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Attitudes and expectations of the ‘geri-boomers’
Disclosures: Sing-I Tsai, MD and Cari R. Levy, MD, CMD have no disclosures to be made that are pertinent to this abstract.
Attitudes and expectations of the ‘geri-boomers’ Presenting Author(s): Sheikh Jasimuddin, MD, Long Island Jewish Medical Center Author(s): Sheikh Jasimuddin, MD; Melissa Martin, MD; Smitha Pillai, MD; Gisele P. Wolf-Klein, MD Introduction/Objective: The baby boomer generation, those 76 million people born between 1946 and 1964, will soon cause a rapid growth in the population of elderly, becoming “GERI-BOOMERS.” The purpose of this study is to identify the perceived needs and expectations of these “GERIBOOMERS.” Design/Methodology: Data was obtained using a four page anonymous questionnaire randomly distributed to a 527 bed nursing home staff, residents and their relatives. Eligibility criteria included subjects born between 1946-1964. Results: One hundred and ten questionnaires were analyzed. The majority of respondents were born between 1946-1957 (51.9%) and in the USA (81.8%). Most subjects were Caucasian (77.3%), females (69.1%), married (67.3%), and with children (77.3%). Eighty-four percent were college educated (p ⬍ .007), and 60.0% reported an annual income of at least $60,000. Forty-four percent would refuse to move to a nursing home, and 20.4% would not even consider assisted living. In fact, 93.7% chose their own home for their old age and would expect to be cared for by geriatricians (88.2%). The overwhelming majority expects preventive care (94.5%), alternative medicine (81.8%), nutrition and exercise (84.6%), and psychological counseling (65.0%). Half of the subjects are not prepared financially for old age, counting on Medicare (81.2%), Social Security (79.8%), private pay (69.0%) or Medicaid (58.8%)for support. They do not expect family or friends to subsidize their care (83.5%). A quarter of them (22.4%) have purchased long-term care insurance, but 61.4% have no such plans. Almost half of the subjects (44.9%) have not discussed advance directives with their family, or with their physicians (83.2%, p ⬍ .03), because they “did not think about it” (79.8%). Conclusion/Discussion: Even in this predominantly educated and financially secure study group, older individuals have unrealistic expectations of the current health system. This study suggests two essential issues: the need to restructure the types of available geriatric care and the importance of programs to educate these “GERI-BOOMERS” on the financial realities of aging. Without implementing new policies and procedures that address these issues, not only will millions of people require unavailable medical services, but society at large will have to pay the price. Disclosures: Sheikh Jasimuddin, MD has no disclosures to be made that are pertinent to this abstract.
Sexuality in nursing homes: Staff attitudes and practices Presenting Author(s): Wahila Alam, MD, Long Island Jewish Medical Center Author(s): Wahila Alam, MD; Barbara C. Tommasulo, MD, CMD; Gisele P. Wolf-Klien, MD; Yosef Dlugacz, PhD; Charles Cal, MBA, MS, RN; Roshan Hussain, MPH Introduction/Objective: Despite a common belief that elderly become asexual, there is convincing data that the need for sexual expression continues into advanced aging, even for residents of long-term care facilities. Yet, there are no guidelines for the multidisciplinary geriatric staff to clarify their role in helping those residents express their sexuality and meet their intimacy needs. Design/Methodology: This descriptive study assesses knowledge, attitudes and practices of geriatric staff with regard to elderly sexuality in a 672 bed skilled nursing facility by using the KATES questionnaire. The staff includes all 21 physicians, the 500 nurses of all three shifts and the 100 CNAs, as well as 8 social workers, 20 therapists and 70 housekeeping workers. Composite scores were compared with demographic variables. Reliability of the KATES questionnaire was assessed by calculating a Chronbach alpha (0.91). Results: Respondents were primarily in supervisory positions (56.6%), between 40 and 60 years(63.3%), female(93.3%) and 66.7% completed graduate education. Seventy percent listed English as their first language and about half(46.7%) were caucasian with 16.7% hispanic and 16.7% asian. B14
