Articles Posted in Quality of Care

Dementia is a serious group of cognitive conditions that promotes progressive deterioration in cognition, increased apathy, and reduced level of physical functioning.  Many older adults, especially those living in long-term care settings such as those in nursing homes or assisted living facilities, suffer from dementia. According to recent reports, more than half of the elderly nursing home population suffer from symptoms of agitation and almost 40% suffer from depressed mood.  These findings are highly similar to those of international studies that have explored the prevalence of neuropsychiatric symptoms expressed in nursing home patients with dementia.  Specifically, they found that the prevalence of neuropsychiatric symptoms significantly increases with severe dementia.  Therefore, it is no surprise that substantial evidence has proven that there is a strong association between dementia’s symptoms of depression and behavioral disorders and decreased quality of life.

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Dementia prevention and treatment has become a pertinent public priority over the years, particularly due to the growing aging population worldwide.  Although some researchers suggest that trends in potential causes of dementia in regards to medicine, lifestyle, and society have most likely led to a decrease in the numbers of people with the disease, statistics show that there will be a global increase in the number of people with dementia with up to 114 million individuals by 2050. Unfortunately, no cure has yet been found for dementia. However, it has been postulated that future numbers of people with dementia may be improved with disease-modifying interventions to combat or stall the progression of the disease.  Strong evidence has indicated that intervention in regards to hearing impairment could contribute to slowing down the onset of or decreasing the likelihood of cognitive decline.

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One of the primary concerns for both skilled nursing facilities (SNFs) and hospitals is the high rate of 30-day hospital readmissions and emergency department (ED) transfers by older adult patients.  The Centers for Medicare & Medicaid Services (CMS) recently included these events as short-stay quality measures that will give skilled nursing facilities further incentives to decrease potentially preventable hospital transfers.  Skilled nursing facilities are increasingly pressured by hospitals to decrease 30-day readmissions due to financial penalties to hospitals for specific readmissions and high readmission rates in general.  Moreover, it is imperative that skilled nursing facilities decrease the high number of preventable hospital admissions and emergency department visits due to the increasing number of Medicare advantage patients, accountable care organizations, and combined payment programs.  The skilled nursing facility hospital readmission quality measure that is going to be established in the upcoming years will give further incentives for these facilities to decrease readmission rates.

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The prevalence of chronic wounds located in the lower extremity area is high among older adults.  Not only can they be extremely deleterious and pose major health risks, they also increase socioeconomic burden because of the high expenses of wound care, long duration of healing time, increased complication rate and negative effect on patients’ and loved ones’ quality of life.  Chronic wounds are related to heightened mortality and significant morbidity because of infection, loss of ability to perform daily activities, pain, and psychosocial issues. Health care clinicians must be trained to identify and diagnose wounds, as well as provide proper management of their etiology. The four most common chronic wounds are venous leg ulcers, diabetic foot ulcers, pressure ulcers, and arterial ulcers.  Although there have been recent advances in wound care, care providers are still struggling to provide the best quality of care in this area, especially for elderly people living in nursing homes and assisted living facilities.

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It is well known that the older adult population residing in long-term care settings are highly heterogeneous, characterized by high rates of dependency in the performance of activities of daily living, multiple diseases, and polypharmacy.  Although it may be challenging, nursing home and assisted living facility staff must provide the best possible care to their residents, striving to meet their needs and staying vigilant for any risk factors that may cause residents to experience adverse outcomes.  According to a recent report from the United Nations, the number of older adults ages 60 and above is predicted to increase by more than double by 2050, with elderly people ages 80 and above constituting the age group with the greatest increase in growth.  The number of older adults residing in long-term care facilities is also predicted to increase, resulting in a critical increase in health care expenses.

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The experience of symptoms indicates common and burdensome issues for older adults, especially for patients suffering from a variety of chronic diseases.  They significantly influence the person’s quality of life and overall functioning, could indicate risk factors for more serious problems, and are credited for increasing the use of health care and associated expenses.  Thus, it is important for elderly care providers and other specialists to identify, assess, and treat these symptoms.  Anergia, defined as the self-perceived lack of energy, is a prevalent complaint among older adults that is related to negative health outcomes.  In a recent study, about every one out of two older adults with comorbid diseases reported experiencing a lack of energy during the previous week, resulting in high levels of distress.

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Known as the “silent killer” due to its lack of expressed symptoms, hypertension is one of the primary preventable causes of premature cardiovascular disease and mortality in the world. The elderly are particularly effected by this disease.  More than 25% of all adults worldwide have hypertension and more than 50% of adults 60 years of age and older are hypertensive. Clinical management of hypertension takes up a significant part of the primary care clinical workload.

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Incontinence is a serious health problem that can affect both men and women at any stage of life.  Although the likelihood of experiencing incontinence increases with age, incontinence is not a normal age-related health issue. Not only does incontinence pose critical psychological and social constraints, it also significantly diminishes an older adult’s quality of life and increases the need for nursing home care. Incontinence is defined as the uncontrollable loss of urine or feces or a combination of both.  Urinary incontinence (UI) is described as “any involuntary loss of urine.”   Staff in nursing home facilities are responsible for providing direct care to their residents.  Thus, nurses are critically responsible for treating and caring for patients with incontinence.

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As the older adult population continues to escalate in North America, so does the elderly population residing in nursing homes and assisted living facilities toward the end of life.  Most older adult residents in long-term care are predicted to die in a nursing home (an estimated 80%) or to be discharged or transferred to a hospital right before passing away. The duration an older adult stays in a nursing home is not long: 20 to 25 months on average in Canada and 5 to 33 months on average in the United States. The quality of death these elderly residents experience as a primary component of late-life quality of life is clearly critical. Unfortunately, many long-term care residents near the end of life are victims to burdensome symptoms and potentially deleterious care practices.

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The rate at which older adults in post-acute care (PAC) facilities are readmitted back into the hospital due to an adverse event is far too high. According to the Office of the Inspector General, 22% of all hospitalized Medicare beneficiaries discharged to post-acute care facilities are victims of an adverse event that sends them back to the hospital. 60% of the adverse events were found to be preventable with better care procedures, such as enhanced medication reconciliation and more vigilant patient monitoring. Residents in post-acute care facilities who experience hospital readmission are less likely to return to the community. Is it crucial that rate of readmissions from post-acute care is significantly reduced.

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