Importance of Preventive Measures in Long-Term Care

A primary objective of medicine is to prevent diseases and subsequent illness. Although the medical care of elders is complex, especially for long-term care (LTC) residents who are frail and have numerous comorbidities, discomfort and injuries should not be considered inevitable in this population. This issue of Annals of Long-Term Care: Clinical Care and Aging® (ALTC) examines three areas where preventive measures can make a considerable difference in preserving quality of life among LTC residents: (1) proper management of incontinence-associated dermatitis (IAD); (2) conduction of regular pain assessments; and (3) implementation of measures to prevent brain injuries, which often have devastating outcomes in older persons. In the first article, “Prevention of Incontinence-Associated Dermatitis in Nursing Home Residents”  the author outlines evidence-based practices that can be used to prevent IAD in the LTC setting. IAD is a fairly common problem among LTC residents, especially those with urinary and/or fecal incontinence, and places individuals at high risk of pressure ulcers, infections, and morbidity. It can also cause considerable discomfort, which has been described as burn-like pain. The author notes that minimizing exposure to urine, feces, and other bodily fluids, and use of a structured skin care regimen that includes gentle cleansing, moisturizing, and use of skin protectants are core prevention strategies. She notes that little research has been done comparing skin protectants, adult briefs, and various IAD assessment instruments in a head-to-head manner, and this is an area where high-quality research is needed.

In the second article, “Challenges of Pain Management in Long-Term Care”, the authors outline the results of their literature review on how guidelines on persistent pain, such as those put forth by the American Geriatrics Society (AGS) and AMDA–Dedicated to Long Term Care Medicine (previously known as the American Medical Directors Association [AMDA]), have been applied in the LTC setting. This article addresses pain assessments and pharmacologic and nonpharmacologic pain management approaches, including in cognitively impaired individuals.  The authors note that although persistent pain is common among older persons, especially those in LTC settings, it remains underrecognized and undertreated. They partly attribute this to deficiencies in education among LTC staff and to a lack of a standardized approach to assess and manage pain in LTC residents. It appears that pain guidelines, such as those by the AGS and AMDA, are often poorly implemented, if at all. While it remains unclear whether strict adherence to any pain guidelines can effectively address pain in the setting of complex patient needs, it is clear that prompt recognition and management of pain can make a considerable difference in quality of life by preventing unnecessary suffering.

The third article, “Traumatic Brain Injury in Elders”, examines the impact of age on outcomes after trauma to the brain. As the authors note, mortality rates are high, especially among elders, with rates increasing as age increases. In addition, even when brain injuries are promptly treated, outcomes are poor among older persons. As a result, preventive measures are critical. While the focus of the article is on factors that affect poor outcomes in elders, the authors also outline some preventive measures. In LTC, one of the most important preventive measures is to protect against falls as much as possible, as 5% to 10% of falls result in head injuries. Some protective measures outlined by the authors include removing hazards from the environment (eg, throw rugs from walkways), using nonslip mats in bathtubs and showers, installing grab bars by toilets and handrails on both sides of any stairs, and optimizing lighting. They also note several health-related recommendations, such as encouraging regular participation in an exercise program focused on increasing strength and balance, prescribing vitamin D and calcium supplements, reducing the number and doses of psychotropic medications, and correcting any visual problems (eg, cataracts).

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