Preview of the 2013 AGS Annual Scientific Meeting

Caring for older adults, particularly those in long-term care (LTC), is a complex and demanding undertaking. Among other challenges, the majority of older patients in LTC have multiple chronic conditions. And as shown by the American Geriatrics Society’s (AGS) recent report, Patient-Centered Care for Older Adults with Multiple Chronic Conditions: A Stepwise Approach from the American Geriatrics Society, healthcare providers caring for medically complex older people must carefully tailor care to these patients’ unique needs and wishes.

Recognizing the challenges of caring for older adults in LTC settings, the AGS is offering a range of sessions on LTC topics during the AGS Annual Scientific Meeting, which is taking place in Grapevine, Texas, from May 3 to 5. Here’s a sample of these sessions and what they have to offer:

Update on the Development of Competencies for Nursing Home Attending Physicians

Providing medical care in nursing homes “demands a unique skill set that recognizes the increasing complexity of patient care in an environment that is highly regulated and resource-constrained,” notes Paul R. Katz, MD, CMD, professor of medicine at the University of Toronto, and moderator of this symposium. The session will examine a set of competencies that AMDA – Dedicated to Long Term Care Medicine (formerly the American Medical Directors Association has developed specifically for attending physicians in nursing facilities. Katz and other experts will address the knowledge and skills needed to provide optimal care for frail, older nursing home residents who undergo multiple care transitions. Among other things, the symposium will cover the rationale behind AMDA’s competencies; the roles and responsibilities of attending physicians in nursing facilities; and how physician competency, staff organization, and commitment to care affect quality of care. 

Breaking the Code to Nursing Home Quality: Lessons from a Unique Approach by One State

This symposium will focus on findings from a recent Agency for Healthcare Research and Quality study of Minnesota’s innovative Performance-Based Incentive Payment Program (PIPP). The PIPP is a state model for funding grassroots, provider-initiated, evidence–based quality improvement (QI) projects. In a departure from conventional pay-for-performance initiatives, PIPP allows participants to design their own projects and to work with the state in selecting targets for intervention and determining their incentive payments. Attendees will learn about PIPP’s unique QI process, including how it can be used to enhance nursing home quality and to enable program evaluation, improvement, and dissemination to occur in tandem. The session is designed to help attendees better understand how to collaborate and foster partnerships among stakeholders with a mutual goal of improving nursing home quality, while also understanding the basic elements of PIPP and physicians’ and medical directors’ roles in enhancing quality via program projects. The session will be moderated by Arif Nazir, MD, assistant professor of medicine and director of nursing home services at Indiana University Geriatrics. Nazir is currently leading an evaluation of physician-engagement in Minnesota nursing home facilities. 

Improving the 30-Day Readmission Rate Quality Indicator for Frail Elders: Strategies and Models of Care

This symposium will spotlight new approaches for further reducing the 30-day hospital readmission rate for frail older adults. It will cover approaches for different subgroups of frail elderly adults upon discharge, including patients requiring post-acute skilled nursing facility rehabilitation before returning home; patients returning to their previous LTC facilities; and patients so frail that they are, ostensibly, homebound. After completing the symposium, participants will, among other things, be able to identify the elements of team-based care central to providing safe and effective care to high-risk populations upon discharge from the hospital. Tom von Sternberg, MD, associate medical director of geriatrics, home care, and hospice with HealthPartners, and director of a large nursing home and a rehabilitation and assisted living program for frail older adults, will moderate. von Sternberg is also a member of the National Quality Forum measurement group on LTC, and the Joint Commission technical advisory committee on LTC.

Management of Coexisting Cognitive, Sleep, and Voiding Problems in Older Adults

George Kuchel, MD, geriatrician, researcher, and director of the University of Connecticut’s Center on Aging will moderate this symposium, which will examine the links between cognitive, sleep, and voiding problems in older adults. Kuchel’s research in this area has established a role for brain white matter disease as a shared risk factor for declines in mobility, cognition, and continence, and has defined roles for hormones and inflammation in detrusor muscle underactivity. He is the primary investigator in a new National Institute on Aging (NIA) U13 Conference Grant (a continuation of the AGS/NIA Bedside-to-Bench Conference series). Participants in this symposium will be briefed on the latest findings regarding the prevalence of concurrent cognitive, sleep, and voiding problems and on the shared risk factors and mechanisms that may contribute to these conditions; become familiar with interventions designed to improve sleep in older adults and their potential impact on cognitive function, voiding, and continence; and learn about both interventions designed to improve nocturia and continence in older adults and their impact on cognitive function and sleep.

Best Possible Interdisciplinary Post-acute Management of Falls, Nutrition, Pressure Ulcers, and Hydration

This multipart session is designed to familiarize healthcare providers with AMDA’s revised 2007 guidelines regarding falls, altered nutritional status, pressure ulcers, and dehydration. After completing this symposium, participants should be able to outline risk factors for falls and altered nutritional status and unintended weight loss among the frail elderly; implement appropriate interventions to prevent and treat these whenever possible; and define an unavoidable fall. Participants should also be able to list risk factors for unavoidable pressures ulcers in the frail elderly; implement interventions for pressure ulcer prevention and treatment; and define an unavoidable pressure ulcer. In addition, participants should be able to define dehydration in the frail elderly. Charles A. Cefalu, MD, MS, chief of geriatrics at Louisiana State University Health Sciences Center in New Orleans, and advisory board member of Annals of Long-Term Care^®, will moderate. Cefalu chairs AMDA’s Clinical Practice Committee and, in that capacity, oversees the development of new clinical practice guidelines relevant to LTC providers. He oversaw the development of the association’s guidelines regarding falls, altered nutritional status, dehydration, and pressure ulcers.

Keep in mind that the outlined symposia are just a sampling of the must-attend sessions at the 2013 AGS Annual Scientific Meeting. In addition to cutting-edge lectures, workshops, symposia, and paper and poster sessions highlighting the latest developments in geriatrics, the meeting also provides invaluable networking opportunities. A networking session specifically for those working in LTC settings will be held on Sunday, May 5, from 10:45 am to 12:15 pm. We hope to see you there.

The AGS 2013 Annual Scientific Meeting will be held May 3 through 5 at the Gaylord Texan in Grapevine, TX, just outside of Dallas. For more information and to register for this event, visit
www.americangeriatrics.org/annual_meeting/attendees.