Recognizing New Diagnoses and Reassessing Chronic Disorders
Navigating the multiple comorbidities often present in older adults is a constant challenge for clinicians managing their care. Polypharmacy adds to this challenge, especially when providers are attempting to diagnose a new condition. Medical records of older adults, which are typically long and complex, add another confounding layer as they may be incomplete or inaccurate; clinicians overseeing medical treatments may not know whether they can trust the record. The articles in this issue address the relatively new diagnosis of functional quadriplegia (FQ) and its impact on care as well as managing seizures and potentially misdiagnosed seizures in older adults.
On October 1, 2008, the Centers for Medicare & Medicaid Services introduced the International Classification for Diseases, Ninth Revision, Clinical Modification billable code for FQ. FQ is defined as complete immobility due to severe physical disability or frailty and excludes hysterical paralysis, immobility syndrome, neurologic quadriplegia, and quadriplegia not otherwise specified. Patients with quadriplegia require the highest level of care and rely on others to assist them with activities of daily living. Physical impairment may limit their ability to communicate, ambulate, bathe, toilet, and eat. Data regarding the incidence of FQ documentation and its association with diseases and hospital resource utilization is lacking. Paris Charilaou, MD, and colleagues examined various trends of documented FQ and variables among this patient population, FQ incidence, Medicare-Severity Diagnosis-Related Groups most commonly associated with FQ, and FQ’s association with length of stay, hospitalization charges, and costs. Protocols that prevent or minimize the cost of care of FQ, such as facilitating earlier discharge to long-term care (LTC) facilities, have the potential to provide improved care with less expense.
Seizure management requires ongoing assessment and reassessment because the risks of both seizures and adverse effects of medications are dynamic over time. Many older adults taking antiseizure medication have a diagnosis of seizure disorders that are not supported by objective diagnostic evidence. These “seizure disorders” are the result of years of misdiagnosis and a belief that the benefits of medication outweigh the potential for a seizure event. In their review article, Richard G Stefanacci, DO, MGH, MBA, AGSF, CMD, and colleagues provide a foundation for geriatrics providers to appropriately manage misdiagnosed seizures as well as true seizures in older adults. Specific considerations for professionals working in LTC are included.
