by Tim Gieseke MD, CMD

Recently, one of my SNFs admitted on a Saturday a 100+ y/o woman whose only transfer medication was Protonix.  From my home, I reviewed her hospital course via their EHR and saw she had CHF, paroxysmal Atrial Fibrillation, HBP, stage 3 CKD, and GERD.  She had been admitted to the acute hospital 4 days prior for esophageal obstruction from fish eaten 2 days prior to that admission.  On the initial H&P, the hospitalist indicated that the patient was on meds from a prior admission (Amiodarone, Lasix, & Lisinopril), but the patient could not tell him what she was currently taking.  She did have food removed via EGD and came to us on a pureed, all liquid diet.

by Robert Gibson, Ph.D., J.D.

Dr. Thaddeus Mason Pope, director of the Health Law Institute at Hamline University School of Law wrote a compelling piece in the New England Journal of Medicine entitled Making Medical Decisions for Patients without Surrogates.  This addresses the sticky problem of how to make decisions for residents who cannot make them themselves and who have no one to speak for them.  This is also addressed in California under HSC 1418.8, which allows the interdisciplinary team (IDT) to provide informed consent for unbefriended and incapacitated residents in LTC.

by Tim Gieseke MD, CMD

For those of you who are not members of AGS (American Geriatrics Society), you should be aware of this just-released comprehensive tool kit for improving the care of persons with Diabetes.  It allows for setting individualized goals for glycemic control, reduces the inappropriate use of daily aspirin for primary cardiovascular disease prevention, encourages the greater use of statin drugs, and gives guidance on safe and effective use of oral agents and insulin, particularly Metformen in persons with CKD.  The tool kit is available in the cloud at the new AGS GeriatricsCareOnLine site, where you can store all your AGS products.