Advances in Long Term Care Medicine

Guest: Thiruvinva Dharmarajan, MD FACP AGSF Host: Eric Tangalos, MD Patients in hospital settings are often screened and promptly treated for venous thromboembolism, or VTE, but perhaps less commonly in long-term care, even though these patients may be at risk. Dr. T.S. Dharmarajan, clinical director of the division of geriatrics at Montefiore Medical Center (North Division) in the Bronx, New York, discusses the medical conditions in long-term care that put patients at risk for VTE, and ways to assess patients for the condition. What anticoagulation medications and treatments may be used for treating VTE in long-term care? Should long-term care clinicians treat VTE as aggressively as hospitals often do, or are there other unique considerations clinicians should keep in mind for managing patients at risk for VTE in long-term care? Dr. Eric Tangalos hosts.

Host: Eric Tangalos, MD Guest: Tena Alonzo, MA How can creating a more positive emotional experience for patients with dementia or Alzheimer's diminish behavior issues and improve quality of life? Tena Alonzo, director of research and co-director of the Palliative Care for Advanced Dementia program at Beatitudes Campus in Phoenix, discusses a common-sense approach to creating a comforting environment for those with dementia and Alzheimer's, which focuses on meeting each patient's unique needs. What simple steps can long-term care facilities and caregivers take to enhance the lives of patients with cognitive disorders? Dr. Eric Tangalos hosts.

Guest: Robert Kane, MD Host: Eric Tangalos, MD Deciding between assisted living facilities or nursing homes can be daunting for patients and families. How can healthcare professionals discuss long-term care expectations with patients and families and help with the selection process? Dr. Robert Kane, Minnesota Chair in Long-term Care and Aging at the University of Minnesota School of Public Health and director of the University of Minnesota's Center on Aging, discusses the genesis and evolution of assisted living facilities and nursing homes. What are some of the common precursors to patients and families deciding it is time to choose long-term care, and how can they determine which type of care is best? Dr. Eric Tangalos hosts.

Guest: Steven Levenson, MD, CMD Host: Eric Tangalos, MD As healthcare reform evolves, so too do the public policies governing long-term care facilities. How can healthcare professionals stay up-to-date with the latest changes in federal and state regulations? What are the differences between regulations governing assisted living versus skilled care environments? How successful have regulations been at facilitating better quality of care in skilled care and assisted living? Dr. Steven Levenson, medical director of six long-term care facilities in Maryland and past-president of AMDA, says that having a "watchful eye" over long-term care facilities is generally useful in promoting quality of care, but laments the fact that there are some inconsistencies in the ways regulations are applied and implemented. How can healthcare providers aim towards regulatory compliance and better patient care, without getting bogged down with seemingly overwhelming details? Dr. Eric Tangalos hosts.

Guest: Matthew Wayne, MD, CMD Host: Eric Tangalos, MD Regulations regarding nurses as prescribing agents of physicians in long-term care facilities are more restrictive than in the hospital setting, because controlled substance licenses are not currently approved for nursing homes in most states. These restrictions can make it challenging for long-term care patients to receive timely access to narcotics. Dr. Matthew Wayne, medical director, geriatric medicine, University Hospital Richmond Medical Center in Richmond Heights, Ohio, and assistant professor of medicine at University Hospitals Case Medical Center in Cleveland, suggests revisions to some provisions of the Controlled Substances Act in order to ensure long-term care patients have access to pain medications when they need them the most. What hurdles are the most significant impediments to improving patient care with appropriate access to narcotics, and how can medical professionals best navigate the waters until revisions are made to the current law? Dr. Eric Tangalos hosts.

Host: Eric Tangalos, MD Guest: Steven Handler, MD, PhD, CMD Because residents in long-term care facilities often have comorbidities, polypharmacy can be an issue. What are the most common types of adverse drug events that can occur among long-term care patients taking multiple medications? Dr. Steven Handler, assistant professor in the department of biomedical informatics and the department of geriatric medicine at the University of Pittsburgh School of Medicine, and the medical director for long-term care health information technology for the University of Pittsburgh Medical Center, says the current methods for monitoring medications in nursing homes are inadequate for protecting against adverse drug events, and suggests ways to improve medication safety in long-term care. What tools might help practitioners in long-term care better detect and prevent adverse drug events? Dr. Eric Tangalos hosts.

