AMDA's 32nd Annual Symposium

Mar 5, 2009 ‐ Mar 8, 2009


The information provided in this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.


Contact Information: For questions about this CME activity contact AMDA’s Education Department at 410-740-9743 or at education@amda.com

Instructions for Course Participation
  • Review the materials on Terms of Use and Disclaimer statements, accreditation information, target audience, learning objectives, and disclosure information
  • Complete the entire self-study activity (viewing the PowerPoint presentation and listen to the audio recording in its entirety)
  • Complete and submit the self-assessment and evaluation/CME claim form
  • Print out CME certificate
  • The online library awards credits for sessions ranging from 1 to 3 hours. Each activity should take you approximately the number of hours to complete as credits which are awarded for that activity, (e.g. for 1.5 credit hours awarded, the completion of the activity should take approximately 1.5 hours to complete.)

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SYSTEM REQUIREMENTS/PRIVACY
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SELF-ASSESSMENT ACTIVITIES

Sponsored by the American Medical Directors Association (AMDA)

Release Date: 04/01/2009      Valid through: 04/01/2012

Click here for a list of Management and Clinical credit designations.

Accreditation

The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

ACCME STANDARDS FOR COMMERCIAL SUPPORT

As an ACCME accredited provider of CME, AMDA adheres to all elements of the ACCME Standards for Commercial Support℠. Individuals in a position to control the content of this education activity were required to disclose all relevant financial relationships with any commercial interest to AMDA. Disclosures were reviewed by the AMDA Education Department to identify any conflicts of interest and methods of conflict resolution were conducted for each of the identified conflicts. Individual presenter’s disclosures can be found within the CME information for each session.

PROGRAM PLANNING

All Program Committee members actively involved in planning reported that they have no relevant financial relationships to disclose.

2009 Planning Committee Members

Alan P. Abrams MD, MPH                 Jeffrey Nichols MD
Charles Crecelius MD, PhD, CMD     Naushira Pandya MD, CMD
Catherine M. Eberle MD, CMD          Dixie M. Stiles MSN, FNP-C
Katherine E. Galluzzi DO, CMD          Brian D. Stwalley PharmD
Donald E. Golden MD                        Belinda A. Vicioso MD, CMD
Daniel Haimowitz MD, CMD              Matthew S. Wayne MD, CMD (Vice Chair)
Steven A. Levenson MD, CMD          Heidi K. White MD, CMD
Jonathan Musher MD, CMD               Peter Winn MD, CMD (Chair)

Target Audience:
Medial Directors, Attending Physicians, Nurses (NPs, DONs, etc.) Nursing Home Administrators, Consultant Pharmacists


Sessions

Treatment of Behavior/Complications of Dementia: A Comprehensive Multi-Disciplinary Care Approach

Mar 5, 2009 8:00am ‐ Mar 5, 2009 11:30am

Identification: A04

AMDCP Credit Designation:

This session has been approved for a total of 3 Management credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

The American Medical Directors Association designates this educational activity fora maximum of 3 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Presenter(s): Eric Tangalos, MD, CMD;Ladislav Volicer, MD, PhD; Joyce Simard, MSW; Mara Ferris, RN, GCNS-BC; Leo J.Borrell, MD

Disclosure(s):
LeoJ. Borrell, MD will discuss substances not approvedin the USfor use under discussion - Trazadone AbilifyDepakote Trazadone
Amita Patel, MD received speakerhonoraria from Eli Lilly and Company, Sanofi Aventis,Bros, and WyethPharmaceuticals and a consultant fee from Eli Lilly and Company. Products madeby these companies related to this topic: Cymbalta, Ambien CR, Abilify and Pristiq.
EricTangalos, MD, CMD received a consultant fee from Novartis, a Data MonitoringCommittee fee from Eli Lilly and Company, and an investigator fee from Elan Pharmaceuticals, Inc. Product(s) made by thesecompanies related to this topic: Exelon, Bapineuzumab.
JoyceSimard, MSW received author royalties for a book from Health Profession Press.

