Susan L. Charette

Hospitalization of the Nursing Home Patient

The scenario is a familiar one. A nurse from the skilled nursing facility calls you because one of your patients is not doing well. “Should I send her to the hospital?” Although hospitalization offers acute services and onsite specialists, physicians can manage a wide range of medical problems in the nursing home. Additionally, nurses at such facilities are able to provide a variety of services from intravenous hydration and medications to wound management and palliative care. The decision to send a patient to the hospital is multifactorial, and influences include the severity of the underlying medical problem, availability of nursing home services, physician comfort level, patient and family request, and economic incentives. Hospitalization is not without its own set of risks and benefits. Hospitalized older patients are at an increased risk for adverse events including delirium, functional decline, and iatrogenesis, and their overall health and quality of life may be deleteriously affected by such experiences. This article will discuss important aspects in the evaluation, treatment, and management of the hospitalized nursing home patient. Emphasis will be placed on the clinical competencies required to provide optimum care for this subset of the geriatric patient population.

Goal-Oriented Care

Inspired in part by psychologists’ concept of goal attainment scaling nearly 50 years ago, this chapter describes a practical, patient-centered, goal-oriented model of geriatric medical care. This customized care approach requires clinicians to be aware of and able to set aside their own, personal preferences and values in order to more actively attend to those of their patients, many of whom live with multimorbidity. Benefits and barriers to implementing this paradigm shift from disease to patient focus are addressed, and possible solutions are offered.

Encouraging geriatric medicine fellows to write review articles: a description of our experience.

Medical education in the United States develops many skills, but writing is not usually one of them. At the UCLA Multicampus Division of Geriatrics, we recently instituted a project that attempts to provide the opportunity for each of our Geriatric Medicine fellows to write and publish a review article. We report our experiences of the first 3 years of this program in an effort to share our successes, our shortcomings and our impressions.