Ensuring Quality of Life for Nursing Home Residents

Quality of life is an important consideration for all nursing home (NH) residents, whether they have just been admitted to an NH or are facing the end of life, as many patients attach more weight to quality of life than to longevity. Many factors can affect an NH resident’s quality of life, from medical problems to social activities. The articles in this month’s issue of Annals of Long-Term Care: Clinical Care and Aging^® (ALTC) focus on reports that outline interventions that can enhance quality of life among NH residents.

In our first article, “Promoting Personhood in Men in Nursing Homes: The Role of Activity Directors”, the authors discuss how activity directors can promote personhood, an essential factor in maintaining identity in late life. They conducted a qualitative study to determine how being male or female shapes the development and provision of activities for NH residents, and they found that many activities are focused on female interests. The authors suggest that this may be attributable to a variety of factors, including a high prevalence of activity directors being female, a lack of standardization with regard to activity director training, and many male activities being more resource intensive (eg, requiring trips outside the NH). As the authors note, not providing male residents with person-appropriate activities that take gender into consideration can result in the loss of personhood, thereby diminishing quality of life. To prevent this, they suggest that the meaning of person-centered care needs to be expanded to incorporate gender identities.

In our second article, “Challenges of Guardianship: Examining Four Cases From New York State”, the authors explain the impact of guardianship on the care of frail elders facing the end of life. They provide four case scenarios that highlight different guardianship challenges, which collectively illustrate how patients may be prevented from receiving the care they would have desired when advance directives are not completed and a guardian is assigned to make healthcare decisions on their behalf. For example, the authors found that guardians often choose more aggressive treatment options. This may be because they have a vested interest in their ward’s longevity, such as if the guardian is being paid privately to serve this role, or because they are uncomfortable with withholding treatment because they are unfamiliar with their ward’s wishes. To remedy this, the authors suggest that physicians should strive to better educate guardians about their range of decision-making possibilities, which includes palliative and hospice care as valid, compassionate options.

Our final article, “Mastication-Associated Rhinorrhea: Importance of Oral Cavity Examinations in Elderly Patients Wearing Removable Devices”, discusses a rare complication in an octogenarian wearing dentures; however, it also serves to highlight why regular oral examinations are important for all NH residents, including those with dentures. Although the case patient’s condition was not life threatening, it did hamper his quality of life. While it is unlikely that many denture-wearing residents will develop the same problem as described in this case report, these individuals may be susceptible to a variety of other and more serious oral health problems. This is because dentures can impact the integrity of oral tissues and cause changes to the oral environment; thus, regular oral screenings by healthcare providers can help identify these issues early and improve overall health and quality of life. Following the article is a helpful tip sheet on how to conduct oral cavity inspections in elderly patients with dentures.

We hope you enjoy this issue of ALTC and, as always, we appreciate hearing from our readers. Feedback on the articles in this issue or suggestions for topics you would like to see covered in future issues can be sent via e-mail to our associate editor, Allison Musante, at amusante@hmpcommunications.com.

As a final note, I would like to invite you to visit our new diabetes medical resource center and Alzheimer’s medical resource center on the ALTC website. These centers are intended to provide you with up-to-date, practical information that you can use in your day-to-day practice. If you have any feedback on these centers or comments on what you would like to see there, please share your thoughts with us by contacting Allison. 

Thank you for reading!