Allother presenters reported they had no relevant financial relationships todisclose.

Session Description:
This session makes the case for a comprehensivemulti-disciplinary care approach for treatment of the complex behavioraldisturbances that can occur relative to many situations and conditions ingero-psychiatric patients. For instance, behaviors that are consideredaggressive are very common in patients with Alzheimer's disease occurring inabout 40-90% of patients during the course of their illness. Certain riskfactors include environment, stage of dementia, psychiatric diagnosis,co-morbid medical conditions and psychosocial factors. The challenges of andstrategies for this ideal treatment approach are discussed.

Learning Objectives:
  • Discuss how agitation and resistiveness to care are mistaken asaggression
  • Identify various behavioral approaches such as how continuousactivities for patients with dementia can decrease isolation, psychotropicmedication use and behavioral disturbances
  • Describe barriers related to organizational changes andimplementation of behavior management
  • Explain how to train staff in behavior management using amulti-disciplinary care approach
References:
1. "An Introduction to Belbin Team Roles", byBernard Chanliau
2. Competetive Strategy, Michael Porter.
3. "Effects of Continuous Activities Programming onBehavioral Symptoms of Dementia" L.Volicer at al. J Am Med Dir Assoc,2006: 7: 426-431.
4. Volicer L, Bass EA, Luther SL. Agitation and resistivenessto care are two separate behavioral syndromes of dementia. J Am Med Dir Assoc.8(8):527-32, 2007.
5. Rogers, EverettM. Diffusion of Innovations, (5th ed.). (2003) New York : Free Press. The Anatomy of Buzz:How to Create Word of Mouth Marketing by Emanuel Rosen. The Structure ofScientific Revolutions (1962) publ. Universityof Chicago Press, MichaelKuhns 1962.

Speaker(s):
Standard: $24.00

Clinical Controversies: Orexigenic Use in Unintended Weight Loss; Amiodarone Use for Atrial Fibrillation; Vitamin D Use in Fall Prevention

Mar 5, 2009 8:00am ‐ Mar 5, 2009 11:30am

Identification: A02

AMDCP Credit Designation:

This session has been approved for a total of 3 Clinical credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

The American Medical Directors Association designates this educational activity fora maximum of 3 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Presenter(s): Mario Cornacchione, DO, CMD(Moderator); Michael Bottorff, PharmD, FCCP; Naushira Pandya, MD, CMD; DennisChapron, PharmD; T.S. Dharmarajan, MD, FACP; Meri Hix, PharmD, CGP; S

Disclosure(s):
Dr.Hix will discuss off-label use of mirtazapine,megestrol, and dronabinolin the anorexia of aging.
MichaelBotteroff received speaker honoraria from Sanofi Aventis, AstraZeneca and Pfizer Inc.
MarioCornacchione, DO, CMD will discuss off-label use of Mirtazapine,Omega III Fatty Acids and Megestrol.

Allother presenters report they had no relevant financial relationships todisclose

Session Description:
This session takes the form of a moderated pro/conevidence-based debate utilizing a long term care physician and pharmacist foreach topic. What is the evidence forusing megestarol, mirtazepine or dronabinol in unintended weight loss? Is theefficacy data and side effect profile of amiodarone enough to support its useversus simple rate control in the frail elderly? Is there enough evidence tosupport using Vitamin D as part of a fall prevention program? In addition, itprovides valuable insight into the sometimes differing perspectives ofconsulting pharmacists and physicians on topics such as these.