Guest: Peter Winn, MD, CMD Host: Eric Tangalos, MD With palliative and hospice care, there is no one-size-fits-all approach. What differentiates these two types of care and how can physicians decide which approach to palliative or hospice care is best for each patient? Dr. Peter Winn, professor in the department of family medicine at Oklahoma University School of Medicine in Oklahoma City, discusses various types of care at the end of life, and outlines conditions that might require such care. What are some of the challenges to providing effective palliative and hospice care, and how can physicians best discuss realistic expectations with families and patients? Hosted by Dr. Eric Tangalos.

Guest: Karl Steinberg, MD, CMD Host: Eric Tangalos, MD "Advance directive" is an umbrella term that encompasses end-of-life documents, including a living will and durable power of attorney for healthcare. Such documents can be scary for many patients, and as such, advance directives are not very common among the general US population. Yet these documents can be powerful tools in ensuring patients receive the type of care they desire. What do physicians need to know about advance directives in caring for patients at the end of life? Dr. Karl Steinberg, associate medical director for skilled nursing care at Scripps Coastal Medical Center in Vista, California, discusses variations, misconceptions and confusion surrounding advance directives, and says there is room for improvement. Many states have enacted Physician Orders for Life Sustaining Treatment (POLST) programs to address end-of-life care issues. What do these programs involve, and how effective are such programs in alleviating confusion with end-of-life care? Dr. Eric Tangalos hosts.

Guest: David Smith, MD, CMD Host: Eric Tangalos, MD Nearly three-quarters of patients in long term care have some form of memory impairment or dementia. And while some forgetfulness is a normal part of the aging process, memory loss can also be overlooked as an early symptom of cognitive impairment. How can physicians distinguish between common memory loss and cognitive impairment? Dr. David Smith, professor of family medicine at the College of Medicine at Texas A&M University, College Station; and president of Geriatric Consultants of Central Texas in Brownwood, Texas, discusses the nuances of different forms of cognitive impairment, and emphasizes the importance of early diagnosis. What activities, medications, environments and other strategies can help physicians slow cognitive decline in these patients? Dr. Eric Tangalos hosts.

Host: Eric Tangalos, MD Guest: Alexandra Papaioannou, MD Millions of Americans have osteoporosis, but too often, a broken bone is the first indication of this common condition. What osteoporosis screening strategies can help diagnose osteoporosis in its early stages, and what treatment regimens are the most effective? Dr. Alexandra Papaioannou, professor in the department of medicine, and past-director of the division of geriatric medicine with a joint appointment in the division of rheumatology at McMaster University in Ontario, Canada, says it's important to target and prevent both falls and osteoporosis in tandem to reduce fractures. What are optimal amounts of calcium and vitamin D for older, less mobile patients? How can long term care facilities incorporate osteoporosis prevention into their screenings? Dr. Eric Tangalos hosts.

Guest: William Schaffner, MD Host: Eric Tangalos, MD Which infectious diseases are most common at long term care facilities? If there is an infectious disease outbreak at a facility, how can we best protect residents? Dr. William Schaffner, president of the National Foundation for Infectious Diseases, as well as professor and chairman of the department of preventive medicine, and professor of medicine in the division of infectious diseases at Vanderbilt University School of Medicine in Nashville, Tennessee, stresses the importance of influenza and pneumococcal vaccinations for not only long-term care residents and staff, but also the residents' families. What strategies can help increase the vaccination success rates at long term care facilities? Dr. Eric Tangalos hosts.

Guest: Alan Lazaroff, MD Host: Eric Tangalos, MD How different is the population of long term care facilities today than in decades past, and how will these new resident communities impact delivery of care? Dr. Alan Lazaroff, director of geriatric medicine at St. Anthony Hospitals Senior Health Centers, and president of Geriatric Medicine Associates in Denver, Colorado, talks about the changes long term care facilities have made to better serve the needs of shifting resident demographics, including flexible scheduling and activities. What challenges face nursing homes today that care for younger, sicker or shorter-term patients? Dr. Eric Tangalos hosts.