While 66.7% were born in the U.S. and 20% in Asia, the majority had lived in the U.S. for at least 20 years(63.3%). Most respondents were of christian faith(80%) with 13.3% muslims. Religiosity(46.7%) and sexuality(90%) were described as very important by most. Sixty percent had at least 10 years of professional geriatric experience; yet 60% reported no formal training in sexuality and 76.7% reported no formal training in sexuality specifically in the elderly. Most(83.3%) stated that elderly should be allowed to express their sexuality in nursing homes. While hand holding was not considered sexual in nature, kissing (83.3%), petting(90.0%), masturbation(96.7%), oral sex (94.7%) and intercourse(96.7%) were clearly recognized as sexual acts. Though half agreed that sexual expression was important to institutionalized residents, 73.3% felt that residents should be allowed private space, and 76.7% felt that the staff can play an important role in helping residents express their sexuality. Eighty-three percent believe that the staff should be willing to talk to residents about their sexuality, and perceive unease on the part of the residents to discuss their sexual issues (60.0%). Whereas 70% expressed a sense of responsibility to assist residents, only 50% felt comfortable with providing them with sexual materials such as condoms, and vibrators. Finally, though the majority(90%) believe that older patients with dementia think about sex, only 53.3% would allow these patients to enter a sexual relationship. Conclusion/Discussion: This study reveals a remarkable lack of formal training in sexuality in experienced health care professionals. Sexual expression in the nursing home is recognized as a major issue for the elderly and the staff is willing to undertake the responsability of assisting their patients in their sexual needs. Disclosures: Wahila Alam, MD, Barbara C. Tommasulo, MD, CMD, Yosef Dlugacz, PhD, Charles Cal, MBA, MS, RN, and Roshan Hussain, MPH have no disclosures to be made that are pertinent to this abstract.
Role of alzheimer’s diseases agents in reducing atypical antipsychotic usage in alzheimer’s patients Presenting Author(s): Malcolm R. Fraser, MD, CMD, GPS, Bay Geriatrics Author(s): Malcolm R. Fraser, MD, CMD; Jim Cummings, MD; John McDonough, PhD Introduction/Objective: Recent actions by the FDA have made off label usage of Atypical Antipsychotics even more difficult. Health care professionals practicing in Long Term Care have been put in the unenviable position of having responsibility for their patients without having control. In addition the new interpretation of Federal Tag 501 has increased both the burden and liability of the Medical Director for the treatment of all patients in the NH. Geriatric Psychological Services provides Behavior and Medication management services to several thousand NH and ALF patients in west central Florida. One NH served has a secure dementia unit. By using a standardized assessment method and a team approach, we have managed to reduce the use of Atypical Antipsychotics from 80% to 20-30%. The purpose of this retrospective view is to: -Quantify the use of Atypical Antipsychotics in a Secure Dementia Unit -Examine the use of concomitant Alzheimer Disease medicines (Acetylcholinesterase Inhibitors and NMDA receptor antagonists) We found that combined use of an Acetylcholinesterase Enzyme Inhibitor (AchEI) and an NMDA Receptor antagonist appears to reduce the behaviors that trigger use of Atypical Antipsychotics. Design/Methodology: Some AD patients need Atypical Antipsychotics (even though it is an off label use) as reported in the Medical Letter. However it appears that it may be possible to reduce the need for APs which in a secure dementia unit can run as high 80%. We reviewed the use of APs, NMDA Receptor Antagonists and Acetyl Cholinesterase Inhibitors. It should be noted that AchEIs were, at the time, being used off label in patients with moderate to severe Alzheimer’s Disease. Results: The snapshot data reflects the patient census on June 23rd, 2006 and use of atypicals was 30% (N ⫽ 19). Conclusion/Discussion: Utilizing a multi disciplinary approach, combined use of an AchEI and an NMDA Receptor antagonist appears to reduce both the need for prescribing Atypical Antipsychotics and also facilitate the reduction and discontinuation of Atypical Antipsychotics in the residents of a Nursing Home Secure Dementia Unit. Disclosures: Malcolm R. Fraser, MD, CMD received homorarium as a JAMDA – March 2007
