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Amda Guidelines Diabetes Long Term Care

The Impact Of An Initiative To Reduce Therapeutic Diets: Healthy Diets For All

The Impact Of An Initiative To Reduce Therapeutic Diets: Healthy Diets For All

The Impact of an Initiative to Reduce Therapeutic Diets: Healthy Diets for All by John Pizzo, RD; Katherine Trintchouk, MD; Jeff Klein, PhD; Rebecca Ferrini, MD, CMD There is a trend toward liberalization of diets in long-term care to reduce the impact of weight loss and promote quality of life, particularly reducing limitations for elderly residents or those with diabetes. However, there is less emphasis in the nursing home environment on healthy diet choices. Our facility is comprised of many younger long-term brain injured residents suffering from problems associated with long-term poor eating habits, weight gain and obesity, as well as frequent food-related complaints or agitation related to feeling deprived of items seen on others plates. In October 2014, as part of a county-wide initiative under the vision Live Well San Diego, our 192 bed facility decided to transition to a Healthy Diet for All, thus reducing or eliminating most of the therapeutic diets it offered (except for texture). In review of the USDA RDAs, DRIs, My Food Plate, DASH diet, and the American Heart Association recommendations: Fat <30% of calories, Saturated fat 10-12% of calories. Fiber increased to 20-30g/day switching to whole grain breads, tortillas and pasta. Calorie ranges for small portions was1600-1800 calories/day, regular 2000-2200 calories/day, and large portions 2300-2600 calories a day. Dessert for Everyone: portions were significantly reduced (for moderation, not deprivation). Increased use of no-sugar added items, particularly for snacks. (see photos below for samples of what this diet might look like.) We analyzed the impact of the Healthy Diet for All initiative looking at diabetic control, weight, food related complaints, food satisfaction, physician evaluation, and an estimat Continue reading >>

Update On The Amda Clinical Practice Guideline For Dehydration In The Long Term Care Setting - Long Term Care Medicine-2010 - Amda - The Society For Post-acute And Long-term Care Medicine

Update On The Amda Clinical Practice Guideline For Dehydration In The Long Term Care Setting - Long Term Care Medicine-2010 - Amda - The Society For Post-acute And Long-term Care Medicine

The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The American Medical Directors Association designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity. This session has been approved for a total of 1.5 Management credit hours toward certification as a Certified Medical Director in Long Term Care (CMD). This session will highlight the important features and changes of the CPG for managing dehydration in the long term care setting. The session will include an introduction and epidemiology section, recognition and assessment section, and a management and summary section. Each section of the presentation will be evidenced-based as per the typical CPG format. Discuss the epidemiology and major risk factors for dehydration in the LTC setting. Explain the major causes of dehydration in the LTC setting. Describe key principles in the evaluation of the major types of Dehydration in the LTC setting. Discuss key principles in the management of Dehydration including ethical and cultural considerations. Charles A. Cefalu, MD, MS; Jackie Vance, RNC, CDONA/LTC; Eric Tangalos, MD, CMD Jacqueline Vance, RNC, CDONA/LTC has no disclosures to report. Charles A. Cefalu, MD, MS has no disclosures to report. Eric Tangalos, MD, CMD - Baxter: Consultant Continue reading >>

Diabetes In Long-term-care And Skilled Nursing Facilities: The Ada Position Statement

Diabetes In Long-term-care And Skilled Nursing Facilities: The Ada Position Statement

US Pharm. 2016;41(10)(Diabetes suppl):7-11. ABSTRACT: As the number of elderly people in the United States continues to rise, an increasing proportion of older adults will develop diabetes and will need long-term or skilled care. In early 2016, the American Diabetes Association issued a position statement on the management of diabetes in long-term-care and skilled nursing facilities. This statement provides recommendations for the general approach to care; goals and strategies for glycemic control; diabetes management during transitions of care and end of life; and suggestions for integration of diabetes management into long-term-care facilities. Pharmacists can play an active role in each of these areas in order to help optimize glycemic control in their patients. The prevalence of diabetes in the long-term-care (LTC) setting is estimated to range from 25% to 34%,1 which is equal to or higher than trends seen in the general population. The latest National Diabetes Statistics Report (2014) estimates that, in the United States, 25.9% of persons aged ≥65 years have diabetes, compared with 16.2% of those aged 45 to 64 years and 4.1% of those aged 20 to 44 years.2 Among persons aged 65 to 74 years and those aged ≥75 years, there was an increase of 113% and 140%, respectively, in the rate of diagnosed cases of diabetes from 1993 to 2014.3 Diabetes is the seventh leading cause of death in the U.S.2 As baby boomers continue to age, the proportion of older adults with diabetes who will need nursing homes (NHs) or skilled care is expected to rise. Pharmacists who serve residents in the LTC environment must be prepared to meet this challenge. Type 2 diabetes (T2D) accounts for 90% to 95% of diabetes in the U.S. Age-related changes in older adults that predispose them to the T Continue reading >>

