Scholars@Duke
Milta O Little

Milta O Little

Associate Professor of Medicine
Medicine, Geriatrics and Palliative Care
milta.little@duke.edu
Box 3003, Durham, NC 27710

Selected Publications

Perspectives on Deprescribing in long-term care: qualitative findings from nurses, aides, residents, and proxies.

Journal Article BMC Nurs · January 31, 2023 BACKGROUND: Deprescribing initiatives in the long-term care (LTC) setting are often unsuccessful or not sustained. Prior research has considered how physicians and pharmacists feel about deprescribing, yet little is known about the perspectives of frontlin ... Full text Link to item Cite

Healthcare for older adults in North America: challenges, successes and opportunities.

Journal Article Age Ageing · October 6, 2022 Older adults in North America face similar challenges to successful ageing as other adults around the world, including an increased risk of geriatric syndromes and functional decline, limited access to healthcare professionals specialising in geriatrics an ... Full text Link to item Cite

Strengthening Resident, Proxy, and Staff Engagement in Injury Prevention in Skilled Nursing Facilities.

Journal Article Gerontologist · September 7, 2022 BACKGROUND AND OBJECTIVES: Engaging residents, their proxies, and skilled nursing facility (SNF) staff through effective communication has potential for improving fall-related injury prevention. The purpose of this study was to understand how multiple stak ... Full text Link to item Cite

Polypharmacy and deprescribing in older adults

Chapter · March 28, 2022 In this latest edition, the authors take a refreshed approach to the material by rigorously applying the latest scientific research to clinical practice and increasing the use of visual examples, algorithms, and clinical practice points. ... Cite

Perioperative medical assessment of older adults

Chapter · March 28, 2022 In this latest edition, the authors take a refreshed approach to the material by rigorously applying the latest scientific research to clinical practice and increasing the use of visual examples, algorithms, and clinical practice points. ... Cite

Pathy's Principles and Practice of Geriatric Medicine

Book · March 28, 2022 In this latest edition, the authors take a refreshed approach to the material by rigorously applying the latest scientific research to clinical practice and increasing the use of visual examples, algorithms, and clinical practice points. ... Cite

Improving shared decision-making for osteoporosis pharmacologic therapy in nursing homes: a qualitative analysis.

Journal Article Arch Osteoporos · January 3, 2022 UNLABELLED: Decisions on whether to use pharmacologic osteoporosis therapy in skilled nursing facility residents are complex and require shared decision-making. Residents, proxies, and staff desire individualized fracture risk estimates that consider advan ... Full text Link to item Cite

Interprofessional competencies of students in a geriatric case competition.

Journal Article Gerontol Geriatr Educ · 2021 This paper presents a valuable activity to teach health professions students - the interprofessional geriatric case competition. This program brought together students from multiple health professions to design and present a comprehensive care plan using a ... Full text Link to item Cite

Addressing Social Isolation in Long-Term Care Facilities Amidst the COVID-19 Pandemic

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · 2021 Cite

Top Ten Tips Palliative Care Clinicians Should Know About Cognitive Impairment and Institutional Care.

Journal Article J Palliat Med · November 2020 Most long-term care (LTC) residents are of age >65 years and have multiple chronic health conditions affecting their cognitive and physical functioning. Although some individuals in nursing homes return home after receiving therapy services, most will rema ... Full text Link to item Cite

Resident and family perspectives on communal dining in the nursing home

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2020 Link to item Cite

High prevalence of geriatric syndromes in older adults.

Journal Article PLoS One · 2020 INTRODUCTION: The geriatric syndromes of frailty, sarcopenia, weight loss, and dementia are highly prevalent in elderly individuals across all care continuums. Despite their deleterious impact on quality of life, disability, and mortality in older adults, ... Full text Open Access Link to item Cite

Treating and preventing clostridium difficile infection in long-term care facilities

Journal Article Annals of Long-Term Care · December 1, 2018 The spore-forming bacteria Clostridium difficile (C diff) can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. C diff infection (CDI) is most common in older adults who have been hospitalized or who reside in long-term ca ... Full text Cite

Reversible Dementias.

Journal Article Clin Geriatr Med · November 2018 As the worldwide prevalence of dementia increases, there is a greater and more urgent need for all health care providers to understand how to evaluate and manage cognitive impairment. Many people presenting with a dementing illness have one or more reversi ... Full text Link to item Cite

Updates in nutrition and polypharmacy.

Journal Article Curr Opin Clin Nutr Metab Care · January 2018 PURPOSE OF REVIEW: Medications have the potential to affect nutritional status in negative ways, especially as the number of medications increase. The inter-relation between polypharmacy and malnutrition is complex and not fully delineated in previous stud ... Full text Link to item Cite

Interventions Against Disability in Frail Older Adults: Lessons Learned from Clinical Trials.

Journal Article J Nutr Health Aging · 2018 As the population ages, the number of older people with frailty is expected to increase worldwide with consequent rising of expenditures for healthcare and long-term care. Effective methods for preventing or delaying the onset of disability are urgently re ... Full text Link to item Cite

End-of-life care in low- and middle-income countries.

