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Reducing Unnecessary Antibiotics for Bilateral Cellulitis

JAMDA
March 1, 2020
Bilateral lesions in the lower extremities are frequently treated with antibiotics for presumed cellulitis. We present a case of bilateral lower leg swelling and redness in a patient with peripheral vascular disease with venous stasis that was...

POA Pickle: How to handle POA Resignation in LTC

JAMDA
March 1, 2020
Advance care planning can be challenging in the long-term care setting, especially in patients with cognitive impairment. This case presentation provides an example how the interdisciplinary facility team including administrator and medical director...

Pilonidal Sinus or Non-healing Pressure Ulcer?

JAMDA
March 1, 2020
New or worsening changes in skin integrity and pressure ulcers are a reportable quality measure in skilled nursing facilities (SNFs). Their management requires comprehensive evaluation for predisposing and precipitating factors and comorbidities...

Parkinson's Disease vs Parkinsonism as a Result of Aging

JAMDA
March 1, 2020
Parkinson’s Disease is a condition characterized by degeneration of the nigrostriatal pathways resulting in marked bradykinesia. Studies have reported that nearly 25% of Medicare beneficiaries with Parkinson’s Disease reside in long-term care...

New Onset Chest Pain in a Long-Term Care Resident With Dementia: First, Believe the Patient!

JAMDA
March 1, 2020
Atypical chest pain is of diverse origin. Typically, we initially consider cardiac etiology. When pain appears non-cardiac, there is a tendency to underestimate the illness, especially if the patient has neuropsychiatric illness. Our resident with...

Hemichorea – A Rare Sequela of Striatal Infarction

JAMDA
March 1, 2020
Chorea is a hyperkinetic movement disorder that manifests as random involuntary movements with an irregular, flowing, and writhing quality. It is often described in the setting of hereditary neurodegenerative conditions; however, it may be secondary...

Fever, Myalgia, and Headache Progressing to Confusion: A Case of Neuroinvasive West Nile Virus in the Older Adult

JAMDA
March 1, 2020
West Nile Virus (WNV) infection is the most common mosquito-borne illness in the United States. Most cases are asymptomatic or with mild symptoms. Older adults are more likely to have central nervous system (CNS) involvement, and a higher risk for...

Early Identification of Acute Pulmonary Emboli Through the Use of Contact-Free Continuous Patient Monitoring

JAMDA
March 1, 2020
Skilled nursing facilities (SNFs) are faced with providing care for residents with increasing clinical complexity. Residents are being discharged from hospitals to post-acute care earlier and with multiple active co-morbidities. Clinicians working...

Discontinuation of Antipsychotic Medication in Two Nursing Home Patients with Diagnosis of Schizophrenia

JAMDA
March 1, 2020
Antipsychotic medications are a vital part of controlling psychosis in schizophrenic patients. However, when those patients live in nursing facilities, we are obligated by CMS to undertake gradual dose reductions of antipsychotic medication if...

Catatonia as an Usual Cause of Change of Mental Status in a Veteran in a Long-Term Care Facility

JAMDA
March 1, 2020
Catatonia – a diagnosis that involves motor, cognitive, behavioral, and autonomic irregularities -- may be seen in a variety of medical, psychiatric, and neurologic conditions or medication exposures. Here, we describe a case of catatonia seen in a...