Planning Postdischarge Care with Cognitively Impaired Adults

McCauley A patient performs the CLOX 1, a clock-drawing task used to assess patients for cognitive impairment. Photo by Ed Eckstein.

By Shawn Kennedy, AJN editor-in-chief

The transition from hospital to home can be fraught with pitfalls, especially if the patient in question is an older adult with multiple conditions and a not-so-prepared caregiver. The transitional care model, in which NPs coordinate care and provide follow-up care after discharge, has been shown to be successful in reducing hospital readmissions in this group of patients.

With Medicare levying penalties on hospitals with higher-than-average readmissions rates, the stakes aren’t just high for patients and their families. Might similar models of care also work with cognitively impaired adults?

In “Studying Nursing Interventions in Acutely Ill, Cognitively Impaired Older Adults,” a feature article in AJN‘s October issue (free until the end of October), Kathleen McCauley and colleagues from the University of Pennsylvania seek to answer this question, among others.

In the article, McCauley and colleagues describe the methodology and protocols used in their study, summarize their findings, and discuss some of the challenges in conducting research in the clinical setting. Among their findings is the important lesson that research involving cognitively impaired older adults must actively engage clinicians, patients, and family caregivers, as well as the need for hospitals to make cognitive screening of older adults who are hospitalized for an acute […]

Poor Assessment of Nursing Home Residents’ Pain — What Can Be Done?

A recent study sought to find out whether relatives and caregivers (proxies) understood residents’ pain well enough to assist in pain assessment and to discover what factors affected their judgments of pain. The findings showed, however, that their reports didn’t consistently match the pain ratings of nursing home residents themselves.

It’s particularly difficult to assess pain in cognitively impaired nursing home residents. This means that there’s a lot of suffering that goes untreated. This AJN article in the December issue discusses the findings of a new study on the topic and offers some recommendations we obtained from the study authors. Here’s another excerpt:

The authors suggest that pain management in nursing homes could be improved through caregiver education, including the implementation of pain assessment education in combination with treatment. They recommend basic training for nurses and nursing assistants on pain, pain behavior, and pharmacologic and nonpharmacologic pain treatment, such as “massage, applying warmth, mobility[, and] distractions with music or story telling.” They also suggest that “treatment effects could be determined more easily using a pain observation scale.”

So check out the article, and also let us know what else can we do to more accurately assess the pain of nursing home residents.

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