptake inhibitors (SNRI) for stress urinary incontinence in adults (Review). The Cochrane Collaboration, 3, 1-54.
Danforth, K.N., Townsend, M.K., Lifford, K., et al. (2006). Risk factors for urinary incontinence among middle-aged women. American Journal of Obstetrics and Gynecology, 194(2): 339-345.
DeMaagd, G.A. & Davenport, T.C. (2012) Management of urinary incontinence. Pharmacy and Therapeutics 37(6), 361B-361H.
DuBeau, C.E., Kuchel, G.A., Johnson, T., et al. (2010). Incontinence in the frail elderly: Report from the 4th International Consultation on Incontinence. Neurological Urodynamics, 29 (1): 165-178.
Ko, Y., Lin, S.J., Salmon, W., & Bron M.S. (2005) The impact of urinary incontinence on quality of life in the elderly. American Journal of Managed Care, 11(4): S103-S111.
Markland, A.D., Goode, P.S., Redden, D.T., et al. (2010). Prevalence of urinary incontinence in men: Results from the national health and nutrition examination survey. Journal of Urology, 84 (3): 1022-1027.
Minassian, V.A., Stewart, W.F., Wood, G.C. (2008). Urinary incontinence in women: Variation in prevalence estimates and risk factors. Obstetrics and Gynecology, 111(2Part1): 324-331.
Pompei, P., Murphy, J. (Eds.). (2006). Geriatrics Review Syllabus: A Core Curriculum in Geriatric Medicine, (6th Ed.). New York, NY: American Geriatrics Society.
Sampselle, C.M., Harlow, S.D., Skurnick, J., et al. (2002). Urinary incontinence predictors and life impact in ethnically diverse perimenopausal women. Obstetrics and Gynecology, 100(6): 1230-1238.
Tomlinson, B.U., Dougherty, M.C., Pendergast, J.F., Boyington, A.R., Coffman, M.A., & Pickens, S.M. (1999). Dietary caffeine, fluid intake and urinary incontinence in older rural women. International Urogynecology, 10, 22-28.
Wyman, J.F. (2000). Management of urinary incontinence in adult ambulatory care populations. In: Fitzpatrick, J.F., Geoppinger, J. (eds.). Annual review of nursing research (vol. 18, pp.171-195). New York, NY: Springer-Verlag.
Zurcher, S., Saxer, S., & Schwendimann, R. (2011). Urinary incontinence in hospitalized elderly patients: Do nurses recognize and manage the problem? Nursing Research and Practice, 2011. Article ID 671302, doi:10.1155.2911.671302, http://dx.doi.org/10.1155/2011/671302