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Oral Care Screening and Medication Management in Long-Term Care

Ann Longterm Care. 2019;27(5):3.

Gregg Warshaw, MD

warshawThe articles in this issue of Annals of Long-Term Care: Clinical Care and Aging (ALTC) investigate oral care practices in long-term care (LTC) as well as an interdisciplinary approach to reducing antipsychotic use as piloted in five LTC facilities. 

While the need for appropriate oral care practices may seem obvious, many patients in nursing facilities are unable to complete such tasks independently and must rely on the staff for assistance. Current research suggests that adequate oral care is oftentimes not provided to patients who need it. Pneumonia is among the conditions targeted by the Hospital Readmissions Reduction Program because it has the highest morbidity and mortality rates of all hospital-acquired infections and is a major cause of mortality of residents in LTC facilities. Risk factors for pneumonia include the presence of respiratory pathogens in the oral cavity as well as changes in swallowing (eg, dysphagia). Poor oral hygiene has been found to be a significant risk factor for the development of pneumonia and to negatively impact overall well-being. In her study, Faerella Boczko, MS, CCC-SLP, BCS-S, investigated oral hygiene practices and assessments in short-term care and LTC units, the effect of independence in oral care, and the difference in oral hygiene quality in patients with and without dysphagia. 

There is a need for regular medication reviews in LTC settings, where frail older adults with multiple chronic conditions are more likely to receive multiple medications. Polypharmacy in older nursing home (NH) patients is a well-documented concern. Several large studies have demonstrated an association between treatment with antipsychotics and increased morbidity and mortality in people with dementia. Current literature on deprescribing for older patients in different care settings shows some promise with educational and multidisciplinary approaches. The Assess, Review, Minimize, Optimize, Re-assess (ARMOR) protocol, first published in 2009, was developed to approach polypharmacy in a systematic and organized fashion. The intent of the tool, which has been used in various settings, is to maintain a balance between evidence-based medicine and the physiology of aging; functional status, comfort, and mobility are upheld as the essential outcome measures for any medication change while using evidence-based strategies. Raza Haque, MD, and Zakia Alavi, MD, implemented the ARMOR protocol in 5 NHs to address the use of psychotropics and measured its impact on 7 Centers for Medicare & Medicaid Services NH quality indicators.

We are also pleased to announce that, moving forward, ALTC will be publishing occasional digital-only issues—accessible exclusively online. As readers already view issue content primarily online, we are embracing this digital trend while simultaneously lessening our impact on the environment by reducing paper waste. Readers can sign up for email alerts for new digital issues of ALTC on our website.

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