Constructive Approaches To Common Problems In Skilled Nursing Facilities

Constructive Approaches To Common Problems In Skilled Nursing Facilities

Constructive Approaches to Common Problems in Skilled Nursing Facilities Chronic Conditions In Nursing Homes Get Another Look The same old approach to persistent disease conditions in long term care isnt good enough any more, experts say. The patient population in this setting is different than it was 10 or 20 years ago, and so is how such conditions are addressed. Developments and promising trends in treatments, medications, and diagnostics are designed to improve outcomes and increase efficiency. Expect to see more such innovations, as accountable care and penalties for rehospitalizations and the occurrence of never events become the norm and facilities wrestle with cost, coverage, and reimbursement cuts. At the same time, long term care has entered a new age of technology, clinical discovery, and personalized care that will have a growing impact on care and outcomes. What kinds of innovations are happening in long term care? There definitely is an increasing recognition of the need to develop better systems of care, says Jason Karlawish, MD, professor of medicine and medical ethics, University of Pennsylvania. William Day, DPh, FASCP, president and chief executive officer, Pharmaceutical Consulting Services of America, New Orleans, adds, As we move to practicing more person-centered care, we increasingly are approaching care from a global perspective. Were seeing an emphasis on systems that involve all appropriate team memberswith the patient at the centerand set goals accordingly. Since the average long term care resident has multiple chronic conditions, it isnt surprising that he or she also is taking several medicationsan average of eight or more. But there currently is a focus on making medications just part of treatment, not the central or main component. Many Continue reading >>

Infection Control In Long-term Care

Infection Control In Long-term Care

Infections have proven to be one of long-term cares most troubling problems ; a significant source of illness and death, many consequences of infections are far-reaching and costly.1 Infections account for up to half of all transfers from LTC facilities to hospitals, and result in an estimated 150,000 to 200,000 hospital admissions annually, at an estimated cost of $673 million to $2 billion annually.2 When an LTC patient is hospitalized with a primary diagnosis of infection, the death rate can reach as high as 40 percent.2 The death rate for LTC patients with infections ranges from 0.04 to 0.71 per 1,000 resident days, with pneumonia the leading cause of death.3 Federal regulations require every LTC facility to establish an infection prevention program based on current standards of practice to identify, investigate, control and prevent infections within the facility. Facilities must also designate a person to coordinate infection prevention and control activities in the facility, which may or may not be a trained infection preventionist. Although facilities are no longer federally required to have an infection control committee, some states still require such a committee. Facilities without an infection prevention and control committee still need a process or system in place to address infection prevention needs and analyze surveillance data. Older adults residing in LTC facilities are particularly prone to developing infection because of factors that result in impaired defenses and increased risk of exposure to microbes. Consistent implementation of a comprehensive infection control program has been shown to reduce rates of infection in LTC facilities.4 When treating infections in the LTC setting it is imperative that staff members have defined roles in the treatment Continue reading >>

Amda / Paltc Diabetes Guidelines Pocket Guide & App

Amda / Paltc Diabetes Guidelines Pocket Guide & App

9. In general, patients with diabetes should be offered a regular diet 10. In general, metformin is preferred as an initial oral medication for the treatment of diabetes in the absence of absolute or relative contraindications 11. If treatment with insulin is required, basal insulin is the preferred initial choice if its use can achieve glycemic targets 12. The use of sliding-scale insulin alone to control blood glucose levels should be avoided 13. It is reasonable to aim for A1C targets between 7.5% and 8.5% for most patients, although higher targets may be appropriate for certain individuals 14. A blood-pressure goal of less than 150/90 is recommended for most older patients with diabetes 15. Statin therapy is recommended for all older patients with diabetes who are able to tolerate it and who lack contraindications 16. Blood glucose patterns should be reviewed regularly to allow logical adjustment of the pharmacological regimen 17. Patients being treated for diabetes should be monitored for the occurrence of hypoglycemia and the treatment regimen adjusted as necessary 18. The facility should monitor its management of patients with diabetes by measuring and tracking selected relevant process and outcome indicators Continue reading >>

