PENNSYLVANIA GERIATRICS SOCIETY Western Division An Affiliate of the American Geriatrics Society Volume 16 No. 1 February 2012 G. van Londen, MD, MSc Discusses Breast Cancer Recurrence at Fall Program The annual fall program of the Pennsylvania Geriatrics Society Western Division was held at the Monterey Bay on October 11, and featured guest speaker G. van Londen, MD, MSc who presented, Breast Cancer. Recurrence What to Look for and How to Avoid It. Society would like to acknowledge and thank Harmony Hospice for support of the evening program, which attracted more than 55 attendees. Dr. van Londen also discussed the benefits of exercise. Evidence is growing that exercise helps a patient to better tolerate treatment and aids in a faster recovery; the strongest evidence suggests that exercise improves the attitude of patients and helps them tolerate the often grueling treatments they must endure. Dr. van Londen, whose research focuses on the assessment and management of symptoms in older survivors who undergo long-term adjuvant endocrine (l. to r.) Seen here at the Pennsylvania Geriatrics Society s WD Annual Fall program are society Secretary/Treasurer Judith S. Black, MD, MHA; guest speaker Josie van Londen, MD, MSc; and President Fred Rubin, MD therapy, discussed ways to help cancer survivors explore the next steps after treatment and provided numerous research updates to participants. She explained how multidisciplinary programs are ideally suited to help cancer survivors and their providers with the management of emotional and physical symptoms and improvement of behaviors. Dr. van Londen, assistant professor, University of Pittsburgh School of Medicine, Department of Medicine (hematology-oncology, geriatric medicine), also serves as director, Women s Cancer LiveWell Survivorship program at UPMC s Magee Womens Hospital and Hillman Cancer Center. Business Meeting Briefs The Society conducted the annual business meeting in conjunction with the Fall Program. The 2011 Annual Report was presented and discussed. The report included the 2011 strategic goals set forth by the Board of Directors at the beginning of the year. Goals included: promoting geriatric education for all geriatric health care professionals; providing an opportunity for networking with other professionals who share an interest in improving care for the older adults; advocating for programs and public policy that will improve the health and well being of older adults; and finally, encouraging students and residents to pursue a career in geriatrics. Dr. Rubin noted that the goals set forth by the Board were accomplished. A copy of the annual report was sent to members in December. If you did not receive a copy, and would like one, please contact Nadine Popovich at 412-321-5030 or email npopovich@acms.org.
2 Pennsylvania Geriatrics Society ~ Western Division President s Message Fred Rubin, MD The Pennsylvania Geriatrics Society-Western Division, in association with the University of Pittsburgh, is proud to present the 20 th session of our popular Clinical Update in Geriatric Medicine. This is the largest ongoing CME event in Western PA and has been the recipient of an achievement award from the American Geriatrics Society. Our program directors, Judith Black, Shuja Hassan, and Neil Resnick, have worked closely with our dedicated Planning Committee, which includes: Daphne Bicket, George Gleeson, Fred Martin, David Nace, Karen Powers, Chip Reynolds, Victor Rudkin, Heather Sakely, Michael Yao, and myself, to assemble an impressive lineup of speakers to present the latest information about clinical problems in geriatric medicine. Sponsors of the course include: Forbes Regional Hospital, Golden Living Centers, Heritage Valley Health System, Highmark Blue Cross Blue Shield, Magee- Womens Hospital of UPMC, UPMC Health Plan, UPMC McKeesport, UPMC St. Margaret, UPMC Shadyside, Western Pennsylvania Hospital of West Penn Allegheny Health System, and the Aging Institute of UPMC Senior Services. Highlights this year include a symposium on patient safety in the hospital, a panel discussion on the evaluation of nonspecific weakness in the elderly, a dinner session on geriatric oncology, and numerous breakout sessions and workshops. The keynote address will feature Dr. Eric Larson, executive director of the Group Health Research Institute in Seattle, WA, on Successful Aging. In addition to Dr. Larson, we will be joined by Dr. Sharon Inouye from Harvard, who will discuss functional decline in hospitalized elderly, and Dr. Arnold Wald from Wisconsin, who will discuss chronic constipation. Simultaneously, we will host the 10 th annual International Hospital Elder Life Program (HELP) conference. This co-programming worked extremely well when we inaugurated it last year. We expect attendees from all over the United States, Canada, Europe, and Asia. Brochures have already been mailed to our entire membership. See Page 3 for additional details, including registration information. I hope to see you there! Fred Rubin Fred Rubin, MD President
