Depression is a disease that involves chemical changes in the brain and impacts the entire body, not just the mind. People who suffer from depression often lose or gain weight, have poor sleep habits, and lack energy.

Almost everyone feels sad, lonely, or unhappy at times. But a person suffering from depression feels this way all or almost all of the time. With the exception of anxiety, depression is the most common mental disorder in the United States.

Many nursing home residents suffer from depression. Symptoms of the disease usually develop slowly over a period of days or weeks. Very early signs of depression include decreased physical and mental activity, and feelings of sadness, irritability, and anxiety.

When people are clinically depressed, they may exhibit any of the following symptoms:

Inability to concentrate
Complaints of physical illness
Inability to feel pleasure or other emotions
Increase in self-critical thoughts
Increase in sleep disturbances. It may be difficult to fall asleep, stay asleep, and wake up at the usual time. May feel excessively tired after a full night’s sleep
Changes in appetite and eating habits
Feelings of helplessness and hopelessness; thoughts or threats of suicide.
Personality changes, such is irritability or introversion
Increase in sexual promiscuity or loss of sexual interest
Increas in use of alcohol or drugs.

If many or most of these symptoms persist for longer than two weeks, there is a good chance that the diagnosis will be clinical depression. Next week, we’ll discuss causes, diagnosis, and treatment of depression.

For LTC Nursing Leaders

Violating the top OSHA citation may cost your SNF money

Published December 2004

If the Occupational Safety and Health Administration (OSHA) knocks on your facility’s door tomorrow, do you know where inspectors’ trained eyes will turn? Although ergonomics is a big focus for OSHA during nursing home inspections, ergonomics violations are not the top trouble spot for skilled nursing facilities (SNF).

Instead, citations related to the bloodborne pathogens standards head OSHA’s nursing home inspection list-by a long shot. Between October 2003 and September 2004, OSHA cited violations under the bloodborne pathogens standard a total of 305 times during 120 inspections as of November, according to OSHA’s Web site. SNFs paid a total of $127,767 for these citations.

“Keep in mind that those statistics [show citations by] federal OSHA only. There are 24 states that enforce their own occupational safety laws, and 26 states have federal OSHA offices enforcing safety laws,” says Sam Church, BA, MA, managing director of The Safety Department, a consulting agency in Pittsburgh.

Although the bloodborne pathogens standard is broad, don’t feel overwhelmed. You already know how important documentation is for reimbursement and resident care, and OSHA compliance is no different. The following documentation gaffes can be cause for citation in OSHA’s eyes, according to Church:

* Omitting a standard requirement from your written policies and procedures. Your exposure control plan must address all bloodborne pathogens standard requirements. “Even if you’re doing [every safety procedure] right, if it’s not written down correctly, it’s a violation,” warns Church.

* Training lapses. If your facility fails to educate employees who were absent from the facility’s annual required bloodborne pathogens refresher training-and you don’t have proof that your SNF trained those employees at another time-OSHA could issue a citation.

* Employer certifications. This important component is a required element of your policies and procedures. An individual must sign the policies and procedures to certify that the facility in fact adheres to its written practices and provides adequate training. That way, OSHA can hold a person accountable for the organization’s actions, Church explains. “This is similar to what you’ve seen with the Sarbanes-Oxley Act.”

* Policies and practices don’t match. If staff fail to practice an element of your facility’s policies and procedures, it is also a violation.

But that’s not all you should document. The federal OSHA standard requires you to assemble a staff committee to review bloodborne pathogens safety, such as testing safer needle devices or evaluating needleless techniques, says Libby Chinnes, RN, BSN, CIC, infection control consultant in Charleston, SC.

Keep a record of your staff committee’s meetings and actions. Many facilities document this information as an addendum to their exposure control plans, Chinnes says. They include which safety devices staff reviewed, which staff participated, and which devices they adopted.

Source: Adapted from Briefings on Long-Term Care Regulations (December 2004), published by HCPro, Inc.

