At Harmony Pointe Nursing Center in Lakewood, CO, where about 30% of residents have a chronic, serious mental illness (SMI) such as schizophrenia or bipolar disorder, the staff receive training about mental illnesses and how to manage behaviors. Psychiatrists and other experts contracted by the facility’s parent company and available through local community alliances help manage treatments and other needs.

Approximately 15% of older adults in the United States live with a mental health condition, and 3% of older adults live with a serious mental illness (SMI). Schizophrenia, bipolar disorder, and recurrent major depression contribute significantly to disability.

The 2021 Carey Cowles Award goes to Joanne Kaldy, senior contributing writer at Caring, for “Not a Pizza Party: How to Help Frontline Staff During the COVID-19 Pandemic” (Caring for the Ages 2020;22[1]:P19).

AMDA Past-President Arif Nazir, MD, FACP, CMD, AGSF, talks about the benefit of guffaws for your older loved one.

In Baltimore, a comprehensive health center for older people learned a valuable lesson when it tried to forge a connection with the surrounding community: the best route to win hearts may be through the stomach.

Internal medicine residents have common knowledge gaps in post-acute care (PAC) services and inconsistencies in communicating when referring patients for these services, according to a multisite study.

Gradual dosage reductions (GDRs) of psychotropic medications are required by federal guidelines in skilled nursing facilities. Equally important is the fact that GDRs are a crucial cornerstone of good clinical and pharmaceutical care. Thorough evaluation of each medication prescribed to residents should be made on a routine basis, with detailed documentation justifying the continued utilization of any medication. This process is especially crucial when medications are being employed outside the typical standards of care.

Post-acute and long-term care facilities are experiencing increases in the percentage of patients who are admitted with serious mental illness (SMI). According to the National Institute of Mental Health, SMI is a mental, behavioral, or emotional disorder that results in functional disability and hinders or negatively impacts engagement in major life activities (NIMH, 2019, https://www.nimh.nih.gov/health/statistics/mental-illness). SMI includes psychotic disorders, such as schizophrenia and schizoaffective disorder, bipolar disorder, and treatment-resistant depression.

The use of sensor technology to detect and monitor aggression, agitation, and other behavioral and psychological symptoms of dementia (BPSD) is in early stages of research but holds significant potential for improving care, researchers said in interviews with Caring.

For adults older than 65, falls are a leading cause of injury — and they occur often. Approximately one-third of all older adults fall in a year. As prevalent and debilitating as falls are, the risk for falls may be up to two to eight times higher for those with dementia (Pharmacotherapy 2019;39:530–543).

Dear Dr. Steve: When residents have behavioral disturbances that result in violent actions, one of my nursing homes sends the patient to the emergency room. In the emergency room, the ER doctors often do not see any acute need for psychiatric stabilization or admission, and I want to send the patient back with clearance from the ER doctor. The nursing home, however, insists that there be clearance specifically from a psychiatrist. Is such clearance necessary? How should my facility handle patients with behavioral and psychiatric issues?

Evolution and change don’t just happen overnight; small steps, new ideas, and innovations move us forward and closer to our goals and visions. That is certainly true of the Foundation for Post-Acute and Long-Term Care Medicine — your Foundation — and the progress we made in 2021. We have reached some milestones as we continue on our path — a path that continues to be paved with powerful transitions, inclusion, shared dreams, and a health care world that supports patients and practitioners alike.

Mrs. R is an 89-year-old resident with a history of schizophrenia, insulin-dependent diabetes, hypertension, osteoarthritis, osteopenia, vascular dementia, and iron deficiency anemia (underlying cause unknown). She had a hip fracture two years ago and has had a right total hip replacement. She moved into the nursing home after an acute hospital admission for increased confusion and delusional ideation with distorted body image. She believes that her feet and legs are absent and that she cannot walk.

Robert was an older man who lived independently and worked full time. He was diagnosed simultaneously with metastatic cancer and myasthenia gravis, an autoimmune neuromuscular disorder that causes muscle weakness in the eyes, face, and throat. Due to his cancer, the only treatment available was high-dose steroids. While his strength improved, he was later hospitalized with steroid-induced psychosis. He was discharged to an assisted living community where he fluctuated between days of psychosis – demanding to leave – with periods of lucidity marked by sincere remorse and understanding of his care needs.

Approximately 15% of older adults in the United States live with a mental health condition. What does their care look like and how can it be improved? 6

AMDA – The Society for Post-Acute and Long-Term Care Medicine has received funding through a cooperative agreement with the Centers for Disease Control and Prevention to develop and implement strategies to increase vaccination rates among both residents and staff in PALTC settings. The CDC has funded the first year of a 5-year, $10.5 million agreement to work across skilled nursing facilities, long-term care nursing homes, assisted living and independent living communities, continuing care retirement communities, hospice, and home- and community-based care such as PACE programs to improve vaccine uptake.

“It’s hard to change habits,” said Leslie Eber, MD, CMD, at the start of a program on “Changing Provider Behavior: Beyond the ‘Just Do It’ Mentality” at PALTC21, the Virtual Annual Conference of AMDA – The Society for Post-Acute and Long-Term Care Medicine. She recalled how she would often come back from Society meetings bursting with ideas and plans, and then she was faced with “how challenging it is to change behaviors and habits.” But she stressed that there is hope.