Guest: Douglas Berkey, DMD, MPH Host: Eric Tangalos, MD A patient's mouth can literally serve as a window to their overall health. Systemic conditions that are common among many older patients, such as diabetes, often have oral manifestations. What are some of the symptoms to look for, and how can we promote and preserve the oral health of vulnerable patients? Dr. Douglas Berkey, professor at the University of Colorado Schools of Dental Medicine and Public Health, where he also serves as co-director of the Center on Aging, discusses some of the most common oral health problems among elderly and long-term care residents, including oral abscesses and periodontal disease, and suggests a proactive approach to dental care for these patients. Dr. Eric Tangalos hosts.

Host: Eric Tangalos, MD Guest: James E. Galvin, MD, MPH Early detection of various conditions can help physicians better manage and treat their patients, and Alzheimer's is no exception. What early screening tests of cognitive impairment or dementia should be administered by primary care providers help detect when the disease process is beginning? Dr. James Galvin, professor in the departments of neurology and psychiatry at New York University Langone Medical Center in New York City, joins host Dr. Eric Tangalos to discuss the correlation between higher scores on cognitive impairment screening tests (such as the AD8 dementia screening test) and the presence of biomarkers for Alzheimer's. How effective is second stage confirmation of Alzheimer's with the use of biomarkers, and what role will biomarkers play in development of new therapies for this condition?

Guest: Frederick Wendt, RPh Host: Eric Tangalos, MD As medication costs continue rising, what strategies can help long-term care facilities reduce drug expenditures, while still providing the best quality of care for patients? Fred Wendt, RPh, vice president of pharmacy services for Senior PharmaStrategies in Burleson, Texas, says one of the most significant pharmacy issues in long-term care is the Drug Enforcement Administration's current position on the nursing facility staff as agent of the physician, with regard to controlled substances. How is the role of the consultant pharmacist changing in long-term care? What programs can help long-term care facilities reign in drug costs, while maintaining high quality care for patients, particularly in the area of diabetes? Dr. Eric Tangalos hosts.

Host: Eric Tangalos, MD Guest: Christine Dunford, PhD Guest: Mary O'Hara, MA, LCSW Although we remain limited in our options for treating patients with memory loss and Alzheimer's, there are a variety of non-pharmacologic treatments that are showing some promise. Mary O'Hara, social worker at Cognitive Neurology and Alzheimer's Disease Center at Northwestern University Feinberg School of Medicine, and Christine Dunford, cultural anthropologist, ensemble member of Chicago's Lookingglass Theatre, and founding teaching artist with the Chicago Arts Partners in Education (CAPE) program, facilitate an improvisational acting workshop called the Memory Ensemble for patients with Alzheimer's and memory loss. One of improv's principles emphasizes being "in the moment," which can be particularly therapeutic for patients with memory loss. How has the Memory Ensemble program been designed to be both challenging and supportive, and what are some of the program's benefits? What other types of creative programs might have a similar effect on improving the quality of life, as well as building confidence and coping mechanisms for these patients? Hosted by Dr. Eric Tangalos.

Guest: Laurie Jacobs, MD Host: Eric Tangalos, MD Patients who have recently had orthopedic and other types of general surgery, those who have recently had a stroke, and those with an ongoing medical condition (such as heart disease) are at most risk for developing venous thromboembolic disease. Do most long-term care facilities screen for this condition among these patient populations, and when should physicians initiate prophylactic care? Dr. Laurie Jacobs, professor of clinical medicine and vice chairman of clinical and educational programs in the department of medicine at Albert Einstein College of Medicine and Montefiore Medical Center, and director of the Resnick Gerontology Center at Albert Einstein College of Medicine in Bronx, New York, discusses ways to reduce the risk of developing venous thromboembolism among long-term care patients. What is on the horizon in terms of new therapies? Hosted by Dr. Eric Tangalos.