Management Of Diabetes In Long-term Care And Skilled Nursing Facilities: A Position Statement Of The American Diabetes Association

Management Of Diabetes In Long-term Care And Skilled Nursing Facilities: A Position Statement Of The American Diabetes Association

Published online 2016 Jan 11. doi: 10.2337/dc15-2512 Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association 1Beth Israel Deaconess Medical Center and Joslin Diabetes Center, Harvard Medical School, Boston, MA 2Geriatric Research Education and Clinical Centers, Miami Veterans Affairs Healthcare System and University of Miami, Miami, FL 3Section of General Internal Medicine, The University of Chicago, Chicago, IL 4Johns Hopkins University School of Medicine, Baltimore, MD 5American Diabetes Association, Alexandria, VA 6Department of Geriatrics, Nova Southeastern University College of Osteopathic Medicine, Ft. Lauderdale, FL 7Kadlec Regional Medical Center, Richland, WA 8University of Rhode Island College of Pharmacy, Providence, RI Copyright 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. This article has been cited by other articles in PMC. Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tail Continue reading >>

Wikipedia:choosing Wisely/amda The Society For Post-acute And Long-term Care Medicine

Wikipedia:choosing Wisely/amda The Society For Post-acute And Long-term Care Medicine

Wikipedia:Choosing Wisely/AMDA The Society for Post-Acute and Long-Term Care Medicine Choosing Wisely is a health campaign which seeks to share health information with patients and health care providers. This project shares information from the AMDA The Society for Post-Acute and Long-Term Care Medicine on Wikipedia. Articles relating to AMDA The Society for Post-Acute and Long-Term Care Medicine content *An arbitrary month has been chosen to present a count of pageviews. This month is neither the busiest nor slowest month, and this number seems typical for most articles in most months. Through the link anyone may check traffic in other months. AMDA The Society for Post-Acute and Long-Term Care Medicine (February 2014), "Ten Things Physicians and Patients Should Question" , Choosing Wisely : an initiative of the ABIM Foundation , AMDA The Society for Post-Acute and Long-Term Care Medicine, retrieved 20 April 2015 Teno, Joan M.; Gozalo, Pedro L.; Mitchell, Susan L.; Kuo, Sylvia; Rhodes, Ramona L.; Bynum, Julie P. W.; Mor, Vincent (2012). "Does Feeding Tube Insertion and Its Timing Improve Survival?". Journal of the American Geriatrics Society. 60 (10): 19181921. doi : 10.1111/j.1532-5415.2012.04148.x . ISSN 0002-8614 . Hanson, Laura C.; Ersek, Mary; Gilliam, Robin; Carey, Timothy S. (2011). "Oral Feeding Options for People with Dementia: A Systematic Review". Journal of the American Geriatrics Society. 59 (3): 463472. doi : 10.1111/j.1532-5415.2011.03320.x . ISSN 0002-8614 . Palecek, Eric J.; Teno, Joan M.; Casarett, David J.; Hanson, Laura C.; Rhodes, Ramona L.; Mitchell, Susan L. (2010). "Comfort Feeding Only: A Proposal to Bring Clarity to Decision-Making Regarding Difficulty with Eating for Persons with Advanced Dementia". Journal of the American Geriatrics Society. Continue reading >>

