Journal of the American Medical Directors Association
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Randomized Controlled Trial Clinical Trial
Effectiveness of a group exercise program in a long-term care facility: a randomized pilot trial.
The purpose of this pilot was to determine whether a strength and flexibility program in frail long-term care facility (LTC) residents would result in improved function. ⋯ Frail elderly in a LTC facility were able to participate and benefit from a strength training program. The program was delivered with low-cost equipment by an exercise physiologist and LTC staff. The advantage of such a program is that it provides recreational and therapeutic benefits.
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Residents of long-term care facilities are at risk of serious medical illnesses and being unable to express choices when difficult treatment decisions must be made. Advance care planning (ACP) allows residents to consider, make, and communicate their preferences for how medical decisions should be made if they are unable to participate in the decision-making process. This article reviews the three steps in ACP: consideration of options and expression of values, communication of decisions, and documentation of the choices. The article defines and describes the particular value of ACP in long-term care facilities, reviews the literature on successful ACP programs in long-term care, and concludes with practical suggestions on how to develop and implement ACP programs.
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Clinical Trial
Pain Assessment for the Dementing Elderly (PADE): reliability and validity of a new measure.
To establish the reliability and validity of a measure to assess pain in individuals with advanced dementia. ⋯ The PADE is a reliable and valid tool to assess pain in dementing elderly residents of long-term care facilities.
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Permanent placement in a Long-Term-Care (LTC) facility following hospitalization or when staying at home is no longer a viable option is the reality for a growing number of Americans. When death is imminent, the specialized knowledge and skill of the hospice team is required and accepted as an important component of end-of-life (EOL) care. The provision of appropriate care at the EOL is contingent on accurate identification of those residents who are approaching the final stage of life. This study describes the prevalence, profile, and survivorship of residents admitted to LTC facilities, using the Minimum Data Set (MDS) designation of being at the EOL. ⋯ Residents designated as EOL who are admitted to LTC are a distinct group from other new residents, with identifiable needs requiring specialist attention. Accurate recognition that EOL is imminent is required for the development of appropriate strategies and resources for care.
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Comparative Study
Tube-feeding versus hand-feeding nursing home residents with advanced dementia: a cost comparison.
To compare the costs associated with caring for severely demented residents nursing homes with and without feeding tubes. ⋯ Nursing homes are faced with a potential fiscal incentive to tube-feed residents with advanced dementia: tube-fed residents generate a higher daily reimbursement rate from Medicaid, yet require less expensive nursing home care. From a Medicare perspective, tube-fed patients are expensive due to the high costs associated with feeding tube placement and acute management of complications. Further work is needed to determine whether these potential financial incentives influence tube-feeding decisions in practice.