Steven Buslovich, MD, MSHCPM, CMD, a New York–based geriatrician, talks about frailty and what this means for your loved one’s health and care options.

Presented at this year’s virtual Annual Conference of AMDA — The Society for Post-Acute and Long-Term Care Medicine, the Year in Review session featured a discussion of several articles published in the past year that the presenters determined to be most relevant to the field of post-acute and long-term care. Each of the three presenters summarized three articles to enable the audience to assess the latest published evidence and to consider changes to their practice based on the evidence. Select articles from the session are summarized below.

Due to the ongoing COVID-19 pandemic AMDA – The Society for Post-Acute and Long-Term Care Medicine held its 2020 Annual Conference virtually. Thank you to the speakers and attendees who helped make it such a big success. We look forward to seeing you in San Antonio in March.

Mr. G is ticked off. The 58-year-old man arrived at your facility about two days ago after a hospital stay for alcohol withdrawal and sepsis. Upon admission, you fielded several questions from him about how soon you would “let me out of here.”

It is always useful to remind practitioners that nonpharmacologic interventions are most effective for the treatment of neuropsychiatric symptoms of dementia, and the review in the recent issue of Caring (2020;21[2]:19) provides excellent guidance. However, the summary table appears to address only evidence from randomized controlled trials (RCTs) on treatment of verbal agitation, sometimes called disruptive vocalization, and it states there are “no effective interventions.” There are no RCT results for treatment of this condition because, fortunately, it is relatively rare.

The Foundation for Post-Acute and Long-Term Care Medicine has announced its 2020 Quality Improvement (QI) and Quality Improvement & Health Outcomes (QIHO) Award recipients. The QI Award went to Fatima Sheikh, MD, MPH, CMD, and her team at FutureCare NorthPoint in Baltimore, MD, for the project “Understanding Long-Term Care Residents’ Perceptions on Interdisciplinary Care Plan Meetings.” Howard Finger, DO, of Coler Rehabilitation and Nursing Care Center in Roosevelt, NY, won the QIHO Award for his program, “MOLST PI Project/Application of the Algorithm for the Unbefriended in Conjunction with the MOLST Form PI Initiative.”

Dimensions, palatability, and the appearance of the final drug product all help determine older individuals’ acceptance of and adherence to medication regimens, according to a mixed-methods systematic review conducted in Birmingham, United Kingdom.

A long-term care provider documents her experience in isolation while awaiting her COVID-19 test result. 3

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Dear Dr. Jeff: On the list of recommendations during the COVID-19 pandemic from every expert is the suggestion that residents and families be approached regarding advance directives such as Do Not Resuscitate and Do Not Intubate orders and Living Wills. Weren’t facilities always required to do this both by federal law and the federal Requirements of Participation in Medicare and Medicaid? Did the coronavirus pandemic change these requirements?

By Fatima A. Naqvi, MD, CMDAll covered up with N-95, personal protective equipment, |I peeked in through the open door,concealing my sentimentsconcealing my sentiments,Wondering how he is recovering on this COVID unit.Even before this pandemic he was frail and unfit.Bouncing back and forth between health and illness,His decline was multiplex leading to further weakness.As they say COVID hits elderly with co-morbidities,How often are we ready to face harsh realities?There he is, lying on bed; oxygen and face mask on,Motionless, except, rapid chest moving up and down.

It was the first day of spring, March 19, 2020. The security guard at the gate asked me the basic questions for COVID-19 screening as well as a few other questions that we had developed for our organization based on the Center for Disease Control and Prevention’s recommendations. I replied “no” to each one, with no hesitation. However, when the staff checked my temperature, to my surprise it was 100.2 degrees Fahrenheit. The security guard told me that I could not enter the building, based on the instructions he’d been given.

Plus ça change, plus c’est la même chose. (The more things change, the more they stay the same.)— Jean-Baptiste Alphonse Karr (1849)

The year 2020 has been filled with surprises, if not bewilderment, for us all. It is unlikely that any of us could have predicted a year ago — or six months ago, or even three months ago — what our world would be like today. COVID-19 has truly turned the planet on its ear. My previous watershed event for before and after used to be the attack on the World Trade Center on September 11, 2001. I measured my thoughts by what life had been like before 9/11 versus afterward. My frame of reference has now changed to what the world was like “pre-COVID-19” and will be measured by “since COVID-19” in the future.

Cardiovascular comorbidities and risk reduction play a major new role in pharmacologic therapy for type 2 diabetes, with sodium-glucose transporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists now recommended as part of the glucose-lowering regimen for patients who have established atherosclerotic cardiovascular disease (ASCVD) or indicators of high-risk, chronic kidney disease (CKD) or heart failure (HF).

Anemia is not a normal consequence of aging — it is an overlooked sign of underlying illness, so the approach should be to evaluate, delineate, and address the cause or causes, said T.S. Dharmarajan, MD, at the Annual Conference of AMDA – The Society for Post-Acute and Long-Term Care Medicine.

“If it was me and I woke up in the morning and only had to thank others for caring for me, I’d want to end it.” That was the honest assessment a certified nurse assistant (CNA) once offered to Matthew Lysobey, MPH, LNHA, of the residents’ daily lives. That was a powerful reminder of how important having a purpose is to residents, he said. Mr. Lysobey addressed this in “When No One Needs You Anymore: A Service-Based Approach to Depression in the Nursing Home,” the Anne-Marie Filkin Lecture he delivered at the virtual Annual Conference of AMDA – The Society for Post-Acute and Long-Term Care Medicine.

The Public Policy Update during the virtual Annual Conference of AMDA – The Society for Post-Acute and Long-Term Care Medicine addressed several developments, challenges, and changes, but one theme was consistent: the Society is working hard to advocate for its members and their patients.

“Together we are stronger,” American Medical Association (AMA) President Patrice Harris, MD, MA, told her audience in the Saturday General Session at the virtual Annual Conference of AMDA – The Society for Post-Acute and Long-Term Care Medicine. “We are a ready and willing partner,” she said, on addressing the COVID-19 pandemic and other issues. “We can’t change the system without everyone’s support and the work we do in our respective professions.”

Quality measurement in assisted living (AL) isn’t a one-size-fits-all proposition, and it is especially challenging because this care setting is state regulated, with wide variations across the country. Yet AMDA – The Society for Post-Acute and Long-Term Care Medicine and its members working in AL have promoted the need to identify metrics for quality care in this setting. “The Role of Quality Measurement in Assisted Living: Current Advances and Controversies,” a session at the Society’s virtual Annual Conference, addressed these efforts in depth.