Multiple Sclerosis (MS) is a progressive, immobilizing disease. The disabling effects of MS are the result of damage to the nerves of the brain and spinal cord. Normally, the nerves are covered by a fatty sheath called myelin, which works much like the insulation over electrical wires. MS causes the myelin to become inflamed and damaged. As a result, scar tissue develops—causing a disruption in the messages to and from the brain.

Because the scar tissue may develop in several different areas, symptoms of MS will vary between residents. The following are some nursing care measures for you to be aware of when working with MS residents:

Vision: Vision may be lost suddenly or over time, or residents may experience blurred or double vision. Visual impairment can increase the danger of falls. To prevent an accident, do not move furniture without the resident’s knowledge. Residents with vision problems will also need additional assistance with ADLs.

Communication problems: Residents with MS often have difficulty speaking and writing because of nerve damage and tremors. Nursing staff should try alternative methods of communication and report successful results to other staff members. Although a resident may have difficulty communicating, it does not mean he or she does not understand.

Skin integrity: Watch carefully for early signs of skin breakdown. Because of immobility, decreased sensory function, and incontinence, the skin is prone to breakdown. Follow standard procedures for prevention of pressure ulcers.

Changes in urinary and bowel patterns: Urinary and bowel retention and incontinence can occur as a result of muscle spasms. Keep accurate records and report changes in urinary and bowel patterns to your supervisor.

Anxiety and depression: Anxiety and depression are common in people with MS. The earlier the signs are reported, the quicker help can be obtained. If you observe symptoms of depression, don’t ignore them or attribute them to “sadness” about being ill. Depression and anxiety can be treated successfully with medication and counseling.

Residents with MS have varying degrees of disability. The nursing care provided should be geared toward each resident’s individual symptoms and conditions.

Better bathing for residents with Alzheimer’s

Can caregivers help residents with Alzheimer’s cope with bathing? A Massachusetts pilot project investigates

Most experienced nursing staff members would have no trouble guessing a CNA’s least favorite job on an Alzheimer’s unit—bathing. The Commonwealth of Massachusetts recently funded a pilot project to improve working conditions for frontline staff in nursing homes and enhance quality of care for residents with Alzheimer’s Disease and Related Disorders (ADRD). Bathing was chosen as the area most in need of attention.

When asked what they disliked about bathing residents with ADRD, CNAs cited examples of aggressive resistance that caused them emotional distress and concern for their physical safety. Some of the behaviors reported included kicking, scratching, grabbing, screaming and cursing at CNAs, pulling on shower hoses, and pounding the bathwater, soaking the CNA and the tub room. One CNA reported, “A soiled patient was fighting and I got scratched and had to go to the hospital for a tetanus shot.” In fact, bathing can be a time of increased risk of injury to residents and caretakers caused, in part, by physical struggles.

Such resident behavior comes as little surprise when one considers the bathing experience from the perspective of a resident with ADRD. Residents who are disoriented are predictably irritated or agitated by splashing water, the multiple transfers from bed to bath, being naked in front of others, time-pressured CNAs, or simply a dislike of showers or baths.

Standard care in participating nursing homes in this pilot project entailed washing each resident on a prearranged weekly schedule in moderate- to large-sized sterile, windowless rooms often described by residents and CNAs as cold, referring to both temperature and the stark atmosphere. In some settings the tub or shower room was oppressively hot with no apparent air-circulation system. In others the tub room doubled as a warehouse for spare wheelchairs and equipment. Residents were assisted and belted into either a stiff shower chair or a tub chair and, in the case of a bath, elevated several feet in the air, swung over the deep bathtub, and mechanically lowered into the tub.

Was there a safer, more pleasant, and healthy alternative?

The Project
Two CNAs with specific training about Alzheimer’s disease were selected by the staff developers at four nursing homes to participate in the project. Their goal: to apply the recommendations of Joanne Rader, who provided training to the facilities based on a publication she edited, Bathing Without a Battle: Personal Care of Individuals With Dementia.1 The recommendations indicated that the distress associated with bathing residents with ADRD can be decreased or eliminated to make the bathing experience positive and pleasant for both resident and caregiver. The key, the authors found, is to change bathing from a task performed on a body into an activity between two people in a relationship. This involves identifying and implementing a bathing plan individualized to meet the needs and preferences of each resident. They further recommend consideration of nontraditional bathing techniques that can be managed within nursing facility guidelines and constraints.

