Long-Term Care Analysis

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More than 5 million Americans currently have dementia in the United States and this number is projected to rise to between 8 and 13 million by 2050 (Alzheimer’s Association, 2015). Dementia is known to become more prevalent with age, increasing from 5 to 10 percent in people over 65 years of age to almost one half of people over the age of 85 (Alzheimer’s Association, 2015). Although family members provide the majority of care for people with dementia, increasing needs over time often lead to placement in a long-term care setting. Dementia is the most common reason for entry into long-term care facilities (Zimmerman, 2013) and nearly 90% of persons with dementia will have at least one stay at a nursing home in their lifetime (Grunier, 2007). …show more content…

The following section provides a review of the literature on the use of physical and chemical restraints in long-term care settings as well as potential institutional-level and resident-level factors that influence care practices in long-term care settings. Given the challenges in caring for nursing home residents with dementia coupled with inadequate staffing levels and high turnover rates, residents with dementia are often subjected to a variety of “restraints” to mitigate the burdens of providing care for this population. Psychotropic medications are approved by the US Food and Drug Administration (FDA) primarily for the treatment of psychosis and mood disturbances associated with schizophrenia or bipolar disorders (Grunier, 2008). Despite FDA black box warnings related to the “off-label” use of these medications in the dementia population, a survey conducted by the Office of Inspector General in 2011 found that 86% to 95% of nursing home residents received these medications for other indications, such as managing behavioral disturbances associated with dementia (Chiu, 2015). It is the overuse and misuse of psychotropic medications, in particular as a strategy to subdue residents, that has designated these drugs to be labeled …show more content…

For example, a lap belt intended to prevent an individual from falling out of a wheelchair is considered a physical restraint if the person is unable to willingly remove the belt. Arguments in favor of physical restraints promote their use for fall prevention, control of aggressive behavior, and protection of treatment devices such as feeding tubes (XXX). However, the use of physical restraints has also been linked to injury, pressure ulcers, incontinence, cognitive decline, and death (XXX). In recent years, there has been a decrease in physical restraints because it has been widely accepted as a sign of poor quality care, but this decline is not observed uniformly across all populations (Kunetzka, 2014; Phillips, 2000). Residents with dementia, physical impairments, and a history of falls continue to be at risk of being restrained in long-term care settings (Grunier, 2008). Although the utilization of restraints in these populations is prevalent, the safety and efficacy of these practices is inconclusive and the ramifications of such restraints can be severe (Agens,

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