Guest: Bruce Troen, MD Host: Eric Tangalos, MD Vitamin D deficiency has been receiving a deluge of media coverage lately, and physicians are likely to hear many related questions from patients, especially long-term care residents and their families. What are the latest developments in vitamin D research, and how can adequate vitamin D levels help prevent falls among our older patients? Even more fundamentally, how do we define vitamin D insufficiency and deficiency? Dr. Bruce Troen, professor of medicine, research scientist at the Geriatric Research, Education, and Clinical Center, and director of the molecular gerontology program at the University of Miami Miller School of Medicine in Miami, Florida, describes the crucial role that vitamin D plays throughout the body, beyond its well-known role in the musculoskeletal system. How common is vitamin D insufficiency among geriatric and nursing home residents? What is the best regimen and dosage to overcome vitamin D insufficiency or deficiency? When should calcium be supplemented to help prevent fractures? Tune in to hear host Dr. Eric Tangalos and this week's guest sift through the latest information on vitamin D.

Guest: Hosam Kamel, MD, MPH, CMD Host: Eric Tangalos, MD Heart failure is a common reason for hospitalization among older adults and long-term care patients. What strategies can help prevent a recurrence of heart failure, and what types of monitoring for exacerbations are most effective in prevention? How can physicians individualize therapy in this population? How crucial are blood pressure and hypertension control in managing patients with heart failure? Dr. Hosam Kamel, director of geriatrics and extended care, at St. Joseph’s Mercy Health Center in Hot Springs, Arkansas and associate clinical professor of geriatrics at the department of geriatrics at the University of Arkansas for Medical Sciences, discusses the goals of managing patients with heart failure in long-term care, and offers pragmatic advice for physicians in managing patients with heart failure. Dr. Eric Tangalos hosts.

Guest: David Dosa, MD, MPH Host: Eric Tangalos, MD Long-term care facilities that include pets as residents are finding that fuzzy friends offer not only companionship to their human residents, but also comfort at the end of life. Dr. David Dosa, geriatrician and health services researcher at Brown University in Providence, Rhode Island, and author of Making Rounds with Oscar: The Extraordinary Gift of an Ordinary Cat, shares his stories about a nursing home cat named Oscar with an uncanny ability to sense when patients are nearing the end of life. What can Oscar teach us about compassionate palliative and hospice care? How prevalent are animal programs at long-term care facilities, and what other benefits do pets offer to residents? How do animal programs fit in with culture change in long-term care? Dr. Eric Tangalos hosts.

Guest: Lori Heim, MD Host: Eric Tangalos, MD The medical home model is designed to increase efficiency by providing a central primary care practice as the coordinator of care for patients. But while efficiency is important, the patient-centered component of this model is just as crucial. Dr. Lori Heim, president of the American Academy of Family Physicians, emphasizes the patient-centered concept for medical homes, and provides real-world examples. How can you re-tool your office to be more accessible to your patients, both in a physical sense, and through better communication strategies? How helpful are patient satisfaction surveys in determining potential areas of improvement for your practice? And let's face it— physicians will spend a significant amount of time outside of the traditional office visit ensuring well-coordinated care for their patients under this model. Dr. Heim recognizes that the fee-for-service payment system will need to change for the medical home concept to thrive, and discusses the payment models that best support the patient-centered medical home. How can the entire medical neighborhood or community be incentivized to fully engage in the medical home model? Dr. Eric Tangalos hosts.

Guest: William Golden, MD Host: Eric Tangalos, MD There's often a disconnect in the continuity of care, creating inefficiency and increased healthcare costs. How can our healthcare system better coordinate transitions of care, especially for patients with chronic conditions? How can we create a system that incentives better coordination of care and long-term management of patients? Join ReachMD for a special broadcast recorded at the AMA House of Delegates meeting with guest Dr. William Golden, chair of the American College of Physicians delegation and medical director of health policy for Arkansas Medicaid. Hosted by Dr. Eric Tangalos. Catch all of ReachMD's coverage and commentary from the 2010 AMA House of Delegates meeting: Highlights From the 2010 Meeting of the AMA House of Delegates AMA House of Delegates: In Conversation With the New AMA President

Host: Eric Tangalos, MD Guest: Herbert Sier, MD, CMD What are some of the unique issues related to patients with Parkinson's in long-term care, and how can all long-term care team members assess and manage the condition? Dr. Herbert Sier, associate chief of geriatrics and assistant professor of medicine at Northwestern University Feinberg School of Medicine, and vice president of medical affairs at the nonprofit community organization, CJE Senior Life, in Chicago, Illinois, joins host Dr. Eric Tangalos to discuss ways physicians can preserve and improve mobility for Parkinson's patients, while providing for appropriate psychological care as well. Hosted by Dr. Eric Tangalos.