3 Pennsylvania Geriatrics Society ~ Western Division clinical update IN GERIATRIC MEDICINE MEMBERS RECEIVE A DISCOUNT WHEN REGISTERING FOR THE CONFERENCE! March 22-24, 2012 Marriott City Center Hotel Pittsburgh, PA Guest Faculty 17.75 AMA PRA Category 1 1.775 CEU s (equal to 17.75 (contact hours) AAFP, ACPE CREDITS AVAILABLE! The conference is jointly sponsored by the Society and the University of Pittsburgh Institute on Aging in partnership with UPMC and the University of Pittsburgh School of Medicine Center for Continuing Education in the Health Sciences. As the population continues to age, we are all challenged to make increasingly complex and evidenced based medical decisions on a daily basis. This course was designed with this in mind. Highlights Include: Keynote Address Successful Aging - Presented by Eric Larson, MD, MPH, MACP, Executive Director, Group Health Research Institute in Seattle, WA. Patient Safety Symposium - Jointly attended ty the Hospital Elder Life Program (HELP) conference audience, includies topics such as: Pressure Ulcers, Hospital Acquired Infections, Falls, Functional Decline, Rehabilitation Concepts and Inappropriate Medication Use. Ask The Expert Sessions - The audience will have the opportunity to ask questions related to geriatric-focused subspecialists in the fields of Cardiology, Neurology, Endocrinology, Psychiatry, Podiatry, and Social Work. Evaluation of Fatigue and Weakness Discussion - registrants will gain insight from various disciplines including Psychiatry, Geriatrics and Sleep Medicine National HELP (Hospital Elder Life Program) The national HELP conference will join with us to allow enrollees of each conference to attend sessions of both. Sharon Inouye, MD, MPH, creator of HELP, will provide a featured talk on Functional Decline. Sharon Inouye, MD, MPH- Professor of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School; Milton and Shirley F. Levy Family Chair; Director, Aging Brain Center Institute of Aging Research Hebrew Senior Life, Boston, MA Eric B. Larson, MD, MPH, MACP - Vice President for Research, Group Health; Executive Director & Senior Investigator Group Health Research Institute, Seattle WA Arnold Wald, MD, AGAF, MACG - Professor of Medicine; Division of Gastroenterology and Hepatology; University of Wisconsin School of Medicine and Public Health, Madison, WI For more information contact Krystal Moore Center for Continuing Education in the Health Sciences telephone: 412/647-8232 fax: 412/647-8222 email: ccehsconfmgmt101@upmc.edu On line registration is now available at https://ccehs.upmc.com/liveformalcourses.jsf
4 Pennsylvania Geriatrics Society ~ Western Division MARK YOUR CALENDAR American Medical Directors Association (AMDA) Long Term Care Medicine 2012: A Mission From the Heart When: March 8-11, 2012 Where: San Antonio, TX Phone: 800-876-2632 website: www.amda.com/education American College of Physicians Internal Medicine 2012 When: April 19-21, 2012 Where: Ernest E. Morial Convention Ctr, New Orleans, LA Phone: 800-523-1546 website: http://im2012.acponline.org/ American Society on Aging National Council on Aging Aging in America When: March 28 - April 1, 2012 Where: Washington D.C. Phone: 415-974-9600 website: www.asaging.org email: info@asaging.org Society of Hospital Medicine Annual Meeting When: April 1-4, 2012 Where: San Diego Convention Center, San Diego, CA Phone: 800-843-3360 website: http://hospitalmedicine2012.org/ American Geriatrics Society 2012 Annual Meeting When: May 2-5 2012 Where: Seattle, WA Phone: 212-308-1414 website: www.americangeriatrics.org National Conference of Gerontological Advanced Practice Nurses Association Coming Together to Meet the Evolving Needs of Older Americans When: September 19-22, 2012 Where: Red Rock Casino Resort, Las Vega, NV. Phone: 866-355-1392 email gapna@ajj.com website: www.gapna.org PMDA 20th Annual Symposium Friday, October 26-27, 2012 Hershey Lodge West Chocolate Ave & University Dr Hershey, PA 17033 phone 717-531-6483 or visit http://www.pamda.org/upcoming-symposium/ for updates on the conference Society of General Internal Medicine 35th Annual Meeting Promoting Genralist Values in Times of Change FREE BMI Posters are available to display in your office. To order, contact 412-321-5030 When: May 9-12, 2012 Where: Walt Disney Swan and Dolphin Hotel, Orlando, FL Phone: 800-822-3060 website: http://www.sgim.org