Each CNA chose one resident with a history of bath refusal and aggressive behaviors with whom to try an individualized bathing approach. CNAs and staff developers agreed to attend training sessions and project meetings and to document their experiences on checklist forms. CNAs were interviewed immediately after bathing trials.

Strategies for Optimal Bathing Experiences
CNAs were instructed and encouraged to experiment with several different bathing strategies during the six-month trial period.

Towel bathing. Project CNAs learned a towel-bathing technique in which a resident is cleansed thoroughly using warm, damp, soapy towels while remaining in bed. The resident stays under the warmth, comfort, and privacy of blankets, in the relative familiarity of his or her room, and is washed without the distracting and, for some, painful spray of a shower.

CNAs reported some initial awkwardness with the new approach, including pressure to complete the bath before the wet towels cooled. Once towel bathing is learned, however, it can be done by a CNA working alone in less than 15 minutes, often in less time than it takes to give a tub bath. Even in early experiences with this technique, staff reported positive outcomes. “It helps calm agitated people,” reported one CNA. “It saves time. No time is lost transferring patients into shower or tub,” added another. And staff remarked that the towel bath is good for observing skin condition.

Benefits of this new approach quickly traveled beyond the scope of the study. One CNA reported that towel bathing was a wonderful alternative to working with non-ADRD residents who didn’t like bathing. “And it would be good for want-to-stay-in-bed types,” added another CNA, emphasizing that towel bathing could be a matter of preference rather than need.

CNAs also liked towel bathing for working with residents with late-stage disease and those who were difficult to transfer because of hip fractures, paralysis, or recent surgery. They also thought it would be useful with residents “on precautions” for contagious conditions, such as skin infections, because they could be bathed without leaving their own rooms.

Massage. In the second training session CNAs were taught massage techniques for the frail elderly that could be integrated into the bathing process. This was the most widely used variation reported by CNAs in the bathing project and one most enthusiastically received by residents. As a result, CNAs promptly began offering massage to other residents experiencing agitation, pain, or other discomforts, whether physical or emotional.

Individualization. Determining the residents’ bathing preferences was not addressed regularly in the preproject bathing routines. But how do you begin customizing care for a disoriented resident? One CNA summed up her learning and advice to others:

Ask a resident what he wants. No matter how disoriented he is, he always remembers some bits and pieces of his past.

Read a resident’s chart to learn about his likes and dislikes.

Ask aides who have more history with that resident than you do for more information.

Ask family about the resident’s past.

Observe what the resident responds to best (i.e., best time of day for each resident.)

“Know the residents and do what they want,” was her overall recommendation, a guideline promoted by the project’s design. As CNAs bathed the same residents week after week, both reaped the benefits of a more familiar and more trusting relationship, according to CNA reports.

With repeated experience, each CNA became familiar with the keys to compliance for her project resident, and tailored bathing accordingly. Sometimes this had nothing at all to do with shower versus tub versus towel bath, but hinged on the promise of a milkshake later or a reminder that family would be visiting that day. This interaction was a result of knowing her resident and using that knowledge to decrease resistance to bathing.

Verbal and Nonverbal Communication
Improved communication between resident and caregiver proved to be an essential tool in customizing bathing, a means to ascertain preferences. At the same time, enhanced communication emerged as a technique in itself for decreasing aggression during bathing. Examples of communication techniques include:

Orienting statements: I’m going to give you a massage and get you clean at the same time.

Opportunities for resident preferences: Do you want to get out now? You can stay longer if you’d like.

Combination of orientation and preference seeking: I’m going to put the bubbles on now. How does that feel? Does that feel good to you?

Reminiscing: Where did you use to vacation? Did you go to Cape Cod often?

Cheerful banter: You look like a queen in all those bubbles!

Nonverbal communication: CNAs often reported that they responded to a resident’s bathing refusal by leaving and trying again later, which is a way of respecting nonverbal expressions of preferences.

