Keeping Up-to-Date on Medical Issues Specific to Older Adults

Older adults often have special medical concerns that are associated with the aging process. The articles in this issue of Annals of Long-Term Care: Clinical Care and Aging^® discuss the identification of several health issues particularly prevalent in older adults and their management in the long-term care setting.

Many nursing home residents experience delirium, a state of confusion characterized by an acute and fluctuating decline in cognitive functioning. Nursing home staff have regular contact with residents over long periods of time, presenting the opportunity for them to recognize changes in their cognitive function over time. Correctly recognizing delirium-induced changes in cognitive function is challenging, however. Melinda R. Steis, PhD, RN, and her colleagues conducted a study to determine the accuracy of delirium recognition by licensed nurses and nursing assistants from eight nursing homes over a 12-month period. Their results demonstrate the limitations of nurses’ and nursing assistants’ abilities to recognize different subtypes of delirium and the need for further education about this condition.

Pulmonary aspiration is defined as the entry of material (eg, saliva, food, drink, stomach contents) from the oropharynx or gastrointestinal tract into the larynx and lower respiratory tract. Pulmonary aspiration can be an innocuous event, and may not lead to medical complications. Alternatively, aspiration may lead to aspirational pneumonia (AP). Frail individuals with compromised immune system response, mobility, and/or airway clearance are particularly at risk for AP, because they are less able to clear the lung of the aspirate. A review article by Mark Richard, PT, et al focuses on risk factors for AP development and multidisciplinary interventions that can reduce the risk for AP development.

One study reported that 51% of older adults in the nursing home setting had a diagnosis of hypertension and that 94% of those with hypertension also had clinical cardiovascular disease, target organ damage, and/or diabetes mellitus. Statin therapy has proven to be effective for improving outcomes in the older patient in the nursing home setting by lowering cholesterol in these patients who are at risk for experiencing vascular events. However, the use of statin agents in older adults is associated with an increased risk of polypharmacy and medication interactions, gait disturbances, falls, increased blood glucose levels with an increased incidence of diabetes mellitus, liver toxicity, and myopathies. Lisa Byrd, PhD, FNP-BC, GNP-BC, discusses current recommendations and guidelines for the use of statins, identifies the patient population that would most benefit from statin therapy, described best practices for monitoring statin use, and lists the possible complications that can occur.

End-of-life care decisions for patients with late-stage, complex, chronic, progressive diseases are difficult for everyone involved. Many patients choose potentially life-extending treatments or interventions, but many others choose to reject these treatments. An example is the discontinuation of a permanent pacemaker, which may be construed as an immediate “life-ending” decision for the patient and as a potentially illegal assistance in suicide or euthanasia for healthcare providers. Michael Gordon, MD, MSc, FRCPC and Daphna Grossman, CCFP(em), FCFP address the psychology behind such decisions, the ethical principles and legal parameters by which such decisions are acted upon by healthcare providers, and the ways in which such decisions can be approached in a humane and supportive manner.

Due to improvements in medical care and nutrition and advances in technology, the number of people in the United States who are over the age of 65 is larger than ever before. Members of the health care team in long-term care facilities must be familiar with the medical challenges unique to this growing population in order to provide the best possible care.