Anticholinergic Burden Assessment and Future Diagnosis of Dementia

by Janice Hoffman Simen, PharmD, EdD, APP, BCGP, FASCP

Recently, an article published in the British Medical Journal, April 2018, looked at patients in the UK with a new dementia diagnosis and the use of prescription medications with anticholinergic adverse effects up to 20 years previously (Richardson, et al., 2018). In this study, the researchers found a link between a new dementia diagnosis and an increasing average Anticholinergic Burden score (ACB). According to the results of this study, the risk of dementia increases with an ACB greater than three, including exposure 15-20 years prior to diagnosis, with the following drug classes: antidepressants, urologic, and antiparkinson agents. The findings are interesting as a risk factor for the onset of dementia and encourages the assessment of anticholinergic burden in younger patients.

Win as Much as You Can

by Timothy Gieseke MD, CMD

As the recipient of the 2018 CALTCM Leadership Award at this month’s annual meeting, I have had time to reflect on my career in medicine and the events that shaped that career.  I recalled my wife’s decision to become a pediatric physical therapist, in large part related to volunteer work she had done in High School at “We Care for Children.” ( and how that led this “Lone Ranger” trained physician to highly value the work of the various disciplines in our specialty. 

State of the Organization - May 2018

by Michael Wasserman, MD, CMD

How many of us have cared for frail older adults who were failing at home, yet seen them thrive in a nursing home?  The structure and socialization that is provided in nursing homes is hard to duplicate in the home setting. The delivery of care in nursing homes is the true definition of teamwork, and at CALTCM we are trying to model this.  In addition to physicians, our members include nurse practitioners, physician assistants, pharmacists, social workers, psychologists, DON’s, and nursing home administrators. The field of geriatrics has always accepted and promoted teamwork.  One thing I have learned through efforts to reduce antipsychotic medications in nursing homes is that it takes a collaborative approach between facility staff and the clinicians caring for the residents. We have a responsibility to lead the way in modeling the most effective collaborative approaches to caring for some of the most vulnerable members of our society.  We also need to effectively message the value of the care that is provided along the long term care continuum. As I visit nursing homes I am often struck by the gratitude of the residents, and am profoundly humbled by the efforts of the front-line staff, many of whom find their work to be a calling. I believe that we can all join them in that regard.

Disaster Preparedness at our Annual Meeting

by Timothy Gieseke, MD, CMD

Late last year, I wrote an article for the WAVE about my experience as a clinician during the Santa Rosa Apocalypse.  That article caught the attention of a palliative care leader on the East Coast because of her experience with Hurricane Irma as an out of area concerned relative.   We are now preparing a Webinar on this subject for the Coalition for Compassionate Care of California (

Regional disasters are becoming the new norm.  CMS expects us to be prepared for the likely disasters in our communities.  I am so pleased that Jocelyn Montgomery will be presenting on this topic at our annual meeting; she is an expert on this subject and a passionate teacher.

As I have been preparing for my Webinar, I am impressed by how many issues should be addressed in a facility disaster plan.  As a non-expert, this is a preliminary checklist I have developed for the CCCC webinar.

Don’t wait until disaster strikes.  Come to our annual meeting and hear from an expert.

See you there,

Tim Gieseke MD, CMD


Best Practices in Diabetes Management

by Timothy L. Gieseke, MD, CMD

Through my work with the Endocrinology Department in Tirana, Albania, I have developed an interest and expertise in the care of persons with Type 2 Diabetes.  However, this is a rapidly changing field, so I attended the online Webinar from AMDA on 3/7/18 with great interest. Dr. Naushira Pandya is a former President of AMDA and a recognized expert on this subject in the PA/LTC setting.  She was a part of the latest ADA update on diabetes care in our setting, January 2016.

I’ll share a few pearls below, but encourage you or your facility to listen to the power point presentation.  It’s available at: .  It’s free for AMDA members, but $99 for non-members.  Here are some pearls:

1.     Some of the variability we see in finger-stick glucose measurements is likely due to errors administering insulin by syringe or pen, wrong size needles, wrong angle of injection, & failure to rotate site or injecting into lipodystrophy or atrophy sites.  She has 3 slides with detailed recommendations for reducing these errors. For facility training the FIT UK Forum for Injection Technique UK, is quite helpful. It’s available at

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