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Putting the Patient First


Gregg Warshaw, MD; Medical Editor

Medicine has benefitted from the great advancements in science and technology that characterize the digital age. Organizational processes for delivering care have become faster and more efficient, and procedures and treatments have become safer, with more predictable outcomes. Although it is tempting to rely heavily on technology for support, let us not forget this important quote from William Osler: “The good physician treats the disease; the great physician treats the patient who has the disease.” Indeed, the human element of patient care may be easily overlooked when we become overwhelmed in our daily practice, especially facing the demands to provide care to the largest and fastest growing aging population that the United States has ever seen. This issue of Annals of Long-Term Care: Clinical Care and Aging® (ALTC ) speaks to this wisdom from William Osler, reminding us to slow down and put the patient back at the heart of what we do.

The desire of many individuals to remain in the community and “age in place” has been met with much apprehension about whether informal caregivers, home health aides, and other community providers are adequately trained to meet their complex medical needs. In our first article, Susan Robinson, MS, PA-C, and colleagues outline several alternatives to institutional long-term care and discuss for whom these programs are appropriate. They present the case of an elderly woman who was admitted to a nursing home following multiple emergency room visits for poorly controlled hypertension and diabetes, as well as an increased risk of wandering and falls. Preferring to live at home with her son, the resident was discharged to the community. The care team helped the woman and her son navigate a state waiver program that enabled them to have a home health aide for 5 days per week and bimonthly home visitation, which resulted in less acute care utilization and better control of her comorbidities.

Our next article highlights the importance of the human element in creating a high quality eldercare workforce and, in turn, improve resident outcomes. Aditi D. Rao, PhD, RN, and Lois K. Evans, PhD, RN, explain the concept and practical implications of nurse empowerment—the ability to take action, engage in decision-making, and take accountability. Based on a literature review, Rao and Evans assert that empowerment is associated with higher job satisfaction and lower rates of turnover, with improved care consistency, resident/family satisfaction, and other healthcare outcomes. Rao and Evans outline the role of the director of nursing for achieving this goal, and outline some of the challenges they face in overcoming the so-called accountability–preparation gap. A viewpoint column from Charlotte Eliopoulos, PhD, executive director of the American Association for Long Term Care Nursing, provides a wonderful complementary perspective on the risks and costs associated with insufficient nurse staffing.

Also in this issue of ALTC, we provide you with three clinical practice tools: two Quick Guide tear-outs and a tip sheet. The first Quick Guide, which introduces our Anticoagulation Road Map series, compares the characteristics of the four novel anticoagulants to warfarin in stroke prophylaxis. The second Quick Guide is intended to help clinicians diagnose epileptic seizures, which remains a challenge as most of the signs and symptoms are nonspecific and may present atypically in older adults. The third resource is a tip sheet to help with recognizing and preventing carbon monoxide (CO) toxicity in older adults. The tip sheet complements a case report presented by Ijeoma M. Muo, MD, MPH, and Steven R. Gambert, MD. CO toxicity is thought to be underestimated in older adults because the symptoms are often misattributed to other conditions or comorbidities, but taking the time to look at specific risk factors, such as increased exposure to fuel-burning appliances, could not only save the patient’s life but also the lives of the people with whom the patient resides.

Finally in this issue, Gambert calls our attention to a beautiful poem that circulates on social media from time to time, taking on an almost folklore persona. The poem, Too Old Soon®, reminds us to value elderly persons as individuals with life experiences from which we can learn and be enriched.

We hope that you enjoy the articles included in this month’s issue of ALTC. As always, we welcome your feedback, which can be submitted to

Thank you for reading!

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