Learning Objectives:
  • Describe the evidence for and against use of megestrol acetate,mirtazapine and dronabinol in unintended weight loss in long term care
  • Perform a risk benefit analysis for use of amiodarone in atrialfibrillation- rate control vs. rhythm control
  • Discuss the evidence for and against use of Vitamin D in FallPrevention

References:
1.Orexigenic Use in Unintended Weight Loss: Miller LJ, Kwan RC. Pharmacological treatmentof undernutrition in the geriatric patient. Consult Pharm. 2002; 17:739-747.
Kennedy DH, Ward CT, Salvig B. Retrospective review ofmegestrol use for weight loss in an elderly population. Consult Pharm. 2005;20:301-305.
Bodenner D, spencer T, Riggs AT, Redman C, Strunk B, HughesBA. A restrospective study of the association between megestrol acetateadministration and mortality among nursing home residents with clinicallysignificant weight loss. Am J Geriatr Pharmacother. 2007;5:137-146.
Yeh SS, Wu SY, Lee TP, Olson JS, Stevens MR, Dixon T, et al.Improvement in quality-of-life measures and stimulation of weight gain aftertreatment with megestrol acetate oral suspension in geriatric cachexia: resultsof a double-blind, placebo-controlled study. J Am Geriatr Soc. 2000;48:485-492.
Sullivan DH, RobersonPK, Smith ES, Price JA, Bopp MM. Effects of musclestrength training and megestrol acetate on strength, muscle mass, and functionin frail older people. J Am Geriatr Soc. 2007; 55:20-28.
Reuben DB, Hirsch SH, Shou K, Greendale GA.The effects of megestrol acetate suspension for elderly patients with reducedappetite after hospitalization: a phase II randomized clinical trial. J AmGeriatr Soc. 2005; 53:970-975.
Yeh SS, Wu SY, Levine DM, Parker TS, Olson JS, Stevens MR,Schuster MW. Quality of life and stimulation of weight gain after treatmentwith megestrol acetate: correlation between cytokine levels and nutritional status,appetite in geriatric patients with wasting syndrome. J Nutr Health Aging.2000; 4:246-251.
Raji MA, Brady SR. Mirtazapine for treatment of depressionand comorbidities in Alheimer disease. Ann Pharmacother. 2001; 35:1024-1027.
Laimer M, Kramer-Reinstadler K, Rauchenzauner M,Lechner-Schoner T, Strauss R, Enl J, et al. Effect of mirtazapine treatment onbody composition and metabolism. J Clin Psychiatry. 2006; 67:421-424.
Nelson JC, Hollander SB, Betzel J, Smolen P. Mirtazapineorally disintegrating tablets in depressed nursing home residents 85 years ofage and older. Int J Geriatr Psychiatry. 2006; 21:898-901.
Wilson MG,Philpot C, Morley JE. Anorexia of aging in long term care: is dronabinol aneffective appetite stimulant? – a pilot study. J Nutr Health Aging. 2007;11:195-198.
Volicer L, Stelly M, Morris J, McLaughlin J, Volicer BJ.Effects of dronabinol on anorexia and disturbed behavior in patients withalzheimer’s disease. Int J Geriat Psychiatry. 1997; 12:913-919.
2.Amiodarone Use for A. Fib: JACC 2003;42:20-29JACC. 2005;46:1891-9 Circulation. 2006;114:e257-e354
3.Vitamin D Use in Fall Prevention: Morley JE. Mo Med. 2007; 8: 276-8
Dharmarajan TS. J Am Med Dir. Assn. 2007; 8: 549-50
Swift CG. Age Ageing. 2006; 35: S2: ii 65-8
Holick MF. NEJM. 2007; 357: 266-81
Holick MF. Mayo Clin Proc. 2006; 81: 353-73
N Engl J Med 2005;352:1861-1872
T.S. Dharmarajan, M. Akula, S. Kuppachi, EP Norkus J NutrHealth Aging. 2005; 9:145
Janssen HC, et al. Am J Clin Nutr. 2002; 75: 611-5
Burleigh E et al. Age and Ageing. 2007; 36: 507-13
JacksonRD et al. N Eng J Med. 2006; 354:669-83
Law M et al. Age Ageing. 2006; 35: 482-6

Speaker(s):
Standard: $24.00

Everything You Wanted to Know About Billing and Coding in Long Term Care

Mar 5, 2009 8:00am ‐ Mar 5, 2009 11:30am

Identification: A06

AMDCP Credit Designation:

This session has been approved for a total of 3 Management credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

The American Medical Directors Association designates this educational activity fora maximum of 3 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Presenter(s): Alva S. Baker, MD, CMD;Leonard Gelman, MD, CMD

Disclosure(s):
Allpresenters reported they had no relevant financial relationships to disclose.

