Optimizing Disease Screening and Treatment Management in LTC

November 7, 2018
Gregg Warshaw, MD
Medical Editor

Immunosenescence, multiple comorbidities, and close-quarter living increase the risk for infectious disease in long-term care (LTC) residents. This setting also contributes to difficulties in screening for and treatment of diseases. The articles in this issue of Annals of Long-Term Care: Clinical Care and Aging address screening and treatment of latent tuberculosis infection (LTBI) as well as enhanced medication management approaches for LTC to improve care efficiency. 

Diagnosing active TB poses specific challenges in older adults, as they tend to have atypical presentations of active TB with involvement of the meninges, kidneys, and skeletal system, and pulmonary involvement with negative sputum test results. This atypical presentation of active TB underscores the importance of screening older adults in all settings and particularly LTC facilities, where an outbreak would have a huge public health and regulatory impact. With the current culture shift toward enabling aging at home instead of in traditional LTC facilities, many older adults are able to live independently with additional support services or in alternative group environments. This has led to a variety of living and care settings such as the Program of All-Inclusive Care for the Elderly (PACE), group homes, continuing-care residential communities, and Green House facilities, all of which pose a new challenge in terms of screening protocols for communicable disease. Shenbagam Dewar, MD, and Theodore Suh, MD, PhD, MHS, present a case series of 7 patients who screened positive for LTBI upon enrollment in a PACE program in Michigan; the screening and confirmatory tests for LTBI are discussed, as well as the feasibility of the standard 9-month isoniazid and 3-month short-course isoniazid plus rifapentine treatment regimens in this setting.

In 2013, the Washington State Legislature passed a law that allowed certified medication assistants (MA-Cs) to administer certain medications to residents in nursing homes (NHs). With this opportunity in mind, the Geriatric Interest Group of Spokane (GIGS) began investigating the possibility of launching an MA-C training program to answer the shortage of licensed practical nurses and registered nurses in local NHs. In preparation for the project, authors Neva L Crogan, PhD, ARNP, GNP-BC, ACHPN, FAAN, and Aditya Simha, PhD, first queried nursing staff to identify the potential barriers to adding MA-Cs to the staffing model of one or more local NHs. Their findings from this survey are presented, followed by a description of the planning, implementation, and evaluation of an MA-C quality improvement initiative in one Eastern Washington NH. It was hypothesized that if routine medication administration were assigned to another professional, nurses may have more time to coordinate care and focus on resident needs. 

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