Guest: Jay Luxenberg, MD Host: Eric Tangalos, MD It can be challenging for caregivers to diagnose depression in long-term care medicine, even though depression in facilities such as nursing homes and assisted living facilities is common. How can long-term care physicians recognize the early signs and symptoms of depression, and determine when pharmacologic or other forms of therapy are most appropriate? What quantitative screening tests and management tools are helpful for physicians to use in diagnosing and treating depression? Dr. Jay Luxenberg, director of medical services at the Jewish Home in San Francisco, and clinical professor in the School of Medicine at the University of California, San Francisco, weighs the options of antidepressant therapy versus other non-pharmacologic treatments for patients with depression in long-term care facilities. What evidence demonstrates the efficacy of bright light therapy, family involvement and other activities in improving the symptoms of depression? Dr. Eric Tangalos hosts.

Guest: Debra Bakerjian, PhD, MSN Host: Eric Tangalos, MD What strengths do physicians and nurse practitioners contribute to the long-term care interdisciplinary team, and what are the keys to a strong collaborative practice? What types of state and specific nursing home regulations impact nurse practitioners in long-term care? Nurse practitioner Dr. Debra Bakerjian, postdoctoral fellow at Betty Irene Moore School of Nursing at University of California Davis, joins host Dr. Eric Tangalos to discuss the impact of supervisory regulations on collaborative practices, and how changes might be made to regulations to improve patient care. Also, what's the job growth outlook for nurse practitioners in long-term care?

Guest: Joseph Ouslander, MD Host: Eric Tangalos, MD What are the most essential elements of ensuring safe transitions of care when a patient is discharged from a hospital into a skilled nursing facility, and vice-versa? Dr. Joseph Ouslander, professor of clinical biomedical science and associate dean for geriatric programs at the Charles E. Schmidt College of Biomedical Science, and professor at the Christine E. Lynn College of Nursing of Florida Atlantic University in Boca Raton, Florida, recommends some of the clinical tools he uses to encourage smoother and safer transitions of care to and from long-term care facilities. How can better communication between physicians and adherence to transfer document checklists reduce hospital readmissions? Dr. Eric Tangalos hosts.

Guest: Tim Fox, DPT Host: Eric Tangalos, MD Guest: Mimi Jacobs, MPT As people are living longer than ever before with a variety of chronic conditions, modified physical activity can help older patients regain or retain functionality. Indeed, physical therapy is also essential to the recovery of patients who have undergone elective or emergency surgeries. What distinguishes therapeutic exercise from physical activity, and how can exercise programs be tailored to meet the various needs of long-term care residents? How can we effectively "dose" therapeutic exercise, setting up an effective care plan that residents can adhere to? Dr. Tim Fox, founder and executive director of Fox Rehabilitation in Cherry Hill, New Jersey, and Mimi Jacobs, founding executive director of the non-profit Fox GERI: Geriatric Education & Research Institute, advocate for the benefits of therapeutic exercise in improving quality of life for all patients. Hosted by Dr. Eric Tangalos.

Guest: Paul Drinka, MD, CMD Host: Eric Tangalos, MD Multi-drug resistant organisms (MRDOs), such as Methicillin-resistant Staphylococcus aureus (MRSA), due to antibiotic use are of significant concern. Not only hospitals, but also long-term care facilities, are particularly susceptible to the impact of antibiotic resistance. Dr. Paul Drinka, clinical professor of internal medicine and geriatrics at University of Wisconsin-Madison and the Medical College of Wisconsin-Milwaukee, tells us that one evidence-based approach is to maintain a database of the MRDOs that will help identify clustering of a specific isolate and document a facility's resistance problem, which can then be addressed more precisely. What other specific steps might facilities take to prevent unnecessary use of antibiotics and therefore limit resistance? Dr. Eric Tangalos hosts.

