Novel Ideas Lead to Innovative Solutions

Citation: Annals of Long-Term Care: Clinical Care and Aging. 2015;23(8)9

In long-term care (LTC), sometimes it helps to think differently about common problems in order to arrive at new solutions. The articles in this issue of Annals of Long-Term Care: Clinical Care and Aging® highlight some unique approaches being used in long-term care to meet the needs of patients in order to improve their quality of life.

Clinicians have highlighted the importance of meeting the psychosocial needs of older patients in LTC. Effective disease self-management can enhance life quality by increasing patients’ sense of independence. Patients may feel empowered by control of their own care, which, with appropriate support, can provide the necessary motivation to engage and persist in health-promoting behavior. Bibliotherapy, the therapeutic use of books or literature, is one self-management modality shown to enhance skills of daily living, including problem-solving and communication.

Benjamin A. Bensadon, EdM, PhD and Salim M. Qureshi, MD took the concept of bibliotherapy and sought to make it more accessible for all residents living in the community living center of the Oklahoma City VA Medical Center by using film instead of books. He and his coauthors conducted a pilot study to assess the feasibility of host monthly screenings of films with aging-related themes. The program appeared to enhance resident-directed care and quality of life by stimulating empathy and fostering a therapeutic sense of community. The authors note that the program can easily be applied in other LTC environments serving older adults.

Older adults living with multimorbidities, also referred to as multiple chronic conditions (MCCs), pose a challenge for clinical management that can negatively affect health outcomes. These individuals often require multiple hospitalizations, many of which may be avoidable. The rate of MCCs among older Americans is even higher than in the general population, presenting a growing need for comprehensive models of care in order to improve the care of individuals with MCCs.

The Program of All-Inclusive Care for the Elderly (PACE) is a model of care for treating patients with multiple chronic conditions in the community setting. PACE incorporates interdisciplinary team care and an adult daycare to meet the needs of older adults with MCCs for whom long-term care facilities are not culturally appropriate or financially feasible. Alex Casiano, MHA, L-MSW presents a review of the available literature pertaining to the PACE model of care and its ability to reduce hospitalizations in persons with MCCs. Core components of PACE, such the adult daycare center and the interdisciplinary team, are discussed, along with the limitations of the model. Other healthcare organizations, including LTC facilities, could greatly benefit from implementing aspects of the model, especially the interdisciplinary team of healthcare providers that promotes comprehensive care across the continuum.

Older medications that were once the treatment of choice for a particular indication often are prescribed less frequently as newer treatment options come on the market. Digoxin is a medication that has followed this pattern. However, there is evidence to suggest that digoxin may be useful for managing symptoms of congestive heart failure in the palliative care setting. Giulia-Anna Perri, MD, CCFP and colleagues describe two cases to illustrate the use of digoxin in end-stage heart failure with the goal of achieving better symptom control while managing the potential for digoxin toxicity. This article demonstrates how the management of end-of-life care sometimes requires physicians to seek alternatives to conventional treatment approaches.

Similarly, LTC clinicians must sometimes seek alternatives to conventional approaches to address the psychosocial, health, and quality of life needs of residents. The articles in this issue all provide examples of how innovative approaches can have powerful effects. It is important to encourage healthcare providers and staff to think outside the box when it comes to provide quality care to LTC residents.