Session Description:
This session provides a review of the most recent CPT changesrelevant to nursing home services and discusses lessons learned in theiruse. Procedural codes, codes withmodifiers, coding for care by nurse practitioners, and day-of-death codes arediscussed in-depth. Instruction includescase-studies and vignettes as examples and participants are led through aprocess of determining codes based on modifiers and procedures.

Learning Objectives:
  • Use the Medicare Carriers Manual as a reference source for definingpayment parameters
  • Explain the concept of medical necessity as it relates to reimbursement
  • Delineate and apply evaluation and management codes for long termcare for physicians and other providers

Speaker(s):
Standard: $24.00

From Diagnosis of the Confused Patient to Managing Problematic Behavior and Delirium

Mar 5, 2009 8:00am ‐ Mar 5, 2009 11:30am

Identification: A05

AMDCP Credit Designation:

This session has been approved for a total of 3 Clinical credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

The American Medical Directors Association designates this educational activity fora maximum of 3 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Presenter(s): Steven A. Levenson, MD, CMD;Dana Saffel, PharmD; Jeffrey M. Behrens, MD, CMD

Disclosure(s):
JeffreyM. Behrens, MD, CMD is a medical director at Vitas HealthCare.
DanaSaffel, PharmD received consultant honoraria from Eli Lilly and Company, ForestPharmaceuticals, Inc., and GlaxoSmithKline.
StevenA. Levenson, MD, CMD has no relevant financial relationships to disclose.

Session Description:
This session presents a comprehensive practical approach tothe management of nursing facility residents and patients with problematicbehavior and changes in mental function. It is geared towards optimizing therole of the primary care practitioner, and the processes and approaches neededto manage these complex patients and challenging situations.

Learning Objectives:
  • Review and discuss effective approaches to analyzing and managingchanges in mental function and problematic behavior in residents andpatients in nursing facilities
  • Identify key areas for collaboration between physicians, facility staff, and the consultant pharmacist related to effective management of altered mental function, behavior, and the use of psychopharmacological medications
  • Interpret regulatory requirements related to prescribing, monitoringand modifying psychopharmacological medications

References:
AMDA Delirium and Acute Problematic Behavior Clinical Practice Guideline (2008 update). Columbia MD, 2008.
CMS State Operations Manual, F329, Unnecessary Drugs survey or guidance

Speaker(s):
Standard: $24.00

Palliative Care Part I: Clinical and Ethical Considerations

Mar 5, 2009 8:00am ‐ Mar 5, 2009 11:30am

Identification: A03

AMDCP Credit Designation:

This session has been approved for a total of 3 Management credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

The American Medical Directors Association designates this educational activity fora maximum of 3 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Presenter(s): Willliam D. Smucker, MD,CMD; Peter Winn, MD, CMD; Amy M. Corcoran, MD; Deborah Way, MD, CMD

Disclosure(s):
Allpresenters report they had no relevant financial relationships to disclose.

Session Description:
This session presents an overview of practical approaches tocommunication, advance care planning, assessment and control of pain, and otherdistressing symptoms experienced by patients in long term care.

