Feature

Sustaining Mobility Through Enhanced Bed Egress

This article focuses on the physical actions required to rise and get out of bed and discusses how these actions may present a challenge for older adults with reduced physical abilities. Solutions that facilitate the successful performance of the physical actions of bed egress are also discussed. To ensure the quality, function, and safety of long-term care living environments, it is important to consider the ergonomics of bed systems and other key furnishings.

Identifying and Managing Long-Term Care Residents With Criminal or Correctional Histories: Preliminary Analysis of One Facility’s Experience

Little is known about the impact of elderly individuals with criminal or correctional histories on nursing facilities or strategies to minimize the risk posed by residents who have the potential to abuse others. To address this paucity of information, the authors conducted a study that included a convenience sample of 46 individuals with disclosed criminal or correctional histories admitted to their facility between 2001 and 2013. They found that although a large proportion of those with known criminal histories can be safely placed in long-term care settings with minimal disruption and risk, there are certain factors that increase the likelihood of problematic behaviors. This article outlines these factors and describes strategies for assessing risk, identifying and protecting potential victims, and preventing or managing problematic behaviors to decrease liability while balancing the rights of the criminal with those of residents, staff members, and the community at large.

Building a Health Information Technology Infrastructure in Long-Term Care

There is increasing interest in the potential of health information technology (HIT) to improve quality of care, prevent medical errors, and increase administrative efficiencies in the nursing home setting. The purpose of this study was to identify characteristics of nursing homes that were predictors of high versus low levels of technology adoption. Using data collected as part of a systematic technology needs assessment among Rhode Island nursing homes, the authors assessed the baseline level of technology adoption prior to a statewide initiative to assist nursing homes with the purchase and installation of computers in clinical areas. The results showed that only 36% of the nursing homes in the state had computers with Internet access placed in all clinical areas. Not-for-profit and chain-affiliated nursing homes were more likely to have computers in clinical areas, positioning them for easier participation in a health information exchange. These findings can guide nursing homes as they plan for increased HIT capacity in the ongoing initiative to improve quality and management of care for their residents.

Advancing Nutritional Care for Older Adults

There is major potential in the year 2014 for improving the quality of nutritional care in long-term care settings. In particular, updated guidelines on the role of nutrition in preventing and treating pressure ulcers are in the pipeline, and the Centers for Medicare & Medicaid Services issued a new rule giving greater autonomy to registered dietitians. Increasingly, dietitians and nutritionists are being viewed as vital members of a resident’s interdisciplinary care team, applying their expertise in “nutraceuticals,” probiotics, and adverse food–medication interactions to ensure optimal nutritional status in older adults. Annals of Long-Term Care: Clinical Care and Aging® discussed these current topics with geriatric nutritionist Becky Dorner, RDN, LD.

Assessing Pain and Falls Risk in Residents With Cognitive Impairment: Associated Problems With Overlooked Assessments

Pain and falls are major challenges in long-term care (LTC) settings, making comprehensive pain and fall assessments essential; however, these assessments can pose a particular challenge in cognitively impaired persons, as these individuals may not be able to fully communicate their experiences. In this column, the authors explain the basis for two original tools that they developed for LTC providers to more thoroughly assess pain and falls risk in their cognitively impaired residents: a checklist of nonverbal indicators of chronic pain in elderly residents, and a form for documenting fall risk. These two resources are intended to be shared and distributed for clinical use.

Implications of New Oral Anticoagulants for Stroke Prophylaxis in Elderly Patients With Atrial Fibrillation

The prevalence of atrial fibrillation (AF) increases with age and is projected to escalate in coming decades as people have longer life expectancies. The burden of this disease has a substantial impact on healthcare costs and quality of life, particularly among AF patients who experience strokes. Until recently, the mainstays of stroke prophylaxis in patients with AF have been anticoagulation with warfarin or antiplatelet therapy with aspirin, depending on patient preferences, clinical risk stratification, and contraindications. However, the limitations of these conventional options, especially among elderly patients, have given rise to the first new oral anticoagulants in over half a century. Successful clinical trials have led to regulatory approval of several alternatives for clinical use. This article reviews the evidence supporting antithrombotic prophylaxis, describes current practice guidelines, and discusses the use of novel therapeutic options for elderly patients with nonvalvular AF.

Determining the Future of Long-Term Care

How will long-term care be financed and delivered in the future? The 15-member Commission on Long-Term Care recently submitted its final report to Congress outlining its answers to this important question. The Commission set forth several specific recommendations within the areas of service delivery and workforce and offered two suggested approaches for financing long-term care services in the future. This article briefly reviews these recommendations and their potential impact on long-term care providers in the coming years. 

Confronting Boundaries in the Treatment of Movement Disorders

The clinical presentations of movement disorders can be highly heterogeneous and complex in older patients. Effective treatment becomes paramount when symptoms significantly affect patients’ quality of life and impede their ability to perform activities of daily living to the point of requiring placement in a long-term care (LTC) facility. Medication is typically at the crux of care, but many of the existing therapies for movement disorders are limited when applied to elderly persons residing in LTC settings. Annals of Long-Term Care® discussed the challenges of treating movement disorders in older adults with Vanessa Hinson, MD, PhD, and asked her to lend insight on several alternative approaches to care, including psychotherapy, deep brain stimulation, and nutrition.

When Should Antipsychotics for the Management of Behavioral and Psychological Symptoms of Dementia be Discontinued?

Regardless of setting, the behavioral and psychological symptoms of dementia often cause significant disruption and discordance between those experiencing the symptoms and their caregivers, other patients and residents, and family members. The use of antipsychotics in such situations and settings is common; however, these medications have many untoward side effects. In this article, the author discusses the possibility of lowering the dose of these medications with an ultimate goal of discontinuation, even in those deemed “stable” recipients of this class of medications.

Fluoroquinolone-Induced Hypoglycemia in an Overweight Nonagenarian With Acute Kidney Injury and Not on Glucose-Lowering Therapy

Fluoroquinolone-induced hypoglycemia remains underreported, especially in elderly patients not on any glucose-lowering therapy. Subsequently, healthcare providers may remain unaware of this complication, which can have significant clinical implications in terms of morbidity, mortality, and adverse drug reactions. The authors present the case of an overweight nonagenarian with diabetes, chronic kidney disease, and acute kidney injury who, due to worsening renal function, became hypoglycemic as a result of being unable to efficiently clear fluoroquinolones. The patient was not on any glucose-lowering therapy. Following the case report, the authors provide an overview of the fluoroquinolones approved for use in the United States and discuss their effects on blood glucose levels.