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Placing a Spotlight on Behavioral Health Within PACE
The Program of All-Inclusive Care for the Elderly (PACE) is a well-established health care model that serves older adults who are eligible for nursing home –level of care but are living in the community. Significantly, PACE has been recognized as a “permanent provider” by the Centers for Medicare& Medicaid Services (CMS) for>25  years.1,2 The primary objective of PACE is to provide coordinated care that focuses on person-centered goals and to minimize use of hospitals and nursing homes. On a national level, PACE has been highly effective at achieving those goals. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - April 30, 2024 Category: Health Management Authors: Matthew McNabney Tags: Editorial Source Type: research

Recommendations for Next Steps in Our Understanding of Use of Antipsychotics among Older Adults in the PALTC Environments
As many of you are likely aware, we are mourning the sudden and untimely death of Dr Steven Levenson. Dr Levenson was a vital part of AMDA: The Society for Post Acute and Long Term Care Medicine for over 40  years, Dr Levenson held a number of leadership positions in AMDA including being a past president (2006-2007) and chair of the clinical care and policy committees. He was instrumental in developing both the medical director and attending physician competencies and recognized by his peers as a thou ght leader. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - April 30, 2024 Category: Health Management Authors: Steven Levenson, Barbara Resnick, Paul Katz Tags: Editorial Source Type: research

A Case of Refractory Pruritis: Celiac Disease in Older Adults
Celiac disease is an autoimmune enteropathy with a wide spectrum of clinical manifestations triggered by the ingestion of gluten. In the assessment of skin changes, weight loss, diarrhea, and abdominal discomfort, celiac disease may be underrecognized in the older population leading to greater morbidity. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - April 30, 2024 Category: Health Management Authors: Rachel A. Saltness, Elizabeth Bukowy Source Type: research

Beer Potomania Post-Skilled Nursing Facility Discharge
We present a patient who was readmitted to the hospital within days of discharge from a SNF with critically low sodium levels due to excessive beer intake. Beer Potomania is a rare cause of severe hyponatremia caused by large volume beer intake with low solute diet, resulting in low solute delivery to the kidney, impairing the inability to excrete both solute and water. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - April 30, 2024 Category: Health Management Authors: Melissa H. Bogin, Bonnie C. Sohn, Ashley Stantz, Anupam Chandra Source Type: research

Benefits of Multi-disciplinary Management in a Patient with Mixed Dementia
Vascular and neurodegenerative disorders frequently present as mixed dementia phenotype. The most common type of mixed dementia is Alzheimer ’s Dementia (AD) with vascular dementia. Dementia symptoms can develop at an earlier age when AD and vascular pathologies are both present. AD occurs with the accumulation of amyloid beta into fibrillar plaques and hyperphosphorylated tau into paired helical filament neurofibrillary tangles. Beta- amyloid Positron Emission Tomography (β-PET) can help establish AD diagnosis, as amyloid-beta deposition is a central pathophysiological marker of Alzheimer disease. (Source: Journal of t...
Source: Journal of the American Medical Directors Association - April 30, 2024 Category: Health Management Authors: Jazmine Duran, Arlen Tucker, Nirmala Bangalore Source Type: research

Bullous Pemphigoid in the Elderly
Bullous pemphigoid is a chronic autoimmune subepidermal blistering skin disease that primarily affects the elderly [1]. Clinically, it presents as urticaria-like and pruritic erythematous lesions that subsequently develop into large tense bullae [1]. These blisters typically have erythematous bases and are often localized to flexural areas, such as the axillae, groin, lower abdomen, and inner thighs. Although Bullous pemphigoid is a rare disease, it has a higher incidence rate in the elderly [2]. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - April 30, 2024 Category: Health Management Authors: Comfort Y. Adewunmi, Monica D. Gavaller Source Type: research

Case of Creutzfeldt-Jakob: How barriers to diagnosis delay essential care
Creutzfeldt-Jakob Disease (CJD) is a fatal, rapidly-progressive dementia, caused by prion proteins. Changes in personality, mood, and motor function, are common in association with CJD. Often a diagnostic challenge, it relies on the clinical exam, EEG, and CSF findings. Therapy is centered around early, high-quality supportive care. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - April 30, 2024 Category: Health Management Authors: Mohammad Khandwala, Lea Buda, Kerry Sheets, Lawrence J. Kerzner Source Type: research

Cognitive Assessment in Post Acute Care
Patients get admitted to Post Acute Care (PAC) facilities for rehabilitation or skilled nursing care. Some of these patients complete their treatment and return home, while others may require transition to long-term care or assisted living. This case presents a patient with unique needs and the interprofessional interventions for a safe transition home. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - April 30, 2024 Category: Health Management Authors: Joviane Louis Marcelin, Christina Harrelson, Letha M. Joseph Source Type: research

