Annals of Long Term Care

To the Editor:

I wanted to add a point to Dr. Finestone and Gail Inderwies’ excellent article “Quo Vadis ICU Hospitalization for End-of-Life Care?”1 A major problem we encounter with hospice enrollment is competition with the Medicare skilled benefit for patients leaving the hospital and going to a nursing home. It is financially advantageous for families and facilities to “skill” patients even when they are at the end of life, and we see numerous patients die without hospice. This not only deprives the patient of services while alive, but also deprives the family of 13 months of

To the Editor:
I wish to share my growing concern about medical care for the medically complex geriatric patient. My dad recently turned 90 years old (on 3/3/08). For most of his life he was healthy and active, looking, feeling, and acting much younger than his age. Twelve and a half years ago he was diagnosed with prostate cancer; that was kept under control with appropriate medical intervention, and Dad was able to go on with his life without much change from the condition. He continued driving and was a good driver up to age 86.

On August 11, 2004, my father sustained a tr

To the Editor:

The recent review article by Keys and DeWald1 on the use of atypical antipsychotics in dementia is disturbing. The authors breeze by the thorny issue of whether the use of antipsychotic drugs—of any kind—is appropriate in people with dementia and behavior disorders without psychosis. The issue is certainly controversial, but the data hardly support the widespread use of these drugs in those without psychosis. Indeed, their use in venues that are overseen by government agencies is highly regulated because of longstanding misuse and the harm that such misuse does to older A

TO THE EDITOR:
Keys and DeWald1 published a review in Annals of Long-Term Care: Clinical Care and Aging recently, and discussion followed in Letters to the Editor in June. In reply to comments by Mark H. Beers, MD, Keys and DeWald stated, “On the other side, the Federal Nursing Home Reform Act, or OBRA ’87, developed clear guidelines and indications for the use of antipsychotic medications in nursing home settings, including indications for psychotic and behavioral symptoms associated with dementia.”

As the author of these Guidelines to Surveyors for the Use of Antipsychotic Medicati

TO THE EDITOR:
The review by Kamel1 dutifully reviews the literature on managing urinary tract infections (UTIs) in the elderly.ÊUnfortunately, he misses the key point, which is that the medical management of UTIs, particularly in extremely vulnerable subgroups of patients such as the elderly withÊFoleyÊcatheters,Êis a delicate balancing act.ÊKamel is right, periodic urine culturing will confuse colonization with infection and may lead to overtreatment and emergence of resistant strains.ÊOn the other hand, waiting for alterations in mental status or delirium before treatment—as the A