5 Pennsylvania Geriatrics Society ~ Western Division National Healthcare Decisions Day - April 16 The Fifth Annual National Healthcare Decisions Day is April 16, 2012. Once again, the goal is simple: use a single day, all across the country, to provide increased focus on the importance of advance care planning and advance directives for both the public and providers. The National Healthcare Decisions Day (NHDD) Initiative is a collaborative effort of national, state and community organizations committed to ensuring that all adults with decision-making capacity in the United States have the information and opportunity to communicate and document their healthcare decisions. The time is appropriate to think about how patients may access a document to begin the advance care planning (ACP) process. A recommended directive is the health Care Power of Attorney and Living Will Form that has the endorsements of both the Allegheny County Medical Society and the Allegheny County Bar Association. This form can be accessed from the home page of the bar association s website, www.acba.org where it can be downloaded or purchased. CALL FOR ABSTRACTS David C. Martin Award Abstracts are now being accepted for consideration for the David C. Martin Award. This is an exciting opportunity for medical students who are interested in specializing in the field of geriatrics to be honored at both the Pennsylvania Geriatrics Society - Western Division s Clinical Update in Geriatric Medicine conference and the national conference of the American Geriatrics Society. The David C. Martin Award was established to encourage and support medical students interest in geriatrics, with the ultimate aim of preparing future leaders in geriatric medicine. An honorarium of up to $1,500 will be given to an awardee. The honoraruim must be used to attend the AGS national conference in Seattle, WA on May 2-5, 2012. Award criteria includes:. Medical students from the region whose abstract, poster or clinical vignette is selected for presentation by AFAR/AGS; students should be first author, but secondary authorship will be considered if the student had substantive input into the project; Entries must be available for display during the annual Clinical Update in Geriatric Medicine conference (March 22-24, 2012) Candidates must adhere to the Abstract Submittal guidelines. Complete abstract submittal guidelines and submittal information can be found on the Society website at www.pagswd.org. All entries must be submitted to the Society for voting by the Board of Directors no later than March 10, 2012. Recipients will be notified on or before March 16. Questions? Contact Nadine Popovich at 412-321-5035 X110 or email to npopovich@acms.org. DID YOU KNOW... Since it s inception, the Society has awarded an incredible $57,000.00 to medical students in our region!
6 Pennsylvania Geriatrics Society - Western Division 2012 Membership Renewal Dues notices for 2012 have been mailed. Society membership dues are renewed on a yearly basis. Your dues are instrumental in assisting the Society to continually provide quality educational programs to health care professionals in the region. Membership dues ($40.00) are essential in continuing the AGS award winning Clinical Update in Geriatric Medicine. Members receive a discount on their registration fee. MEMBERSHIP NEWS Dues also aid in one of the many affiliate goals, which is to recognize and financially support qualified medical students who are specializing in the field of geriatrics. Invite a colleague to join. A membership application can be found in the back of the newsletter. To renew dues over the phone, or to inquire about membership status, contact Nadine Popovich at npopovich@acms.org. Resident Residents who are currently enrolled in an Internal Medicine or Family Medicine residency program are eligible for FREE membership for the length of their residency. Contact Nadine Popovich at npopovich@acms.org to take advantage of this valuable opportunity. Election Congratulations to the following newly elected Board of Directors. Each Board member will serve a term from January 1, 2012 through December 31, 2014. George Gleeson, MD David Nace, MD,MPH Victor Rudkin, MD Results Fred Rubin, MD - President Membership Heather Sakely, Pharm.D, BCPS Michael Yao, MD OFFICERS Board of Directors John F. Delaney, Jr., MD, MPH, DrPH Anthony Giampolo, MD, MBA, DAAPM, ABPN George Gleeson, MD Shuja Hassan, MD David A. Nace, MD, MPH Karen Powers, MD Neil Resnick, MD, COSAR Representative Judith S. Black, MD, MHA Secretary/Treasurer Eric Rodriguez, MD Victor Rudkin, MD Heather Sakely, Pharm.D., BCPS Kawita Vichare, MD Carey Vinson, MD, MPM Michael Yao, MD
7 Pennsylvania Geriatrics Society ~ Western Division POLST UPDATE Judith S. Black, MD, MHA; Marian Kemp, RN; Michael J. Yao, MD What is POLST? Are you familiar with the Pennsylvania Orders for Life-Sustaining Treatment (POLST) form? The POLST is a document designed to help health care professionals honor the treatment wishes of their patients. POLST is used in states across the country as well as within all levels of care in this region, from acute care hospitals, to skilled nursing and long-term care, to hospice. Since we last wrote about POLST in the bulletin two years ago, more many physicians and other health care professionals have recognized how POLST can help ensure a patient s treatment wishes are respected toward the end-of-life. In Pennsylvania, Act 169 of 2006 mandated formation of a statewide advisory committee, the Patient Life-Sustaining Wishes (PLSW) Advisory Committee to examine the advisability and possible adoption of a standardized form such as Physician Orders for