Pages From Diabetes Management

Pages From Diabetes Management

CPG CLINICAL PRACTICE GUIDELINE SERIESDIABETES MANAGEMENTin the Post-Acute and Long-Term Care Setting AMDA The Society for Post-Acute and Long-Term Care Medicine (AMDA) pro- vided the funding for the development of this guideline. The annual dues of the member physicians and other practitioners fund AMDAs work. A portion of the costs associated with the revision of this guideline were supported by a restricted grant from the Retirement Research Foundation. AMDA does not permit direct company support of the development of clinical practice guidelines or guideline revisions. Individuals in the work group that developed this guideline are not paid by AMDA, however, these individuals are volunteers. No members of the work group are employees, consultants, or speakers for a company with a commercial product within the subject matter of this guideline. AMDA facilitates and coordinates the guideline development and revision process. AMDA, its members, and peer organizations review and provide feedback, but do not have editorial control over the work group. All recommendations are based on the work groups independent evaluation of the evidence.For more information about the AMDA guidelines or to order copies of these clinical practiceguidelines, call 800/876-2632 or 410/740-9743 or visit our web site at www.amda.com.For guideline updates visit www.CPGNews.org.To cite this guideline use: American Medical Directors Association. Diabetes Management in thePost-Acute and Long-Term Care Setting Clinical Practice Guideline. Columbia, MD: AMDA 2015 Original Panel Members: Lin Nyce, RD Ann OMalley, GNPNaushira Pandya, MD, FACP, CMD, Chair Carolyn D. Philpot, MSN, CS, GNP Roger A. Shewmake, Ph.D., L.N.Paul Block, LCSW-C Deborah Vincent, RN, DONKristen Graves, CNT, TMAE. Coy Irvin, MDBar Continue reading >>

Specific Conditions

Specific Conditions

Managing Diabetes in the LTC Setting , (American Medical Directors Association-AMDA) CPG Managing Diabetes in the Long Term Care Setting is the AMDA Clinical Practice Guideline for a systematic approach to management of diabetes in LTC. ($)- Discount when purchased through AHCA Bookstore. Caring For Residents Who Wander , (Tilly, Reed, AHCA Provider, October 2006.) Discusses the Phase 2 Alzheimers Recommendations including having a Lost Persons Plan. Alzheimers Association , Provides professional care providers a site to obtain information about the disease process, counseling families, care and treatment of Alzheimers. Dementia Care and Quality of Life in Assisted Living and Nursing Homes , (Schultz, et al, The Gerontologist, October 2005.) A special issue of The Gerontologist published in cooperation with the Alzheimers Association highlighting issues such as mobility, pain, family interaction, and activities. Research based. Depression , (American Medical Directors Association-AMDA) CPG Depression is the AMDA Clinical Practice Guideline on the assessment and treatment of depression in LTC. ($)- Discount when purchased through AHCA Bookstore. Incontinence Management , Incontinence Management Module Registration , (Borun Center for Gerontological Research, UCLA School of Medicine/ Jewish Home of Greater LA) Resource for incontinence management including training module, an Excel program for prompted voiding. Continue reading >>

Icp - Icp: Articles

Icp - Icp: Articles

As seenin theConsultant Connection July 2016 Issue Tracey Pierce RPh, CGP, FASCP, Consultant Pharmacist In a recent publication of Diabetes Care (Diabetes Care 2016;39:308-311) the American Diabetes Association released a position statement for strategies and goals of diabetes management in LTC. Three specific patient populations seen in long term care were identified: 1)Transitional care/rehab; 2) general LTC; and 3) hospice/palliative care. Each of the 3 areas have unique problems, goals, and treatment strategies. A truly patient specific approach is necessary due to the complexities of the patients, complicating comorbidities, and transitions in care. A change in approach to diabetes management is underway in LTC. The tight glycemic control that is the goal of treatment in younger patients and hospitalized patients is not appropriate for the frail elderly due to the risk of hypoglycemia and the complications that occur. The risk for hypoglycemia is greater in the elderly due to decreased renal function, variable appetites, cognitive impairment, altered GI motility, and altered GI absorption. This risk is compounded by recent hospitalization, advanced age, medication changes, and polypharmacy. Some general guidelines for diabetes care in the elderly residing in LTC include: Consider discontinuing medications not providing comfort Tight glycemic control in younger persons will improve and increase longevity along with decreasing complications of diabetes. However, in the frail elderly, this risk of hypoglycemia outweighs any benefits of tight control due the frequency of hypoglycemia and to the potential increased costs of care due to complications of hypoglycemia and its management. Signs of hypoglycemia in the elderly may not be typical (palpitations, sweating, trem Continue reading >>

Amda – The Society For Post-acute And Long-term Care Medicine

Amda – The Society For Post-acute And Long-term Care Medicine

Don’t use sliding scale insulin (SSI) for long-term diabetes management for individuals residing in the nursing home. SSI is a reactive way of treating hyperglycemia after it has occurred rather than preventing it. Good evidence exists that SSI is neither effective in meeting the body’s physiologic insulin needs nor is it efficient in the long-term care (LTC) setting in medically stable individuals. Use of SSI is associated with more frequent glucose checks and insulin injections, leads to greater patient discomfort and increased nursing time and resources. With SSI regiments, patients may be at risk from wide glucose fluctuations or hypoglycemia when insulin is given when food intake is erratic. These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician. Continue reading >>

