More Than Just Location: Helping Patients and Families Select an Appropriate Skilled Nursing Facility

The decrease in length of hospital stay for an episode of care has resulted in a larger proportion of older patients requiring a stay in skilled nursing facilities (SNFs). SNFs vary in their strengths and weaknesses, and some may not be equipped to care for the complex needs of individuals who are ill. It is crucial that the healthcare system educates and assists patients, their family members, and members of the discharge team so that they can collaborate on finding the best SNF to meet the patients’ needs. In this article, the authors present evidence- and experience-based strategies that can guide hospitals to implement systems for facilitating the selection of the most appropriate SNF.

Managing Clostridium difficile Infection on the Verge of the Postantibiotic Era

Over the past few years, there has been nationwide reporting of greater frequency and severity of Clostridium difficile infection (CDI) due to the emergence of so-called hypervirulent strains. In 2013, the Centers for Disease Control and Prevention described the urgency of CDI in the context of an imminent postantibiotic era, a time in which certain infectious diseases will become unresponsive to antibiotic treatment. Annals of Long-Term Care: Clinical Care and Aging® spoke with Teena Chopra, MD, MPH, and Amar Krishna, MD, to gain insight on the complex, multifaceted treatment of CDI in the long-term care setting and how healthcare professionals are rising up to meet the challenge of antibiotic resistance.

Diabetes Foot Education: An Evidence-Based Study in Long-Term Care

In this article, the authors describe a study that evaluated the efficacy of an evidence-based program for training nurses in LTC facilities that had two objectives: (1) to increase the knowledge and skills of nurses about foot care in residents with diabetes to prevent and manage diabetic foot lesions; and (2) to encourage nurses to incorporate regular foot examinations in clinical practice. The results of the study show that implementation of the training program can heighten awareness of the barriers involved when executing quality improvement initiatives in LTC environments.

Hyperbaric Oxygen Therapy: A Brief History and Review of its Benefits and Indications for the Older Adult Patient

Hyperbaric oxygen (HBO2) therapy has long been used to treat decompression sickness, but more recently has been explored as a primary or adjunctive therapy for a number of injuries and medical conditions, many of which commonly affect the aging adult population. This article provides a brief overview of HBO2 therapy, reviewing its history, potential mechanism of action, indications in the older adult population, safety and side effects, and its potential role in nursing home care.

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.