Participants were recruited from two primary care clinics to watch an online informational video on how to recognize medication-related side effects. All were aged 65 years and older and about 40% took three to five medications. 

After viewing the video, participants answered survey questions about their understanding of potential medications issues and attitudes toward deprescribing, among other questions. One month later, they were sent a followup survey asking about their experiences with self-advocacy regarding medication-related harms.

The majority (97%) of respondents agreed that the video helped them understand how to be alert for adverse reactions caused by medications, reported lead author Robert G. Wahler, PharmD, of the University at Buffalo School of Pharmacy and Pharmaceutical Sciences.

In addition, most respondents (89%) taking medications responded that they were willing to deprescribe medications if their doctor said it was possible. What’s more, 92% of video viewers agreed that they felt confident about talking to their doctor about medication-related concerns.

The results were presented at the 2022 ACCP Global Conference on Clinical Pharmacy.

Related articles:

Nursing home residents may be more open to deprescribing when suggested by physician: study

Here’s how elders want you to talk to them about deprescribing: survey

Docs ignore EHR nudges to deprescribe dementia-linked drugs: study

AMDA aims for 25 percent meds reduction in data-sharing deprescribing campaign

As a Physical Therapist for several years (and even several decades), I’ve participated in rehabilitating a lot of joints. Some shoulders, a few elbows, some hips, and lots and lots of knees.

Our job is to increase strength and range, increase mobility and function, and ultimately get our seniors (literally) back on their feet and back to their lives. Some of our patients aren’t even seniors. My youngest (and worst) patient was a 38-year-old knee-replacement patient who thought he’d be back on his feet and back to work by next Monday. Reality + disappointment resulted in some difficult discussions and severely delayed his rehabilitation.

A bunch of my peers have had their knees replaced recently, and I’ve been getting calls and texts asking for advice. I offer what I can, but ultimately my advice is “listen to your therapist and be realistic about how long this will take.” Now I’m one of them.

I went to my Joint Replacement class yesterday. I didn’t want to, but I went because it was required. The class was a diverse microcosm of ages, genders, and races. I knew what to expect, except I didn’t. The healthcare professionals who held the class offered kindergarten-level, step-by-step, low-and-slow explanations of what to anticipate. But the questions from the class blew me away.

“I don’t want to do the exercises on my bed. Can I do them on the floor?” (How will you get up?)

“Are you the therapist who’ll stay at my house all day?” (Unreasonable expectations about how healthcare works are not limited to family members.)

“Why can’t I stay in bed for a month once I get home?” (Do you stay in bed all day now? Do you want to get better?)

“Once I get my hip replaced, I know I can’t cross my legs for a few days, but can I still do yoga?” (I can hear the new hip popping out of the socket right now.)

“I know I can’t eat before my surgery, but can I at least have breakfast?” (The education had a slide in all caps: DO NOT EAT THE DAY OF SURGERY.)

As therapists, nurses, CNAs and other providers who encounter patients and residents, we often gloss over important parts of our jobs by assuming our patients’ knowledge level. We often assume all our residents have the same experience base and same knowledge base, and we even assume that they know what we know.

I once had a 29-year-old resident who came to our SNF after an opiate overdose shut down his kidneys. We scheduled him for rehab and dialysis, and he kept asking why he couldn’t just drink a ton of water to get his kidneys working again. I explained that his kidneys didn’t work anymore and dialysis would keep him alive until they did. He said no one at the hospital or at our facility ever explained how important dialysis was. No one had told him his kidneys stopped working. I once had a hip replacement patient crying that no one told her that surgery would hurt.

No one told her that surgery would hurt.

I walked into the joint replacement class thinking that this was a waste of my time, but what I learned is that patient education is perhaps the most important thing we can do to encourage healing, promote good outcomes, and help people realize the benefits of their procedures. Thorough education not only provides better outcomes and increases patient satisfaction while decreasing provider liability, it decreases the load on the healthcare system and insurance by ensuring that repeat hospitalizations are less likely, and making the patient responsible for their own success.

Our job is not just to rehabilitate and send them home. Our job requires us to engage our patients and make them as independent and in control of their health as possible.

Jean Wendland Porter, PT, CCI, WCC, CKTP, CDP, TWD, is the regional director of therapy operations at Diversified Health Partners in Ohio.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Clinicians at Baycrest Health Sciences developed the program after recognizing that when it came to skin care, “physicians taught physicians, and nurses taught nurses,” said geriatrician Carol L. Ott, M.D., in a presentation recorded for the PALCT22 Annual Conference last weekend. 

And there were other inefficiencies, she said. For example, nurses needed to call a physician for bandaging orders every time a patient had a skin tear.

