The regular use of physical restraints on patients in nursing home facilities without an appropriate medical reason or regard for their dignity and wellbeing is not only a strong indicator of poor quality of care, but also a sign of elder abuse and neglect. Older adults with dementia in particular are affected by this organizational conduct and are vulnerable to debilitating physical and psychological side effects. Moreover, it is a violation of their human rights. In the United States, a staggering 38% of senior patients in these types of facilities experience being physically restrained at least once every day. Although a variety of organizations that strive to reduce or eliminate the use of physical restraints exists, most of their initiatives have not been successful. However, a longitudinal, multidirectional psychosocial and educational program that was developed to promote patient-centered care for older adults with dementia and reduce the use of physical restraints was implemented in 41 nursing homes with positive results.
Malnutrition is one of the primary dangers for older adult residents living in long-term care settings. Defined as the state of not having adequate food and micronutrient intake, malnutrition is common among elderly patients and can damage physical and cognitive functioning. Nursing home and assisted living facility staff must protect their patients from inadequate micronutrient intake in order to help maintain their quality of life and avoid increasing their risk of morbidity and mortality. Multiple factors at the patient (e.g., dementia), staff (e.g., training, staffing levels during meals), and home (e.g. quality of meals) levels interact and contribute to the increase in risk of poor food intake. Substantial research has shown that inadequate nutrient density of food is one of the top 10 deficiencies in nursing homes. These facilities must improve their quality of meals in order to promote food intake and enhance nutritional status and quality of life of their patients. Studies that have focused on micronutrient needs for improving the health and quality of life of residents in long-term care have found that even at the meal planning level, much improvement is needed in regards to nutrient density.
Innovative care environments are created for older adults with dementia to enhance patient-centered care. Studies have shown that green care farms, which provide 24-hour nursing care, are an excellent alternative to traditional nursing homes. These farms allow patients to engage in more physical activities and social interactions than residents in traditional nursing home settings, allowing them to have better quality of life and improved health outcomes.
Some recent discoveries have shown that there is a need to redefine the National Pressure Ulcer Advisory Panel’s (NPUAP) definition of deep tissue injury. Although etiological studies of deep tissue injury (DTI) primarily pertained to the characterization of biomechanical factors influencing its onset and progression, new findings suggest that the criteria of DTI should be evaluated and refined. According to a recent article published by Ostomy Wound Management (OWM), there are several reasons why the current definition is insufficient:
The prevalent use of forced arbitration agreements by corporations continues to plague our society. Not only are they used in long-term care facilities like nursing homes, they are also used in big businesses such as banks. Just last week, Wells Fargo took the heat in hearing rooms of congress and national television alike for scamming thousands of customers with fake accounts.
After the Wells Fargo scandal earlier this year in which the company admitted that its bankers created millions of fraudulent accounts, Wells Fargo is once again in the public eye for its attempt to stay out of courts by forcing the customers of these fraudulent accounts into closed door arbitration agreements. When existing customers were set up with fake accounts, they were entered into a new contract that required any disputes to be handled through arbitration and out of the court room. This new contract left existing customers dealing with an agreement that they never signed. The unfairness of this situation has left many customers without the legal rights to address the issue of fraudulent accounts in the court room or through a class action. Several Democrats have expressed their concern at the unfairness of these arbitration agreements and have advocated for legislation that provides remedies to those who were forced into these binding contracts without their consent. For example, California state Senator Bill Dodd introduced a bill to “override forced-arbitration clauses in contracts created through fraud”. This type of legislation would allow law suits to be brought against companies committing fraud despite the arbitration agreements in the customer’s contracts.
An editorial by the LA Times also disagrees with Wells Fargo’s ability to force their customers into arbitration for accounts their customers did not create, especially when these arbitration agreements are usually meant to favor the business rather than the consumer. Leaders such as Representative Brad Sherman and Senator Sherrod Brown have proposed similar bills to that of Senator Dodd’s, hoping to bar banks from requiring arbitration agreements in the future. Since these arbitration agreements are an attempt by Wells Fargo to stay out of the court room and settle disputes privately, the Consumer Financial Protection Bureau has proposed to prohibit banks from blocking future class action lawsuits brought on by customers. This will allow class actions to serve as a check on bank’s actions.
Similar to Wells Fargo’s practice of forcing their customers into arbitration agreements before doing business with them, some nursing homes and skilled living facilities also have their incoming patients sign into similar arbitration agreements before being admitted. These types of agreements are unfair to residents of these facilities since they are denied full legal remedies in the event that they are wrongfully treated. If their needs are not taken care of properly or they experience abuse and/or neglect residents with an arbitration agreement often find it difficult to pursue legal measures against the facilities that wronged them. These arbitration agreements create a legal barrier around these facilities, aiding them in avoiding law suits if they commit elder abuse or neglect towards their residents.
Falling is a common occurrence and a serious problem among the elderly population. A myriad of studies has found that the use of psychotropic drugs on older adult patients in nursing homes significantly increases the risk of falling. A recent study published by the Journal of the American Medical Directors Association (JAMDA) examined the relationship between fall occurrence and the prescription of psychotropic drugs and various categories of psychotropic drugs, such as antidepressants, antipsychotics, and benzodiazepines, among a representative nursing home population.
With more than 47 million people worldwide suffering from Alzheimer’s disease and other forms of dementia there is a growing need to identify the cause of these diseases as well as treatments for them. Millions of dollars have gone into the improvement of technologies and the research of brain mapping. At the USC Stevens Neuroimaging and Informatics Institute, Arthur Toga and Paul Thompson have been leading projects that are changing the world of neuroimaging. Toga and his team of researchers are on a quest to use digital imaging to map the brain. They believe that this type of detailed brain mapping will lead to solutions for neurodegenerative diseases such as Alzheimer’s and Dementia. Recent developments have led these scientists closer to the goal of better understanding these diseases and providing a breakthrough in how to prevent them.
As we begin to age our bodies react to the changing conditions and often sleep disturbances can begin to occur. The effects of aging can have an impact on the sleep cycles of the elderly. Sleep disturbances, common amongst seniors, bring about less meaningful REM sleep and shorter sleep periods in general. This puts them at risk of developing serious health conditions and increases the risk of injuries.
While the elderly need about 7-9 hours of sleep a night, many of them do not manage to sleep undisturbed for this long. About 50% of elders’ experience sleep insomnia and about 30% suffer from excessive daytime sleepiness. Both insomnia and excessive daytime sleepiness can bring about muscle strength loss, impaired mobility and balance, slower gait speed and awareness, often leading to accidents that could injure a senior. Other conditions, such as increased inflammation or insulin resistance, can also develop from these sleep disturbances.
An increase in the health of the elderly population has produced a spike in the number of elderly that undergo surgery at an older age. Elderly who are candidates for major surgery often run great risks that are increased when partnered with frailty. Frailty in s can increase the risk of complications during medical procedures and surgery, or with the prescription of medications. Yet, within the surgery population, frailty is believed to be seriously under recognized, leading to a lack of proper preparation of these patients. Diagnosing an elderly patient with frailty early on can seriously reduce the risk of unforeseen complications post medical procedures.