Life-Sustaining Treatment which was in use in other states. In October 2010 a standard POLST form, called the Pennsylvania Orders for Life- Sustaining Treatment (POLST) form that was recommended by that committee was approved. The use of the term Pennsylvania in the form name was simply to distinguish it from other state forms and to reflect the fact that the orders may be signed by certified nurse practitioners or physician assistants. Who is POLST For? The POLST form is recommended for persons who have advanced chronic progressive illness and/ or frailty, those who might die in the next year or anyone of advanced age with a strong desire to further define their preferences of care in their present state of health.to determine whether a POLST form could be encouraged, clinicians may ask themselves, Would I be surprised if this person died in the next year. If the answer is No, I would not be surprised, then a POLST form is appropriate. The POLST Conversation The POLST process starts with a conversation, the key element of the process. An 8-step protocol has been designed to guide the discussion that is to occur between the health care professional and the patient or a legally designated decision-maker 1. 1. Prepare for the discussion 2. Begin with what the patient or family knows 3. Provide any new information about the patient s condition and values from medical team perspective 4. Try to reconcile differences in terms of prognosis, goals, hopes and expectations 5. Respond empathetically 6. Use POLST to guide choices and finalize patient/family wishes 7. Complete and sign POLST 8. Review and revise periodically 1 The 8-Step Protocol was originally developed for the MOLST Program of New York State. Program information is found at www.compassionandsupport.org
8 Pennsylvania Geriatrics Society ~ Western Division Effective communication between the patient or legally designated decision-maker and health care professionals ensures decisions are sound and based on the patient s understanding their medical condition, their prognosis, the benefits and burdens of the life-sustaining treatment and their personal goals for care. Upon completion the POLST form, it is signed by the physician, physician assistant 2 or certified nurse practitioner and either the patient or the patient s legal decision-maker. In this respect, the requirement that patients or their legal decision-maker review and sign the form provides a safeguard for patients that the orders on the form accurately convey their preferences. Does the POLST Replace an Advance Directive? No. The POLST is not intended to replace an advance health care directive document or other medical orders. It is recommended that people with advanced illness and/or advanced frailty have both an Advance Directive and a POLST form.the POLST process and health care decision-making works best when the person has appointed a health care agent to speak for them if they are unable to speak for themselves. A health care agent can only be appointed through an advance health care directive called a health care power of attorney. A good practice is to attach a copy of the advance health care directives to the POLST form. Frequently Asked POLST Questions As with an advance directive, can a POLST form be completed by a patient or legal decision-maker and then forwarded to a physician, CRNP or PA for their signature? A distinction between an advance directive and a POLST form is that a POLST form is a legal medical order and completed by a health care professional only after a discussion of end-of-life choices with a patient or his/her legal decision-maker. Does one document, the advance directive or POLST, supersede the other? Ideally the values expressed on the advance directive do not conflict with the medical orders on the POLST. One document does not necessarily supersede the other. If there is conflict between the two instruments, then it is best to amend the one that is not representative of the patient s values and choices for medically indicated treatments. How can I obtain further information on POLST? A resource is the POLST coordinator of the Coalition for Quality at the End of Life (CQEL), Marian Kemp at papolst@verizon.net. The POLST Form and educational materials are available through the website of The Aging Institute of UPMC Senior Services and the University of Pittsburgh: http://aging.upmc.com/professionals/resources-polst.htm Users should download and print the form on Pulsar Pink stock (#65). 2 In Pennsylvania, a physician assistant signature requires a physician co-signature within ten days. Judith S. Black, MD, MHA is Medical Director, Senior Markets for Highmark Inc. and current Secretary/Treasurer for the Pennsylvania Geriatrics Society - Western Division; Marian Kemp, RN, PAGS-WD member; and Michael J. Yao, MD who is Director of Geriatric Education and Coordinator of Internal Medicine Rotation for Forbes Family Medicine Residency Program and serves as a Board of Director for the Pennsylvania Geriatrics Society - Western Division.