Considerations of Care in Dementia of Schizophrenia
With an aging population, there is increasing number of persons with schizophrenia and dementia in the post-acute and long-term care settings. By eighty years of age, the prevalence of dementia diagnoses is 70.2% in persons with schizophrenia, compared to 11.3% in persons without. This high rate posits unique care considerations in the post-acute and long-term care settings. These include balancing medication management for mood and behavior stability while minimizing adverse side effects such as tardive dyskinesia and metabolic syndrome, and optimizing non-pharmacological interventions to enhance quality of life and safet...
Source: Journal of the American Medical Directors Association - April 30, 2024 Category: Health Management Authors: Sara Shu, Paul Takahashi Source Type: research

Delirium with Psychosis in an Elderly Woman with Autoimmune Encephalitis
Delirium is very common in elderly patients with acute illnesses. Patients can display a broad array of symptoms ranging from lethargy to severe behavioral abnormality (1). Antipsychotics were used in a case of delirium that turned out to be due to autoimmune encephalitis. This case helps to shed the light on the need to avoid polypharmacy in the geriatric population. The Post-Acute and Long Term Care setting can be the perfect environment to implement such an important concept. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - April 30, 2024 Category: Health Management Authors: Patricia Boromee, Lidia Valjan, Ingrid Cantave, Catherine Nicastri Source Type: research

Dementia and Neurosyphilis, Are We Honoring the Patient ’s Wishes?
Dementia (major neurocognitive disorder) is characterized by a decline in cognition severe enough to interfere with daily function and independence Syphilis is a chronic infection caused by treponema pallidum. Syphilis progresses into four stages if left untreated: primary, secondary, latent and tertiary. Tertiary syphilis is seen 1-30 years after primary infection. This inflammatory disease progresses as neurosyphilis or gummatous syphilis. Cerebrospinal fluid, meninges and vascular structures are involved in the early stages of neurosyphilis, while in the late stage; cerebral tissue and spinal cord are affected. (Source:...
Source: Journal of the American Medical Directors Association - April 30, 2024 Category: Health Management Authors: Rodrigo A. Mojica, Vinita Shastri Source Type: research

Fentanyl Overdose in a Nursing Facility: Call for Bedside Naloxone
There has been a rise in patients with substance use disorders (SUD) in the post-acute and long-term care setting due aging patients with SUD, and younger patients with SUD who require admission for ongoing care after acute hospitalization for complications related to substance use. Patients with SUD in nursing facilities face barriers in accessing treatment for substance use disorder, putting them at risk for relapse and overdose. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - April 30, 2024 Category: Health Management Authors: Jennifer Y. Moyer Source Type: research

Grover ’s Disease: An Uncommon Diagnosis and a Simple Fix
We present the case of a post-acute care (PAC) patient with GD triggered by heat exposure and discuss a simple treatment modality that optimized his recovery. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - April 30, 2024 Category: Health Management Authors: Daniel Meshoyrer, Erika Granda, Keerti Sharma Source Type: research

Implementing Ketamine in PA-LTC for a Patient with Chronic Pain
A rapidly expanding array of available therapies are available for complex chronic pain. This in turn necessitates that clinicians develop proficiency in using these treatments safely. Additionally, facilities such as PA-LTC settings need to have protocols in place for proper procurement and oversight of drugs that are at risk for diversion. Ketamine, a potent NMDA receptor antagonist and schedule III substance, is one such medication rapidly gaining traction for severe, chronic pain. The following case explores the process of an interprofessional (IP) PA-LTC team developing workflows and relationships necessary to safely ...
Source: Journal of the American Medical Directors Association - April 30, 2024 Category: Health Management Authors: Jennifer D. Muniak, Katlyn McBride Source Type: research

Mad as a Hatter: Revisiting Primary Hyperparathyroidism in the Elderly
Primary Hyperparathyroidism (PHPT) is a common endocrine disorder and its prevalence increases with age. It is characterized by an abnormal regulation of calcium secretion resulting from increased parathyroid hormone (PTH) levels. Symptomatic PHPT can present with neuropsychiatric symptoms including depression, anxiety, cognitive decline, psychosis, and agitation. In patients with longstanding PHPT with mildly elevated serum calcium, acute change in personality can be overlooked to be related to rising serum calcium. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - April 30, 2024 Category: Health Management Authors: Miriam Donis-Garcia, Keerti Sharma Source Type: research