Preventative and Timely Care for Common Geriatric Conditions

Many preventive health measures are available to older adults, including screening tests (eg, mammograms), counseling about a healthy lifestyle (eg, exercise) and/or geriatric health issues (eg, incontinence), immunizations (eg, flu shot), and chemoprophylaxis (eg, aspirin). Ideally, older adults should receive preventive health measures from which they are most likely to benefit based on their health and remaining life expectancy. In this era of patient-centered practice, recommendations should incorporate patient preferences as well. 

The articles in this issue of Annals of Long-Term Care: Clinical Care and Aging (ALTC) discuss the management and potential prevention (or at least early recognition) of dementia and herpes zoster (shingles)—2 examples of prevalent geriatric conditions that most geriatricians are well-practiced in managing. Authors investigate how clinicians can utilize the latest evidence-based research and new agents to better manage and perhaps prevent these conditions, including how care settings may be optimized for management of these patient populations. 

In the October 2017 issue of ALTC, the American Geriatrics Society discussed the establishment of the Geriatric Emergency Department Collaborative (GEDC) “to help improve emergency care for our nation’s older adults.” In the present issue of ALTC, Allan S Vann, EdD, comments on that column and what he sees as a lack of recognition for patients with dementia and their caregivers when they seek care in the emergency room. He goes on to detail practical steps that can be taken by emergency departments (EDs) to optimize care for dementia patients accompanied by caregivers based on his own work and experiences with caregiving. For years, Dr Vann was a caregiver for his wife who had been diagnosed with early onset Alzheimer disease (AD); since she passed away, Dr Vann has made it a point to increase awareness of AD through frequent contributions to medical journals, caregiver magazines, and medical conferences. Leaders and interprofessional advisors for the GEDC add their response to Dr Vann, commending him for the issues raised and explaining how these concerns will be addressed through the GEDC. They acknowledge that there are as many questions as answers at such an early stage of this work, and they welcome the feedback from all stakeholders involved, including patients, caregivers, administrators, and leaders in order to make their efforts a success. 

Persons with dementia are at greater risk of experiencing a fall as a result of the loss of motor function, cognition, and difficulty in judging aspects of their environment. Previous studies have shown that hearing loss can directly influences fall rates. Coupled with the increased number of hospital visits and the potential for removal of patients from a group-living environment, the consequences of falling among residents of assisted-living memory-care facilities with dementia are multifaceted. Ethan Schonfeld and colleagues sought to investigate the relationship between hearing loss and falls in older adults with dementia, specifically nursing facility residents. By identifying those residents at a greater risk earlier, measures may be implemented to redcue falls and prevent associated complications.

Vaccination against shingles can reduce its occurrence, but vaccination rates are low in the older adult population, particularly among residents of long-term care (LTC) facilities, who are at highest risk of developing shingles. The live attenuated vaccine (Zostavax, Merck & Co) is contraindicated in immunocompromised persons, a population that is highly represented in LTC settings. The recent availability of a newer non-live, recombinant, adjuvanted herpes zoster vaccine (Shingrix, GlaxoSmithKline) offers the potential for a larger population to gain protection against the varicella-zoster virus reactivation and its associated complications and has more favorable outcomes for immunocompromised persons like those in LTC. Tolulope Famuyiro, MBBS, MPH, and colleagues discuss the need for higher rates of vaccination for herpes zoster and the benefits of this newer vaccine for this population. 

Together, the articles in this issue present proactive solutions to improve care and care delivery for prevalent and persistent geriatric issues. While being proactive in health care is generally a great strategy, preventative health measures should always take individual patient preferences and life expectancy into account as well.