Journal Article Bull World Health Organ · November 1, 2017 Full text Link to item Cite

Clinical Update on Nursing Home Medicine: 2017.

Journal Article J Am Med Dir Assoc · November 1, 2017 This is the 11th annual Clinical Update from the AMDA meeting article. This year the topics covered are hypertension after the Systolic Blood Pressure Intervention Trial; chronic obstructive pulmonary disease risk factors, diagnosis and management includin ... Full text Link to item Cite

Clinical Update on Nursing Home Medicine: 2016.

Journal Article J Am Med Dir Assoc · November 1, 2016 This is the tenth clinical update. It covers chronic kidney disease, dementia, hypotension, polypharmacy, rapid geriatric assessment, and transitional care. ... Full text Link to item Cite

Policy: Impact on Delivery and Access

Chapter · October 5, 2016 This volume is divided into five parts and fifteen chapters that address these topics by examining ethnogeriatric foundations, research issues, clinical care in ethnogeriatrics, education and policy. ... Cite

The Burden of Overmedication: What Are the Real Issues?

Journal Article J Am Med Dir Assoc · February 2016 Full text Link to item Cite

More than just location: Helping patients and families select an appropriate skilled nursing facility

Journal Article Annals of Long-Term Care · November 1, 2014 The rapid evolution of the healthcare system is affecting how care is delivered to frail older patients. Most importantly, the length of a hospital stay for an episode of care is decreasing. This decrease has resulted in a larger proportion of older patien ... Cite

Considering complementary and alternative medicine for older adults

Chapter · September 22, 2014 SUMMARY Dyspnea is a common complaint among geriatric patients. Key points to remember in addressing ... Caregivers are often instrumental in implementing a treatment plan, and in monitoring symptoms. Treatment instructions should be in ... ... Cite

Assessing antiaging therapies for older adults

Chapter · September 22, 2014 SUMMARY Dyspnea is a common complaint among geriatric patients. Key points to remember in addressing ... Caregivers are often instrumental in implementing a treatment plan, and in monitoring symptoms. Treatment instructions should be in ... ... Cite

Nursing home research: the first International Association of Gerontology and Geriatrics (IAGG) research conference.

Journal Article J Am Med Dir Assoc · May 2014 The International Association of Gerontology and Geriatrics held its first conference on nursing home research in St Louis, MO, in November 2013. This article provides a summary of the presentations. ... Full text Link to item Cite

International survey of nursing home research priorities.

Journal Article J Am Med Dir Assoc · May 2014 This article reports the findings of a policy survey designed to establish research priorities to inform future research strategy and advance nursing home practice. The survey was administered in 2 rounds during 2013, and involved a combination of open que ... Full text Link to item Cite

Clinical update on nursing home medicine: 2014.

Journal Article J Am Med Dir Assoc · 2014 This is the eighth yearly update on clinical care in the nursing home. Topics covered this year are heart failure, delirium, nutrition, hospice, diabetes mellitus, frailty, and sarcopenia. ... Full text Link to item Cite

Erratum: Nutrition and skin ulcers (Current Opinion in Clinical Nutrition and Metabolic Care (2013) 16 (39-49))

Journal Article Current Opinion in Clinical Nutrition and Metabolic Care · May 1, 2013 Full text Cite

Nutrition and skin ulcers.

Journal Article Curr Opin Clin Nutr Metab Care · January 2013 PURPOSE OF REVIEW: Skin ulcerations cause significant morbidity and mortality, while driving up healthcare utilization and costs. Interventions to prevent ulcers and improve wound healing times are needed to reduce the burden on patients and healthcare sys ... Full text Link to item Cite

Climbing out of the black hole of subacute care.

Journal Article J Am Med Dir Assoc · July 2012 Full text Link to item Cite

Perioperative and Postoperative Medical Assessment

Chapter · March 12, 2012 As the population ages, more surgical interventions are being performed on elderly patients. The presence of age-related diseases increases morbidity and mortality; however, surgery should not be denied solely based on age. Instead, a comprehensive preoper ... Full text Cite

Matching the environment to patients with delirium: lessons learned from the delirium room, a restraint-free environment for older hospitalized adults with delirium.

Journal Article J Am Geriatr Soc · November 2011 Delirium is associated with several negative outcomes and is not always preventable. Current practices for the management of older hospitalized adults with delirium, such as one-on-one sitters, antipsychotic medications, and physical restraints, have limit ... Full text Link to item Cite

Hypertension: how does management change with aging?

Journal Article Med Clin North Am · May 2011 Hypertension is a significant risk factor for cardiovascular morbidity and mortality in people older than 60 years. Isolated systolic hypertension and widened pulse pressure appear to be more important than diastolic hypertension. Very low blood pressure a ... Full text Link to item Cite

Diagnostic Challenge of Bloodstream Infections in Long-Term Care

Journal Article Journal of the American Medical Directors Association · January 1, 2011 Full text Cite

Aging male.

Journal Article Clin Geriatr Med · May 2010 There are several special issues that confront the physician when dealing with the older male. Physicians need to pay attention to these issues and recognize their importance to their patients. This article briefly reviews these unique challenges. ... Full text Link to item Cite