The prevalence of skin tears in the facility was already fairly low, so the study team focused on finding ways to combine clinician education groups and create other efficiencies, Ott said in a recorded conference presentation.

To challenge current institutional habits, she and her colleagues brought in an educational model about improving the identification and treatment of skin tears. This was presented to combined groups of care providers who were then evaluated for content knowledge, learner satisfaction and subject-matter confidence level.

“There was overwhelming enthusiasm and support,” for the educational model, Ott and colleagues reported. The study results showed that learning in interprofessional groups is likely to be more efficient, and inspired the clinicians to propose new skin care procedures, they said.

“We are thinking possibly that this could be a way to introduce directives – where the nurses perform certain activities without a physician order,” they wrote in a summary. “In the future we would like to evaluate the impact of the education program on clinical outcomes.”

Additional details on this study and other long-term care-specific research can be found via the AMDA conference portal.

The American Board of Post-Acute and Long-Term Care Medicine (ABPLM) commissioned a survey of attending physicians in the industry. Questions were developed by a task force of experts who agreed on practice-related activities relevant across multiple post-acute and LTC care settings. Fully 389 participants responded, describing the tasks, experience and medical knowledge needed in their roles. 

“The results of this job analysis highlight the unique and specific nature of medical care provided by attending physicians across a range of PALTC settings,” corresponding author Laura J. Morton, M.D., of the University of Louisville Health, said.

The findings establish a foundation for recognizing PALTC medicine as a specialized area of medical practice, Morton and co-authors wrote in an article published in JAMDA. The findings could help lead to the formation of a focused practice designation in PALTC — as well as changes in practice and/or policy, they explained.

Medical education should foster these specialty skills, they said. 

“Physicians should undergo an effective educational process to learn the requisite knowledge to perform necessary roles and tasks in this specialized area of medicine,” they argued. “This process should also include training about the settings and systems of care and methods for improved collaboration with the interdisciplinary team to provide person-centered care.” 

Long-term changes in education could be the reason for reduced sex differences seen in cognitive aging, according to a new investigation. This trend may eventually lower women’s risk of dementia as well, the researchers say.

Women are known to have an increased risk of developing Alzheimer’s disease and related dementias. Education is thought to be linked with dementia onset.

The study team analyzed the effect of education and birth year on differences in memory and verbal fluency among nearly 16,000 participants born between 1930 and 1955. Women had better memory scores overall, which became more significant in the groups born more recently. But in the older birth cohort, women had poorer fluency scores than men. That difference progressively reversed in the groups born later, reported Mikaela Bloomberg, a Ph.D. candidate from University College London. 

Women born between 1946 and 1955 had better fluency scores than their male counterparts, a change that could be partially explained by an increase in education level with each successive birth cohort. In the first half of the 20th century, these education inequalities led to lower education levels among women, the authors contend.

Poor performance on memory and verbal fluency tests is strongly tied to dementia, Bloomberg wrote. An increase in educational opportunities may therefore not only help improve midlife cognition for women but reduce sex differences in dementia risk for future generations, she and her colleagues concluded.

The study was published in The Lancet.

These misses and other adverse financial mistakes may lead to an increased risk of lowered credit scores. This impact on credit can be seen 2.5 years before a dementia diagnosis, the researchers reported.

They also found that Medicare recipients with a lower educational status began missing payments as early as seven years before diagnosis, as compared to 2.5 years prior to a diagnosis for beneficiaries with higher educational status. What’s more, rates of higher payment delinquency and credit risk persisted for up to 3.5 years after beneficiaries received their dementia diagnoses.

These mistakes may serve as early predictors of dementia and highlight the benefits of earlier detection, said lead author Lauren Hersch Nicholas, Ph.D., of Johns Hopkins University, Baltimore. They also suggest an ongoing need for assistance managing money.

“[E]arlier screening and detection, combined with information about the risk of irreversible financial events, like foreclosure and repossession, are important to protect the financial well-being of the patient and their families,” Nicholas said.

The investigators found no link between increased missed payments or subprime credit scores before diagnosis of arthritis, glaucoma, or a hip fracture. And no long-term associations were found with heart attacks.

Full findings were published online Monday in JAMA Internal Medicine.

That’s according to leading physicians at a National Foundation for Infectious Diseases news conference on Thursday, who highlighted their concerns about the heightened dangers of flu this winter for older adults with chronic conditions.

“We have the potential for a lot of additional confusion since flu and COVID-19 are both contagious respiratory diseases, said Federico M. Asch, M.D., a cardiologist with MedStar Health Research Institute and Georgetown University. “And many of the same groups are at higher risk for complications for both viral infections.”

