Home-Based Medical Care for Older Adults

As the population of older adults in the U.S. continues to grow, medical house calls are increasingly part of a system of comprehensive home-based care for patients who have difficulty accessing office-.based care. Clinicians who have been trained mostly in office and hospital settings must adapt their usual approaches to accommodate a wide range of environmental, social, and physical circumstances that impact home-limited patients. Ideally, a comprehensive team of clinicians proficient in multiple domains of functional, social, and medical care can work together to address potential gaps in any one clinician's expertise. Unfortunately, such teams are still rare. This book aims to equip individual clinicians with the interdisciplinary knowledge, skills, and perspective they need to provide the best care possible with limited formal interdisciplinary support.

This book offers 20 patient cases drawn from the collective experience of experts in home-based medical care from highly respected academic and clinical programs across the United States. Each case demonstrates a scenario that is frequently encountered and/or very important in home-based medical care practice. Each scenario frequently proves to be challenging for many professionals because it requires an approach or leverages aspects of care delivery that most are not trained in. Additionally, each scenario reflects an approach to care that is enhanced by interdisciplinary input. Finally, each case lends itself to a practical problem-solving approach that could be accomplished by most home-based medical care providers, even in the absence of an interdisciplinary team.

Written by interdisciplinary experts in geriatric home-based care, this book serves as both an educational tool for learners in all related disciplines as well as a quick reference for experienced clinicians looking to augment their existing house call 'toolbox.'

Jessica Colburn, MD
Assistant Professor of Medicine
Johns Hopkins School of Medicine
Division of Geriatric Medicine and Gerontology
5200 Eastern Avenue, Suite 2200
Baltimore, MD 21224

Bruce Leff, MD
Professor of Medicine
Johns Hopkins School of Medicine
Division of Geriatric Medicine and Gerontology
5200 Eastern Avenue, Suite 7000
Baltimore, MD 21224

Jennifer Hayashi, MD
Medical Director, MedStar House Call Program
5601 Loch Raven Boulevard
Smyth Building, Suite 201
Baltimore, MD 21239

Mattan Schuchman, MD
Medical Director, Johns Hopkins Home-Based Medicine
5200 Eastern Avenue, Suite 2200
Baltimore, MD 21224

Dr. Bruce Leff is a professor of medicine at the Johns Hopkins University School of Medicine. He holds a joint appointment in the department of health policy and management in the Johns Hopkins Bloomberg School of Public Health.

Dr. Leff is an internationally recognized leader and researcher in the development, evaluation and dissemination of novel models of care for older adults, including the Hospital at Home, Guided Care, geriatric service line models and medical house call practices. In addition, his research interests extend to issues related to multi-morbidity, performance measurement and case-mix issues. He has a strong interest in health policy issues, is a Health and Aging Policy Fellow of the American Political Science Association, and has served on multiple technical expert panels for the Centers for Medicare and Medicaid Services. In 2016, he published Geriatric Home Based Medical Care with Springer Science+Business Media, which remains the only authoritative texts on the subject.

This book aims to equip individual clinicians with the interdisciplinary knowledge, skills, and perspective they need to provide the best care possible. Written by experts in home-based medical care, this book consists of 20 of the most common scenarios that challenge physicians administering home-based care for geriatric patients. Each scenario requires an approach or leverages aspects of care delivery that most are not trained in. Additionally, each scenario reflects an approach to care that is enhanced by interdisciplinary input. Finally, each case lends itself to a practical problem-solving approach that could be accomplished by most home-based medical care providers, even in the absence of an interdisciplinary team.

Home-Based Medical Care for Older Adults is a valuable resource for all clinicians who may administer medical care in a non-medical setting, including geriatricians, family medicine physicians, psychiatrists, home nurses, social workers, students, and other interdisciplinary team members.

Auteur

Jessica Colburn, MD
Assistant Professor of Medicine
Johns Hopkins School of Medicine
Division of Geriatric Medicine and Gerontology
5200 Eastern Avenue, Suite 2200
Baltimore, MD 21224

Bruce Leff, MD
Professor of Medicine
Johns Hopkins School of Medicine
Division of Geriatric Medicine and Gerontology
5200 Eastern Avenue, Suite 7000
Baltimore, MD 21224

Jennifer Hayashi, MD
Medical Director, MedStar House Call Program
5601 Loch Raven Boulevard
Smyth Building, Suite 201
Baltimore, MD 21239

Mattan Schuchman, MD
Medical Director, Johns Hopkins Home-Based Medicine
5200 Eastern Avenue, Suite 2200
Baltimore, MD 21224

Dr. Bruce Leff is a professor of medicine at the Johns Hopkins University School of Medicine. He holds a joint appointment in the department of health policy and management in the Johns Hopkins Bloomberg School of Public Health.

Dr. Leff is an internationally recognized leader and researcher in the development, evaluation and dissemination of novel models of care for older adults, including the Hospital at Home, Guided Care, geriatric service line models and medical house call practices. In addition, his research interests extend to issues related to multi-morbidity, performance measurement and case-mix issues. He has a strong interest in health policy issues, is a Health and Aging Policy Fellow of the American Political Science Association, and has served on multiple technical expert panels for the Centers for Medicare and Medicaid Services. In 2016, he published Geriatric Home Based Medical Care with Springer Science+Business Media, which remains the only authoritative texts on the subject.

Contenu

1.Involuntary weight loss

Bruce Leff, MD

2.Assessing Decision-Making Capacity

Sharon Levine, MD, Megan Young, MD

3.Acute illness at home

Abigail Holley Houts, MD

4.Dementia Behavior Management

Erin Zahradnik, MD, Katherine Wang, MD, Shahla Baharlou, MD, & Jonathan Ripp, MD, MPH

5.Bacteriuria in a Patient with Incident Delirium

Thomas E. Finucane, MD

6.Caregiver Burden

Mia Yang, MD & Rachel Zimmer, DNP

7.Elder Abuse and neglect

Ania Wajnberg, MD, Sarah Koppel, MD, Fay Kahan LCSW

8.Management of Frequent Falls

Mattan Schuchman, MD, Joe Graziano

9.Home Assessments: Improving Patients' Capacity for Self-Management

Monika Robinson, OT, Sarah Szanton, PhD, ANP

10.Transitioning to long-term care

Namirah Jamshed, MD

11.Pressure Injuries

Yasmin Meah, MD, & Fred Ko, MD, Elizabeth Arrabito, MD

12.Opioid management

Elizabeth McCormick, MD, Meng Zhang, MD

13.Social isolation

Thomas K.M. Cudjoe, MD, Jessica Colburn, MD

14.Serious mental illness

Sonica Bhatia, MD, Victoria Kopke, MD

15.Functional Rehabilitation and Realistic Goals

Jennifer L. Hayashi, MD, Cindy Seidenman, PT

16.Polypharmacy Melissa Morgan-Gouveia, MD

17.Telephone medicine

Christian Escobar, MD, Cameron Hernandez, MD

18.Morbid obesity

Jean Yudin, MD, Bruce Kinosian, MD

19.Urinary Catheter Management at Home

Rachel Kaplan, RN, Karen Abrashkin MD, Konstantinos E. Deligiannidis, MD, MPH

20.End of life care

Ina Li, MD, Linsey O'Donnell, MD