Preparatory Grief in Frail Elderly Individuals
- Wed, 2/2/11 - 9:16am
- 2 Comments
- 5460 reads
When patients begin to realize that their lifespan is coming to a close and that they will soon lose all that they have known, they may begin to grieve, a process known as preparatory grief. While this is a normal process, it can cause considerable emotional distress in patients. At times, preparatory grief can overwhelm them, becoming pathological or triggering depression, yet healthcare workers often underestimate the emotional distress that terminally ill patients experience.
Hospice as a Care Option in Long-Term Skilled Nursing Care
- Tue, 12/21/10 - 12:07pm
- 0 Comments
- 3594 reads
Currently, approximately 1.45 million individuals are receiving hospice care in the United States, but many more could benefit from hospice services. While hospice originated to support individuals caring for terminally ill relatives at home, hospice services under the Medicare hospice benefit (MHB) can also be accessed by individuals residing in nursing homes or assisted living facilities. Although the number of hospices participating in Medicare is rapidly increasing, there is still considerable confusion about hospice as a care option in the long-term care (LTC) skilled nursing setting.
Identifying, Tracking, and Managing Pain in LTC
- Thu, 9/16/10 - 3:17pm
- 0 Comments
- 2976 reads
Little is known about the effect of structured interventions for pain assessment and management in LTC. Pain is challenging to measure in this setting because of its subjective and variable nature, the inability of many residents to articulate pain, and the need for repeat measures to assess changes and treatment response. The Minimum Data Set (MDS) 2.0 includes three pain items that have relatively good reliability and validity among cognitively intact patients, but not among those with cognitive impairments or trouble communicating.
The Treatment of Neuropathic Pain in the LTC Setting
- Thu, 9/16/10 - 3:13pm
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- 2602 reads
This article addresses the most current data to help clinicians make up-to-date decisions regarding the management of neuropathic types of pain in LTC residents. For example, diabetic peripheral neuropathy (DPN), postherpetic neuralgia, and trigeminal neuralgia are recognized causes of neuropathic pain. Common symptoms associated with neuropathic pain include allodynia, paresthesias, hyperalgesia, and dysesthesia. Among published guidelines and literature reviews, antidepressants and antiepileptics are consistently touted as first-line agents.
Recognizing the Risks of Chronic Nonsteroidal Anti-Inflammatory Drug Use in Older Adults
- Thu, 9/16/10 - 3:09pm
- 0 Comments
- 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.
Are Joint Contractures in Patients with Alzheimer’s Disease Preventable?
- Tue, 8/24/10 - 9:03am
- 0 Comments
- 11848 reads
Joint contractures impair quality of life and lead to further complications and disability. In severe dementia, many patients are seen in a fetal position. This position causes flexion of the muscles at joints, causing the muscles to undergo shortening, resulting in degenerative tissue changes, and then leading to potential irreversible deformity. The authors discuss the development of joint contractures in Alzheimer’s disease (AD), where it is thought that the natural progression of AD terminates with patients in the fetal position.
Cerumen: Insights and Management
- Wed, 7/21/10 - 8:41am
- 0 Comments
- 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.
Palliative and End-of-Life Care in LTC: Practical Implications of Understanding Spirituality and Religion
- Wed, 7/21/10 - 8:30am
- 0 Comments
- 3771 reads
This article is the third in a series on palliative care in the LTC setting. Part I appeared in the April issue, and Part II appeared in the May issue of the Journal.
Prevention of Overuse of Wheelchairs in Nursing Homes
- Tue, 6/15/10 - 2:05pm
- 0 Comments
- 4094 reads
The number of nursing home residents in the United States is projected to reach three million by the year 2030. Currently, over 80% of residents spend time sitting in a wheelchair every day. Many of these residents are overlooked for therapeutic treatment because they are perceived as being too physically disabled and/or without rehabilitation potential.
