Confronting Boundaries in the Treatment of Movement Disorders

The clinical presentations of movement disorders can be highly heterogeneous and complex in older patients. Effective treatment becomes paramount when symptoms significantly affect patients’ quality of life and impede their ability to perform activities of daily living to the point of requiring placement in a long-term care (LTC) facility. Medication is typically at the crux of care, but many of the existing therapies for movement disorders are limited when applied to elderly persons residing in LTC settings. Annals of Long-Term Care® discussed the challenges of treating movement disorders in older adults with Vanessa Hinson, MD, PhD, and asked her to lend insight on several alternative approaches to care, including psychotherapy, deep brain stimulation, and nutrition.

When Should Antipsychotics for the Management of Behavioral and Psychological Symptoms of Dementia be Discontinued?

Regardless of setting, the behavioral and psychological symptoms of dementia often cause significant disruption and discordance between those experiencing the symptoms and their caregivers, other patients and residents, and family members. The use of antipsychotics in such situations and settings is common; however, these medications have many untoward side effects. In this article, the author discusses the possibility of lowering the dose of these medications with an ultimate goal of discontinuation, even in those deemed “stable” recipients of this class of medications.

Fluoroquinolone-Induced Hypoglycemia in an Overweight Nonagenarian With Acute Kidney Injury and Not on Glucose-Lowering Therapy

Fluoroquinolone-induced hypoglycemia remains underreported, especially in elderly patients not on any glucose-lowering therapy. Subsequently, healthcare providers may remain unaware of this complication, which can have significant clinical implications in terms of morbidity, mortality, and adverse drug reactions. The authors present the case of an overweight nonagenarian with diabetes, chronic kidney disease, and acute kidney injury who, due to worsening renal function, became hypoglycemic as a result of being unable to efficiently clear fluoroquinolones. The patient was not on any glucose-lowering therapy. Following the case report, the authors provide an overview of the fluoroquinolones approved for use in the United States and discuss their effects on blood glucose levels.

Mastication-Associated Rhinorrhea: Importance of Oral Cavity Examinations in Elderly Patients Wearing Removable Devices

Oral health is often neglected in older adults. To help address this issue, healthcare professionals should routinely perform oral health assessments, including for patients wearing dentures. In this article, the authors report the case of a patient who developed mastication-associated rhinorrhea after many years of using a dental device. Upon the patient noting this troubling symptom, the authors performed a thorough oral examination, which enabled them to identify the etiology and recommend an intervention.

Challenges of Guardianship: Examining Four Cases From New York State

The authors explain the impact of guardianship on the care of frail elders. Four case studies highlight complications faced when patients’ agents are guardians. The authors also emphasize the need for guardians’ education and outline two important guardianship laws in New York State: the Family Health Care Decisions Act and the Palliative Care Information Act. Ultimately, this article raises concerns that guardians may not be effectively advocating for their wards and/or setting appropriate goals for them.

Promoting Personhood in Men in Nursing Homes: The Role of Activity Directors

Personhood, bestowed on others through social interactions, implies recognition, respect, and trust, making it an essential factor in maintaining identity in late life. Activity directors have a responsibility to provide opportunities to their residents for recreation, leisure, and social engagement in a way that is person-centered. One often overlooked aspect of identity and person-centeredness in nursing homes may be an individual’s sex. This article outlines a qualitative study that was conducted to gain insight into how being male or female plays a role in the development and provision of activities for nursing home residents. Suggestions for practice, education, and further research are also provided.

Weighing in on Changes Affecting Medicare Advantage and Prescription Drug Benefits

The Centers for Medicare & Medicaid Services recently proposed making changes to the Medicare Advantage plans and the prescription drug benefit program. Among the major provisions proposed, a change in the definition of protected drug classes could affect access to antipsychotic, antidepressant, and immunosuppressant medications for older adults.

Underrecognition of Osteoporosis in Men in the Long-Term Care Setting

The National Osteoporosis Foundation estimates that 1 in 4 men aged 50 years and older will experience a fracture as a result of osteoporosis, placing men in this age group at greater risk of fracture than of developing prostate cancer. The 1-year mortality rate after hip fracture has been found to be as high as 32% for men—almost double the 17% documented for women. Each year, it is estimated that 80,000 men will experience a hip fracture, often leading to permanent institutionalization in a long-term care (LTC) facility. Despite the danger associated with this progressive bone disease, it is often underdiagnosed and undertreated in men in clinical and LTC settings.

Role of Nutrition in the Prevention of Cognitive Decline

Due to the ever-growing prevalence of neurodegenerative diseases and their social and economic repercussions, environmental and behavioral interventions and prevention strategies that may delay the onset of these disorders are imperative. This article discusses the role of specific nutrients in the prevention and progression of dementia through the examination of current published scientific literature. The findings of this review contribute further evidence for the role of nutrition in the clinical management of dementia and related symptoms.

Highlights from the 2013 Trends Report - Central Nervous System Diseases

In December 2013, Annals of Long-Term Care and Clinical Geriatrics released the Trends Report, examining the latest trends in long-term care (LTC) and geriatric medicine. The survey results were provided by a variety of key thought leaders within the field of LTC and geriatric medicine. The following provides information regarding the participants and the organizations they are associated with, as well as their facilities’ guidelines and resident demographics.