Examining Comfort Issues in Long-Term Care

The word comfort can be used as either a verb or a noun. As a verb, comfort is defined as the act of “soothing in a time of affliction or distress.”¹ As a noun, comfort can take several meanings: “a condition or feeling of pleasurable ease, well-being, and contentment”; “help, assistance”; and “solace in time of grief or fear.”¹ As long-term care (LTC) providers, comfort is an important consideration when it comes to our residents, and it can be provided in many ways, including managing physical needs, offering psychological support, addressing environmental factors, and respecting resident wishes. This issue of Annals of Long-Term Care: Clinical Care and Aging^® (ALTC) examines multiple ways that comfort can be provided in LTC settings.

In “Vestibular Disorders in an Aging Population: Practical Applications for Long-Term Care Facilities”, the authors discuss feelings of dizziness and vertigo, both of which are uncomfortable sensations frequently reported among LTC residents. In addition to affecting quality of life by causing psychological distress and reducing participation in activities and socialization with others, dizziness and vertigo often lead to falls that can result in fatal and nonfatal injuries.  The authors note that most dizziness and vertigo cases are caused by vestibular disorders, such as benign paroxysmal positional vertigo and Meniere’s disease, and they outline strategies for diagnosing and managing these and other vestibular disorders in older adults. Prompt recognition and treatment of these conditions is imperative for restoring comfort.

In the United States, disease treatment often relies on prescribing a medication, and the patient’s inner being may not be considered, unless he or she is being treated for or known to have a psychological condition. In those cases, alternative strategies may also be employed, but what can be done for cognitively impaired patients who are unable to communicate their needs and feelings? In “Use of Art Therapy in Geriatric Populations”, the authors examine how art has been used as a novel therapy in some older adult populations as a means of bringing comfort, whether by helping cognitively impaired elders communicate better with their loved ones or by enabling physically impaired individuals to reengage in an activity. The authors note that while additional research on art therapy is needed, especially in older populations, studies have shown that it can increase motivation and self-esteem, enhance mood, and reduce anxiety.

Environmental factors are another important comfort consideration. When it comes to our homes, we furnish and stock them with items that are intended to bring comfort to our everyday lives. For many individuals, a key component is the bed, which is fitting considering that the average person sleeps 7.6 hours daily; however, as we age, the time spent sleeping increases, and it is reported that individuals aged 65 years and older sleep an average of 9 hours daily.² While not all of this sleeping occurs in beds, LTC residents may spend the vast majority of their day in bed, even when they are not sleeping.  In “Examining Bed Width as a Contributor to Risk of Falls From Bed in Long-Term Care”, the authors discuss how bed width in LTC facilities is generally considerably less than the widths of consumer products, at 35 inches versus ≥39 inches, respectively. This may not only make LTC beds uncomfortable for LTC residents, but may increase their risk of falls. Based on the findings of their small laboratory pilot study, the authors suggest that bed width become a consideration in falls prevention programs.

Our final article, “Doing the Right Thing” examines the issue of cessation of hand feeding in the setting of severe cognitive decline. The authors outline the case of Jane, a resident with severe dementia, who had an advance directive that indicated she did not want medically administered fluids and nutrition if she were to develop a terminal illness; however, her advance directive did not address hand feeding. As a result, Jane continued to be fed by hand, a care measure her children stated she would not have wanted. The article outlines the steps that were taken to ensure Jane’s wishes were honored. Jane’s case raises many questions regarding end-of-life care and advance directives. For example, should the presence of severe suffering that cannot be relieved by any available means be a necessary finding before enabling cessation of hand feeding in cognitively impaired adults? Let us know your thoughts by voting in our online poll at www.annalsoflongtermcare.com or by sending an e-mail to our assistant editor amusante@hmpcommunications.com.

Thank you for reading!

References

1. The Free Dictionary. Comfort. www.thefreedictionary.com/comfort. Accessed June 5, 2012.

2.  United States Department of Labor. American time use survey. www.bls.gov/tus/charts/sleep.htm. Accessed June 5, 2012.