02/02/12

Residents aged 31–64 make up one of the fastest growing populations in long-term care. Statistics suggest that about 14% of new admissions are these younger patients, and they present some unique challenges for long-term care practitioners.

To help physicians and others address the needs of younger residents, AMDA has established a special committee to work on a toolkit addressing this issue.

Younger residents may be physically disabled but alert and hungry for intellectual stimulation and conversation. Or they may have brain injuries, addiction problems, or behavior issues. A young man or woman may come to the facility because a family no longer can care for the person. When this happens, the new resident often is resentful and the family has tremendous guilt. While facilities are prepared to handle the basic care these individuals require, their emotional, social, and medication needs require special attention.

Dr. Sharlene Rajapakse, an internist in Maryland and co-chair of the group working on the toolkit, said, “Many long-term care physicians are trained in geriatrics but aren’t fully prepared to deal with younger residents. For example, they need more guidance on preventive issues—such as screening recommendations—in this population. Clinical medicine and medication management also are different in this population.”

The other co-chair, Dr. Rebecca Ferrini, CMD, added, “Pain management issues also are different in the younger population. When you’re considering a patient with a 30-year life expectancy, the choice of pain medications is more complicated.” There also is more drug- seeking behavior in this population, a situation that can be challenging to practitioners used to caring for geriatric residents.

The committee surveyed AMDA members about their concerns and perceived challenges in caring for younger residents. The committee will hold a roundtable discussion on this topic during AMDA’s annual meeting in March, Long Term Care Medicine – 2012, in an effort to identify members with specific interest or experience in this area and to help tar- get research needs surrounding the care of younger residents. “There isn’t much research about younger residents in long-term care,” Dr. Ferrini said. “We are confident that future research directions can be established by people sharing their experiences and best practices.” (See Dr. Ferrini’s guest editorial on Huntington’s disease care on page 18.)

Dr. Rajapakse added, “We need to focus on specific case examples and find out what people have done in some of these situations. We need to hear about what they have learned, what not to do as well as what works.”

The toolkit, expected to be finalized and released some time next year, will follow the proven format of other toolkits in AMDA’s Long Term Care Information series. It will include background on the issue as well as useful tools such as staff educational materials and sample forms and documents. For example, Dr. Ferrini has an “Opiate Agreement” she uses with younger residents. Signed by residents who are able and willing, this form details goals of treatment, the cooperation that is expected of the resident, and other information.

If you are interested in the toolkit about younger residents, look to the AMDA website and other AMDA publications for updates on this issue.

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