- N Engl J Med 2022; 386:e54
Although the Covid pandemic drew renewed attention to problems in U.S. nursing homes, the underlying issues with long-term care are long-standing. Susan Mitchell moderates a Perspective Roundtable about shortcomings and possible solutions.
- N Engl J Med 2022; 386:1869-1871
More than 30 years after the Nursing Home Reform Act, the United States still fails to protect nursing home residents and provide them with high-quality care. The Covid-19 pandemic’s devastating effect on nursing homes reminds us that further reforms are sorely needed.
- N Engl J Med 2022; 386:614-615
When her mother is discharged from rehab after a fall that caused multiple pelvic fractures, a doctor experiences first-hand the frustrations of getting the requisite home help up and running. Even in a generous health system, time, advocacy, and resources are required.
- N Engl J Med 2022; 386:399-401
During a surge in cases of Covid-19 in Israel, a rapid deployment of BNT162b2 booster injections was initiated in long-term care facilities over a 3-week period in July. When infection rates were increasing in the general population, rates in long-term care facilities decreased by 71%, and hospitalization rates fell by...
- N Engl J Med 2021; 385:203-216
Older patients hospitalized for heart failure were randomly assigned to a rehabilitation intervention (which included multiple function domains) or control; the intervention began during, or early after, hospitalization and continued for 3 months. At 3 months, physical function, as assessed by the Short Physical Performance Battery, was better in the...
- N Engl J Med 2021; 385:276-277
Exercise rehabilitation has a long history in the management of chronic heart failure, with the first randomized trial of exercise training dating back to 19901 — and by the late 1990s, it had become an integral part of therapy.2 There is solid evidence from multiple trials...
- N Engl J Med 2021; 384:51-59
Knee osteoarthritis is highly prevalent among older adults. Treatments include exercise, weight management, training in self-efficacy and pain-coping skills, and medications (commonly topical or oral NSAIDs, the latter often with a proton-pump inhibitor).
- N Engl J Med 2020; 382:734-743
Patients should be asked annually about falls in the past year to identify those at high risk for future falls. The risk of falling can be reduced by exercise programs focused on balance and strength training and, among persons at high risk, by assessing a standard set of risk factors...
- N Engl J Med 2020; 382:499-501
After a successful revascularization, a 72-year-old man becomes delirious. Though he’s seen by multiple medical teams, there is not a single consultation to address the failure of the organ that most patients prioritize over all others — his brain.
- N Engl J Med 2019; 381:302-303
The shift away from fee-for-service payment puts pressure on hospitals to reduce low-value care and to manage care delivered outside their walls. Thus far, hospitals have found savings by using an unusually consistent strategy: reducing institutional postacute care.
- N Engl J Med 2016; 374:1907-1909
World War I is believed to have ushered in modern medicine and the modern hospital, but an equally important contribution was the establishment of rehabilitation medicine, a specialty that helped pave the way for the creation of the Veterans Administration.
- N Engl J Med 2016; 374:1804-1806
Despite the substantial burden borne by informal caregivers, our society has only recently recognized that our conception of illness as solely an individual experience is too narrow. Acknowledgment of illness’s effects on families suggests a better approach to care.
- N Engl J Med 2016; 374:1831-1841
Investigators evaluated the caregivers of patients who had received mechanical ventilation for at least 7 days in an ICU. Although there was a large burden of depressive symptoms soon after discharge, the burden diminished in magnitude, in most caregivers, during the subsequent year.
- N Engl J Med 2016; 374:182-187
Long-term care is not covered by Medicare or private insurance. Medicaid pays for long-term care for the poor and those who qualify after paying out of pocket for care. This article discusses the financing challenges in the context of aging baby boomers and fiscal constraints.
- N Engl J Med 2015; 373:892-893
Some provisions of the Affordable Care Act should extend the advances made by the Americans with Disabilities Act, passed in 1990. But the persistence of health disparities and barriers to care for people with disabilities indicates that more remains to be done.
- N Engl J Med 2015; 373:747-755
Palliative care, a rapidly growing medical specialty, uses a team approach to enhance quality of care for persons with serious illness. This review summarizes recent trends and the focus of such care on communication, pain and symptom management, and psychosocial assessment.
- N Engl J Med 2014; 370:1626-1635
Stays in intensive care units are commonly accompanied by muscle weakness. This article reviews the basis for these changes and provides guidance on how to prevent, diagnose, and treat this condition.
- N Engl J Med 2012; 366:1270-1273
By 2015, half of HIV-infected U.S. patients will be older than 50 years of age. As antiretroviral therapy coverage expands globally, the aging of the epidemic will be mirrored in developing countries. Yet the world is unprepared to deal with an aging population with HIV.
- N Engl J Med 2011; 365:2453-2462
This trial compared a restrictive hemoglobin threshold with a liberal threshold for blood transfusion among hip-surgery patients with risk factors for CVD. The liberal strategy resulted in more transfusions and did not reduce death or inability to walk independently.
- N Engl J Med 2011; 365:2532-2533
Even though red-cell transfusion is an accepted and widely used intervention, questions regarding which patients should receive transfusions and under what circumstances continue to spark debate. There has been limited evidence from clinical trials to inform policy. Meanwhile, concern about potential risks of blood transfusion and the costs of maintaining...