Indications and Contraindications for Anti-Thrombotic Therapy to Prevent Venous Thromboembolism (VTE): Observations in Long-Term Care Facilities (LTCF) based on Clinical Practice Guidelines (CPG)

2010 ◽  
Vol 11 (3) ◽  
pp. B13 ◽  
Author(s):  
T. Dharmarajan ◽  
T.S. Dharmarajan ◽  
Larry Lawhorne ◽  
Aman Nanda ◽  
Bikash Agarwal ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Long Term Care ◽  
Term Care ◽  
Care Facilities

Frailty Status and Cognitive Function Should Guide Prescribing in Long-term Care Facilities

2021 ◽  
Vol 36 (10) ◽  
pp. 469-473
Author(s):  
Shin J. Liau ◽  
J. Simon Bell
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Long Term Care ◽  
Adverse Drug Events ◽  
Cognitive Status ◽  
Term Care ◽  
Care Facilities ◽  
Disease Specific

Frailty, dementia and complex multimorbidity are highly prevalent among residents of long-term care facilities (LTCFs). Prescribing for residents of LTCFs is often informed by disease-specific clinical practice guidelines based on research conducted among younger and more robust adults. However, frailty and cognitive impairment may modify medication benefits and risks. Residents with frailty and advanced dementia may be at increased susceptibility to adverse drug events (ADEs) and often have a lower likelihood of achieving long-term therapeutic benefit from chronic preventative medications. For this reason, there is a strong rationale for deprescribing, particularlyamong residents with high medication burdens, swallowing difficulties or limited dexterity. Conversely, frailty and dementia have also been associated with under-prescribing of clinically indicated medications. Unnecessarily withholding treatment based on assumed risk may deprive vulnerable population groups from receiving evidence-based care. There is a need for specific evidence regarding medication benefits and risks in LTCF residents with frailty and dementia. Observational studies conducted using routinely collected health data may complement evidence from randomized controlled trials that often exclude people living with dementia, frailty and in LTCFs. Balancing over- and under-prescribing requires consideration of each resident’s frailty and cognitive status, therapeutic goals, time-to-benefit, potential ADEs, and individual values or preferences. Incorporating frailty screening into medication review may also provide better alignment of medication regimens to changing goals of care. Timely identification of frail residents as part of treatment decision-making may assist with targeting interventions to minimize and monitor for ADEs. Shifting away from rigid application of conventional disease-specific clinical practice guidelines may provide an individualized and more holistic assessment of medication benefits and risks in the LTCF setting.

scholarly journals Designing clinical practice feedback reports: three steps illustrated in Veterans Health Affairs long-term care facilities and programs

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Zach Landis-Lewis ◽  
Jennifer Kononowech ◽  
Winifred J. Scott ◽  
Robert V. Hogikyan ◽  
Joan G. Carpenter ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Long Term Care ◽  
Veterans Health ◽  
Term Care ◽  
Care Facilities

scholarly journals Practice Guidelines for Assessing Pain in Older Persons with Dementia Residing in Long-Term Care Facilities

2010 ◽  
Vol 62 (2) ◽  
pp. 104-113 ◽  
Author(s):  
Thomas Hadjistavropoulos ◽  
Theresa Dever Fitzgerald ◽  
Gregory P. Marchildon
Keyword(s):  
Practice Guidelines ◽  
Older Persons ◽  
Long Term Care ◽  
Term Care ◽  
Care Facilities
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