Annals of Long Term Care

Aquatic therapy (AT) has been used for decades to provide physical therapy for patients with lower extremity deformities. Recently, investigators also have shown potential benefits for patients with neurological conditions, such as balance disorders, Parkinson’s disease, and post-stroke effects. This case report documents a patient with severe Alzheimer’s disease who responded well to Halliwick-concept AT, and both subjective and objective evidence is presented to document his improvement. This case suggests a need to further investigate the potential of AT to improve the quality of life of patients with dementia. 

Medication safety is an important issue in long-term care (LTC) settings. Prevention of complications and medication-related problems are essential areas of practice for nurses who administer medications and for those who prescribe them. Although there are numerous medication safety issues to contend with in LTC settings, a common hazard is administering prescribed medications in ways that change their form, such as crushing extended-release tablets. When medications are administered in ways they are not supposed to be patients may have poor outcomes. This article describes insights gleaned from an observational case study and focus group that shed light on this issue. The author advocates for improved communication between prescribers and nurses to ensure medications are administered appropriately and in their intended form, improving patient safety and outcomes in LTC settings. 

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. 

Weight loss is common among patients with dementia and may decrease their quality of life and increase their risk of mortality; thus, prompt attention to weight loss is warranted. A variety of factors have been associated with weight loss in these patients, including dementia treatments such as acetylcholinesterase inhibitors (AChEIs) and memantine. Weight loss has been reported to occur in up to 20% of patients receiving an AChEI, but it is not known whether particular agents in this drug class are more likely to cause weight loss than others. It is also unclear whether patients who lose weight while taking one agent in this drug class can be safely treated with another agent in this drug class. The authors report a case that suggests that weight loss associated with the use of one AChEI does not necessarily predict weight loss from another AChEI. Their report also suggests that when clinicians encounter weight loss in a patient receiving an AChEI, switching to a different AChEI may be a reasonable strategy if the patient’s weight loss appears to be related to this treatment. 

Pressure ulcers are highly prevalent among older adults and elders receiving palliative care in numerous care settings. A palliative care approach to wounds involves a comprehensive assessment of existing wounds and prevention of new wounds. Treatment of wounds and their associated complications is typically driven by symptom management to improve patient comfort and quality of life. While much is known about palliative wound care in general, evidence to guide palliative care of pressure ulcers, specifically in older adults residing in long-term care (LTC) settings, is severely lacking. Many LTC facilities may follow the evidence-based guidelines developed by the National Pressure Ulcer Advisory Panel and the European Pressure Ulcer Advisory Panel. Although these organizations make specific recommendations to palliative care providers, scientific evidence should be strengthened and expanded upon. This article reviews the current body of medical literature on the palliative care of pressure ulcers in older adults, particularly those in LTC settings; examines how the medical literature compares with clinical practice guidelines; and identifies gaps where further research is needed.