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There's No Place Like Home


Warshaw G. There's no place like home. Annals of Long-Term Care: Clinical Care and Aging. 2013;21(1):10.


Gregg Warshaw, MD.

We hope you had a wonderful holiday season and that the New Year has been off to a good start. Whether you spent more time at home during the holidays or were away, you probably felt at some point that there truly is no place like home. After a long day at work seeing patients, or even after a fantastic vacation, it’s always a good feeling to come back home. This is not surprising given that home is where you can just relax and access all the familiar comforts. In this issue of Annals of Long-Term Care: Clinical Care and Aging® (ALTC), we include several articles that in some way explore the concept of home and comfort.  

In “Reducing Wandering Through Improved Waiting Room Design”, the authors discuss how moving into a space that evokes feelings of home has curtailed wandering among their patients with dementia. Before this move, the authors’ dementia consultation office resembled a traditional healthcare office space. There was fluorescent lighting, regular padded chairs for seating, and staff was located behind a sliding glass window. Other medical offices were located down the hall and an elevator ride was required to get to the office. While caregivers consulted with healthcare providers, office staff would often have to sit with patients to keep them from wandering away, and caregivers would sometimes note that the office environment made their loved one anxious and restless. After the office moved into a two-bedroom condominium that was furnished like a regular living space, the wandering problem was eliminated and patients appeared at ease. The authors speculate that a home-like environment provides patients with a sense of familiarity and taps into their often-expressed desire to remain at home. 

When most of us think of our ideal home, it’s often a clean and well-organized space. But some people view things differently. In “Hoarding by Elderly Long-Term Care Residents”, the authors examine the issue of compulsive hoarding of possessions in the nursing home setting. Although hoarding has been brought to the public’s attention through reality TV shows, little information is available on how to manage hoarding by nursing home residents. In this population, hoarding poses unique problems because these persons are more clinically complex and have smaller areas in which to store their possessions. In addition, nursing homes need to maintain a clean and safe environment for residents and staff. Because hoarders derive emotional comfort from acquiring possessions, when this source of comfort is taken away, other comfort strategies likely require consideration. In addition to their general review of hoarding by elders, the authors examine some treatment strategies for nursing home residents based on their review of the scant literature. 

If you ever held an open house to sell a home, your realtor may have suggested that you bake cookies in the oven beforehand as a way to entice buyers. After all, what evokes a greater sense of comfort and of home than the aroma of something warm and delicious baking in the oven? Because food is associated with comfort, it is exceedingly difficult for families to decide what to do when their loved one loses the ability to self-feed and maintain adequate nourishment because of advanced dementia. Although the literature does not support improved survival with use of percutaneous endoscopic gastrostomy (PEG) tubes, they are still frequently used in late-stage dementia. The article “Feeding Dementia Patients via Percutaneous Gastrostomy” advocates for the contrarian position that PEG tubes can sometimes keep people alive for months or even years, and the authors indicate that it may be better in some cases to place these tubes at an earlier stage of dementia, when malnutrition first becomes apparent. By placing PEG tubes earlier, the authors postulate that patients may avoid developing more serious debilitating conditions that might render later PEG placement futile. 

On the other hand, in the article “Tube Feeding Versus Assisted Oral Feeding for Persons With Dementia: Using Evidence to Support Decision-Making”, the author notes that the literature shows oral assisted feeding to be a viable option to maintain weight and caloric intake for patients with dementia, and that this strategy is generally preferable to feeding through artificial means. In addition, the author notes that assisted oral feeding may be another way to provide comfort when weight gain or maintenance is no longer the goal of medical care. Let us know your views on this controversial topic. We plan to publish a sample of letters from readers in a future issue of ALTC.

We hope you find the articles in this issue useful. As always, we welcome your feedback. You can send your comments to Allison Musante at Letters may be published in an upcoming issue of the journal.

Thank you for reading!

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