Primary Care - Addressing Issues of Aging Patients

1. Atrial Fibrillation
   Objectives: After this session, the learner will be able to:
   • Be able to use evidence based data to decide between rate and rhythm control in your patient
   • Be able to utilize the CHAD score to decide about anticoagulation in your patient
   • Be able to advise your patient about the pros and cons of ablation as a treatment
2. Falls Prevention and Management
   Objectives: After this session, the learner will be able to:
   • Define falls
   • Understand gait and balance disturbances in the elderly
   • Implement a falls management program for long-term care residents
   • Apply quality measures to benefit patient care and practice reimbursement
   • Describe four age related changes which may contribute to falls in your elderly patient
   • Be able to assess environmental changes that may contribute to falls in your patients
   • Be aware of strategies to reduce the incidence of frequent falling in your patients
3. Osteoporosis
   Objectives: After this session, the learner will be able to:
   • Understand the Institute of Medicine report on vitamin D
   • Review definitions of osteoporosis by DEXA and FRAX
   • Know which of your patients need to be screened, when and how often
   • Know how to interpret the T score on a DEXA scan and its limitations
   • Utilize therapies that include bisphosphonates, PTH and inhibitors of the RANK/RANKL/OPG system
   • Recommend appropriate vitamin D therapy
   • Council patients on calcium supplementation and cardiovascular risk
   • Summarize the various dental guidelines on osteonecrosis
4. Mild Cognitive Impairment
   Objectives: After this session, the learner will be able to:
   • Define Mild Cognitive Impairment in both amnestic and non-amnestic disease states
   • Understand the potential implications of early diagnosis of dementia for patient care outcomes
   • Describe progress in biomarker research for Alzheimer’s disease
5. Dementia
   Objectives: After this session, the learner will be able to:
   • Evaluate patients for symptoms of cognitive and functional loss
   • Know the clinical manifestations of Alzheimer's disease and how to work up this problem in your patients
   • Be able to diagnose Frontotemporal dementia and distinguish it from Parkinson’s disease in your patients
   • Apply appropriate drug and non-drug interventions for patients with dementia
   • Counsel families and caregivers at all stages of disease
6. Anemia and CKD in the Elderly
   Objectives: After this session, the learner will be able to:
   • Discuss prevention methods for anemia in CKD with a healthcare team and older patients
   • Identify patients who are at-risk of developing anemia of CKD
   • Develop therapy courses for older people with CKD that combine healthy lifestyle choices and medication
   • Describe best practices in the management of anemia and CKD
7. Management of Constipation
   Objectives: After this session, the learner will be able to:
   • Evaluate interdisciplinary strategies to overcome common barriers that hinder the optimal management of chronic constipation in health care settings
   • Discuss the key components of a facility-wide approach to managing chronic constipation
   • Describe the implementation of appropriate bowel protocols in health care settings
   • Outline the elements of treatment plans that can be tailored for individual residents for chronic constipation to prevent severe complications
8. Depression in the Elderly
9. Objectives: After this session, the learner will be able to:
   • Recommend primary and adjuvant therapy for the depressed elderly patient
   • Utilize the PHQ-9 in all practice settings
   • Identify opportunities for non-drug interventions for depression including cognitive behavioral therapy
   • Know three ways to distinguish Late Life Depression from Major Depressive Disorder in your older patients
   • Recognize three "trigger diseases" which are associated with Late Life Depression
   • Be familiar with four classes of anti-depressant medications and when to utilize them in your patients
10. Delirium
    Objectives: After this session, the learner will be able to:
    • Be able to apply the confusion assessment method in diagnosing delirium in your older patients
    • Know at least four major causes of delirium in your patients
    • Be able to develop a plan to prevent and when not possible to effectively treat delirium
11. Management of Chronic Non-malignant Pain in the Elderly
    Objectives: After this session, the learner will be able to:
    • Understand the pathogenesis of pain
    • Evaluate pain in elderly patients
    • Apply recent guidelines in pain management
    • Choose appropriate drug therapy and multimodal interventions for the relief of pain
12. Improving Safety and Reducing Medication Errors
    Objectives: After this session, the learner will be able to:
    • Identify medications that place long term care residents at high risk of medication misadventure
    • List mechanisms available to decrease the risk of medication errors in select environments
    • Identify the major areas of medication risk in the elderly residents
    • Outline strategies to improve medication safety
13. COPD and the Management of Respiratory Disease in the Elderly
    Objectives: After this session, the learner will be able to:
    • Evaluate interdisciplinary strategies to overcome common barriers that hinder the optimal management of COPD in health care settings
    • Discuss the key components of a facility-wide approach to managing respiratory illness
    • Implement the appropriate use of nebulizers, MDIs and oxygen for long-term care residents
14. Medical Ethics and the End of Life
    Objectives: After this session the learner will be able to:
    • Understand 3 ethical principles which may be utilized in decision making at the end of life
    • Know when and how to utilize hospice care for your patients
    • Know how to discusss the issue of parenteral feeding with patients and families who are no longer taking food by mouth
15. Transitions in Care
    Objectives: At the end of this session the learner will be able to:
    • Apply the principles of INTERACT in long term care environments "Interventions to Reduce Acute Care Transfers”
    • Consider Project BOOST for hospital transitions “Better Outcomes for Older adults through Safe Transitions”
    • Understand the principles underlying Project RED “Re-Engineered Discharge”
16. Case Discussions
    Objectives: At the end of this session the learner will be able to:
    • Address any additional discussion items not previously reviewed
    • Present cases for all to consider
    • Review information not clearly stated

Key Applications

• Apply geriatric care quality indicators into every day practice
• Effectively manage common geriatric syndromes and conditions in different settings of care
• Re-engineer clinical practice to improve quality, efficiency, and safety in geriatric patients
• Participate in innovative models of geriatric care that will evolve as Medicare changes its reimbursement policies
• Apply the updated Beers Criteria in deciding about medication use in your patients
• Utilize the CHAD score when deciding about anticoagulation in your patients with atrial fibrillation
• Utilize the Geriatric Depression Scale to screen for depression in your older patients

Conference Sessions generally take place during the days at sea (as cruise itinerary allows) to avoid conflicts with Ports of Call or evening entertainment.