Welcome to SCANCME

The Annual Wellness Visit (AWV) provides a rare opportunity for physicians to get to know their patients’ medical, functional, and emotional status. It allows time for counseling and care planning, health promotion, and preventive strategies. By assigning tasks to the entire office team and utilizing simple, yet reliable assessment tools , the AWV becomes an efficient and professionally satisfying process to maintain, monitor, and document the patient’s health and wellbeing. The suggested process allows for office professionals to perform her/his task independently, while allowing the physician to spend quality unpressured time with patients.

Dementia and associated disorder have increased prevalence with age. Dementia is often associated with other treatable disorders such as depression and delirium, both are often misdiagnosed and inappropriately managed, thus contributing to the complexity of care, unnecessary service utilization and poor quality of life.

Clinicians have reported not being prepared to diagnoses and manage those conditions. Diagnosis and management of depression in dementia evaluation for acute change in behavior and determining decision-making capacity are critical in the management of elderly with chronic illness. Knowledge of sign and symptoms, familiarity with the available methods and tools to assess these conditions will allow clinicians to play an important role in providing education psychosocial support, and referrals for the identified problems, among others, for patients and caregivers. It will also allow clinicians to manage their other chronic illness more effectively.

Mood symptoms occur frequently among older adults. Depression contributes to distress and disability, and can also exacerbate disability related to medical illnesses. Identifying and treating mood syndromes are a key component of healthcare, and effective treatment can improve function, well-being, and life quality. Clinically meaningful depressive symptoms can be assessed in the course of usual healthcare visits, and a thoughtful plan for treatment and follow up can be initiated.

Several treatment options are available, including psychotherapy and pharmacotherapy. The goal is to develop an optimal treatment strategy that is based on the individual’s particular circumstances. Many older adults respond to initial treatment, although some have residual mood symptoms and there is risk for recurrence. The treatment goal is not only to get well, but to stay well over time.

The relationship between mood syndromes and cognition has been better understood recently. Cognitive deficits appear in many older adults with depression, while mood symptoms, apathy, and blunted affect occur in many patients with Alzheimer’s disease or vascular dementia. Attention to these co-occurring symptom clusters can help improve symptoms and foster better outcomes.

Components of comprehensive geriatric assessment include medical, cognitive, affective, functional, social support, economic, environmental, advance directives, prevention, prognosis and patients' goals and preferences. This approach provides and organized methodology for performing geriatric assessment in a timely manner; and provides the basis for care plan for multiple chronic conditions. This approach is more efficient than the customary piecemeal evaluation that takes place in primary care today, as it engages the patients and/or his caregiver, and utilizes expertise from physicians, nurses and social workers, thereby avoiding duplication and misuse of healthcare professionals' time.

Management of pain is often challenging in Long Term Care settings, particularly because many residents have some type of cognitive impairment that keeps them from readily self-reporting pain. In addition, myths such as the belief that pain should be expected in older adults and fears about potential addiction prevents many older adults and their family members from asking for pain medication. Similar concerns and beliefs by nurses and physicians may also contribute to poor pain management and resident suffering.

Long Term Care settings need to establish a comprehensive program that creates a systematic approach to pain management. A good pain management program needs to be resident focused and include pain assessment, interventions/treatments, monitoring, quality improvement and education for patients, families and staff. By establishing a systematic and comprehensive program, Long Term Care settings can ensure that residents have their pain goals met and do not suffer needlessly.

Establishing patient-centered goals of care and treatment limitations is an important component of care in patients facing advanced illness. At the same time, communication during serious illness can be difficult for patients as well as providers. Research has demonstrated that the ethical ideal for decision making, involving shared decision making between an informed patient and a physician knowledgeable in both the patient's values and achievable treatment outcomes, is far from the norm in clinical practice.

Improving communication about goals of care and treatment limitations requires that providers and patients (or their surrogates) develop a shared understanding of desired and achievable outcomes, which can be accomplished by incorporating key principles and a step-wise approach to the goals of care discussion. This approach leads to high levels of patient satisfaction as well as treatment decisions that truly reflect the patient's goals.

Urinary incontinence (UI) is a common and treatable problem, especially in women and the elderly. The prevalence of UI increases with age, but it is not a part of normal aging. In women over age 60 years the prevalence of UI ranges from 15% to 43%. In contrast, the prevalence of UI in men at all ages, ranges from 1.6% to 24%. Despite this, UI remains under diagnosed and underreported with only 32% of primary care physicians routinely asking all of their patients about UI, and 50%-75% of incontinent community-dwelling patients never describing their symptoms to physicians.