Background: The Palo Alto VA Hospital has an interdisciplinary Clinical Command Center (C3) that includes “Flow” nurse practitioners (NPs) who work closely with case management, social work and primary medical teams to identify and address barriers to care and assist in discharge planning and coordination. We have created a novel collaboration between a C3 Flow [...]

Background: Most cases of pneumonia in older people are aspiration pneumonia,[1] and the prognosis among patients hospitalized for aspiration pneumonia is very poor.[2] After being hospitalized for aspiration pneumonia, a certain number of patients become unable to take orally, and some chronic conditions are reported to be negatively associated with the retrievement of oral intake.[3] [...]

Background: The American Geriatric Society (AGS) creates a consensus report, the Beers Criteria, of medications that may potentially inappropriate for older persons. The 2019 Beers Criteria consists of medications across many classifications and indications that could have potentially harmful effects on older patients, including contributing delirium, falls, hypotension, and urinary retention. Providing the highest quality [...]

Background: At our Level 1 trauma center, geriatric trauma (GT) patients are primarily managed by hospitalists with surgical consultation. This care model offloads the trauma surgical services, improving time to surgery and hospital throughput. As the number of injured GT patients rose, so did the need to address a higher complication risk, longer hospital stays, [...]

Background: Assessing and treating pain in older adults is challenging. Although having patients self-report pain on a numeric scale is the recommended approach, age-associated conditions such as dementia, delirium, and impaired vision or hearing can prevent patients from effectively communicating their symptoms. Older patients are also at risk of adverse effects from commonly used analgesics [...]

Background: At our institution, an interprofessional (IP) hospital team consisting of a hospitalist, pharmacist, and nurse practitioner, meets with IP teams from local skilled nursing facilities (SNFs) in a weekly teleconference to discuss patients recently discharged from the hospital to the SNFs. The purpose is to identify and reconcile gaps in care during patients’ transitions. [...]

Case Presentation: A 75-year-old woman with a past medical history of latent tuberculosis, hypertension, and type 2 diabetes mellitus presented with three days of non-bloody, non-bilious emesis, diarrhea, abdominal pain, and a new onset of weakness, pitting edema, and rash with burning sensation in the bilateral lower extremities. Admission labs were notable for elevated creatinine [...]

Case Presentation: Planning a safe discharge from the hospital is a collaboration that includes the care team and the patient. At our VA hospital, a geriatric 4M’s (Mobility, Medications, Mentation, What Matters Most) assessment helps to determine “What Matters Most” to older Veterans as well as to connect them with the right community services (such [...]

Case Presentation: Nocardia has a known predilection for brain tissue and may present with unique symptoms. We share a case of significant dysgeusia in a presumptively immunocompetent patient as a complication of disseminated nocardiosis.A 70-year-old previously healthy male with a history of diabetes, presented with three months of fatigue, productive cough, loss of appetite, and [...]

Case Presentation: Patients presenting with melena are often found to have an upper gastrointestinal source: melenic stool on exam has a likelihood ratio of 25 for upper gastrointestinal bleed (1). But what if repeated endoscopies are unimpressive? Mr. S is a 75 year old male with a history of atrial fibrillation on apixaban for three [...]