Managing Diabetes In The Long-term Care Setting: Strategies And Tools

Managing Diabetes In The Long-term Care Setting: Strategies And Tools

Back when we started practicing, every patient was supposed to have a glycated hemoglobin level (HbA1c) of less than 7%. I think we have gotten much more realistic about that in terms of trying to match HbA1c target goals to the needs of the patient. And for patients in LTC facilities, which is mainly the elderly population, the HbA1c target goal is not just less than 7% without hypoglycemia. We have to also look at the patient's comorbidities and life expectancy. Does the patient have cardiovascular disease? Do they have hypoglycemia unawareness? What resources do they have? Do they live alone? Are they taking medications that cause hypoglycemia? All of these factors are important when we establish a target HbA1c ; if you have an elderly individual who is in their 80s, their individualized HbA1c target may be 8 or 8.5%. [1] Ms Novak: We have to be even more conservative when patients are in an LTC facility because those patients are not only more ill, they are also compromised as far as what they can do for themselves and relying on others to actually do for them. The limitation of the HbA1c, especially in patients with diabetes who have an elevated HbA1c, is that they have the same risk of hypoglycemia as patients with an HbA1c closer to 7% or 6.5%. A study by Lipska and colleagues showed that the HbA1c is quite deceiving and that the risk of hypoglycemia is quite high in patients with an elevated HbA1c, [2] so we cannot use that as a tool to determine whether or not we need to change a patient's medication or adjust the dose. The HbA1c should only be used as a ballpark number; glucose monitoring is what is important when it comes to actually changing medications, managing a patient, and generally keeping a patient safer. Ms Kruger: I agree with that, because you wan Continue reading >>

New Ada Guidelines For Diabetes Management In Long-term Care Facilities

New Ada Guidelines For Diabetes Management In Long-term Care Facilities

New ADA Guidelines for Diabetes Management in Long-Term Care Facilities New guidelines from the American Diabetes Association (ADA) address diabetes management in long-term care and skilled nursing facilities, emphasizing treatment simplification, avoidance of hypoglycemia, and reassessment of therapeutic goals for patients who are nearing the end of life. The guidelines were published in the February issue of Diabetes Care. Previous statements from the ADA have addressed diabetes care for the elderly in community settings and among hospitalized patients, but this is the first set of guidelines to specifically address the unique needs of patients in long-term care settings, where the approach to diabetes management often needs to be dramatically different from those for younger and healthier patients. The guidelines, authored by Medha N Munshi, MD, director of the Joslin Geriatric Diabetes Program, Boston, MA, and colleagues, are aimed at a variety of audiences. For endocrinologists and primary care clinicians with expertise in diabetes, they provide additional information about the special considerations in institutionalized older adults. This includes guidance on the assessment of functional capacity and common comorbidities that may interfere with diabetes care as well as strategies for simplifying treatment regimensthe opposite of the usual practice of adding more medications. For nursing home directors, nurses, clinical pharmacologists, and others who work in centers with older patient populations, the document provides detailed diabetes-specific information and guidance, including minimization of hypoglycemia and a medication roundup. Increasing evidence points to the risks of hypoglycemia in older adults. Even less severe hypoglycemia can be catastrophic in olde Continue reading >>

Cpgs | Massachusetts Medical Directors Association

Cpgs | Massachusetts Medical Directors Association

Each guideline is presented in a user-friendly format, and contains an introduction explaining the purpose, development process, and terminology; a step-by-step narrative text that covers definition, recognition, diagnosis, treatment, and monitoring of the condition discussed; and an algorithm that summarizes the steps involved in addressing the condition. These guidelines were developed by interdisciplinary workgroups using a process combining evidence- and consensus-based thinking, and reviewed by several national organizations and individual experts. As a result, these guidelines are applicable to members of the long-term care interdisciplinary team including physicians, nurses, consultant pharmacists, and others. Guidelines may be ordered individually or as a full set; multiple copies of each individual guideline are also available. For more information on AMDA's continuing program of clinical practice guideline development, please call or write AMDA , or send e-mail to AMDA Clinical Affairs . For a complete listing of AMDA resources, follow this link . Continue reading >>

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