Clinical practice in nursing homes as a key for progress

Abstract

With the aging of the world's population there has become a major need for the development of nursing homes throughout the world. While some countries provide high quality care for the disabled elderly, in others this is not the case. Education of a medical director has been shown to improve the quality of the nursing home. Physicians need to have knowledge of how to implement continuous quality improvement and culture change. Key medical issues include moving to a restraint free environment, subsyndromal delirium, behavioral disturbances, weight loss, pain management, pressure ulcers, falls, hip fractures, polypharmacy, depression and frailty.

Can we improve care for patients with dementia?

“…this should be coupled with regular aerobic exercise at least 3 times a week. Cognitive intervention programs should also be included in the regimen (107)(108)(109). adequate control of hypertension and hypercholesterolemia in middle age will decrease vascular dementia and possibly alzheimer's disease.…”

Impoverished environment, cognition, aging and dementia

“…Some nursing homes try to improve this quality together with residents (Phillips et al , 2007 ). Low quality is often caused by poor pay, shortage of qualifi ed workers and high rates of staff turnover (Morley , 2010 ). However, in the care of physical activity and loneliness most nursing homes fall short in the 21st century despite the stimulation of physical activity since 1974 (Ice , 2002 ).…”

Frailty and polypharmacy

“…The decrease in L-thyroxine clearance with aging often results in excess L-thyroxine doses which lead to weight and muscle loss, osteoporosis and heart disease. The use of selective serotonin reuptake inhibitors (SSRIs), can lead to hyponatremia and delirium (54). Proton pump inhibitors (PPIs) are overused in older persons, leading to reduced vitamin B12 and calcium absorption and possibly bacterial overgrowth and clostridium difficile infections (55).…”