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JAMDA
March 1, 2016

Medicare requires skilled medical facilities to have a medical director. The presence of medical directors in a facility has been shown to enhance the quality of care delivered to the residents of these facilities. Thus it is important that Geriatric fellows be prepared to assume this role upon graduation. The University of Maryland Geriatric Fellowship provides Geriatric Training at a variety of clinical settings. The fellow's long-term care (LTC) experience for the past 4 years has been limited to a longitudinal nursing rotation at a VA Community Living Center (CLC).

JAMDA
March 1, 2016

Valproic acid (VPA) is commonly prescribed to treat epilepsy, bipolar disorder & migraine headaches. Though it has been associated with numerous adverse events, its effects on speech & one's ability to articulate has not been thoroughly studied. We report here an interesting case of VPA induced aphasia in a post stoke patient.

JAMDA
March 1, 2016

Warfarin is a commonly prescribed medication for patients in the post-acute or long-term care setting for conditions such as acute deep venous thrombosis (DVT), pulmonary embolus, or atrial fibrillation. Warfarin induced skin necrosis (WISN) has high rates of complications including acute severe anemia, hemorrhagic bullae, and life threatening wounds. Early recognition is critical in managing potential complications.

JAMDA
March 1, 2016

Orthostatic hypotension (OH) is common, affecting up to 30% of the general population over 65 and up to 70% of people living in nursing homes. It is defined by a drop in the systolic blood pressure (BP) of 20 mmgh or/and diastolic BP of 10 within 3 min of standing. Neurogenic orthostatic hypotension is a type of OH caused by autonomic failure and multiple system atrophy. It is relatively common condition associated with disorders affecting central or peripheral pathways of the baroreflex. One of the challenges in treating OH is the side effect of supine hypertension with the conventional...

JAMDA
March 1, 2016

Adverse drug events (ADEs) are common and masquerade as new onset medical disorders or syndromes. Recognition improves outcomes and avoids needless testing and costs, as demonstrated in this case.

JAMDA
March 1, 2016

Until recently, the only treatment for severe, symptomatic aortic stenosis was open heart surgery. With the advancement of medical devices and minimally invasive surgical techniques, the transcatheter aortic valve replacement (TAVR) procedure has emerged as a potential option for patients previously denied surgical treatment. However, recent sub-group analysis of the PARTNER I trial and similar cohorts has demonstrated that 25-30% of patients are dead at one year. Properly counseling patients and families on the risks associated with this “new” technology is an important consideration in...

JAMDA
March 1, 2016

In 2012, individuals diagnosed with Alzheimer's disease and other dementias comprised 48.5% of nursing home residents in the United States. As the number of individuals diagnosed with dementia continues to rise each year, it is imperative for nursing homes to establish engaging environments for residents with dementia. Creating routine musical activities and programming is one strategy for constructing such environments. Music improves behavioral and psychiatric symptoms of dementia. Use of iPods in nursing homes allows for individualization of musical activities through personalized...

JAMDA
March 1, 2016

Jugular Vein Aneurysm is a rare condition most commonly occurring as a congenital defect in children. Atypical in older patients it can occur as an acquired defect in hypertensive patients.

JAMDA
March 1, 2016

Neuromyelitis optica (NMO, Devic's Syndrome) is a demyelinating disease of the central nervous system that predominantly affects the spinal cord and optic nerves. It is often confused with multiple sclerosis. The discovery of NMO immunoglobulin G (IgG), directed against aquaporin-4 (AQP4), has dramatically changed the clinical definition of NMO and is important in the diagnostic criteria of this disease.

JAMDA
March 1, 2016

Presbyphagia is common in nursing home residents due to age and common comorbid conditions. In an attempt to avoid aspiration during acute illness, initial inpatient hospital orders may designate NPO (Nil Per Os, or nothing by mouth) status until the swallowing ability can be evaluated by a speech therapist. This places patients at risk for medication withdrawal syndromes.