Hospitalists' Guide to the Care of Older Patients.
Title:
Hospitalists' Guide to the Care of Older Patients.
Author:
Williams, Brent C.
ISBN:
9781118674956
Personal Author:
Edition:
1st ed.
Physical Description:
1 online resource (281 pages)
Series:
Hospital Medicine: Current Concepts
Contents:
Cover -- Hospital Medicine: Current Concepts -- Title page -- Copyright page -- Contents -- Contributors -- CHAPTER 1: Introduction and Overview -- Intended Audience and Use -- Acknowledgments -- References -- CHAPTER 2: The Hospitalized Older Adult: Communication and Physical Examination -- Introduction -- Pearls for Communicating with Older Patients -- Make It a Habit to Demonstrate Reverence for Older Patients -- Control the Environment to Facilitate Communication -- Sit Down and Listen to the Patient -- Performing the Geriatric Physical Examination -- Appearance -- Dress -- Language -- Behaviors -- The Face -- The Eyes -- The Mouth -- Arm and Hand Movements -- Sitting and Standing Postures -- Putting It All Together -- Illness versus Disease -- Further Reading -- CHAPTER 3: Geriatric Assessment for the Hospitalist -- Introduction -- Framework for Geriatric Assessment in the Hospital -- Evidence for Geriatric Assessment -- Comprehensive Geriatric Assessment -- Acute Care of the Elderly (ACE) Units -- Geriatric Assessment in "Usual Care" Hospital Services: Hospital Elder Life Programs (HELPs) -- Geriatric Assessment in Hospitalist Practice -- At Admission and During the Hospital Stay -- Discharge Planning (Transition Care) -- Integrating Assessment in the Hospital Team Workflow -- Tools to Integrate Assessment into Hospital Care of Older Patients -- Conclusion -- References -- CHAPTER 4: Informed Decision-Making and the Evaluation of Decision-Making Capacity -- Introduction -- How Often Do Patients Lack Decision-Making Capacity? -- Neuropsychiatric Conditions that Affect Capacity -- Delirium -- Dementia -- Psychiatric Illness -- Determination of Decision-Making Capacity -- Before the Assessment: The Clinician's Responsibilities to the Patient -- Applying the "Four Abilities" Model: Considering Function in Context.
Documentation of the Evaluation -- Clinical Implications of a Capacity Evaluation Document -- Beyond Capacity Assessment: Working with Patients Making Decisions -- Influences on Medical Decision-Making -- Obstacles to Good Decision-Making -- Conclusion -- References -- CHAPTER 5: Caring for Patients with Limited Prognosis: Negotiating Goals of Care and Planning for the End-of-Life -- Introduction -- Role of Palliative Care in the Care of Patients with Limited Prognosis -- Assessing Prognosis -- General Concepts of Prognosis -- Tools used in Prognosis: Debility and Dementia -- Debility -- Dementia -- Communication with Patient and Families Regarding Prognosis and Negotiating Goals of Care -- Family Meeting: Before You Begin -- Family Meeting: The Opening -- Family Meeting: Elements of Effective Communication -- Family Meeting: Closing and Follow-Up -- Goals of Care: Specific Topics and Scenarios -- Code Status and Do-Not-Resuscitate Orders -- The Role of Advance Directives in Decision-Making -- Dealing with Conflict: The Family That Wants "Everything" and the Concept of Futile Care -- Planning for the End of Life: Hospice Care -- Conclusion -- References -- CHAPTER 6: Geriatric Pharmacotherapy -- Challenges in Prescribing for Older Adults -- Representation in Clinical Trials -- Altered Response to Medication -- Pharmacokinetic Changes -- Pharmacodynamic Changes -- Polypharmacy -- Prescribing Cascades -- Identifying Potentially Inappropriate Medications -- The Beers Criteria -- Screening Tool of Older Person's Prescriptions (STOPP) -- Underprescribing of Appropriate Medications -- Adverse Drug Events in the Hospital -- Prescribing During Transitions of Care -- Medication Adherence -- Patient Factors -- Cost -- A Step-Wise Approach to Prescribing for the Hospitalized Older Patient -- Reconcile Medications -- Identify High-Risk Medications.
Consider Goals of Care -- Be Mindful When Starting a New Medication -- Improve Adherence -- Improve Transitions in Care -- References -- CHAPTER 7: Managing Behavioral Disturbances with Psychoactive Medications: Dos, Don'ts, and Maybes -- Introduction -- Assessing Behavioral Disturbances -- General Considerations for Utilizing Psychotropic Medications to Address Behavioral Disturbances -- Treatment of Specific Behavioral Symptoms -- Depression -- Mania -- Anxiety -- Psychosis -- Insomnia -- Behavioral Disturbances Associated with Dementia and Delirium -- Other Geriatric Conditions -- Parkinson's Disease and Lewy Body Dementia -- Poststroke Neuropsychiatric Sequelae -- Pain -- Conclusions -- References -- CHAPTER 8: Issues and Controversies Surrounding Nutrition in Hospitalized Older Adults -- Introduction -- Malnutrition -- Nutritional Assessment: Geriatric Considerations -- Gathering Relevant History -- Understanding Baseline Functional Status -- Understanding Baseline Cognitive Status -- Tools Used for Screening and as Diagnostic Aids for Malnutrition -- Further Clinical Evaluation -- Medication Review -- At the Bedside: Physical Exam Pearls for Assessing Nutritional Concerns -- Dysphagia, Aspiration Concerns, and Swallowing Evaluations: Pearls and Pitfalls -- Appearance of the Oral Mucosa -- Instrumental Assessments -- Aspiration Concerns -- Starvation -- Managing Persistent Eating Problems -- Comfort Feeding -- Nutritional Supplements and Pharmacologic Agents -- Nutritional Supplements -- Orexigenic Agents -- Managing Swallowing Difficulties: Compensatory Strategies -- Conclusion -- References -- CHAPTER 9: Hip Fracture: Managing the Medically Complex, Older Surgical Patient -- Introduction -- Epidemiology -- Models of Care: The Role of the Hospitalist -- Preparing for Hip fracture Surgery.