Learning Objectives:
  • Define palliative care as it relates to each resident within the longterm care continuum
  • Identify organizationalbarriers to palliative care in the long term care setting
  • Describe comprehensive assessment and treatment of pain in thenursing facility
  • Examine a systematic approach to assessing and managing pain andnon-pain symptoms
  • Choose communication skills that best match patient and family needsfor acquiring and assessing information. Enhance communication withpatients, families, and caregivers regarding goals of care and advancedcare planning


Speaker(s):
Standard: $24.00

Latest Approaches to Difficult Medical Issues in Long Term Care

Mar 5, 2009 1:30pm ‐ Mar 5, 2009 5:00pm

Identification: A11

AMDCP Credit Designation:

Thiss ession has been approved for a total of 3 Clinical credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

The American Medical Directors Association designates this educational activity fora maximum of 3 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Presenter(s): Barbara J.Messinger-Rapport, MD, PhD, CMD; Julie Gammack, MD, CMD; John Morley, MB, BCh;David Thomas, MD

Disclosure(s):
Barbara J. Messinger-Rapport, MD, PhD, CMD received speaker honoraria from Forest Pharmaceuticals, Inc. and Novartis. Products made by these companies related to this topic: Reclase and Namenda.
John Morley, MB, BCH received grant/research Support from Ascend, Baxter, Numico, Nestle, and Danone and onthe Speaker's Bureau at Merck & Co, Novartis, Indevus,Orthobiotec, GTx, Amgen,Novartis Nutritional and Mattern. He is a consultantfor Novartis, Mattern Pharmaceuticals Amgen, Edunn Biotec, Indevus,Abbott, Glaxo Smith Kline, Cytokinetics,Ligand, and Baxter and has stocks in Mattern Pharm and Edunn Biotec.

Allother presenters reported they had no relevant financial relationships todisclose.

Session Description:
This session presents the latest and sometimes controversialapproaches to medical conditions commonly found in frail elders in thecontinuum of care, particularly in nursing facility. Topics addressed at thissession include dysphagia, constipation, cachexia, dehydration, hypertension,and heart failure. Information is presented in a didactic format withopportunities for questions from the audience.

Learning Objectives:
  • Identify different methods of preventing aspiration in dysphagia
  • Understand the different approach to diastolic heart failure, the mostcommon type of heart failure in the older adult
  • Suggest treatments for constipation

References:
BJ Messinger-Rapport, JE Morley, DR Thomas, JK Gammack.Intensive Session: New approaches to medical issues in long-term care. JAMDA.2007. 8(7):421-433

Speaker(s):

Transitional Care: Challenges and Strategies for Improvement

Mar 5, 2009 1:30pm ‐ Mar 5, 2009 5:00pm

Identification: A10

AMDCP Credit Designation:

This session has been approved for a total of 3 Management credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

The American Medical Directors Association designates this educational activity fora maximum of 3 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Presenter(s): Matthew Wayne, MD, CMD(Moderator); Gwendolen T. Buhr, MD, CMD; Susan Nicole Hastings, MD; CristinaHendrix, DNS, CFNP, CCRN; James E. Lett, II, MD, CMD; David E. Sandvik, MD,CMD; Priscilla Bade, MD, CMD

Disclosure(s):
DavidE. Sandvik, MD, CMD is a medical director at GoldenLiving Centers and Good Samaritan Society and a director of geriatric servicesat Rapid City Regional Hospital.
Priscilla Bade, MD, CMD receives hourly reimbursement as a medical director from Regional Senior Care and Hospice of the Hills and a salary from Golden Living Center.

All other presenters reported they had no relevant financial relationships to disclose.

Session Description:
This session introduces the broad concepts for best practicesin care transitions, followed by real world examples of strategies beingimplemented along the care continuum. The barriers encountered in multiple settings of the transitionalprocess are described and models of multiple projects, programs and solutionsfor addressing them are shared. Count on an engaging Q&A where lessonslearned are revealed and the answer to the question ‘whose business is it’ isprovided.