One CNA interviewed family members to learn about her resident’s background. She learned not only the woman’s pre-illness bathing preferences but also about the aspects of her life that made her most proud. The resident was for many years an accomplished nurse. The CNA now engages the formerly combative resident during bath time by discussing their common experiences in the nursing field. They talk about the many places where the elderly resident once worked, the resident glowing with pride while the CNA is completing a thorough bath. Because the CNA was able to distract the resident with conversation, no further adjustments to her bathing routine were needed.

Facilitating Institution-Wide Changes
Each participating nursing home agreed to integrate the identified “optimal bathing approach” for the project-involved residents into their care plans to ensure continued implementation. Project CNAs began mentoring coworkers formally and informally even before the end of the project to teach the techniques they were finding successful. Formal training in towel bathing and massage techniques was scheduled for groups of additional staff and, in one setting, for the entire caregiving staff.

Moreover, each site committed to writing policies and procedures that establish towel bathing as an accepted bathing practice at the facility, on par with tub baths and showers. Relevant policies were written for all sites by the conclusion of the six-month pilot project.

While administrative/managerial support is necessary for many changes, some meaningful outcomes were effected with interventions as small as improved communication with little to no draw on institutional resources.

One CNA involved in the project predicted at its conclusion that an outcome of this project will be more baths. When staff realize they can calm an agitated resident in just ten minutes with a towel bath or other soothing tub bath, she expects bathing will take place more often.

Challenges
Still, the current cultures and constraints of nursing homes can make change difficult. Although most CNAs agreed that individualization was preferable, nursing home baths are not always influenced by what the resident likes because of time pressures and staffing constraints. A resident may prefer a bath but the tub room may be occupied during the time allotted for her bathing. Showers were reported as the fall-back bathing option in each of the four sites, reportedly because of time considerations, yet for no resident in the project was a shower the most successful bathing approach.

Staffing shortages increase the pressures on CNAs to do tasks quickly. Learning a new strategy is often considered too time consuming. There is comfort in familiarity. This situation is often reinforced by supervisory staff who are reluctant to “rock the boat” with new and untried approaches.

Both supervisory staff and CNAs may need help in thinking beyond the task of bathing to see that if residents are upset by the standard shower method, they often remain upset for hours, disturbing others and taking more staff time overall.

Scheduling. Residents’ baths usually follow a fairly rigid weekly schedule, determined by nursing staff. Many CNAs reported that if the requested CNA was not working on the resident’s scheduled bath day, the resident would be bathed by a less familiar CNA, even if the bathing experience would be more combative or otherwise less successful.

Typically, CNAs change bathing assignments weekly or monthly. More consistent assignments would, in many cases, facilitate more successful bathing experiences, as indicated by this project.

Supporting changes. Working as a team, administrators, supervisors, and CNAs can develop procedures to improve the bathing experiences of residents, making them more pleasant and efficient.

Staff meetings conducted for this project served as support groups for CNAs to discuss experiences and share ideas. These meetings appeared to be a meaningful component to the project and are recommended for transitions in practice.

Conclusions
At the start of the project, bathing was documented as the most unpleasant task in a CNA’s workday, a task some colleagues tried to avoid whenever possible. By the end of the project, bathing was a more positive than negative experience. CNAs reported that bathing had, in fact, become an activity that they now chose to offer outside of scheduled bath times and that residents accepted voluntarily. CNAs offered evening bathing to residents with sleep difficulties to decrease agitation or simply because of resident preference.

Source

Preventing aspiration pneumonia in at-risk residents

Aspiration pneumonia is an infection in the lungs commonly perceived to be caused by food or liquid that goes down the windpipe (trachea) into the lungs, rather than into the stomach. However, aspirated bacteria are the true culprits. Which residents of your nursing home are at risk for aspiration pneumonia? The answer may surprise you. The resident who is diagnosed with aspiration pneumonia is often referred to the Speech-Language Pathologist (SLP) for evaluation of a swallowing problem, or dysphagia, but this is just one of several risk factors for aspiration pneumonia. Indeed, residents who do not have swallowing disorders also can fall prey to this illness. Formerly perceived as a simple cause-effect diagnosis, aspiration pneumonia is more correctly viewed as a multifactor disorder.

