Annals of Long Term Care

Despite the high prevalence of chronic pain among older adults in long-term care settings, a search of the literature indicates a poor pattern of pain management practices, suggesting that management of pain in these patients is limited and only partially effective. This article reviews nurses’ and families’ involvement in pain management care for older adults living in nursing homes and outlines some barriers to effective pain management, including a lack of pain education among nursing staff; attitudes of staff caregivers; organizational barriers that impede effective communication among residents, physicians, and staff caregivers; and the lack of a clear understanding by nursing personnel of families’ perceptions and concerns as they relate to the care of their loved one. When nursing staff listen to and collaborate with families, rather than viewing them as a barrier to care, more appropriate services may be provided, resulting in better pain management, more positive outcomes, and improved overall care. 

Atrial fibrillation is common among frail elders in long-term care (LTC) and is a significant risk factor for severe stroke. This risk can be reduced with antithrombotic therapy, but the risk of bleeding complications from these treatments may in some cases outweigh their stroke-reduction benefits. Therefore, the decision to initiate antithrombotic therapy should be made after each patient’s benefits and risks are systematically estimated and discussed with the patient and his or her family so that a shared decision is reached. If the benefits of antithrombotic prophylaxis are judged to outweigh the risks, the clinician must then consider each patient’s comorbidities and preferences when deciding which agent to prescribe. Compared with warfarin, new oral antithrombotic agents are associated with potentially improved clinical outcomes, have better safety profiles, and are more convenient for patients and clinicians. However, clinical trials evaluating these agents excluded patients with conditions and risk factors common among patients residing in LTC settings, suggesting cautious consideration is warranted before prescribing these agents to this population. Regardless of which antithrombotic agent is chosen for a particular patient, facilities should closely monitor patients and employ policies and procedures to ensure its safe use. This article provides a review of the safety of various antithrombotic agents and how LTC providers can make evidence-based treatment decisions when prescribing these agents.  

Behavioral problems and psychological symptoms of dementia (BPSD) are commonly encountered in nursing homes. The literature shows that nonpharmacological methods of controlling undesirable behaviors in patients with dementia include staff education, activity interventions, and sensory stimulation. When these interventions fail, pharmacological therapy may include antipsychotics, cholinesterase inhibitors, and anticonvulsants, which are prescribed for BPSD management off-label. In this article, the author outlines the best evidence-based practice interventions, based on her literature review, for reducing problematic BPSD in the nursing home population. Although the literature supports nonpharmacological treatment as first-line therapy in these patients, there have been no large, high-quality studies conducted to identify which interventions work best in long-term care settings, indicating that this is an area where future research is needed. Additionally, due to the absence of medications approved for BPSD by the US Food and Drug Administration, pharmacovigliance is vital when prescribing available medications in this vulnerable patient population.

In the United States, the population of older adults continues to grow as more baby boomers reach retirement age. Aging is associated with an increased number of cognitive and physical impairments, requiring various interventions. For decades, art has been used in long-term care facilities to provide residents with something constructive to do. Less commonly, it is used as a therapy to address older adults’ psychological needs. When art therapy is employed, various forms and mediums are used to foster the creative process as a vehicle for healing. Research indicates that art therapy can increase motivation, self-esteem, and self-confidence while facilitating communication and maintaining cognitive functioning in older adults. In this article, the authors review the effectiveness of using pottery, mandalas, therapeutic thematic arts programming, and home-based art therapy in elderly populations with various impairments.

Incontinence-associated dermatitis (IAD), a common problem in nursing home residents, is a major risk factor for pressure ulcers, which are painful, costly, and can become life-threatening when they become infected; thus, prevention of IAD is imperative. The author conducted a comprehensive literature review of several databases, including PubMed/MEDLINE and CINAHL (Cumulative Index to Nursing and Allied Health Literature), to identify evidence-based practices for the prevention of IAD in nursing home residents. A total of 24 articles met the author’s inclusion and exclusion criteria. Although these articles shed light on the prevalence of, risk factors for, and preventive skin care protocols for IAD, many articles were expert opinions, systematic reviews, or had conflicts of interest, indicating more research is needed in this area.