Asking Questions

Happy New Year! We hope that you had a wonderful holiday season. The start of any new year always brings lots of questions, but one that you no doubt hear quite frequently is “What are your resolutions?” As healthcare providers, we’re accustomed to asking and answering lots of questions. We routinely ask patients about their medical history, social history, family history, symptoms, and even personal lives, and we ask our colleagues about their experiences and findings so that we can apply that knowledge. Medicine puts us on the perpetual quest to find answers, and this requires an inquisitive mind that looks beyond the surface to find explanations, particularly when a complex patient population such as long-term care (LTC) residents is involved. In this issue of Annals of Long-Term Care: Clinical Care and Aging^® (ALTC), we include several articles that demonstrate the benefit of asking questions and persisting beyond the most obvious answers.

Our first article, “Advising Alzheimer’s Caregivers About Assisted Living”, is a perspectives piece written by a caregiver who spent time researching potential assisted living facilities for his wife, Clare. In doing so, he discussed his intentions with members of his spouse support group to gather their feedback, researched facilities online, and put together a form of questions to ask administrators of prospective facilities, which is included as part of the article. As one final step before touring local facilities, he had two social workers review the form, which led to an important question being added—one that ultimately helped him understand the assisted living landscape in New York State and make an important decision regarding his wife’s care. A commentary by Sheryl Zimmerman, PhD, follows this article and sheds additional light on the complexity of choosing assisted living residences.

The second article, “Strategies for Reducing Falls in Long-Term Care”, emphasizes the need to look beyond the most obvious reasons for falls. As the authors note, after a patient falls, the goal to prevent subsequent falls may prevent the true cause of the fall from being identified. They provide two case scenarios that show that the answer may not always be obvious. In some cases, it may be a cascade of events that culminate in a fall. In other cases, the answer may be buried somewhere in the patient’s history. Therefore, asking a variety of questions when performing a root cause analysis of why a fall occurred is essential, and the entire interdisciplinary care team and the patient’s family should be involved, as everyone may have important information to contribute. The authors also outline fall risk assessment tools and discuss a variety of factors that can lead to falls, such as syncope, pain, visual and cognitive defects, and use of alarms, and review how to mitigate risk. Does your LTC facility have any specific strategies in place for preventing falls? Send us a letter to the editor or vote on our poll at www.annalsoflongtermcare.com.

In our third article, “Applying the New Statin Guidelines to the Long-Term Care Population”, ALTC board member Wilbert S. Aronow, MD, discusses the new guideline for managing blood cholesterol that was released by the American College of Cardiology and the American Heart Association in November 2013. These guidelines recommend moderate- or high-intensity statin therapy for the following four patient groups:

•   Patients with cardiovascular disease;

•   Patients with a low-density lipoprotein cholesterol level ≥190 mg/dL;

•   Patients with type 2 diabetes mellitus and aged 40 to 75 years; and

•   Patients with an estimated 10-year risk of cardiovascular disease of ≥7.5% and aged 40 to 75 years.

Naturally, there have been a lot of questions circulating in the healthcare community about these guidelines, including among LTC providers. Dr. Aronow puts these guidelines in perspective and offers his expert insights on their applicability in the LTC setting.

We hope you find the articles in this issue of ALTC useful. As always, we welcome your feedback. You can send any comments or suggestions to Amanda DelSignore at adelsignore@hmpcommunications.com. Letters may be published in an upcoming issue of the journal.

Thank you for reading!