Who else is at risk?
The following categories describe other residents who are vulnerable to this illness.

Category 1: Anyone with a mouth, especially those with teeth or dentures, because of the presence of oral bacteria. Aspiration pneumonia can result when these bacteria enter the airway.1 When teeth or dentures are not brushed, the bacteria quickly multiply, potentially to the point where they completely fill the space they occupy. When a resident has dental cavities, bacteria multiply even faster. These bacteria can migrate to the pharynx, sinus, larynx and, finally, the trachea, bronchi, and lungs. They can enter the lungs by aspiration regardless of whether swallowing problems are present. In fact, most healthy adults aspirate small amounts of their own saliva during deep sleep, setting up the potential for pneumonia to develop. Those with dysphagia may aspirate even greater amounts of oral bacteria, as well as food and liquid, compounding their risk.

Category 2: Anyone who has an acute illness or who has experienced brain injury, surgery, or trauma—which are among the chief reasons for admission to nursing homes. One consequence of trauma is altered immune response, resulting in an inability to fight infection.2 The healthy person with mild to moderate sleep aspiration and a normal immune response does not develop pneumonia. However, victims of fractures, stroke, heart attack, and other traumatic occurrences suffer from a complex stress response that reduces energy expenditures but compromises respiratory immune function. Further, this response reduces saliva production, alters the normal oral chemical balance, and allows for growth of gram-negative bacteria. Combine that with three days of minimal oral hygiene, and nosocomial (facility-originated) pneumonia can arise.

Category 3: Anyone who is classified as “NPO” (nothing by mouth).3 Is that surprising? Although tube feeding and NPO are established treatment regimens for individuals in whom aspiration of food and beverages has been identified, researchers reviewing this practice have found that people receiving tube feedings are as likely to develop pneumonia as those with moderate aspiration.

When the mouth is not used for food and fluid intake, the natural process of washing down contaminated secretions to the sterile stomach does not occur. Also, oral care often is not perceived as needed for residents who do not eat and, as a result, bacteria grow rapidly in their mouths. Add to that the stress of the condition that precipitated placement of the feeding tube, and you have a resident with a compromised immune response. Aspiration of oral flora occurs and pneumonia follows.

Cumulative risks
Oropharyngeal bacteria, illness, trauma, and tube feeding are priority conditions that set the stage for pneumonia. Concern is heightened for residents with the added complications of:
Dehydration (inadequate salivary flow)

Malnutrition (altered immune response)

Chronic respiratory disease, such as chronic obstructive pulmonary disease (higher susceptibility to further insult)

Low mobility (poor pulmonary clearance and circulation)

Gastroesophageal reflux disease (GERD) (risk of aspirating stomach contents, especially if tube fed)

Diabetes (slow gastric emptying)

Source/MORE—->

Documentation clearly shows that acute and chronic ailments associated with advancing age place nursing home residents at increased risk for swallowing disorders. Recent studies have demonstrated that swallowing disorders may affect from 30 to 60% of residents. Swallowing issues predispose these individuals to malnutrition and its concomitant harmful effects. With weight loss and protein energy undernutrition shown to be strongly correlated with morbidity and mortality in the nursing home population, malnutrition and hydration are considered to be all-too-common problems.

Numerous studies have evidenced that there is a general decline in food intake with aging that parallels physiological changes in body composition, as well as progressive decreases in the basic functioning of organ systems. Effects of severe weight loss are also evidenced in findings of increased incidence of decubitus ulcers and poor wound healing. The respiratory system is also disturbed, with decreased maximal breathing capacity observed in undernourished residents. Finally, impact on the central nervous system is evidenced in decreased cognition and increased delirium.

In addition to neural and muscular losses, sensory changes that accompany the aging process further affect food intake. A decreased sense of taste and/or olfaction may diminish the palatability of certain foods, resulting in poor appetite; this decline in taste and smell may be compounded by the administration of varied medications.4 Decreased flexibility in physical structures related to swallowing and overall declinations in muscle physiology may also reduce maximal strength and pressure within the oral, pharyngeal, and esophageal systems.6 These physiologic changes may place the elderly at greater risk for developing dysphagia.

