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Resident Preferences and Managing Back Pain in Older Adults

Ann Longterm Care. 2019;27(4):3.

Gregg Warshaw, MD, Medical Director

warshawExperts are increasingly advocating for more person-centered care models in long-term care (LTC) settings that place resident values, past history, and current preferences at the forefront of care delivery rather than as integrated elements. Equally important as assessment of patients’ preferences are ratings of patient satisfaction. How satisfied a resident is with the fulfillment of important preferences can guide quality improvement in care delivery. Articles in this issue focus on the importance of integrating patient preferences into care. This issues also includes an article on diagnosing mechanical back pain more effectively by obtaining a detailed medical history from the patient. 

Assessment of resident preferences can serve as a cornerstone to care planning with reported preferences guiding care. However, we have not developed an effective approach to measuring and utilizing individuals’ reports of their satisfaction with preference fulfillment. Allison R Heid, PhD, and colleagues conducted a study at an LTC facility to determine if older adults’ satisfaction ratings for everyday preference fulfillment are consistent over a short period. Authors interviewed LTC residents at baseline and 3 days later to reassess satisfaction prior to adjustments by the care team to better align with the individual’s preferences or any changes in health status.

As medical care advances, specifically in the area of genetic testing and biomarkers, providers may need to have some difficult discussions with patients. The Human Genome Project opened the door to an explosion of scientific inquiry that has directly led to unraveling the underlying genetic contribution to many diseases. In her column on dementia, Freddi Segal-Gidan, PA-C, PhD, asks readers: “If there was a test that could show that you were developing changes known to be associated with one of the neurodegenerative dementias, would you opt for the test or not?” She emphasizes that providers will increasingly face these types of questions and will need to be ready to discuss the implications with patients and families. 

Finally, this issue includes a review article on diagnosing and managing back pain in older adults, a prevalent condition among the LTC population. According to Bahram Badri, MD, and colleagues, essential to accurate diagnosis and subsequent treatment approaches is the categorization of back pain into 4 patterns by way of a complete history and physical examination. An appropriate rehabilitation protocol, utilizing a multidisciplinary team that integrates medication, physical therapy, and behavioral therapy, can result in successful recovery from back pain without invasive procedures.

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