Many NH residents have life-threatening illness associated with physical, psychosocial, and spiritual pain. Sustaining a successful palliative care program requires that it be integrated into the fabric of the facility by establishing and acknowledging the goals of all who contribute to the program. This article provides information on establishing facility goals, designating a “palliative care champion,” identifying residents who are at risk of death and/or who may benefit from in-depth discussions about their care goals and palliative care needs, understanding goals of clinicians and staff—and empowering them, and collaborating with palliative care and hospice programs. Website resources for advance planning tools are included.

The highest incidence of new-onset epilepsy occurs in individuals over the age of 60. Seizures can be either provoked or unprovoked. Metabolic disturbances and alcohol withdrawal are common causes of acute provoked seizures, and treatment is directed towards the underlying provoking medical condition. In contrast, the diagnosis of epilepsy is made when a patient experiences recurrent unprovoked seizures. This article addresses the type of epilepsy older individuals experience, the causes of new-onset epilepsy in the elderly, the diagnostic evaluation of the older patient with spells of alteration in level of consciousness, and the treatment of epilepsy in the elderly. (Annals of Long-Term Care: Clinical Care and Aging 2008;16[1]:28-32)