The long-term care resident who presents with both dementia and dysphagia poses a unique therapeutic challenge. The pronounced negative effects resulting from the varied number of influences detailed above clearly threaten residents’ nutritional status. This led us to undertake our study, the purpose of which was to explore a plan of care that would keep weight loss in this population to a minimum.

We initiated a pilot study at a long-term care facility one year ago aimed at providing a more comprehensive approach to improving residents’ nutritional status and encouraging weight gain. Pivotal to this study was the concept of handheld, highly spiced or sweetened snacks treated as a “medication protocol” to ensure both regular delivery and consumption. It was hypothesized that approaching snack intake as medication administration would ensure reliable delivery by staff and promote resident cooperation.

It was also hypothesized that handheld, highly spiced or sweetened snacks would be successfully consumed by this population for a variety of reasons: (1) residents’ self- feeding leads to their increased awareness of food; (2) snacks based on residents’ preferences (e.g., for sweet or spicy foods) are better tolerated; and (3) consumption of discrete, small amounts of food may serve to satisfy appetite without overloading the system.

The interdisciplinary team members specific to the initial pilot study were identified to include food and nutrition services, nursing, and speech-language pathology (SLP). Food and nutrition services were required to provide handheld, highly spiced or sweetened snacks while maintaining records regarding caloric content. Nursing was responsible for obtaining the pre- and poststudy weights and weekly indications; nursing also provided an in-service to define ways to apply a medication protocol to the distribution of snacks, and was charged with compiling logs to record distribution times and the percentage of food consumed. SLP was required to select the appropriate subjects for the study, provide and collect the daily logs, and coordinate weekly interdisciplinary meetings, as well as problem-solve for instances of resident noncompliance.

Six residents were selected for the first pilot study conducted over a period of four weeks. Participants included three women and three men, ranging in age from 81 to 101 years of age (mean age: 89.5 years). Each individual was presented with three handheld, highly spiced or sweetened snacks per day to be taken as “medication” at specifically timed intervals: two hours post breakfast, two hours post lunch, and two hours post dinner. The snacks were pureed/soft—for example, pureed salami with pureed pickle was spread on white bread with the crust removed; the bread was cut into triangles which were placed in the resident’s hand and the hand directed to the mouth. Our purpose was to bombard the oral cavity with increased taste; directing the hand was needed at times because of resident forgetfulness in self-feeding. Residents were weighed at the beginning of the study and then at one-week intervals for its duration to determine if the snacks were successful in increasing body weight. We also sought to determine which method of providing and dispensing the snacks was most efficient.

The purpose of the second pilot study was to determine the efficacy of snack recommendations without the benefit of using a medication protocol to ensure their achievement. Six different residents from the first study were chosen. Criteria for selection by the SLP included a diagnosis of concurrent dementia and dysphagia, as well as a significant weight loss triggering an initial evaluation. Participants included four women and two men, ranging from 80 to 96 years of age (mean age: 88.5 years). Snack recommendations continued to include handheld, highly spiced or sweetened snacks.

During this second pilot study, a medical chart review by the SLP was undertaken six weeks postrecommendation to: (1) determine when and how snack recommendations were initiated by the nutrition team, since they were not on a medication protocol, and (2) confirm the residents’ weights at time of the dysphagia evaluation and their weights following two months of intervention. In addition, whether daily snacks were indeed delivered routinely to each individual was assessed.

Results
Results of the first pilot study revealed that four residents gained weight, one maintained pre-study weight, and one lost weight. A review undertaken two weeks poststudy indicated weight gains were maintained. These findings were a positive indicator for continued consideration of the benefits of a timed provision of snacks. In addition, according to a staff survey conducted at the conclusion of the study, most of the nursing staff found that the prescribed protocol for administration of snacks was not excessively time-consuming.