Attitudes and expectations of the ‘geri-boomers’ Presenting Author(s): Sheikh Jasimuddin, MD, Long Island Jewish Medical Center Author(s): Sheikh Jasimuddin, MD; Melissa Martin, MD; Smitha Pillai, MD; Gisele P. Wolf-Klein, MD Introduction/Objective: The baby boomer generation, those 76 million people born between 1946 and 1964, will soon cause a rapid growth in the population of elderly, becoming “GERI-BOOMERS.” The purpose of this study is to identify the perceived needs and expectations of these “GERIBOOMERS.” Design/Methodology: Data was obtained using a four page anonymous questionnaire randomly distributed to a 527 bed nursing home staff, residents and their relatives. Eligibility criteria included subjects born between 1946-1964. Results: One hundred and ten questionnaires were analyzed. The majority of respondents were born between 1946-1957 (51.9%) and in the USA (81.8%). Most subjects were Caucasian (77.3%), females (69.1%), married (67.3%), and with children (77.3%). Eighty-four percent were college educated (p ⬍ .007), and 60.0% reported an annual income of at least $60,000. Forty-four percent would refuse to move to a nursing home, and 20.4% would not even consider assisted living. In fact, 93.7% chose their own home for their old age and would expect to be cared for by geriatricians (88.2%). The overwhelming majority expects preventive care (94.5%), alternative medicine (81.8%), nutrition and exercise (84.6%), and psychological counseling (65.0%). Half of the subjects are not prepared financially for old age, counting on Medicare (81.2%), Social Security (79.8%), private pay (69.0%) or Medicaid (58.8%)for support. They do not expect family or friends to subsidize their care (83.5%). A quarter of them (22.4%) have purchased long-term care insurance, but 61.4% have no such plans. Almost half of the subjects (44.9%) have not discussed advance directives with their family, or with their physicians (83.2%, p ⬍ .03), because they “did not think about it” (79.8%). Conclusion/Discussion: Even in this predominantly educated and financially secure study group, older individuals have unrealistic expectations of the current health system. This study suggests two essential issues: the need to restructure the types of available geriatric care and the importance of programs to educate these “GERI-BOOMERS” on the financial realities of aging. Without implementing new policies and procedures that address these issues, not only will millions of people require unavailable medical services, but society at large will have to pay the price. Disclosures: Sheikh Jasimuddin, MD has no disclosures to be made that are pertinent to this abstract.
Sexuality in nursing homes: Staff attitudes and practices Presenting Author(s): Wahila Alam, MD, Long Island Jewish Medical Center Author(s): Wahila Alam, MD; Barbara C. Tommasulo, MD, CMD; Gisele P. Wolf-Klien, MD; Yosef Dlugacz, PhD; Charles Cal, MBA, MS, RN; Roshan Hussain, MPH Introduction/Objective: Despite a common belief that elderly become asexual, there is convincing data that the need for sexual expression continues into advanced aging, even for residents of long-term care facilities. Yet, there are no guidelines for the multidisciplinary geriatric staff to clarify their role in helping those residents express their sexuality and meet their intimacy needs. Design/Methodology: This descriptive study assesses knowledge, attitudes and practices of geriatric staff with regard to elderly sexuality in a 672 bed skilled nursing facility by using the KATES questionnaire. The staff includes all 21 physicians, the 500 nurses of all three shifts and the 100 CNAs, as well as 8 social workers, 20 therapists and 70 housekeeping workers. Composite scores were compared with demographic variables. Reliability of the KATES questionnaire was assessed by calculating a Chronbach alpha (0.91). Results: Respondents were primarily in supervisory positions (56.6%), between 40 and 60 years(63.3%), female(93.3%) and 66.7% completed graduate education. Seventy percent listed English as their first language and about half(46.7%) were caucasian with 16.7% hispanic and 16.7% asian. B14
