Supporting Residents With Chronic Conditions
Chronic medical conditions, such as osteoarthritis, cardiovascular disease, chronic pulmonary disease, chronic kidney disease, neurological illness, and diabetes mellitus, are very common in older adults. The challenge of managing these conditions is compounded by the fact that many older adults experience multiple chronic medical problems. These comorbidities complicate long-term care (LTC) delivery and can adversely effect patients’ quality of life. Utilizing the entire care team to provide consistent medical management of these conditions as residents get older and as their chronic conditions progress can support better health outcomes for LTC residents.
Heart failure (HF) is an increasingly common condition in older adults and can be challenging to manage, especially in the oldest geriatric patients. Constant medical supervision and an interdisciplinary approach to medical management are often required. Seki A Balogun, MBBS, CMD, FACP, AGSF, and colleagues present a case series highlighting an approach to clinical management of the oldest patients with HF in a continuing care retirement community. This model of care facilitates a multidisciplinary approach to medical management, involving disciplines such as nursing, dietary, physical and occupational therapists, social work, and medicine. In the care model, three main strategies were utilized in optimally managing these medically complex patients with HF: medication management, close clinical supervision, and cardiology co-management.
Another chronic condition commonly seen in older adults residing in skilled nursing facilities is bipolar disorder, a mental illness characterized by periods of mania and depression. In older adults, bipolar disorder is associated with significant comorbidity and increased mortality. This patient population often exhibits atypical symptoms that mimic other conditions, notably delirium, dementia, or unipolar depression. Therefore, management of this chronic disease presents unique challenges. Although treatment is generally managed by a psychiatrist, geriatricians and the entire LTC team play important roles in caring for patients with bipolar disorder.
Jonathan T Stewart, MD, DFAPA, AGSF, and coauthors provide an overview of bipolar disorder presentation in older adults and discuss the considerations for diagnosis in this patient population. They also review management strategies for bipolar disorder in older adults, which they assert should be individualized based on the patient’s medical conditions, functional status, and level of compliance.
The medical social worker plays a significant role in the management of LTC residents with chronic conditions. With their understanding of the psychosocial influences on a patient as well as barriers to disease management, they are uniquely positioned to expand their clinical and disease management roles in LTC settings, helping patients to understand and manage all of their interventional needs and any behavioral and attitudinal changes that may accompany their health conditions.
Meaghan Conlisk, MHA, LSW, CHC, and Alex Casiano, MHA, LSW, describe the importance of the medical social worker in the context of the Triple Aim concept; that is, improving patient experiences, improving the health of populations, and reducing care costs. The authors argue that models of care that are led or supported by a strong social work component should be integrated into LTC settings in order to improve the care management of and quality of life for chronically ill patients while helping to reduce overall health care expenditures.
The articles in this issue highlight the importance of the interdisciplinary care team working together to manage patients with complex chronic conditions. Particularly in the LTC setting, integrated medical management strategies can be used to plan and implement more personalized care plans, better monitor patients’ health, and empower patients to take part in achieving their medical goals.
