Journal of the American Medical Directors Association
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It is recognized that pain has been undertreated and psychotropic medications overused in institutional settings. ⋯ The prevalence of opioid use in institutional settings has doubled during the past decade. The prevalence of psychotropic medications has decreased in nursing homes but increased in assisted living facilities. The increase in opioid use may reflect improved recognition and treatment of pain. However, initiatives are needed to monitor opioid-related adverse drug events and ensure appropriate use of psychotropic medications, particularly in assisted living facilities.
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To explore factors associated with frailty across the continuum of healthy aging to cognitive impairment (mild cognitive impairment [MCI], mild and moderate Alzheimer disease [AD]). ⋯ Our findings lend initial support to the case for stage-specific interventions for physical frailty with the focus on SO in healthy community-dwelling older persons and cognitive-based measures in older adults with cognitive impairment. The accurate clinical phenotyping would then set the stage for future potential investigative therapies along these specific lines, rather than an undifferentiated approach.
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The aim of this study was to describe the process of advance care planning (ACP) and to explore factors related to the timing and content of ACP in nursing home patients with dementia, as perceived by family, physicians, and nurses. ⋯ ACP is a multifactorial process, which may lean on professional caregivers' guidance. The most acute decisions are covered in advance, but a responsive as well as a proactive style is seen with other treatment decisions. Further research is needed to increase understanding of whether and how the physicians' strategies affect care processes and outcomes.