9 Pennsylvania Geriatrics Society ~ Western Division legislative TAKE ACTION NOW The Health in Aging Advocacy Center, hosted by the American Geriatrics Society, offers the following tools for advocating on issues important to the health and well being of older adults: Stay informed Spread the word Action E-List Get an alert when your involvement can make a critical difference. Tell-A-Friend Send a note to a friend to let them know about this site! MegaVote Get your reps votes by e-mail weekly!! Web Widget Put our Write to Congress web sticker on YOUR website Visit http://capwiz.com/geriatrics/home to TAKE ACTION NOW on the following campaigns: Medicare Pay Cuts Tentatively Delayed 10 Months; Long-Term Fix Still Needed. Contact Your Members Today! While Congress has reached a tentative agreement to give physicians reprieve from a 27.4 percent Medicare payment cut, permanent repeal of the broken Sustainable Growth Rate (SGR) formula is still necessary. AGS has launched a public policy advocacy campaign asking members of the recently convened Senate-House conference committee to fix the SGR Formula that continues to mandate cuts in Medicare payments year after year. The bipartisan conference committee is in charge of negotiating a legislative package (H.R. 3630), including extension of the current two month physician payment patch. You can help today by contacting your members of Congress and asking them to reach out to their colleagues serving on the conference committee on this important issue. Ask Your Senators to Support and Cosponsor the caring for an Aging America Act (S.1095). Take Action Now! Recently, Senators Boxer (D-CA), Collins (R-ME), Kohl (D-WI), and Sanders (I-VT) introduced the Caring for an Aging America Act (S.1095), legislation that recognizes the importance of ensuring that the healthcare workforce is prepared to meet the needs of the nation s growing population of older adults. Take Action Now and urge your Senators to cosponsor this important piece of legislation. Act Now to Preserve Funding for Workforce Training Programs and Aging Research. Urgent: Contact Your Senators! Help with the American Geriatrics Society s efforts to urge the Senate to reject proposed cuts to several of the programs we care about, including funding for geriatrics training programs, as well as research for the National Institute on Aging. These cuts were part of the recently passed House Continuing Resolution (H.R. 1). As you know, continued federal investments are needed to support the training of the healthcare workforce and to foster groundbreaking medical research so that our nation is prepared to meet the unique healthcare needs of the rapidly growing population of seniors.
10 Pennsylvania Geriatrics Society ~ Western Division JOIN/RENEW TODAY! Pennsylvania Geriatrics Society- Western Division MEMBERSHIP APPLICATION Membership benefits include: Clinical Update in Geriatric Medicine ~ a highly successful, AGS award-winning local conference that attracts internationally and nationally respected speakers to our region. It is designed by a number of society members in conjunction with the University of Pittsburgh Institute on Aging and the University of Pittsburgh School of Medicine Center for Continuing Education in the Health Sciences. Members can take advantage of a discount when registering for this CME conference. Fall Business Program ~ to further educate members and provide in-depth and practical information on a key topic of interest in the field of geriatrics, members are invited to a dinner and program held each fall. This dinner program is COMPLIMENTARY to members. David C. Martin Award ~ this prestigious award supports medical students interest in Geriatrics by offering recipients an honorarium of up to $1,500 to attend the American Geriatrics Society national conference to display their work. Since its inception, the Society is proud to have awarded over $57,000 to medical students in our region. Residents ~ The Society encourages and supports physicians in training who are considering careers that will involve patient care, education or research related to aging. Membership in the organization is an excellent opportunity for residents to attend meetings of the society and network with fellow physicians. A complimentary membership is offered to residents and is valid for the length of the residency program. Support of Local Geriatric Programs ~ the society continues to financially support many local conferences that further educate health care professionals. Please check one: Checks may be made payable to PA Geriatrics Society Student ($10.00 / year) Resident /Fellow (free) Resident/Fellow Year: Start date End date MD, DO, PharmD, RN, CRNP or other healthcare professional ($40.00/ year) Credit Card Payment Visa/Mastercard Card Billing address: Exp date Last 3 digits on the back of card Amount to be charged Name Title Preferred Address (circle: Business or Home) Company Address: City State Zip Phone Fax Email