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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It is well known that the older adult population around the world is rapidly increasing. This fact implies that health care systems must make readjustments to better meet the needs of elderly people, no matter their socioeconomic background.  Multimorbidity and needing social support increase as one grows older.  Health issues and disabilities due to age create burden for the older adult, his or her loved ones, and public health care systems.  A strong association exists between the number of older adults in the population and health care costs in developed countries. Health care costs for the elderly population have grown at a faster rate than those for younger adults, primarily because of inadequate systems that are unable to meet the varied and complex needs of vulnerable, frail, and impaired older adults.  Such situations clearly pose a threat to the sustainability of social and health care frameworks.  Due to these reasons, in the past few years, the calls for the implementation of preventative measures against age-related and debilitating conditions in older adults have increased.

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Medical care in long-term care facilities, such as nursing homes, is a complex task due to the high number of dependent older adult residents with comorbidities varying in severity, polypharmacy, and psychological, physical, and neurosensory impairments.  Unfortunately, the management of chronic illnesses such as diabetes mellitus and the prevention of atherosclerotic issues are very rarely addresses in this vulnerable population.

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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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A critical issue that has long been a challenge to manage is apathy among older adult residents in long-term care settings, such as assisted living and nursing home facilities.  Apathy is commonly seen in residents with neurodegenerative disorders.  For those with Alzheimer’s disease, apathy is the primary behavioral syndrome. It also may occur in the early of stages of mild cognitive impairment (MCI) and could act as an indicator for future development of dementia, especially in older adults with apolipoprotein E ε4.  The progression of dementia exacerbates the severity of apathy, and apathy may represent a behavioral marker of a more serious form of dementia, indicated by a faster development of mental, functional, and emotional deterioration.  Older adults with Lewy bodies and Parkinson’s disease also express apathy, even if they do not have dementia.  It is also a prominent syndrome in dementia related to alcohol.

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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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It is well known that physical exercise is beneficial for the body, no matter one’s age.  Even an editorial published last year in the Journal of the American Medical Directors Association deemed exercise “the ultimate medicine.”  Now, research has shown even more evidence that exercise is crucial for the human body, especially in older ages, when adults become more vulnerable to frailty and sarcopenia.

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