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Updating Health care Practices


Warshaw G. Updating healthcare practices. Annals of Long=Term Care: Clinical Care and Aging. 2013;21(10):9.


Gregg Warshaw, MD; Medical Editor

People tend to get set in their ways. This is no different for healthcare providers. Although there are constantly new developments and findings in the healthcare arena, certain practices can be difficult to shed, even when new evidence points to better strategies. In this issue of Annals of Long-Term Care: Clinical Care and Aging® (ALTC), we include several articles that outline some of these practices that need to change in the long-term care (LTC) setting.

In our first article, “Resident-Focused and Evidence-Based Management of Diabetes Mellitus in the Nursing Home Setting”, the author discusses the dangers of sliding-scale insulin and describes how LTC providers can move away from this diabetes management strategy and toward safer medication regimens, such as basal-bolus insulin. Although the 2012 American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults recommended that LTC providers avoid using sliding-scale insulin due to the “higher risk of hypoglycemia without improvement in hyperglycemia management,” and other organizations have made similar recommendations (eg, AMDA–Dedicated to Long Term Care Medicine [formerly the American Medical Directors Association] and the American Diabetes Association), the use of sliding-scale insulin persists. As the author notes, developing the diabetes plan of care according to the resident’s condition, goals, preferences, and participation is essential to ensure optimal treatment and outcomes.

In our second article, “End-of-Life Nutrition: Is Tube-Feeding the Solution?”, the author reviews the complex decision of whether to place a feeding tube when an individual is at the end of life. During this time, the patient’s family members may place pressure on healthcare providers to place feeding tubes because they believe this to provide comfort or to extend life and/or quality of life for their loved one; however, the evidence has generally shown none of these benefits. In addition, healthcare providers may have regulatory concerns to contend with, but as the author notes, the Centers for Medicare & Medicaid Services is unlikely to question the use of hand feeding rather than tube feeding for a terminally ill resident if this plan of care gives priority to the resident’s choices. Clear communication with residents and their families, as well as proper documentation of end-of-life care and care plans, are essential strategies for avoiding unnecessary tube feedings that may only burden the patient.

In this issue, you will also find several new features, including a patient perspective that outlines three important actions for Alzheimer’s caregivers, and a department called What’s Buzzing in the Literature? , which provides an overview of some of the most significant contributions to the palliative care literature within the past year, as selected by palliative care specialist Sean Marks, MD. Also, be sure to turn to the Ask the Expert, where you will find some interesting insights on how robotics will potentially impact the care of older adults.

As always, we welcome your thoughts on the articles in this issue of ALTC. Responses can be sent to our associate editor, Allison Musante, at

Thank you for reading!  

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