Issue

Management of Diabetes Mellitus in the Nursing Home

admin — Fri, 05 Sep 2008 17:54:50 -0400

INTRODUCTION
Diabetes mellitus (DM), primarily type 2, is a prevalent, resource-intensive condition in nursing homes (NHs), which may have significant impact on residents’ function and quality of life. Upon admission to a NH, 26.4% of residents have a diagnosis of DM, including short-stay (< 6 months) and long-stay residents (> 6 months), whose placement may be permanent.1 Almost half of residents with DM will become long-stay residents.1 Compared to those admitted without DM, residents with DM have a higher burden of comorbid disease, disability, and cognitive impairment, pain, depression

Diagnosis and Management of Gout in the Long-Term Care Setting

admin — Fri, 05 Sep 2008 17:54:50 -0400

INTRODUCTION
Gout is a clinical syndrome caused by tissue (synovial, bursa, cartilage) deposition of monosodium urate (MSU) crystals in a patient with an elevated body pool of uric acid.1 New-onset gouty arthritis is common in the elderly population, and prevalence of gout is on the rise. In a study using a managed care population database, the prevalence of gout and/or hyperuricemia (defined as serum uric acid level > 6.8 mg/dL) in persons over age 75 years increased from 20.55 to 41.28 cases per 1000 enrollees over a 10-year period.2

This seems to be related to increasing lifespan, and

FUNDING IS LIMITED FOR THE YOUNGEST AMERICANS

admin — Fri, 05 Sep 2008 17:54:50 -0400

Increasingly, economists and lawmakers are taking a close look at the cost of financing Medicare, Social Security, and other entitlement programs that benefit older Americans. This is, of course, a good thing. Spending on these entitlements is rising significantly and will increase dramatically as the nation's 77 million baby boomers reach retirement age. As a nation, we need to take a critical look at these programs, know what’s coming, and know how to prepare.

While we do this, it’s important that those of us who care for and about older adults also acknowledge the value of programs

Q & A With the Expert on: Nursing Home Management

admin — Fri, 05 Sep 2008 17:54:50 -0400

Q: What is the flexibility management principle in long-term care?

A: The flexibility management principle asserts that flexibility is a necessary component of the way in which management deals with residents and staff members in long-term care. With respect to residents, the process of providing quality care includes trying to understand the person with dementia and fulfilling the needs of that person, as well as trying to create an environment that compensates for the cognitive, sensory, and physical losses the person experiences.1 Thus, the care environment needs to be flexible to meet

End-of-Life Nursing Home Care: Resource Allocation and Ethics

admin — Fri, 05 Sep 2008 17:54:50 -0400

Many individuals will receive their end-of-life care in long-term care settings. Nursing home residents with life-limiting illness may or may not be formally enrolled in a hospice program, but in either case are entitled to appropriate care at the end of life.1 The broader proposition is that it is or should be a societal norm to value providing compassionate end-of life care to persons across the continuum of care settings. An important question to consider is how well or poorly the current economic and regulatory frameworks support the quality of end-of-life care that nursing home residents

10 ETHICAL PRINCIPLES IN GERIATRICS AND LONG-TERM CARE

admin — Fri, 05 Sep 2008 17:54:50 -0400

1. BENEFICENCE
• Do right (“good”) by the patient.
• The physician’s main concern is the welfare of the patient.
• Do what is medically helpful.

2. NON-MALEFICENCE
• Avoiding harm.
• Implement effective non-hospital treatment when possible (due to complications that can arise during hospitalization of elderly patients).
• Withhold diagnostic work-up or treatment when intervention is unlikely to result in meaningful survival or patient well-being.

3. FUTILITY OF TREATMENT
• Treatment should be consistent with the patient’s (clinically realistic) goals.
• A

Abstracts from the Journal of the American Geriatrics Society

admin — Fri, 05 Sep 2008 17:54:50 -0400

Effect of an In-Home Occupational and Physical Therapy Intervention on Reducing Mortality in Functionally Vulnerable Older People: Preliminary Findings

Laura N. Gitlin, PhD, Walter W. Hauck, PhD, Laraine Winter, PhD, Marie P. Dennis, PhD, EdM, and Richard Schulz, PhD

Objectives: To evaluate the effect of a multicomponent intervention on mortality and the role of control-oriented strategy use as the change mechanism.

Design: Two-group randomized design with survivorship followed for 14 months. Participants were randomized to intervention or a no-treatment control group.

Setting

Preventing Aspiration in Older Adults with Dysphagia

admin — Fri, 05 Sep 2008 17:54:50 -0400

Best Practices in Nursing Care to Older Adults
From The Hartford Institute for Geriatric Nursing
New York University, College of Nursing

Issue Number 20, Revised 2007
Series Editor: Marie Boltz, MSN, APRN, BC, GNP
Managing Editor: Sherry A. Greenberg, MSN, APRN, BC, GNP
New York University College of Nursing

WHY: Aspiration (the misdirection of oropharyngeal secretions or gastric contents into the larynx and lower respiratory tract) is common in older adults with dysphagia and can lead to aspiration pneumonia. In fact, it has been suggested that dysphagia carries a seven