Learning Objectives:
  • Outline two examples of effective approaches to improving the qualityof the care transition from hospital to home for older adults and theirfamily caregivers
  • Explain an innovative educational strategy to teach health professionstudents about important aspects of transitional care
  • Describe the global concepts of transitions of care and the careprocess associated with AMDA recommended best practices
  • Explain lessons learned from case examples of transitions in varioussettings

References:
Hendrix C, Ray C. Informal caregiver training on home careand cancer symptom management prior to hospital discharge: a feasibility study.Oncol Nurs Forum. 2006 Jul 1;33(4):793-8.
Eric A. Coleman EA, Parry C, Chalmers S, Min S. The caretransitions intervention:Results of a randomized controlled trial. Arch InternMed. 2006;166:1822-1828. Care Transitions InterventionSM
Hendrix, C.C., Heflin, M., Twersky, J., Knight, C., Payne,J., Bradford, J., Schmader, K. (2008). Post-Hospital Clinic for Older Patientsand their Family Caregivers. Annals of Long-Term Care: Clinical Care and Aging,16[5]:20-24

Speaker(s):
Standard: $24.00

Is There a Specialist in the Home? Dermatology, Presbycusis and Foot Health

Mar 5, 2009 1:30pm ‐ Mar 5, 2009 5:00pm

Identification: A07

AMDCP Credit Designation:

This session has been approved for a total of 3 Clinical credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

TheAmerican Medical Directors Association designates this educational activity fora maximum of 3 AMA PRA Category 1 Credit(s)TM. Physicians should only claim creditcommensurate with the extent of their participation in the activity.

Presenter(s): Belinda A. Vicioso, MD, CMD(Moderator); Kathleen Y. Harrell, NP-C; Bonnie L. Wirfs, MD, CMD; Elizabeth G.Finigan, MD; Arthur Helfand, DPM

Disclosure(s):
BelindaA. Vicioso, MD, CMD is on the P&T committee and received an honorarium fromOmnicare, Inc.

Allother presenters reported they had no relevant financial relationships todisclose.

Session Description:
This session brings pearls from the domains of long term carespecialists. Topics to be coveredare: geriatric skin disorders in variouslong term care settings; hearing loss and its impact on SNF residentcommunication, cognition and socialization with a bedside diagnostic method toidentify common otologic problems; foot health and how to develop a Foot HealthProgram for long term care practitioners including the assessment, education,care, management and training components of the program.

Learning Objectives:
  • Outline the demographic imperative for our elderly patients’ needs inthe areas of skin problems, hearing loss and foot health
  • Diagnose and treat common disorders in these domains in the elderly
  • Explain diagnostic and treatment strategies and methods for use bypractitioners in each specialty area

References:
Gilchrest BA Skin and Aging Process CRC Press Boca Raton, Florida1988
Young EM, Newcomer VD, Kligman AM. Geriatric Dermatology, LeaFebiger, Philadelphia1993
Winker MA, Glass RM: The aging global population. JAMA: 1758,1996
Marks R Skin Disease in Old Age Martin Dunitz London 1999
Norman, R ed Geriatric Dermatology (book) ParthenonInternational Publishing London/New York (2001)
Norman, R Clinical Geriatrics Norman, R (book co-editor withT.S. Dharmarajan) January 2003 Parthenon/CRC Publishing
Norman R Dermatologic Therapy Geriatric Dermatology
Volume 16, Number 3, November 2003 Guest editor
Rhodes L, Norman R, Wrone D, Alam M Cutaneous surgery in theelderly: ensuring comfort and safety Dermatologic Therapy Volume 16, Number 3,November 2003 pp. 243-253.
Norman, R Dermatologic Clinics Geriatric Dermatology
January 2004 Guest editor
Norman R, The Future Direction of Dermatologic Therapy (coverarticle) Skin and Aging January 2005 p. 32-34, 47
Norman, RECPN (Extended Care) Xerosis and Pruritus in the Elderly, Part 1 pp 12-14February 2006 Vol 52 Issue 2
Norman, RECPN (Extended Care) Xerosis and Pruritus in the Elderly, Part 2 pp 1820-14March 2006 Vol 52 Issue 3
Norman, R The American Experience The Age of Skin TheNewsletter of the Senior Skin Group for Skin Disease of the Elderly (Great Britain)Issue 7, March 2006.
Norman R Updates in Geriatrics The Division of GeriatricMedicine at Saint Louis University Geriatric Dermatology (in four subjectCD-ROM) May 2006
Norman, R ed Diagnosis of Aging Skin Diseases (book)Springer-Verlag London May 2008

