A 35-year-old man with Huntington’s disease has fallen and fractured his arm. During his hospital stay, he is agitated and requires a sitter. He occasionally kicks and strikes out at staff members who approach him. His doctor has prescribed haloperidol.

The patient’s gait is unsteady and made worse by the cast on his arm. He insists on walking, often... »

As the incidence of Alzheimer’s disease rises and genetic risk factors become better understood, patients are increasingly requesting genetic testing for risk assessment. Such testing is generally not recommended, since the results usually cannot definitively determine whether or not someone will develop the disease and because there is no clinically proven... »

In recent years, entities such as the Congressional Budget Office and Medicare’s board of trustees have expressed concern that the Medicare program is fiscally unsustainable. Medicare’s fee-for-service payment system has been considered the driver of this problem because it rewards volume of services regardless of the services’ appropriateness, cost,... »

Author and humorist Richard Lederer just turned 73 years old, and he celebrated by writing a book titled “The Gift of Aging: Wit and Wisdom, Information and Inspiration for the Chronically Endowed and Those Who Will Be” (Portland, Ore.: Marion Street Press, 2010). Asked what message he would like to deliver to long-term care providers, he struck an... »

I recently attended a conference in Australia and had the opportunity to visit a nursing facility there and make comparisons to how we do things in the United States.I spent some time with Mike Birrell, ChB, a general practitioner, and Joy Walsh, director of nursing at Emmaus Nursing Home, a 50-bed facility affiliated with Catholic Care of the Aged about 4... »

In the past decade, many states have authorized new advance care planning instruments such as Physician Orders for Life-Sustaining Treatment (POLST), Medical Orders for Life-Sustaining Treatment (MOLST), Physician Orders for Scope of Treatment (POST), and Medical Orders for Scope of Treatment (MOST). Because these forms are physicians' orders, they have... »

Evidence-based medicine is central to what I do as a physician. Yet, looking back on 30 years of working in long-term care, I know the limits of evidence-based medicine.In spite of all our scientific efforts, human beings suffer illness and die under our care. Sometimes, we must bring nonpharmacologic as well as pharmacologic methods to pain management at... »