Journal of the American Medical Directors Association
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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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A clinical study was conducted to measure the effectiveness and operational characteristics of a new device intended to reduce the incidence of falls in elderly patients at high risk of falling. The NOC.watch device consists of a credit-card size device contained within an adhesive "patch"worn on the thigh continuously for many days. The patch is small, wireless, disposable, waterproof, shockproof, and unobtrusive. When a patient's leg becomes weight-bearing (such as when a patient gets out of bed or stands up unassisted), the receiver emits an audible signal which both alerts the patient to sit down and also summons a caregiver. ⋯ The prototype NOC.watch device appears to have a large impact on reducing fall risk in nursing home patients, with minimal adverse effects. However, due to the lack of an equivalent control group, these results should be confirmed with a larger, randomized, controlled study to better estimate the true magnitude of the effect of the NOC.watch device on fall rates.
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To determine the prevalence of hypertension and the appropriate treatment of hypertension in older persons in an academic nursing home. ⋯ Of older persons with hypertension in an academic nursing home, 16% had poor control of their hypertension. There was overuse of calcium channel blockers and alpha blockers and underuse of diuretics, beta blockers, and ACE inhibitors in treating hypertension. Physician education needs to be intensified to provide better medical care of older persons with hypertension through the use of optimal doses of drugs found to be effective and safe by evidence-based studies.
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Because of difficulty experienced in assessing pain in frail older patients and the lack of pain assessment tools with standardization in the elderly, the Functional Pain Scale (FPS), an instrument incorporating both subjective and objective components to assess pain, was developed and evaluated. ⋯ The Functional Pain Scale was determined to be reliable, valid, and responsive. The responsiveness of the Functional Pain Scale was superior to the other instruments tested. The Functional Pain Scale is an acceptable instrument for assessing pain in older adults and may reflect changes in pain better than other instruments tested. Further testing in other populations is warranted.