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JAMDA
March 1, 2020

A Deep Dive into Urinary Tract Infections

JAMDA
March 1, 2020

Post-traumatic hydrocephalus (PTH) or secondary normal pressure hydrocephalus (NPH) are common complications that follow traumatic brain injury (TBI). PTH clinical features are similar to NPH and can be characterized by a triad of gait apraxia, cognitive deficits, and urinary incontinence. Symptoms may progress to psychomotor slowing, dementia, and the need for institutionalized care. Additionally, patients with TBI often experience a loss of impulse control, aggressive behaviors, and personality changes.

JAMDA
March 1, 2020

End-of-life care is often assumed to be similar across cultures, countries, religions, and the ethnic background. Its concept and understanding is as varied as the cultures and religions it represents.

JAMDA
March 1, 2020

Cerebrovascular accident is a common diagnosis in the rehabilitation and long-term care setting and can be associated with deficits in both language and cognition. Because capacity assessment requires a patient to both understand the decision in question and express a choice, it can be particularly challenging to determine capacity in patients with aphasia. Complex medical decision-making and use of healthcare proxies in this setting require careful navigation of patient needs, goals, and rights.

JAMDA
March 1, 2020

This is the case of a 94-year-old female with a prolonged hospitalization for a small bowel obstruction complicated by multiple intubations and dysphagia leading to a recommendation for a percutaneous endoscopic gastrostomy (PEG) tube for enteral feeding. Geriatric medicine was consulted and an unnecessary PEG tube placement was avoided.

JAMDA
March 1, 2020

Falls are common in long-term care residents, often multifactorial. Our case highlights recurrent falls in a resident with comorbidities, assumed to be from his diseases, although he expressed frankly that the cause was different. Paying attention to his complaint ended his falls.

JAMDA
March 1, 2020

Chronic pain is among the most common reasons for seeking medical attention. In the United States, 1 in 5 adults had chronic pain in 2016 and it is estimated to cost over $500 billion annually in direct medical costs and disability. It is a prevalent problem among residents in the nursing home. Non-pharmacologic therapies are the most preferred treatment for chronic pain as pharmacological therapies, such as opioids, have proven to be less effective and associated with numerous side effects among older adults.

JAMDA
March 1, 2020

Bilateral lesions in the lower extremities are frequently treated with antibiotics for presumed cellulitis. We present a case of bilateral lower leg swelling and redness in a patient with peripheral vascular disease with venous stasis that was mistakenly diagnosed as cellulitis and treated with five courses of antibiotics over a period of 18 months.

JAMDA
March 1, 2020

Advance care planning can be challenging in the long-term care setting, especially in patients with cognitive impairment. This case presentation provides an example how the interdisciplinary facility team including administrator and medical director successfully navigated an ethical dilemma.

JAMDA
March 1, 2020

New or worsening changes in skin integrity and pressure ulcers are a reportable quality measure in skilled nursing facilities (SNFs). Their management requires comprehensive evaluation for predisposing and precipitating factors and comorbidities that may impede healing. A thorough history and clinical examination is an essential first step in this process.