Investigation during the second pilot study revealed that only one of the six patients actually received the recommended snacks as requested: a half sandwich and 4 oz juice daily at 2 pm along with a diet health shake. A weight gain of 1 lb was recorded during the period covered by the study. One other resident demonstrated a weight gain of 2 lbs; this appeared to be related to a diet change made at the time of the dysphagia evaluation, downgrading the resident’s diet from a chopped to a ground consistency for improved mastication and bolus control. Of the four remaining residents who received neither snacks nor a diet change, three showed continued weight loss while one individual’s weight remained constant.

The fact that the one resident confirmed as receiving snacks on a routine basis during the second pilot study did gain weight is reason to suggest that more must be done to encourage between-meal intake. This finding is also consistent with the earlier pilot study that revealed weight gain for the majority of participants. Comparison of the two studies is nonetheless striking for the significant breakdown in delivery of snacks during the second study and its apparent impact on the results: Without the input of the interdisciplinary team in conjunction with a concerted effort to provide snacks with the deliberateness of a medication protocol, follow-through was critically lacking, and residents lost the opportunity for improved nutritional status and potential weight gain.

The current study supports the following conclusions: An interdisciplinary team is essential to ensure complete follow-through of all nutritional recommendations. In approaching the concept of snacks as “medication,” intake can be prescribed by medical personnel to ensure its delivery, as well as encourage a different perspective on the part of the resident who refuses meals. It is critical that the medical and nursing staffs continue to learn about the benefits of maintaining nutrition in this population. In dealing with dysphagia, the SLP must be vigilant in examining all options available to encourage a positive meal experience. While self-feeding as an aspect of positive ADL independence represents an ideal scenario, creative methods must be explored to encourage food intake when self-feeding possibilities are compromised. A need exists for future research to determine appropriate intervention measures that will yield measurable outcomes regarding improvement in the self-feeding ability in residents with dementia. In addition, the weight gain noted in the resident having undergone a diet change supports the importance of offering less-restrictive dietary choices.

Further study should include a larger subject base from which to draw, possibly enlisting several long-term care facilities to participate. An interdisciplinary team should be assembled to ensure complete cooperation and follow-through of all recommendations, with the clear mission and understanding that improved nutritional status is ultimately an integral factor in enhancing quality of life for the elderly.

Source

This is an excellent article about side rails and safety. Read it, print it out and share it!

More than 2.5 million hospital beds are in use in the United States.1 The U.S. Food and Drug Administration (FDA) received approximately 575 entrapment reports from January 1, 1985, to January 1, 2004. 2,3 During this 19-year period, 358 people died, 111 were injured, and 106 were near-miss events with no injury. One limitation of the report data is that many adverse events may not be reported to the FDA; thus, the true number of bedrail entrapments may be unknown. Entrapments happen in all care settings—nursing homes, hospitals, and home healthcare. 4 Entrapment occurs when a resident/patient is caught, trapped, or entangled in the space in or about the bedrail, mattress, or hospital bed frame. 5 Sadly, entrapments can result in serious injury or death. Clearly, risk management strategies aimed at reducing or eliminating entrapment occurrence best serve resident/patient interests and an institution’s legal interests.

This is interesting…

Evidence Challenges Widespread Current Beliefs on the Treatment of Constipation
11 Jan 2005

New Evidence Highlights the Myths Surrounding Laxatives and Supports Their Use in Early Stages of Constipation -

A new independent review published in the American Journal of Gastroenterology,1 has revealed that widespread long-held beliefs for the treatment of chronic constipation are incorrect and unsubstantiated.

The Myths & Misconceptions About Chronic Constipation paper - written by four leading international experts in the field of gastroenterology - reveals that treatment practices, such as increasing fibre intake, fluid and exercise are not always the most effective methods of alleviating the symptoms of chronic constipation. Yet the release of new data from an UK inquiry has revealed that two thirds of the general public would increase fibre intake in the first instance to cure a bout of constipation.2

The paper also highlights that many widely held assumptions are not based on hard fact or medical evidence. One of the key learnings from this is that diet and lifestyle alone should not be assumed to be the cause of constipation in general. Although for some people a diet rich in fibre may be helpful, the authors conclude that in many people with more severe constipation, increasing fibre intake can make symptoms even worse, and that increased fluid intake has not been shown to provide significant relief except in people where there is evidence of dehydration.

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