Anthony Fauci, M.D., director of National Institute of Allergy and Infectious Diseases agreed. “It really is a diagnostic challenge because there are shared signs and symptoms,” he said. “There is considerable concern that as we enter the fall and winter months and into the flu season, that we’ll have that dreaded overlap of two respiratory-borne diseases.”

But vulnerable adults do not appear to be entirely on board with getting their flu shots. An NFID survey has found that 22% U.S. adults who are at high risk for flu-related complications due to age and underlying health conditions were not planning to get vaccinated this season.

“We still have a lot of work to do to educate our community and convince people they need to be protected against flu and pneumococcal disease,” said Asch.

Antivirals while awaiting COVID results?

NFID Medical Director William Schaffner, M.D., said he wouldn’t be surprised if physicians in communities where flu is extensive are treating patients empirically with an antiviral drug while they await the results of a COVID-19 test.

October is the “golden month” for flu vaccination, he said. Highly vulnerable groups — including older adults whose immune systems are not as robust and who were vaccinated in August — may not enjoy protections extending into February and March, when flu season peaks in the United States, Schaffner said. No formal recommendations exist for revaccination during the season, he noted. 

Meanwhile, cardiologist Asch explained that older adults have accounted for 50% to 70% of flu-related hospitalizations in recent years. And last year, 93% of adults hospitalized for flu-related complications had at least one reported underlying medical condition, including cardiovascular disease, diabetes or lung disease.

Asch recounted seeing some of the worst complications of flu in the cardiac intensive care unit, including myocarditis, an inflammation of the heart muscle that can cause chest pain and result in abnormal heart rhythms and heart failure. 

Pneumococcal disease awareness is low

The speakers also stressed the need for educating older adults about the importance of being vaccinated against pneumococcal disease. The NFID’s survey found that 51% of those at high risk for the bacterial infection reported that they have not been advised to seek vaccination.

Pneumococcal disease, which can manifest as pneumonia, ear infections, sinus infections or bloodstream infections, causes 150,000 hospitalizations each year in the United States, with up to 7% of those hospitalized dying from the disease, Fauci said. 

Flu and pneumococcal vaccine options for older adults this season:

• An adjuvanted vaccine and a high-dose vaccine, both designed to help initiate a more robust immune response for adults 65 and older.
• The regular dose influenza vaccine, which covers four influenza viruses, for children and adults 6 months and older.
• A flu vaccine using recombinant technology, for adults 18 and older.
• Pneumococcal vaccine PCF13, recommended for adults and children with certain underlying medical conditions.
• Pneumococcal vaccine PPSV23, recommended by the CDC for all adults 65 and older. 

For the 2020-2021 season, vaccine manufacturers estimate that up to 198 million doses of influenza vaccine will be available, surpassing the previous record of about 174 million doses set last year.

The researchers followed nearly 1,000 U.S. adults with an average age of 77 years. Many were born and raised in areas of the Dominican Republic where access to formal education was limited. They were given health and cognitive exams over a two-year period.

Among participants who were illiterate, 35% had dementia at the start of the study compared with 18% of those who were literate. Among those who reported being illiterate and did have dementia when the study began, 48% had dementia at an average four-year follow-up. In contrast, 27% of their literate peers had dementia at follow-up.

The study also found that literacy was linked to higher scores on memory and thinking tests overall, not just reading and language scores, said Jennifer J. Manly, Ph.D., from Columbia University, New York. “These results suggest that reading may help strengthen the brain in many ways that may help prevent or delay the onset of dementia,” she said

“Even if they only have a few years of education, people who learn to read and write may have lifelong advantages over people who never learn these skills,” Manly concluded.

The study, “Illiteracy, dementia risk, and cognitive trajectories among older adults with low education,” was published online on Nov. 13 in the journal Neurology.

The guidelines, presented in a joint statement written by representatives of the American Diabetes Association, American Association of Diabetes Educators and the Academy of Nutrition and Dietetics, highlight four critical times when DSME/S referrals are needed, including at diagnosis, on a yearly basis, when new complications arise and when transitions in care occur.

The statement also includes the type of information and support that should be given to patients at each time, like providing safety guidelines and coping strategies at diagnosis, a reevaluation of treatment goals each year, and more personalized information when a patient’s health status or physical condition changes.

Research has shown that DSME/S improves diabetes outcomes, including reducing the onset and advancement of complications, improving lifestyle behaviors and decreasing the risk of diabetes-related depression. It’s also been shown to reduce diabetes-related hospital admissions.

The new guidelines were presented at the American Diabetes Association’s 75th Scientific Sessions, and have been published online in Diabetes Care, The Diabetes Educator, and the Journal of the Academy of Nutrition and Dietetics.