From the Guidelines
Neurological conditions, particularly Alzheimer's disease, are highly prevalent in nursing homes, affecting approximately 64% of Medicare beneficiaries, and require a comprehensive approach to management, including pharmacological and non-pharmacological interventions, as well as a multidisciplinary care team 1.
Common Neurological Conditions
- Alzheimer's disease
- Parkinson's disease
- Stroke
Management Approach
- Combination of pharmacological and non-pharmacological interventions
- Individualized care plans considering each resident's specific needs, preferences, and comorbidities
- Regular assessments of cognitive function, mobility, and activities of daily living to adjust care plans
- Environmental modifications, such as clear signage and fall prevention measures, to ensure patient safety
Pharmacological Interventions
- Cholinesterase inhibitors like donepezil (starting at 5mg daily, increasing to 10mg if tolerated) and memantine (starting at 5mg daily, titrating up to 10mg twice daily) for Alzheimer's disease
- Levodopa for Parkinson's disease, often starting at 100mg three times daily and adjusting based on response
- Antiplatelet therapy (e.g., aspirin 81mg daily) and blood pressure control for stroke patients
Non-Pharmacological Interventions
- Cognitive stimulation therapy and maintaining daily routines for Alzheimer's disease
- Physical therapy and occupational therapy to maintain mobility and independence for Parkinson's disease and stroke patients
- Comprehensive rehabilitation, including physical, occupational, and speech therapy, for stroke patients
Multidisciplinary Care Team
- Neurologists
- Geriatricians
- Nurses
- Therapists
- Social workers
- Regular medication reviews to minimize polypharmacy and potential side effects
- Involving family members in care decisions and providing education about these conditions to improve overall care quality and resident well-being, as supported by recent studies on nurse-led physical activity interventions 1 and guidelines for managing high blood pressure in adults 1.
From the Research
Common Neurological Conditions in Nursing Homes
- Dementia is a prevalent condition in nursing homes, with residents often exhibiting behavioral and psychological symptoms such as resistiveness to care, agitation, and aggression 2
- These symptoms can be addressed through person-centered care (PCC) approaches, which are documented in care plans for a significant proportion of residents 2
- Other neurological conditions, such as cognitive impairment, are also common in nursing homes, and can impact residents' ability to participate in care planning 3
Care Planning for Neurological Conditions
- Care planning is a key activity in nursing homes, and involves the development of individualized plans to address residents' needs 4
- The Resident Assessment Instrument (RAI) is a standardized tool used to assist in assessment and care planning for nursing home residents 5
- Advance care planning is an important aspect of care planning for residents with dementia, but is often not realized in practice 6
- Family participation in care planning is variable, and is more common for residents with severe cognitive impairment 3
Factors Influencing Care Planning
- Resident characteristics, such as age, functional ability, and cognitive ability, can influence the development of care plans 2
- Facility characteristics, such as staffing levels and use of antipsychotic medications, can also impact care planning 2, 5
- Social work staffing is associated with greater family participation in care planning 3