Barriers to effective medication management among older adults include cognitive impairment, poor vision, and financial burden. Polypharmacy, poor communication, drug-drug interactions, and pharmacokinetic changes with age also contribute to medication problems and nonadherence, and can lead to hospitalizations in 25% of persons age 80 and older. For all of its benefits, the electronic medical record has the potential to reproduce and reinforce inaccuracies. Steps to improving medication management can include using combination drug therapies to simplify schedules, assembling medication teams (some with pharmacists), and reconciling medications across practice sites. Important guidelines are available for successful management of hypertension, lipids, diabetes, respiratory disorders, and thrombotic disorders in patients who may require five or more medications. Health care providers must be mindful that the fewer and more effective the therapies, the safer it will be for patients. (Ann

Indwelling urethral or suprapubic catheters are commonly used to treat urinary retention in those who cannot perform clean intermittent catheterization due to limited hand dexterity or alterations in cognition. Indwelling urinary catheters may be used as well to provide supportive care for those with severe incontinence who cannot manage otherwise, are terminally ill, or need short-term treatment of pressure ulcers. This article discusses indications, prevalence, and complications related to catheter use. Suggestions are given for clinicians providing catheter care, including choosing proper equipment and promoting quality of life through appropriate and sensitive care that helps persons adjust to this lifestyle change. (Annals of Long-Term Care: Clinical Care and Aging 2006;14[8]:38-42)

With long-term care facilities becoming increasingly diverse in both their staff and resident populations, the challenge is to maintain positive interaction in the midst of cultural differences. In their research, the authors explored the ongoing communication barriers within 10 nursing homes across eastern Massachusetts. Managers, nurses, and certified nursing assistants were interviewed to identify common problems and potential solutions. In most cases, the communications problems went well beyond the difficulties of translating native languages into English and included cultural differences in communication style, body language, and tone. This article summarizes the results from a series of focus groups and details potential strategies for improvement. (Annals of Long-Term Care: Clinical Care and Aging 2006;14[8]:34-37)