Features

Preparing for the New Medicare Reimbursement Guidelines: Part I--When Are Pressure Ulcers in the Hospital Avoidable?

Dr. Levine is Clinical Associate Professor of Medicine, New York Medical College, Valhalla, NY, and Attending Physician in the Geriatrics Section, St. Vincent Catholic Medical Center, New York, NY.
This is Part I of a two-part series on pressure ulcers and Medicare reimbursement. Part II will discuss documentation of altered skin integrity and will appear in the next issue of the Journal.

Introduction
Medicare recently announced that as of Oc

Light as Therapy for Sleep Disorders and Depression in Older Adults

Proper lighting is necessary for vision and to carry out one’s daily activities. This aspect of light-light for vision - is well known by the general public and health professionals. What is less well appreciated is the large and growing body of scientific literature on light as a therapeutic agent. Indeed, although much has been documented over the past decades about its therapeutic uses, light is rarely prescribed by physicians and other healthcare providers. In part, this is because much is yet to be understood

Evidence-Based Treatment of Behavioral Problems in Patients with Dementia

Point of View

The purpose of this article is to review current perceptions of appropriate use of antipsychotic medications for behavioral problems in skilled nursing facility (SNF) residents with dementia. This is especially critical now given the public concern. While evidence regarding the pharmacologic treatment of behavioral problems in patients with dementia is sorely lacking, public focus is moving clinicians to stick to the

The 17th Annual Congress of the European Respiratory Society

MEETING REPORT
Stockholm, Sweden
September 15-19, 2007

The European Respiratory Society’s Annual Congress is the largest international gathering of health professionals and researchers involved in respiratory medicine in the world. This year, over 15,000 persons attended the meeting held in Stockholm, Sweden. This forum has increasingly become the preferred venue for the presentation of important new research findings and landmark clinical trials in the field of respiratory medicine. Some highlights from the

Alternatives to Oral Therapies for Erectile Dysfunction

Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. Although ED is not a normal change of age, it is very common. While not a life-threatening problem, it nevertheless is a source of significant stress to many men. Regardless of the man’s age, it is likely to have a significant effect on self-esteem and quality of life. While there are some normal changes in sexual function with healthy aging, these changes are not so severe that enjoyment of sexual activity must be abandoned. Unlike younger men, psyc

Designing a Health System for Good Behavior

Medicare’s name change from the Health Care Financing Administration (HCFA) to the Centers for Medicare & Medicaid Services (CMS) was meant to be more than simply a replacement of signage and stationary. It was meant to be a move to a new direction. A change from an organization that focused on writing over a billion dollars worth of checks daily (including weekends) for acute care to an organization that led the way to improved health outcomes. It is said that one gets the results that a system was designed to deliver. Clearly, the old Medicare was not designed to deliver superior health ou

Physician Assistants in Geriatric Medicine

Introduction
Physician assistants (PAs) are healthcare professionals who practice medicine with physician supervision. Their use is widespread in all areas of medical care delivery, including geriatrics. Over the past four decades, the role of PAs in American medicine has expanded and, as of 2003, PAs account for at least 10% of all outpatient contact.1 Of the nearly 65,000 PAs currently in practice in the United States, the majority work in ambulatory care settings, but with significant numbers in specialty and subspecialty areas. Their contribution to medical care delivery

Do Hypogonadal Older Men Benefit from Testosterone Therapy?

Introduction
For younger males with profound hypogonadism, such as those with hypogonadotropic hypogonadism due to Kallmann’s syndrome, testosterone is routinely prescribed to induce and maintain secondary sex characteristics, to allow for normal sexual function, to promote a male body composition, and to provide estrogen for bone health. The situation is more complex when it comes to older men with borderline low testosterone levels and nonspecific symptoms of hypogonadism. The Endocrine Society recently published a Clinical Practice Guideline entitled “Testosterone Therapy in Adu

The Medicare Beneficiary of the 21st Century: Effect on Geriatric Practices

The Medicare beneficiary is changing, and these changes are affecting how geriatric care providers practice. From the physical layout of the practice, to marketing, to management from an administrative and clinical aspect, all is about to change. The Medicare Payment Advisory Commission (MedPAC; www.MedPAC.gov) recently assessed for Congress the changing demographics of the Medicare beneficiary by identifying eight major changes,1 as follow:

Increase in Number of Beneficiaries as Baby Boomers Age
Everyone is aware of the aging baby boomers becoming Medicare-eligible, but the

Identifying Functional Deficits in Persons Living with Developmental Disability: Examples with Cerebral Palsy or Spina Bifida

Introduction
Adults with developmental disabilities are becoming more commonplace in society, particularly those who have lived with a disability their entire lives. Survival rates have vastly improved for children with chronic disabilities affecting physical function, such as cerebral palsy (CP)1 and spina bifida (SB).2 Current predictions suggest that many individuals with developmental disabilities will live into adulthood and age much like the general population; however, little is known about the natural history of these disorders over the lifespan.1 S