Evolving Geriatric Care Concerns

More than anyone, geriatricians are well aware of the rapidly increasing population of older adults in the United States and the myriad of problems this occurrence will create for health care systems and specifically long-term care (LTC) settings. As this phenomenon evolves, geriatric health care professionals will be challenged mentally, physically, and professionally. In this issue, we present details on how care professionals are responding with research to address these pressing concerns.

With the dramatic increase in residential care facilities being built, Maria Costello, MBBCh, and coauthors studied the demographic and emergency medical service utilization characteristics of a cohort of assisted living facility (ALF) residents compared with nursing home residents. Previous research shows that ALFs contributed to 75% of all new senior housing in 1998, yet the health-related composition of individuals in ALFs has not been given adequate attention in research. Upon analysis of resident electronic medical records and emergency transport records, authors found high medical comorbidity burden in the ALF population and saw more use of emergency care services. The study findings provide initial insights into this population, providing a starting point to a greater understanding of the differences and similarities between ALF and LTC residents utilizing emergency services. The authors hope these results may contribute to better care coordination strategies to reduce potentially avoidable emergency department visits.

With growing numbers of older adults who have complex care needs, health care personnel at facilities find themselves experiencing higher levels of stress. Indeed, evidence has shown that the burnout rate for health professionals has been on the rise for the past 30 years. Some professionals witnessing this occurrence think that holistic methods may be the answer to lessening this burden. Authors Sunny Alperson, PhD, FNP-BC, and Christianne Fowler, DNP, GNP-BC, performed a quality improvement project aimed at professional caregivers working at an Alzheimer disease specialty center. The intervention combined simple centering movements of tai chi and qigong along with loving kindness mediation, which aims to increase participants’ self-love and compassion for themselves. The ideology behind the intervention is that when caregivers spend time caring for their own mental and spiritual selves, they will be equipped to care for others more efficiently with more compassion.

Advancing medical technology and therapies for the older adult population also means people are not just living longer but are living more fully and actively. One way this idea can be demonstrated is by looking at the increased trend of older adults continuing to travel by air despite advanced age and comorbidities. Geriatric providers will increasingly encounter instances of patients who are preparing to travel and should be aware of the complications that can arise during air travel. Richard G Stefanacci, DO, MGH, MBA, AGSF, CMD, and Sevy Gambs, MBA, ALA, MSN-GR, provide a comprehensive overview of air travel considerations, including how plane crews handle emergency medical situations, what medical equipment and supplies are always available in-flight, and what medical items should be requested by passengers beforehand. They also discuss how high altitudes can exasperate medical conditions and also how physicians can prepare older adults for flights based on the types of conditions their patient may have, such as cardiovascular issues or diabetic management needs.

Maintaining awareness of symptom variations and medication lists in older individuals will become an even greater challenge with more and more patients in LTC—potentially outnumbering geriatric practitioners. Case studies that share clinical insights on underlying causes of conditions and/or drug interactions will play a key role in maintaining physicians’ collective alertness in clinical settings. Kobi T Nathan, PharmD, MEd, BCGP, and colleagues provide a case report of a 78-year-old nursing home resident who presented with a 2-month history of increasing lethargy and confusion. Upon review of his medications and medical history, the symptoms appeared to coincide with initiation of sertraline; one of his other medications was found to be phenytoin. After the phenytoin was held and the sertraline slowly tapered, the patient’s symptoms eventually resolved. These findings show that neurological and clinical changes should be closely monitored when selecting and prescribing drugs with concomitant phenytoin use.