Surgical Options and Optimal Timing for Surgical Repair -- The Preoperative Medical Evaluation for Patients Undergoing Hip Fracture Repair -- Postoperative Care -- Venous Thromboembolism Prophylaxis for Hip Fracture Patients -- Delirium -- Urinary Tract Infections and Bladder Management -- Pressure Ulcers -- Pain Management -- Anemia -- Physical and Occupational Therapy -- Osteoporosis -- Quality Improvement Measures -- References -- CHAPTER 10: Falls and Mobility During Hospitalization -- Hospital Falls -- Falls Tracking and Reporting -- Risk Factors for Falls During Hospitalization -- Intrinsic Risk Factors: On Admission -- Intrinsic Risk Factors: In the Hospital -- Extrinsic Risk Factors: In the Hospital -- Interventions -- Postfall Follow-Up -- Coding for Fall Risk Assessment and Management -- Hospital Mobility -- Barriers to Mobility -- Interventions to Improve Mobility -- References -- CHAPTER 11: Pressure Ulcers: A Primer for the Hospitalist -- Pressure Ulcers Are Prevalent, Morbid, Avoidable, and Put Hospitals at Financial Risk -- Identifying Patients at Risk for Pressure Ulcer Formation or Progression -- Prevention Strategies -- Staging Pressure Ulcers -- Stage I -- Stage II -- Stage III -- Stage IV -- Deep Tissue Injury -- Unstageable -- Documentation -- Pressure Ulcer Treatment: Wound Bed Preparation -- Tissue Debridement -- Infection/Inflammation -- Moisture Balance -- Edge -- Goals of Treatment/Discharge Strategies -- Conclusion -- References -- CHAPTER 12: Delirium -- Introduction -- Admission Assessment: Identifying Patients at Risk for Delirium -- Preexisting Cognitive Impairment -- Sensory Impairment -- Low Functional Performance -- Comorbidities -- Abnormal Laboratory Values -- Precipitating Factors for Delirium -- Medications -- Hospital Environment -- Iatrogenic Events -- Mitigating Risk Factors to Prevent Delirium.
Nonpharmacological Interventions -- Pharmacological Prophylaxis -- Monitoring for Delirium -- Diagnosing Delirium -- Differentiating the Criteria for Delirium, Dementia, and Depression -- Treatment of Delirium -- Identify and Treat the Etiology -- Management of Agitation Associated with Delirium -- Implications of Delirium Beyond the Hospital Stay -- Conclusion -- Acknowledgments -- References -- CHAPTER 13: Transitional Care Planning: Assuring a Safe Discharge -- Introduction -- Why Are Hospital Discharges Challenging? -- Best Practices Around Care Transitions at Hospital Discharge -- Comprehensive Needs Assessment -- Identifying Solutions and the Appropriate Level of Postdischarge Care -- Building a Systematic Discharge Process -- Postdischarge Interventions -- Conclusion -- Additional Resources -- References -- Index.
Abstract:
The first book designed specifically for hospitalists and other hospital-based staff who need concise, evidence-based guidance on the vital topic of caring for older hospitalized patients Hospitalists' Guide to the Care of Older Patients is an up-to-date, practical reference in geriatric medicine for hospitalists, as well as other physicians and nurses working in the hospital setting. The book uses numerous tables, figures, and images to highlight the areas of geriatric medicine that are most relevant to hospitalists. Written by nationally recognized experts, chapters broadly follow the course of hospitalization, from admission through daily care and active management of the transition to post-hospital settings, providing practical, evidence-based guidance at each point. Contents include: A systematic approach to the care of older patients, emphasizing clinical skills and daily activities that can be implemented in today's hospital environment Techniques for effective communication with patients and their caregivers Tools and "pearls" for quickly and accurately assessing the whole patient, including risk for in-hospital complications, function, decision-making capacity, and home support Best practices for prevention and management of the complications of hospitalization, including delirium, falls, pressure ulcers, and hip fractures Specific recommendations in areas with wide practice variation, such as psychopharmacology and nutrition in older hospitalized patients Practical guidance on complex issues, such as establishing goals of care, managing patients who lack decision-making capacity, and managing the discharge transition Methods to improve the daily work and communication of the whole hospital team, including physicians, nurses, and other healthcare providers As the population ages, hospitalists are caring for an increasing number
of older patients. This book helps hospitalists expand their knowledge, incorporate key clinical skills into daily practice, build more efficient patient care teams, and teach more effectively in today's fast-paced, complex hospital environment.
Local Note:
Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, 2017. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries.
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Electronic Access:
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