Guest: Dan Osterweil, MD, Msc Ed, CMD Host: Eric Tangalos, MD Telehealth refers to the constantly evolving tools and technologies used to care for patients remotely. These technologies can be applied in many types of clinics, including long-term care facilities, to improve patient access to care and reduce healthcare costs. Dr. Dan Osterweil, clinical professor in the department of geriatrics at the David Geffen School of Medicine at University of California Los Angeles, and medical director for Silverado Senior Living in Calabasas, California, joins host Dr. Eric Tangalos to discuss some of the current practical applications of telehealth, ways to overcome barriers to implementation and the future outlook for remote care. How can telehealth be particularly beneficial to long-term care patients and providers? What are some of the limitations to the use of telemedicine while managing elderly patients? Can telehealth effectively replace in-person exams, are the technologies best utilized in monitoring or consulting situations?

Guest: John Waugh, MArch, FAIA Host: Eric Tangalos, MD Design of healthcare environments is about more than style and aesthetics. A skillfully-designed hospital room can encourage a patient's healing process, overall well-being and better health outcomes, while reducing stress by creating comfortable surroundings. Much like medicine, healthcare design is now focusing on using an evidence base to inform best practices in design. How is evidence-based design being incorporated into planning of healthcare spaces? How can small changes in design, such as lighting from below or lowering the height of windowsills, make a big impact on patient experience? John Waugh, design and planning principal for the firm Ellerbe Becket, discusses design ideas and innovations that are transforming the healthcare landscape from institutional to inspiring. A beautiful atrium can even provoke an impromptu patient concert, as seen here. Dr. Eric Tangalos hosts.

Host: Eric Tangalos, MD Guest: Harold Bob, MD, CMD If you were told there was a method of reducing pain that was low- or no cost, not harmful, and effective, would you be interested in learning more? Nothing can replace evidence-based medicine, but the human connection between physician and patient can go a long way to reducing patients' pain and suffering. How can Reiki and other alternative healing methods complement conventional evidence-based medicine? Dr. Harold Bob, managing partner of a group practice in Reisterstown, Maryland, and medical director at two nursing homes and a hospice in Maryland, discusses the benefits Reiki has brought to his patients and suggests ways all physicians can apply the basic principles of this method in their own practices to connect with patients. How big of a difference can compassionate presence bring to a patient's quality of life and well being? Hosted by Dr. Eric Tangalos.

Guest: Alan Abrams, MD, MPH Host: Eric Tangalos, MD As our older patient population grows more diverse, it will become increasingly important to understand how to best communicate with patients, and their families, about values and expectations. In addition, teams of medical providers come from different backgrounds, so good dialogue within the team is crucial to providing quality care to patients. What should we keep in mind when caring for our older patients, who may be from cultures than our own? Dr. Alan Abrams, assistant professor of medicine at Harvard Medical School, emphasizes that the skills of ethnogeriatric communication are learnable, teachable and paramount to medicine. Dr. Eric Tangalos hosts.

Host: Eric Tangalos, MD Guest: Manjula Kurella Tamura, MD, MPH How do the processes leading to kidney failure differ for various patient populations? What special considerations should physicians keep in mind when caring for patients in long-term care facilities undergoing dialysis? Dr. Manjula Kurella Tamura, nephrologist and assistant professor of medicine at Stanford University School of Medicine, reviews findings from a study regarding functionality for patients undergoing dialysis. Dr. Kurella Tamura points out that although dialysis may increase longevity, it may not improve quality of life. What is recommended for optimal care of patients with kidney failure? Hosted by Dr. Eric Tangalos.

Guest: Lory Bright-Long, MD, CMD Host: Eric Tangalos, MD The diversity of residents in long term care medicine can present unique challenges in diagnosing and caring for patients with various psychiatric conditions. What should physicians keep in mind when caring for younger patients, those with Alzheimer's disease, or patients who have had a stroke at long term care facilities? Dr. Lory Bright-Long, clinical assistant professor of psychiatry at State University of New York Stony Brook and certified medical director, discusses the role of the interdisciplinary team in managing patients with psychiatric conditions. Hosted by Dr. Eric Tangalos.

