Difficulties in Diagnosing Extrapulmonary Tuberculosis in Older Patients
- Mon, 11/15/10 - 11:06am
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- 1491 reads
Tuberculosis (TB), caused by Mycobacterium tuberculosis, is a highly infectious airborne disease that is classified based on disease symptoms and site of infection. When TB affects the lungs, which is the most common presentation, it is called pulmonary TB. When other parts of the body are infected, this is referred to as extrapulmonary TB. Some common sites of extrapulmonary infection include the lymph nodes, genitourinary tract, peritoneum, skin, pericardium, and meninges.
A Systematic Review of Spirituality and Dementia in LTC
- Mon, 10/18/10 - 1:43pm
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- 4034 reads
A systematic review was conducted to document all articles addressing spirituality among residents with dementia in long-term care (LTC) facilities. Three major themes emerged: (1) the spiritual needs identified included preserving a sense of purpose, fostering meaningful connections with the surrounding world, and retaining a relationship with God; (2) effective strategies for assessing individual spiritual needs were identified (eg, 2-level method); and (3) clinical guidelines suggested the use of formal religious interventions (eg, prayer, spiritual reminiscence).
Recognizing the Risks of Chronic Nonsteroidal Anti-Inflammatory Drug Use in Older Adults
- Thu, 9/16/10 - 3:09pm
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- 2355 reads
Older adults commonly take nonsteroidal anti-inflammatory drugs (NSAIDs) chronically. Studies of older adults show that chronic NSAID use increases the risk of peptic ulcer disease, acute renal failure, and stroke/myocardial infarction. Moreover, chronic NSAID use can exacerbate a number of chronic diseases including heart failure and hypertension, and can interact with a number of drugs (eg, warfarin, corticosteroids).
Nonpharmacologic Approaches to Insomnia in Older Adults
- Tue, 8/24/10 - 9:20am
- 1 Comments
- 3094 reads
This review discusses options for nonpharmacologic management of insomnia in older adults. A proposed model provides insights into the multidimensional nature of insomnia as a geriatric syndrome and provides a framework for evaluation and treatment. Practical nonpharmacologic interventions (sleep hygiene, sleep restriction, stimulus control, relaxation techniques, cognitive interventions) have demonstrated effectiveness in older adults and may be considered as a component in a multifaceted approach to improve sleep quality.
Cerumen: Insights and Management
- Wed, 7/21/10 - 8:41am
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- 3272 reads
Cerumen is an amalgam of secretions from the cerumenous and sebaceous glands that line the lateral aspect of the external ear canal, and shed epithelial remnants and occasional extraneous material that finds its way into the external auditory canal. Although present in all age groups, cerumen may become particularly problematic in the elderly population and those residing in LTC facilities; impacted cerumen may lead to both worsening of an existing hearing deficit and unexpected cognitive and behavioral irregularities.
Improving the Quality of Care in the Nursing Home: Regulation and Litigation
- Tue, 6/15/10 - 1:52pm
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- 3158 reads
Introduction
A recent General Accounting Office report notes that inadequate care or physical harm continues to affect one in five nursing home (NH) patients annually,1 an unacceptably high figure. More than 20% of residents who have been in long-term care facilities for two or more years will develop at least one pressure ulcer.2 In one study in patients with pain unassociated with cancer, 25% of NH patients received no analgesic medication at all.1 Inadequate NH care results in patients suffering pain, loss of function, decreased quality of life, and
Palliative and End-of-Life Care in LTC: Evaluation and Treatment of Dyspnea, Death Rattle, and Myoclonus
- Thu, 5/20/10 - 2:29pm
- 2 Comments
- 4491 reads
This article is the second in a series on palliative and end-of-life care in the LTC setting. The first article appeared in the April issue of the Journal.
The goal of palliative care is to prevent and relieve suffering for patients, regardless of their stage of illness. Most LTC patients should have palliative treatments integrated into their comprehensive care plan because of their high mortality rate and prevalent burden of suffering due to their chronic illnesses. These patients can be expected to suffer from many symptoms as their illness progresses. Three troubling symptoms t
Determination of Life Expectancy: Implications for the Practice of Medicine
- Thu, 4/15/10 - 9:29am
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- 3071 reads
Healthcare providers working in long term-care facilities are often called upon to make a judgment regarding a patient’s life expectancy. These judgments can be broadly broken down into three time frames: (1) Will a patient live long enough to benefit from a specific intervention directed at treating or preventing a disease or illness? (2) Is the patient’s life expectancy less than 6 months so that the patient can be considered for enrollment in Medicare-covered hospice? (3) Is the patient going to die so soon that family members should make arrangements now to visit the patient? This arti
Challenges in Antihypertensive Therapy in Older Persons
- Fri, 1/22/10 - 11:23am
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- 5080 reads
High blood pressure increases the risk of cardiovascular (CV) morbidity and mortality in a continuous fashion, even in very old adults. It is also associated with dementia and physical disability. Now it seems evident that treating stage 2 hypertension can reduce CV morbidity and mortality (especially stroke), and dementia to a modest degree in older adults. Although the HYpertension in the Very Elderly Trial was the first to report benefit of antihypertensive therapy in very old adults, the benefits of pharmacological treatment of uncomplicated stage 1 hypertension and lowering blood pressure