Speaker(s):
Standard: $24.00

Medical Practice in Assisted Living: Medication Management, Falls Prevention, and Physician Care

Mar 5, 2009 1:30pm ‐ Mar 5, 2009 5:00pm

Identification: A09

Presenter(s): Sheryl Zimmerman, PhD;Daniel Haimowitz, MD, CMD; Kirsten Nyrop, MACT; John Schumacher, PhD; PhilipSloane, MD, MPH; Paula Carder, PhD; Barbara Resnick, PhD, CRNP

Disclosure(s):
Daniel Haimowitz, MD, CMD received a speaker honoraria from Eisai Inc., Pfizer Inc.,Novartis, and Ortho Biotech, L.P. Dr. Haimowitz received an advisory board honorarium from Wyeth Pharmaceuticals.

Allother presenters reported they had no relevant financial relationships todisclose.

Session Description:
This session presents new information from three assistedliving projects (funded by the National Institutes on Aging) of theCollaborative Studies of Long Term Care, as well as other work, including:observational and interview studies of medication administration (prevalenceand types of medications related to severe errors, and use of over the counter (OTC) medications), a fallsprevention and a restorative care intervention study (focusing on the physicianrole), and a survey of physician practices and staff capacity in variedsettings.

Learning Objectives:
  • Discuss the scope of and issues related to medication errors and theuse of over the counter (OTC) medications
  • Describe how physicians and support staff can reduce errors andmonitor OTC use
  • Describe physician involvement in falls prevention in the context ofmonitoring medications and performing falls assessments
  • Discuss the physician’s role in helping to preserve resident function
  • Examine different physician practice patterns in assisted living andhow they relate to patient and community characteristics and care provision

References:
1. Assisted Living Workgroup. (2003). Assuring quality inassisted living: guidelines for federal and state policy, state regulation, andoperations. A report to the U.S. Senate Special Committee on Aging. Washington, D.C.
2. American Geriatrics Society, British Geriatrics Society, American Academy of Orthopedic Surgeons Panel onFalls Prevention. Guideline for the prevention of falls in older persons.(2001). Journal of the American Geriatrics Society 49(5):664-72.
3. Schumacher, J.G., Eckert, J.K., Zimmerman, S., Carder, P.,& Wright, A. (2005). Physician care in assisted living: a qualitativestudy. Journal of the American Medical Directors Association 6: 34-45.

Speaker(s):

Palliative Care Part II: Clinical and Organizational Considerations

Mar 5, 2009 1:30pm ‐ Mar 5, 2009 5:00pm

Identification: A08

AMDCP Credit Designation:

This session has been approved for a total of 3 Management credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

The American Medical Directors Association designates this educational activity fora maximum of 3 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Presenter(s): Willliam D. Smucker, MD,CMD; Lory Bright-Long, MD, CMD; Anthony Lechich, MD; Deborah Way, MD, CMD

Disclosure(s):
All presenters reported they had no relevant financial relationships to disclose.

Session Description:
This session provides an overview of practical approaches toethical decision-making, evaluating benefits and burdens of artificialnutrition and hydration, encouraging spiritual and emotional considerations inend-of-life care, collaboration between nursing facilities and hospice, andorganizational changes to improve end-of-life care.

Learning Objectives:
  • Describe benefits and burdens of artificial nutrition and hydration
  • Enhance understanding of emotional and spiritual issues at theend-of-life
  • Describe how hospice and nursing facilities can work togetherproductively
  • Identify organizational barriers to improving end-of-life care

Speaker(s):
Standard: $24.00
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