While 66.7% were born in the U.S. and 20% in Asia, the majority had lived in the U.S. for at least 20 years(63.3%). Most respondents were of christian faith(80%) with 13.3% muslims. Religiosity(46.7%) and sexuality(90%) were described as very important by most. Sixty percent had at least 10 years of professional geriatric experience; yet 60% reported no formal training in sexuality and 76.7% reported no formal training in sexuality specifically in the elderly. Most(83.3%) stated that elderly should be allowed to express their sexuality in nursing homes. While hand holding was not considered sexual in nature, kissing (83.3%), petting(90.0%), masturbation(96.7%), oral sex (94.7%) and intercourse(96.7%) were clearly recognized as sexual acts. Though half agreed that sexual expression was important to institutionalized residents, 73.3% felt that residents should be allowed private space, and 76.7% felt that the staff can play an important role in helping residents express their sexuality. Eighty-three percent believe that the staff should be willing to talk to residents about their sexuality, and perceive unease on the part of the residents to discuss their sexual issues (60.0%). Whereas 70% expressed a sense of responsibility to assist residents, only 50% felt comfortable with providing them with sexual materials such as condoms, and vibrators. Finally, though the majority(90%) believe that older patients with dementia think about sex, only 53.3% would allow these patients to enter a sexual relationship. Conclusion/Discussion: This study reveals a remarkable lack of formal training in sexuality in experienced health care professionals. Sexual expression in the nursing home is recognized as a major issue for the elderly and the staff is willing to undertake the responsability of assisting their patients in their sexual needs. Disclosures: Wahila Alam, MD, Barbara C. Tommasulo, MD, CMD, Yosef Dlugacz, PhD, Charles Cal, MBA, MS, RN, and Roshan Hussain, MPH have no disclosures to be made that are pertinent to this abstract.
Role of alzheimer’s diseases agents in reducing atypical antipsychotic usage in alzheimer’s patients Presenting Author(s): Malcolm R. Fraser, MD, CMD, GPS, Bay Geriatrics Author(s): Malcolm R. Fraser, MD, CMD; Jim Cummings, MD; John McDonough, PhD Introduction/Objective: Recent actions by the FDA have made off label usage of Atypical Antipsychotics even more difficult. Health care professionals practicing in Long Term Care have been put in the unenviable position of having responsibility for their patients without having control. In addition the new interpretation of Federal Tag 501 has increased both the burden and liability of the Medical Director for the treatment of all patients in the NH. Geriatric Psychological Services provides Behavior and Medication management services to several thousand NH and ALF patients in west central Florida. One NH served has a secure dementia unit. By using a standardized assessment method and a team approach, we have managed to reduce the use of Atypical Antipsychotics from 80% to 20-30%. The purpose of this retrospective view is to: -Quantify the use of Atypical Antipsychotics in a Secure Dementia Unit -Examine the use of concomitant Alzheimer Disease medicines (Acetylcholinesterase Inhibitors and NMDA receptor antagonists) We found that combined use of an Acetylcholinesterase Enzyme Inhibitor (AchEI) and an NMDA Receptor antagonist appears to reduce the behaviors that trigger use of Atypical Antipsychotics. Design/Methodology: Some AD patients need Atypical Antipsychotics (even though it is an off label use) as reported in the Medical Letter. However it appears that it may be possible to reduce the need for APs which in a secure dementia unit can run as high 80%. We reviewed the use of APs, NMDA Receptor Antagonists and Acetyl Cholinesterase Inhibitors. It should be noted that AchEIs were, at the time, being used off label in patients with moderate to severe Alzheimer’s Disease. Results: The snapshot data reflects the patient census on June 23rd, 2006 and use of atypicals was 30% (N ⫽ 19). Conclusion/Discussion: Utilizing a multi disciplinary approach, combined use of an AchEI and an NMDA Receptor antagonist appears to reduce both the need for prescribing Atypical Antipsychotics and also facilitate the reduction and discontinuation of Atypical Antipsychotics in the residents of a Nursing Home Secure Dementia Unit. Disclosures: Malcolm R. Fraser, MD, CMD received homorarium as a JAMDA – March 2007