Diabetes Management Is Less Aggressive in LTC Residents
Hemoglobin A1c levels (HbA1c) in the 7%–8% range recommended by the American Medical Directors Association and the American Geriatrics Association are met in many diabetic nursing home patients without the need for frequent glucose monitoring or care at a special diabetic clinic, according to results from a 12-month review of 168 diabetic nursing home residents in 20 facilities (average age 65 years). The data came from 18 health care providers (10 physicians and 8 nurse practitioners) in one practice who provided care to these patients.
The average HbA1c level was 7.1% for the 135 patients whose HbA1c levels were measured. Overall, higher HbA1c levels were significantly associated with age younger than 65 years, frequent use of insulin, regular glucose monitoring, and with regularly attendance at a diabetes clinic.
A majority (67%) of the 18 health care providers said they agreed that 7%–8% is appropriate for community-dwelling elders with diabetes. Of note, although 72% of the health care providers reported that their diabetes management of long-term care patients was less aggressive, compared with community-dwelling patients, they achieved fairly low HbA1c levels for the long-term care patients. In addition, the researchers found no association between HbA1c levels and a provider's perception of health status and life expectancy in patients younger than 65 years old, compared with those older than 65 years.
▸ Source: Variability in Glycosylated Hemoglobin Values in Diabetic Patients Living in Long-Term Care Facilities—Meyers et al.
Different Strategies Are Needed For Agitation vs. Resistance to Care
Agitation and resistance to care are two distinct behavior problems in long-term care patients that require different management strategies, based on an analysis of data from 23,837 residents in Veterans Administration nursing homes with diagnoses of Alzheimer's disease or dementia. Each individual was confirmed as not comatose and having a Cognitive Performance Scale (CPS) score greater than 0 (not cognitively intact), leaving 21,487 patients for the analysis.
The definition of agitation included repetitive questions and verbalizations, expressions of seemingly unrealistic fears, repetitive health complaints, repetitive anxieties and concerns, and repetitive physical movements. The definition of resistance to care included demonstrating resistance to any care including assistance with activities of daily living, eating, taking medications, or receiving injections.
Overall, 3,712 (17%) of the residents met the criteria for agitation and 1,951 (9%) met the criteria for resistance to care, and 1,717 (8%) met the criteria for a combination of the two. Agitation was most common among residents with mild to moderate dementia, and the prevalence decreased among severely impaired residents. By contrast, resistance to care was less common among mildly impaired residents but it was most prevalent among residents who were severely impaired.
A majority of the reported episodes of physical and verbal abuse (63% and 75%, respectively) occurred in residents who were resistant to care. Consequently, caregivers who manage resistant nursing home residents may need to keep their behavior from escalating to abusive levels, while agitated residents can often be managed by engaging them in meaningful activities.
▸ Source: Agitation and Resistiveness to Care Are Two Separate Behavioral Syndromes of Dementia—Volicer et al.
Hypertension Controlled in a Majority of Elderly Nursing Home Residents
Hypertension was present in 71% of nursing home residents but the condition was adequately controlled in 85% of them, based on a recent study of 202 residents aged 50–98 years in an academic nursing home.
Of the residents who were treated with antihypertensive drugs, 107 (75%) received b-blockers and 88 (62%) received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. These drugs were the most common choices in part because of the high prevalence of vascular disease, diabetes, or heart failure in the hypertensive patients (80%), the researchers noted.
▸ Source: Adequacy of Control of Hypertension in an Academic Nursing Home—Koka et al.
This column was compiled by Heidi Splete, a senior writer with Elsevier Global Medical News.
© 2007 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.