Guest: David Thomas, MD, CMD Host: Eric Tangalos, MD How common are pressure ulcers in hospitals, nursing homes and other long-term care facilities? What clinical situations put patients at risk for developing pressure ulcers, and how are these wounds diagnosed? Dr. David Thomas, professor of internal medicine and geriatric medicine at Saint Louis University Health Sciences Center, joins host Dr. Eric Tangalos to review strategies for managing pressure ulcers.

Guest: Susan Levy, MD, CMD Host: Eric Tangalos, MD When patients are admitted to long term care facilities, it's crucial to conduct a health screening and identify a preventative patient health plan in order to preserve their well-being. What are some of the areas to pay particular attention to when screening a new patient at a long term care facility? What is the role of the family in creating a health maintenance plan? How might an individualized health maintenance plan differ from standard guidelines? Dr. Susan Levy, vice president of medical affairs and medical director at Levindale Hebrew Geriatric Center and Hospital in Baltimore, discusses these and other questions about health maintenance with host Dr. Eric Tangalos.

Guest: Alva (Buzz) Baker, MD, CMD Host: Eric Tangalos, MD Among older patients, who is most at risk for developing dementia? How can a team of caregivers at a nursing home best assess dementia, and what are some of the causes of this condition? How can activity programs help to decrease the cognitive decline of residents at long-term care facilities? Host Dr. Eric Tangalos discusses these and other questions about dementia with Dr. Alva Baker, faculty member of the division of geriatric psychiatry and neuropsychiatry at Johns Hopkins University School of Medicine.

Guest: Barbara Resnick, PhD CRNP Host: Eric Tangalos, MD How is interdisciplinary collaboration of crucial importance in long term care medicine, and how can a team of health care providers communicate most effectively? What are some of the challenges presented by interdisciplinary collaboration? Dr. Barbara Resnick, professor in the department of organizational systems and adult health at the University of Maryland School of Nursing, discusses collaboration in geriatric and long term care medicine with host Dr. Eric Tangalos.

Guest: John Morley, MB, BCh Host: Eric Tangalos, MD Weight loss, especially among older patients, can be a key indicator of other health problems. How much weight loss is safe, and at what point should physicians address any potential underlying causes of weight loss, including nutritional deficiencies? What are the most common symptoms of dehydration, which can be even more challenging to recognize than nutritional deficits? Join host Dr. Eric Tangalos as he reviews these and other questions with Dr. John Morley, the Dammert Professor of Gerontology at Saint Louis University Medical Center.

Guest: Paul Sanders, MD Host: Eric Tangalos, MD At the American Medical Association's 2009 House of Delegates meeting President Obama discussed the need to re-emphasize primary care, determine the most appropriate physician reimbursement rates and reduce re-hospitalizations. How will each of these aspects of healthcare reform impact long term care medicine? Dr. Paul Sanders, family physician and corporate medical director, discusses these issues with host Dr. Eric Tangalos.

Guest: Peter Hollmann, MD Guest: Ronald Crossno, MD Host: Eric Tangalos, MD Guest: Charles Cefalu, MD MS What are the most significant issues to be addressed in long term care medicine, and how will long term care medicine be affected by healthcare reform in the years ahead? Tune in to hear host Dr. Eric Tangalos reporting from the 2009 American Medical Association House of Delegates Meeting, where he is joined by Dr. Ronald Crossno, from the American Academy of Hospice and Palliative Medicine; Dr. Peter Hollmann, from the Rhode Island Medical Association; and Dr. Charles Cefalu, from the American Geriatrics Society. How will one of the American Medical Directors Association's resolutions about nurse as agent that passed at the AMA meeting help improve efficiency in long term care facilities? Hear ReachMD's complete coverage of the 2009 AMA House of Delegates Meeting: AMA President Dr. J. James Rohack's inauguration speech President Obama's keynote address to the AMA House of Delegates Dr. Rohack discusses President Obama's plan for healthcare reform Delegates respond to President Obama's address Perspectives from members of the AMA Board of Trustees Voting round-up and one-on-one with Dr. Steven Stack

Guest: Sandra Aamodt, PhD test